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As surgical wait lists grow, Canada’s private clinics cash in

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It’s a contentious reality in a country with a universal medicare system: Canadians can pay to sidestep the queue for surgeries with long waiting lists, such as hip and knee replacements.

Private clinics across Canada are advertising to prospective patients that within weeks they can get surgeries that typically take six months or more under provincial health plans. The price for a single hip or knee replacement runs in the range of $20,000 to $28,000, depending on the clinic.

In the wake of the COVID-19 pandemic driving up surgical wait times, there’s some evidence suggesting a growing number of Canadians are pulling out their wallets to pay privately.

The trend is raising concerns about the potential for private clinics to drain more health professionals away from the already strained public system, and it’s provoking fears that two-tier health care is becoming a reality.

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The private Duval Clinic in Laval, Que. — where surgeons only do hip and knee replacements for fee-paying patients — has seen a significant increase in demand over the past few years, says its medical director, Dr. Pascal-André Vendittoli.

“We’ve quadrupled the number of cases we do at the clinic,” said Vendittoli in an interview with CBC News.

“There are more and more patients willing to pay for their hip or knee replacement because they see that it is almost impossible to get their treatment in the public system.”

‘Best investment’ says patient

Mike Johansen, 62, of Edmonton spent $23,500 for a hip replacement at the Duval Clinic.

“Best investment I ever made,” Johansen said in an interview. “I don’t look at myself as a person who jumped to the front of the queue, I got out of the queue.”

Mike Johansen is pictured walking down a staircase in his home.
Mike Johansen, 62, of Edmonton spent $23,500 to get a hip replacement at a private clinic in Quebec rather than wait 18 months for the surgery through Alberta’s public health system. (Scott Neufeld/CBC)

Before the operation, Johansen’s hip problem made just about any movement painful.

“About 70, 80 per cent of the time I was laying in bed. That was the only way that there really wasn’t a whole lot of pain,” he said.

His doctor told him his wait for surgery through Alberta Health Services would be 18 to 24 months. He got into the Duval clinic in just two months.

The Clearpoint Health Network building on Dixon Road in Toronto.
Clearpoint Health Network is the largest chain of private surgical clinics in Canada, with 53 operating rooms in 14 locations, including this one in Toronto specializing in orthopedic surgery. (Paul Smith/CBC)

Hip and knee replacements are among the most frequently performed surgeries in the Canadian health system, and come with some of the longest wait times.

Hospitals did nearly 139,000 joint replacements in 2019-2020, according to the Canadian Institute for Health Information (CIHI). Its research puts the average cost per operation at $12,223, which means the private clinics are charging patients roughly double what the surgery costs provincial medicare systems.

CIHI’s most recent wait-time figures show that just 65 per cent of hip replacements and 59 per cent of knee replacements were done within the national standard of six months after consultation with a surgeon.

The private sector’s potential role in tackling surgical wait lists is firmly in the spotlight right now:

  • Ontario unveiled a plan last month that opens the door to for-profit clinics performing endoscopies and hip and knee replacements, paid for by the Ontario Health Insurance Plan (OHIP).
  • Both Manitoba and Saskatchewan are attempting to deal with backlogs by paying private clinics outside the province to do surgeries.
  • Alberta announced in January that it’s contracting Canadian Surgery Solutions to perform more than 3,000 orthopedic surgeries covered by the provincial medicare plan.

Canadian Surgery Solutions is a Calgary branch of a company called Clearpoint Health Network, the country’s largest chain of private surgical clinics.
Nearly 140,000 people get a hip or knee replacement each year in Canadian hospitals and wait times can run to more than a year. Private surgical clinics around the country are advertising that patients can get surgeries done in just a few weeks, if they pay.

Clearpoint is wholly owned by Kensington Private Equity Fund, and it was created in 2019 through a $35 million purchase of private clinics.

The company announced an expansion in January, taking Clearpoint to 53 operating rooms across 14 surgical clinics, touching every province from British Columbia to Quebec.

Most patients must leave home province to pay

Clearpoint officials did not respond to repeated requests from CBC News for an interview.

While the company says 90 per cent of the surgeries it performs are publicly funded, Clearpoint also markets to Canadians waiting for care in the public system that they can get hip and knee replacements done much faster by paying privately.

“Avoid long wait times,” says the website of Surgical Solutions Network, a division of Clearpoint. “After your initial surgical consultation, surgery can generally be scheduled within a few weeks.”

The company explains a catch to patients who want to pay: they’ll likely have to leave their home province for the operation.

An image captured from a webpage with a stock photo of surgical staff.
The website of Surgical Solutions Network, a division of Clearpoint Health Network, describes how Canadian patients can pay privately for surgery by travelling to another province. (surgicalsolutionsnetwork.ca)

The Canada Health Act prohibits extra-billing. What that means is doctors are banned from charging patients more than the medicare rate for an “insured service” — any medically necessary procedure that is covered by provincial health plans.

In provinces other than Quebec, where the system differs, private clinics get around that ban by operating only on patients from other provinces.

This loophole is opened up by how the Canada Health Act and the provinces define an insured service.

A medically necessary non-emergency surgery such as a hip replacement is an insured service when you’re in your home province. When you visit another province, non-emergency surgery is not insured.

The upshot: a doctor in a private clinic in Toronto cannot charge an Ontario patient for a hip replacement, but can charge someone who has flown in from any other province for that very same operation.

CBC News obtained an email from a Clearpoint official to a prospective hip replacement patient in Ontario.

Dr. David Urbach is pictured inside an operating room at Women’s College Hospital in Toronto.
Dr. David Urbach, who leads the department of surgery at Women’s College Hospital in Toronto, says private pay clinics are making wait lists worse in the public system. (Mike Crawley/CBC)

“Unfortunately, due to government regulations, you are unable to have private surgery in your home province. You would need to travel to Calgary for the procedure,” said the email, which also priced the surgery at $28,000.

“It’s not in keeping with the principles of the Canada Health Act,” said Dr. David Urbach, chief of surgery at Women’s College Hospital in Toronto.

Urbach argues that the growth in private-paid surgeries worsens wait lists by luring medical staff away from public hospitals.

“It increases wait times for the rest of the people who are still in the public system because of the loss of resources from that public system into the private system,” said Urbach in an interview.

He says governments should not be looking to the private sector to shorten surgical wait lists, but could achieve the same goal by better investing in public hospitals.

As evidence, Urbach gestures at the location of his interview: a state-of-the art operating room, not in use for surgery on a weekday morning, because medical staff aren’t available.

A doctor looks at a computer screen showing images of a patient's knee replacement surgery.
Hospitals did nearly 139,000 joint replacements in 2019-2020, according to the Canadian Institute for Health Information. (Louis-Marie Philidor/CBC)

“If the hospital had funding, if this hospital had staffing, it could be used to provide all sorts of surgical procedures,” he said.

‘No way I could afford … that’

The growth in private surgical clinics leaves Saskatchewan resident Vicki Macdonald, 59, worried for the future of the health system. In the birthplace of Canadian medicare, Macdonald spent two years waiting for knee surgery.

“I got slower and slower in my walking,” said Macdonald in an interview at her home in Kronau, Sask.

“When you are in that much pain, it really takes a toll on your emotional and mental well-being.”

She found out that people were shortening their waits by paying for their surgeries in private clinics outside the province, but dismissed the idea for herself.

“There is no way I could afford to do something like that,” Macdonald said. “Those that can afford it can get it, and then we who need it just as bad are getting left behind.”

Vicki Macdonald is pictured in her home.
Vicki Macdonald waited two years for a knee replacement in the Saskatchewan public health system and says there was ‘no way’ she could have afforded to pay privately for the surgery. (Richard Agecoutay/CBC)

Urbach says the apparent rise in people willing to pay privately for surgeries saddens him.

“What it tells me is we’re not addressing the needs of the population. We should be able to provide the services that people need in a reasonable time frame,” Urbach said.

“What we need to do is create the types of system changes so that people aren’t driven to pay out of pocket or seek out two-tiered care.”

The only jurisdiction where residents can opt for private surgery without leaving the province is Quebec, a result of a 2005 Supreme Court of Canada ruling that applies strictly to the Quebec health system.

In British Columbia, Dr. Brian Day has attempted to persuade courts that patients should have the right to pay for private care when wait times in the public system are too long.

Day, owner of the private Cambie Surgery Centre, lost at the B.C. Court of Appeal in July 2022 and is asking the Supreme Court of Canada to consider his case.

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Alberta's population surges by record-setting 202,000 people: Here's where they all came from – CBC.ca

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Alberta smashed population-growth records in the past year, mainly due to people moving to the province from across Canada and around the world.

The province’s population surged to just over 4.8 million as of Jan. 1, according to new estimates released Wednesday by Statistics Canada.

That’s an increase of 202,324 residents compared with a year earlier, which marks — by far — the largest annual increase on record.

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Alberta also broke a national record in 2023 for interprovincial migration, with a net gain of 55,107 people.

“This was the largest gain in interprovincial migration nationally since comparable data became available in 1972,” Statistics Canada said in a release.


Most of the interprovincial migrants came from Ontario and British Columbia.

Statistics Canada estimates that 38,236 Ontarians moved to Alberta last year, versus 14,860 Albertans who moved to Ontario, for a net gain of 23,376 people.

Similarly, an estimated 37,650 British Columbians moved to Alberta, compared to 22,400 Albertans who moved to B.C., for a net gain of 15,250.


All told, interprovincial migration accounted for 27 per cent of Alberta’s population growth over the past year.

That put it just ahead of permanent immigration, which accounted for 26 per cent, and well ahead of natural population increase (more births than deaths), which accounted for eight per cent.

The largest component, however, was temporary international migration.

Non-permanent residents from other countries accounted for 39 per cent of the province’s population growth in the past year, reflecting a national trend.


Canada’s population reached 40,769,890 on Jan. 1, according to Statistics Canada estimates, which is up 3.2 per cent from a year ago.

“Most of Canada’s 3.2-per-cent population growth rate stemmed from temporary immigration in 2023,” Statistics Canada noted.

“Without temporary immigration, that is, relying solely on permanent immigration and natural increase (births minus deaths), Canada’s population growth would have been almost three times less (1.2 per cent).”

Alberta’s population, meanwhile, grew by 4.4 per cent year-over-year.

Alberta now represents 11.8 per cent of the country’s population, its largest proportion on record. 

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Why Canada's record population growth is helping – and hurting – the economy – CTV News

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Canada has recorded the fastest population growth in 66 years, increasing by 1.3 million people, or 3.2 per cent, in 2023, according to a new report from Statistics Canada.

The country has not seen such growth since 1957, when the spike was attributed to the baby boom and an influx of immigrants fleeing Hungary.

The vast majority of Canada’s growth last year was due to immigration, with temporary residents — which includes foreign workers and international students — making up the largest proportion of newcomers.

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“We need people coming to Canada to help with our economy,” says Matti Siemiatycki, a professor of planning at the University of Toronto. “There are many jobs and professions where there are vacancies, and that is having an impact, whether in the healthcare sector or trades and construction sector.”

Siemiatycki adds immigrants also bring “ingenuity… resources… and culture” to Canada.

Newcomers are relied on to help keep pace with Canada’s aging population and declining fertility rates, but the influx also presents a challenge for a country struggling to build the homes and infrastructure needed for immigrants.

“It’s an incredibly large shock for the economic system to absorb because of just the sheer number of people coming into the country in a short period of time,” says Robert Kavcic. a senior economist and director with BMO Capital Markets.

“The reality is population can grow extremely fast, but the supply side of the economy like housing and service infrastructure, think health care and schools, can only catch up at a really gradual pace,” Kavcic says. “So there is a mismatch right now.”

The impact of that mismatch can most acutely be seen in the cost of rent, services and housing.

In December, Kavcic wrote in a note that Canada needs to build 170,000 new housing units every three months to keep up with population growth, noting the industry is struggling to complete 220,000 units in a full year.

To address this, Ottawa has announced plans to cap the number of new temporary residents while also reducing the number of international student visas, a move economists say could offer some relief when it comes to housing and the cost of living.

“The arithmetic on the caps actual works relatively well because it would take us back down to 1 per cent population growth which we have been used to over the last decade and which is more or less absorbable by the economy,” Kavcic says. “The question is whether or not we see policy makers follow through and hit those numbers.”

Economists believe these changes could help ease inflationary pressures and may make a Bank of Canada rate cut more likely, but could also lead to slower GDP growth.

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Canada’s population hits 41M months after breaking 40M threshold – Global News

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Nine months after reaching a population of 40 million, Canada has cracked a new threshold.

As of Wednesday morning, it’s estimated 41 million people now call the country home, according to Statistics Canada’s live population tracker.

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The speed at which Canada’s population is growing was also reflected in new data released Wednesday by the federal agency: between Jan. 1 2023 and Jan. 1 2024, Canada added 1,271,872 inhabitants, a 3.2 per cent growth rate — the highest since 1957.

Most of Canada’s 3.2 per cent population growth rate stemmed from temporary immigration. Without it, Canada’s population growth would have been 1.2 per cent, Statistics Canada said.


Click to play video: 'Business News: Job growth fails to keep pace with population'

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Business News: Job growth fails to keep pace with population


From Oct. 1 to Dec. 31, 2023, Canada’s population increased by 241,494 people (0.6 per cent), the highest rate of growth in a fourth quarter since 1956.

Usha George, a professor at the Toronto Metropolitan Centre for Immigration and Settlement at Toronto Metropolitan University, told Global News in June a booming population can benefit the economy.

“It is not the bodies we are bringing in; these are bodies that fill in the empty spaces in the labour market,” she said.

“They bring a very-high level of skills.”


Click to play video: 'Canadian millennials surpass baby boomers as dominant generation: StatCan'

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Canadian millennials surpass baby boomers as dominant generation: StatCan


However, Ottawa has recently sought to ease the flow of temporary immigration in a bid to ease cost-of-living woes.


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Immigration Minister Marc Miller said on March 21 Ottawa would set targets for temporary residents allowed into Canada to ensure “sustainable” growth in the number of temporary residents entering the nation.

The next day, BMO economist Robert Kavcic in a note to clients the new limits will have a positive impact on Canada’s rental market and overall housing crisis.

“We’ve been firm in our argument that Canada has had an excess demand problem in housing, and this is maybe the clearest example,” Kavcic said.

“Non-permanent resident inflows, on net, have swelled to about 800K in the latest year, with few checks and balances in place, putting tremendous stress on housing supply and infrastructure.”

Alberta gains, Ontario loses: A look at Canadian migration in 2023

If Alberta is truly calling, then it appears more Canadians are choosing to answer.

Putting the pun on the provincial government’s attraction campaign aside, Canada’s wild rose country saw the largest net gain in interprovincial migration in 2023, Statistics Canada said in Wednesday’s report.


Click to play video: 'Is Alberta ready for population growth?'

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Is Alberta ready for population growth?


The agency said 55,107 Canadians moved to Alberta last year, which was the largest gain in interprovincial migration nationally since comparable data become available in 1972.

“Alberta has been recording gains in population from interprovincial migration since 2022, a reverse of the trend seen from 2016 to 2021, when more people left the province than arrived from other parts of Canada,” Statistics Canada said.

“Approximately 333,000 Canadians moved from one province or territory to another in 2023, the second-highest number recorded since the 1990s and the third straight year that interprovincial migration topped 300,000.”

Meanwhile, British Columbia had 8,624 more residents move out than in in 2023, meaning net interprovincial migration was negative for the first time since 2012, Statistics Canada said.

In general, the largest migration flows for British Columbia and Alberta are with each other, and most of the net loss from British Columbia in 2023 was to Alberta, it added.


Click to play video: '‘Enormous pressure’ expected in Ontario home care due to high growth of senior population'

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‘Enormous pressure’ expected in Ontario home care due to high growth of senior population


It also seems that good things may no longer be growing in Ontario; Canada’s most populous province lost 36,197 people to other regions in 2023, the biggest regional loss in 2023, Statistics Canada said.

That followed a loss of 38,816 people in 2022; the only other times a province has lost more than 35,000 people due to migration to other parts of Canada occurred in Quebec in 1977 and 1978.

Alberta aside, net interprovincial migration was also up in Nova Scotia (+6,169 people), New Brunswick (+4,790) and Prince Edward Island (+818), although all three Maritime provinces gained fewer interprovincial migrants in 2023 than in the two previous years, Statistics Canada said.

— with files from Uday Rana and Sean Previl

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