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.
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, 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.
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.
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, 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.
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 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.
BATHURST, N.B. – RCMP in New Brunswick say a weekend ground search for evidence related to the disappearance of a teenage girl in 2021 didn’t reveal any new information.
In an emailed statement, the RCMP said 20 people participated in the search for evidence in the case of Madison Roy-Boudreau of Bathurst.
The release said the search occurred in the Middle River area, just south of the girl’s hometown.
Police have said the 14-year-old’s disappearance is being treated as a homicide investigation.
The RCMP said the search “did not reveal any new information regarding the circumstances of her disappearance.”
There are no plans for another search until police receive a tip or a lead pointing to a new search area.
This report by The Canadian Press was first published Oct. 21, 2024.
VICTORIA – A middle school in Victoria was forced into a lockdown after a man entered the building without permission, and police say they had to use a stun gun to make an arrest.
Victoria police say officers received multiple calls around noon on Monday of an unknown male entering Central Middle School, leading staff to set off emergency procedures that put the building under lockdown.
Police say its emergency response team arrived within minutes and found the suspect, who “appeared to be in a drug-induced state,” in the school’s library.
A statement from police says the suspect resisted arrest, and officers had to use a Taser to subdue the man.
He’s being held by police and has been assessed by emergency medical staff.
Police say the man was not armed and there were no continuing safety concerns for students and staff following the arrest.
This report by The Canadian Press was first published Oct. 21, 2024.
VANCOUVER – Former B.C. Green leader Andrew Weaver knows what it’s like to form a minority government with the NDP, but says such a deal to create the province’s next administration is less likely this time than seven years ago.
Weaver struck a power-sharing agreement that resulted in John Horgan’s NDP minority government in 2017, but said in an interview Monday there is now more animosity between the two parties.
Neither the NDP nor the B.C. Conservatives secured a majority in Saturday’s election, raising the prospect of a minority NDP government if Leader David Eby can get the support of two Green legislators.
Manual recounts in two ridings could also play an important role in the outcome, which will not be known for about a week.
Weaver, who is no longer a member of the Greens, endorsed a Conservative candidate in his home riding.
He said Eby would be in a better position to negotiate if Furstenau, who lost her seat, stepped aside as party leader.
“I think Mr. Eby would be able to have fresh discussions with fresh new faces around the table, (after) four years of political sniping … between Sonia and the NDP in the B.C. legislature,” he said.
He said Furstenau’s loss put the two elected Greens in an awkward position because parties “need the leader in the legislature.”
Furstenau could resign as leader or one of the elected Greens could step down and let her run in a byelection in their riding, he said.
“They need to resolve that issue sooner rather than later,” he said.
The Green victories went to Rob Botterell in Saanich North and the Islands and Jeremy Valeriote in West Vancouver-Sea to Sky.
Neither Botterell nor Valeriote have held seats in the legislature before, Weaver noted.
“It’s not like in 2017 when, you know, I had been in the (legislature) for four years already,” Weaver said, adding that “the learning curve is steep.”
Sanjay Jeram, chair of undergraduate studies in political science at Simon Fraser University, said he doesn’t think it’ll be an “easygoing relationship between (the NDP and Greens) this time around.”
“I don’t know if Eby and Furstenau have the same relationship — or the potential to have the same relationship — as Horgan and Weaver did,” he said. “I think their demands will be a little more strict and it’ll be a little more of a cold alliance than it was in 2017 if they do form an alliance.”
Horgan and Weaver shook hands on a confidence-and-supply agreement before attending a rugby match, where they were spotted sitting together before the deal became public knowledge.
Eby said in his election-night speech that he had already reached out to Furstenau and suggested common “progressive values” between their parties.
Furstenau said in her concession speech that her party was poised to play a “pivotal role” in the legislature.
Botterell said in an election-night interview that he was “totally supportive of Sonia” and he would “do everything I can to support her and the path forward that she chooses to take because that’s her decision.”
The Green Party of Canada issued a news release Monday, congratulating the candidates on their victories, noting Valeriote’s win is the first time that a Green MLA has been elected outside of Vancouver Island.
“Now, like all British Columbians we await the final seat count to know which party will have the best chance to form government. Let’s hope that the Green caucus has a pivotal role,” the release said, echoing Furstenau’s turn of phrase.
The final results of the election won’t be known until at least next week.
Elections BC says manual recounts will be held on Oct. 26 to 28 in two ridings where NDP candidates led B.C. Conservatives by fewer than 100 votes after the initial count ended on Sunday.
The outcomes in Surrey City Centre and Juan de Fuca-Malahat could determine who forms government.
The election’s initial results have the NDP elected or leading in 46 ridings, and the B.C. Conservatives in 45, both short of the 47 majority mark in B.C.’s 93-seat legislature.
If the Conservatives win both of the recount ridings and win all other ridings where they lead, Rustad will win with a one-seat majority.
If the NDP holds onto at least one of the ridings where there are recounts, wins the other races it leads, and strikes a deal with the Greens, they would have enough numbers to form a minority government.
But another election could also be on the cards, since the winner will have to nominate a Speaker, reducing the government’s numbers in the legislature by one vote.
Elections BC says it will also be counting about 49,000 absentee and mail-in ballots from Oct. 26 to 28.
The NDP went into the election with 55 ridings, representing a comfortable majority in what was then an 87-seat legislature.
Jeram, with Simon Fraser University, said though the counts aren’t finalized, the Conservatives were the big winners in the election.
“They weren’t really a not much of a formal party until not that long ago, and to go from two per cent of the vote to winning 45 or more seats in the B.C. provincial election is just incredible,” he said in an interview Monday.
Jeram said people had expected Eby to call an election after he took over from John Horgan in 2022, and if he had, he doesn’t think there would have been the same result.
He said the B.C. Conservative’s popularity grew as a result of the decision of the BC Liberals to rebrand as BC United and later drop out.
“Had Eby called an election before that really shook out, and maybe especially before (Pierre) Poilievre, kind of really had the wind in his sails and started to grow, I think he could have won the majority for sure.”
He said he wasn’t surprised by the results of the election, saying polls were fairly accurate.
“Ultimately, it really was a result that we saw coming for a while, since the moment that BC United withdrew and put their support behind the conservatives, I think this was the outcome that was expected.”
— With files from Darryl Greer
This report by The Canadian Press was first published Oct. 21, 2024.
