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.
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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.”
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.
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.
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 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.
“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.
“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.”
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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