B.C. spends at least $27M at private clinics to catch up on surgical backlog

B.C.’s Ministry of Health has spent at least $27.2 million at private surgical clinics in an effort to catch up on thousands of surgeries postponed due to waves of COVID-19, CTV News has learned.

And even before the pandemic began, the number of those surgeries being performed in those settings had been growing for years under the province’s NDP government.

The $27 million figure, which was provided by the ministry, only covers the 2020-2021 fiscal year, and there have been more procedures completed in private clinics since then. The ministry emphasized the health authorities’ budget is $11.8 billion, and that the funds covered 13,863 contracted surgeries, representing 4.4 per cent of the 316,275 surgeries performed in the province that year.

“We have a publicly funded system that is delivered in large part by private providers – great family doctors, specialists, community health clinics who are private businesses – and each year the health authorities contract out to private clinics for acute care services,” wrote a spokesperson in an email. “In doing this the services continue to be provided to patients at no cost - with one payer, the government.”

Health Minister Adrian Dix announced a commitment to catch up on postponed surgeries from the first wave of the pandemic in May of 2020, with a 12-page plan that specified part of the strategy included “all private contracted facilities working at maximum available capacity” in addition to the public system running at pre-pandemic levels.

However, this is the first time the province has revealed how many procedures went through the private system, and how much was billed to taxpayers. Last year, the ministry’s published service plan described private surgical clinics as part of government’s plan to minimize the impacts of COVID-19, “at contracted private surgical clinics that agree to follow the Canada Health Act and not extra bill patients.”

The ministry provided CTV News with additional information showing a growth in the share of day procedures performed in these clinics, which range from dental, plastic, and orthopaedic surgeries, with ophthalmology being the single biggest category:

• 3.5 per cent of total surgeries in 2018/2019
• 3.7 per cent of total surgeries in 2019/2020
• 4.4 per cent of total surgeries in 2020/21

WATCHDOG SOUNDS ALARM AS MINISTER DEFENDS APPROACH

The B.C. Healthcare Coalition has conducted an analysis of health authority documents and found that while just $4.7 million went to private clinics for surgeries in 2015/2016, that number rose to $14.5 million the following year. Steady increases saw the annual cost surge to $23 million in 2019/2020.

“It can become more difficult to reduce wait time in the medium- to long-term in the public system because you're actually moving those resources -- namely people, specialized health-care professionals – from public hospitals because you're trying to outcompete and pay them for shifts in for-profit clinics," said BCHC research associate Andrew Longhurst. “The most efficient way to reduce wait times is to move to single entry models, where you’re referred to a group of specialists rather than one surgeon.”

The health minister insisted there have already been such improvements under his tenure, and added that the contracts with the private clinics had been signed and established before he took the portfolio, with overall procedures going up in the public system as well.

“We’ve used the public system more in every possible way – adding hours, going on weekends,” said Dix. “We’re also not ideological about it, we want patients to get their surgeries, and in some cases it’s been an effective way of dealing with surgical procedures.”

Dix claimed the wait lists themselves have been reduced across the system, which several doctors’ organizations dispute. 

When CTV News raised the issue of health-care workers leaving the public system to work in the private sector, Dix disputed that.

“That would be true if we weren't massively increasing the capacity of the public system as well, and that's what we've been doing so what you see is a very similar percentage of private contracted surgeries, but more surgeries (overall),” he said. “This is particularly true in orthopedics, where we went from, in the last year of the Liberal government, about 14,250 surgeries for hip and knees to 18,800." 

SURGEONS URGE DRAMATIC ACTION TO CUT DOWN WAIT TIMES

On Monday, the B.C. Orthopaedic Association told CTV News that Health Minister Adrian Dix had not responded to their request for a meeting to give their input on catching up with the latest backlogs, which they describe as being impossible under the current way of doing things. 

The incoming president urged Dix to not only sit down to hash out new ways of helping patients who are suffering through increasing pain and decreased mobility, but also to consider relying more heavily on private surgical clinics to address the backlog and help cut down on wait lists at a time the public health system is short-staffed and only provides surgeons with one to two days per week of operating room time.

“I'm not talking about creating a two-tiered health-care system today,” said Dr. Cassandra Lane Diewart, urging out-of-the-box solutions. “I'm talking about using centres and using operating rooms that are functional, well-staffed and provide excellent care and using them to the benefit of this province.”