It’s a contested reality in a country with a universal Medicare system: Canadians can pay to skip the line for surgeries with long waitlists like hip and knee replacements.
Private clinics across Canada are touting to potential patients that they can receive surgeries in weeks that typically take six months or more under provincial health plans. The price of a single hip or knee replacement ranges from $20,000 to $28,000 depending on the clinic.
With the COVID-19 pandemic driving up wait times for surgeries, there is some evidence that a growing number of Canadians are whipping out their wallets to pay privately.
The trend raises concerns that private clinics could potentially draw more medical professionals out of the already strained public system and raises fears that two-tier healthcare is becoming a reality.
The private Duval Clinic in Laval, Que. — where surgeons only perform hip and knee replacements for fee-paying patients — has seen a significant increase in demand in recent years, says its medical director, Dr. Pascal André Vendittoli.
“We’ve quadrupled the number of cases we treat in the clinic,” Vendittoli said in an interview with CBC News.
“There are more and more patients who are willing to pay for their hip or knee replacements because they see that getting their treatment in the public system is almost impossible.”
“Best investment,” says the patient
Mike Johansen, 62, of Edmonton spent $23,500 on a total hip replacement at the Duval Clinic.
“The best investment I’ve ever made,” said Johansen in an interview. “I don’t see 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 almost every movement painful.
“About 70, 80 percent of the time I was in bed. Just like that, I really didn’t have a lot of pain,” he said.
His doctor told him he would wait 18 to 24 months for surgery from Alberta Health Services. He came to the Duval Clinic in just two months.
Hip and knee replacements are some of the most commonly performed surgeries in Canada’s healthcare system and have some of the longest wait times.
According to the Canadian Institute for Health Information (CIHI), hospitals performed nearly 139,000 joint replacement surgeries in 2019-2020. His research puts the average cost per surgery at $12,223, which means private clinics charge patients about double the cost for the surgery that provincial Medicare systems charge.
CIHI’s latest waiting time figures show that only 65 percent of hip replacement surgeries and 59 percent of knee replacement surgeries were performed within the national standard of six months after consulting a surgeon.
The potential role of the private sector in tackling surgical waiting lists is currently firmly in the spotlight:
Canadian Surgery Solutions is a Calgary subsidiary of a company called Clearpoint Health Network, the nation’s largest chain of private surgical clinics.
CLOCK | Why patients pay for faster surgery:
100% owned by the Kensington Private Equity Fund, Clearpoint was founded in 2019 through the purchase of private hospitals valued at US$35 million.
The company announced an expansion in January that will bring Clearpoint to 53 operating rooms in 14 surgical clinics, touching every province from British Columbia to Quebec.
Most patients have to leave their home province to pay
Clearpoint officials did not respond to repeated requests for an interview from CBC News.
While the company says 90 percent of the surgeries it performs are publicly funded, Clearpoint is also marketing to Canadians waiting for care in the public system that they can have hip and knee replacements much faster if they pay privately.
“Avoid long waits,” says the website of Surgical Solutions Network, a division of Clearpoint. “After your initial surgical consultation, surgery can usually be scheduled within a few weeks.”
The company explains a catch to patients who want to pay: They will probably have to leave their home province for the operation.
Canadian health care law prohibits additional billing. That means doctors are prohibited from charging patients more than the Medicare rate for an “insured service” — any medically necessary procedure covered by provincial health plans.
In provinces other than Quebec, where the system is different, private clinics circumvent this ban by only operating on patients from other provinces.
This loophole is created by how Canada’s Health Care Act and provinces define an insured benefit.
Medically necessary non-emergency surgery such as hip replacement is a covered benefit while in your home province. If you are visiting another province, non-emergency surgeries are not covered.
The result: a doctor at a private clinic in Toronto can’t bill a patient in Ontario for a hip replacement, but can bill someone flown in from another province for the exact same surgery.
CBC News received an email from a Clearpoint official to a potential hip replacement patient in Ontario.
“Unfortunately, due to government regulations in your home province, you cannot have surgery privately. You would have to travel to Calgary for the procedure,” the email said, which also listed the surgery at $28,000.
“This is not in accordance with the principles of the Canadian Public Health Act,” said Dr. David Urbach, chief of surgery at Women’s College Hospital in Toronto.
Urbach argues that the rise in privately paid surgeries is worsening waiting lists by drawing medical staff away from public hospitals.
“It increases waiting times for the rest of the people who are still in the public system because resources are leaking from that public system to the private system,” Urbach said in an interview.
He says governments shouldn’t look to the private sector to reduce surgical waiting lists, but could achieve the same goal by investing better in public hospitals.
As proof, Urbach points to the location of his interview: a state-of-the-art operating room that is not used for operations on a weekday morning because there are no medical staff available.
“If the hospital had financial resources, if this hospital had staff, it could be used for all kinds of surgical procedures,” he said.
“There’s no way I could afford… that”
The growth of private surgical clinics is leaving Saskatchewan resident Vicki Macdonald, 59, behind. Concerns about the future of the healthcare system. At the birthplace of Canadian medicine, Macdonald spent two years waiting for knee surgery.
“I was getting slower and slower walking,” Macdonald said in an interview at her home in Kronau, Sask.
“When you’re in so much pain, it really takes a toll on your emotional and mental well-being.”
She found that people shortened their waiting times by paying for their surgeries at out-of-province private clinics, but dismissed the idea.
“There’s no way I could afford something like that,” said Macdonald. “Those who can afford it can get it, and then we, who need it just as badly, are left behind.”
Urbach says the apparent surge in people willing to pay privately for surgeries saddens him.
“What tells me is that we are not responsive to the needs of the population. We should be able to provide the services that people need in a reasonable timeframe,” Urbach said.
“What we need to do is create the kind of system changes so people aren’t pushed to pay out of pocket or seek two-tier care.”
The only jurisdiction where residents can elect to have private surgery without leaving the province is Quebec, a result of a 2005 ruling by the Supreme Court of Canada that applies exclusively to Quebec’s healthcare system.
In British Columbia, Dr. Brian Day is trying to convince the 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 in the BC Court of Appeals in July 2022 and is asking the Supreme Court of Canada to review his case.
