New academic research shows privatization of surgeries in England worsened inequalities and lengthened wait-times, offers lessons for Ontario

OHC investigation reveals private clinics charging up to $4,590 for cataract surgeries that must be provided free of cost

OTTAWA--(BUSINESS WIRE)--The privatization of hospital surgeries in England led to growing inequality, longer wait-times and disruption of services in the public health care system, according to new academic reports.

Allyson Pollock, co-author of the reports and professor emerita at Newcastle University, has been investigating the provision of cataract, knee, and hip surgeries in England and Scotland over a twenty-year period.

She said the current system in England benefits more affluent patients who can jump the queue by accessing care at private, for-profit facilities while the poorest and less healthy people suffer longer wait-times for hip and knee surgery due to reduced capacity in public hospitals.

The reports contrast extensive privatization with Scotland, which continued to invest in public health care and was able to increase surgical rates without using the private sector while offering egalitarian access.

The Ontario Health Coalition and CUPE’s Ontario Council of Hospitals Unions (OCHU-CUPE) say this research offers important lessons for Ontario, where the current government has been expanding privatization of cataract, hips, and knee surgeries through private, for-profit clinics.

Case of cataracts: bull’s eye for private companies

By 2024, 59 per cent of cataract surgeries were being delivered privately in England, up from 15 per cent in 2019. The report says this expansion came at a steep cost to the public purse as expenditures increased dramatically.

Between 2018/19 and 2022/23, the number of cataract surgeries across England increased by 25 per cent while annual expenditure went up by 95 per cent to £522 million.

It has been estimated that just five companies alone extracted £90m in one year in interest payments and dividends from their publicly-funded cataract surgery – funds which could have been invested back into public hospitals.

Pollock said the diversion of resources to the private sphere also weakens the public system in other ways, including destabilizing training for junior doctors and disrupting service provision and research. While simple cataract surgeries are performed by the private sector, public hospitals are left to deliver more complex care with fewer resources.

“The private sector takes away precious resources from the public system,” Pollock said. “In addition to the significant amount of money diverted to private owners, public hospitals lose doctors and other staff who are required to manage and monitor more complicated eye care.”

Rising inequalities in England

By 2024, for-profit provision of hip and knee replacements in England increased to 60 per cent from 20 per cent in 2016. This expansion offers greater access to care for patients living in affluent areas where most private facilities are located.

Pollock says that readmissions and complications in the first 30 days following surgery are common. However, 99.5 per cent of patients who suffer complications are readmitted for treatment in public hospitals which are also equipped to provide more complex care.

It’s estimated that 60,000 patients have been displaced from surgical waitlists to make way for patients who had their original treatment in private facilities. Hence, wealthier people can jump the queue by visiting private clinics for the initial surgery and are then prioritized in the public system for post-surgical care if they are readmitted.

“The private sector cherry-picks healthier patients, discharges them early, and then washes its hands of patients, so that the management of readmissions including complications following surgery goes back to the public system,” Pollock said. “Meanwhile, the poorer and sicker patients suffer longer wait-times in England. In Scotland, where privatization is minimal, access to care is based on need instead of affluence.”

While waiting times have been shorter for patients going to the private sector, for every one per cent of patient growth in publicly funded private sector treatments, the overall waiting times for all patients rise by two per cent in England.

Treacherous path of privatization must be avoided in Ontario, say advocates

Ontario must learn from the perilous path of privatization followed in England, and abandon its privatization of surgical care, say the OHC and OCHU-CUPE.

Between 2017 and 2022, about 19 per cent of cataract surgeries in Ontario were delivered by private clinics. The Conservative provincial government is also providing $125 million over two years to private clinics for 20,000 hip and knee surgeries, while another $155 million is being shunted to the private sector for diagnostic tests.

“England has traveled further down the path toward privatization, and its experience should be a warning to the Ford government, which is now diverting more than a hundred million dollars a year to private clinics rather than funding our public hospitals,” said Natalie Mehra, executive director of the Ontario Health Coalition. “Like in England, Ontario is paying a higher price for cataract surgeries in private clinics. Like England, we are seeing increasing inequities in access to care.”

Unethical practices by private clinics in Ottawa

The OHC has been investigating private clinics across the province for unethical practices including charging for cataract surgeries, which should be provided free of charge through OHIP.

The OHC contacted all of the private clinics in Ottawa listed on the government website, asking them the cost of getting a cataract surgery. Half the clinics quoted out-of-pocket costs as high as $4,590 per eye, while neglecting to mention that cataract surgeries can be accessed free of cost.

Some clinics acknowledged that the cataract operation is covered through Medicare but referred to that option as ‘basic’ while offering “upgraded” lenses for a steep price – information which could lead patients into thinking that OHIP provides a lower-quality option, Mehra said.

The OHC emphasized that Ottawa patients should know that they can get the surgery at The Ottawa Hospital within reasonable wait-times.

Patients with urgent need can get the surgery within two to three months. The average wait time for the lowest priority patients (whose surgery does not need to be done imminently) is 4 to 5 months. At Hopital Monfort, the lowest priority patients are waiting 85 days on average (just under three months).

The health coalition is concerned about health care services being fragmented along class lines.

Michael Hurley, president of OCHU-CUPE, pointed to the findings of a study published last year in the Canadian Medical Association Journal, which found that private for-profit surgical centres in Ontario were correlated with increasing inequity in access to care. The most affluent people increased their access to care by 22 per cent while the most marginalized suffered a nine per cent decline in surgical rates.

He said it was important for Ontario to course-correct as soon as possible before the system is deeply fractured like in England, where restoring capacity and reducing inequalities would be expensive due to the extent of privatization.

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