Public-private partnerships the norm in higher-performing universal health-care systems

According to a recent poll, only 19 per cent of Ontarians are satisfied with the Ford government’s handling of health care. It’s not hard to guess why. From frequent emergency room closures, hospitals straining to deliver acute care, and long waits for non-emergency care—there’s a desperate need for improvement.

Last year the median wait time in Ontario (21.6 weeks) was more than twice as long as the 9.1-week wait in 1993 when these waits were first recorded. In other words, waits have grown significantly in the last three decades and are now longer than ever.

These delays for medically necessary care can be devastating for both patients and their loved ones. For some, long waits can be physically distressing and leave some patients unable to work. For others, long waits can result in available treatment options becoming less effective as the patient’s health deteriorates.

Given these long waits, Ontario’s Health Minister Sylvia Jones plans to increase the surgical capacity of the province by expanding its partnership with private clinics to deliver publicly-funded surgeries. Still, defenders of the status quo in Canada oppose using the private sector to deliver care paid for by the public health-care system. But in other countries with higher-performing universal health-care systems, public-private partnerships are the norm.

Consider Australia, which spends slightly less than Canada (as a share of its economy) but ranks higher than Canada on 33 of 36 performance measures including more patients reporting timely access to specialist and surgical care.

Patients in Australia can choose to receive a wide range of care at either private facilities or public hospitals, but critically, the public system provides funding for both (although usually partial funding in the case of private hospitals). Indeed, private hospitals in Australia delivered care for more than 70 per cent of all non-emergency admissions involving surgery in 2021/22, the latest period of available data.

It’s also worth noting that the Ford government is not the first Canadian province to experiment with public-private partnerships.

From 2010 to 2014, the Saskatchewan government ran the Saskatchewan Surgical Initiative (SSI), a multipronged wait times reduction strategy that, among other things, partnered with for-profit clinics to deliver publicly-funded surgeries. In the end, the SSI lowered the wait in Saskatchewan from 26.5 weeks in 2010 to 14.2 in 2014. And the private clinics delivered procedures at 26 per cent lower cost (on average) than comparable public hospitals in the province.

Beyond the success of any one of these models, one thing is certain. If provinces such as Ontario want to lower wait times, they must break from the tired status quo of endlessly trying and failing to “fix health care” by simply spending more taxpayer money. Instead, policymakers looking to reduce delays for surgery should look to success stories both here and abroad.