Shortcomings of two decades of privatization in England must be
learnt by Ontario before it’s too late, warn advocates
London, ON – 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 in London, Ontario
The OHC has been investigating private clinics in London, Ontario, and recently found that for-profit clinics are charging between $1,750 to $4,900 per eye for cataract surgeries – which is illegal as the operation is covered by public insurance.
Mehra said that patients might feel compelled to pay out of pocket, because they may be unaware that cataract surgeries can be accessed for free at public hospitals in London in a reasonable time-frame. She said the average wait-time for the lowest priority patients (who wait the longest) was 53 days and 110 days for St. Thomas-Elgin General Hospital and St. Joseph’s Hospital respectively.
“The whole scheme begs the question: since it is less efficient, costlier and violates our core values about access to care based on need not wealth, why is the Ford government expanding privatization rather than cancelling it, and instead increasing capacity in our public hospitals?” she said.
Mehra noted that virtually every public hospital in Ontario has operating rooms sitting unused the majority of the time because they do not have the funding to run them at full capacity. Ontario funds its public hospitals at the lowest rate of all provinces.
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 was correlated with increasing inequity in access to care. The most affluent people increased access to care by 22 per cent while the most marginalized suffered a nine per cent decrease 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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For more information, contact:
Zee Noorsumar, CUPE Communications
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647-995-9859
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