A past Saskatchewan initiative to outsource publicly funded medical work to private clinics could serve as a lesson for other provinces, a study argues.
However, the risk is that lessons of an improved healthcare system will be forgotten only a decade after they were learned.
The research, released Thursday by the Fraser Institute, revisits the Saskatchewan Surgical Initiative ten years after it concluded. The initiative reduced median wait times from referral to treatment from 26.5 weeks in 2010 to 14.2 weeks in 2014, a reduction of 47%. By 2015, immediately after the initiative’s conclusion, the wait time fell further to 13.6 weeks, the lowest recorded by any province that year.
During the four years, the median medical wait time from when a patient was referred from their family doctor to a specialist fell to 14.2 weeks, resulting in Saskatchewan transitioning from having one of the longest wait times in the country to one of the shortest. Wait times across the country did not fall in other places during that time frame.
The Saskatchewan Surgical Initiative used private clinics to perform publicly-funded procedures, such as non-emergency but necessary surgical procedures like knee and hip replacements. Contracting publicly funded care to third parties helped expand the province’s surgical capacity.
There were many rules and regulations regarding this private contracting, such as the cost of services being equal to or less than what is offered by the publicly delivered health system. The initiative also included centralized pooling of surgical referrals and specific wait time targets and guarantees.
While the Fraser Institute’s previous research showed that procedures in private clinics cost 26% less than they would have in a hospital, more recent research done by Second Street showed that per-procedure costs in private surgical centres were between 35% and 45% less costly than in public hospitals.
When the initiative began, 15,352 patients were waiting more than three months. By the initiative’s conclusion, only 3,824 patients were waiting longer than three months, a reduction greater than 75%. During the initiative, the number of patients waiting more than six months decreased by 84%.
“Wait times then increased substantially after SSI ended,” reads the report.
Following the initiative’s conclusion, the number of patients waiting more than three months increased by 575% between March 2015 and February 2020. Patients waiting more than six months increased by 1,171% during the same timeframe. Worse still were the patients required to wait more than a year and a year and a half, which increased by 1,185% and 1,198%, respectively.
The median wait time among all patients from booking to treatment fell from 49 days in March 2010 to 28 days in February 2015, a decrease of 43%.
The 90th percentile wait time, a measure for which 90% of patients receive their treatment, fell from 332 days to 109 days between March 2010 and 2015, a decrease of 67%.
While wait times plummeted during the initiative, the report said that this change could not be attributed to a change in spending. When calculating for % change in per-capita inflation-adjusted spending, the period between 2010-2014 only saw a 0.8% average annual change in provincial healthcare spending.
“The success of the Saskatchewan Surgical Initiative offers valuable lessons for policymakers across Canada—and hope for patients—that the unacceptably long waits that plague healthcare systems nationwide can be reduced meaningfully with sensible reform,” said Nadeem Esmail, Fraser Institute senior fellow and co-author of the report: 10 Years On—Revisiting the Saskatchewan Surgical Initiative.
The report’s authors suggest that other Canadian provinces struggling with backlogs for surgeries and long wait times can learn from Saskatchewan’s approach by adopting it or implementing an “enhanced and bolder version of it.”
“What the SSI does clearly demonstrate is that, even in a limited and restricted setting, private for-profit clinics can have a positive and significant impact on the patient experience and can serve as a vital partner in wait-time reduction strategies,” concluded the report.