B.C. should consider long-term collaboration with private clinics

Earlier this year, the Horgan government in British Columbia postponed of more than 30,000 “non-urgent” scheduled surgeries due to the COVID pandemic. At the time, official estimates projected it would take approximately two years to get through the resulting backlog (including an additional 24,000 patients waiting for surgery referrals). Then last week, B.C. Health Minister Adrian Dix suggested that initial efforts to tackle this backlog have been moderately successful.

However, there remains much work to do to clear the rest of the COVID-related backlog and deal with the long wait times for elective surgery that patients in the province face every year.

The Horgan government, and our remarkable health-care professionals, deserve congratulations for the recent progress of the province’s “Surgical Renewal” program. Non-urgent surgical procedures were ramped back up to an estimated 87 per cent of the previous year’s volumes between May 18 (when non-urgent surgeries were resumed) and June 25. Urgent surgeries are also being completed in higher volumes than last year, and additional health care personnel have been recruited. Subsequently, the estimated time to clear the backlog has been reduced from 24 months to 15 months.

While all positive news, there are a few reasons for concern.

First, although the expected timeline to get through the COVID-related backlog has decreased, the fact is that British Columbia now has a much larger annual backlog for medically necessary treatment. In fact, official estimates reveal there are currently over 95,000 patients on B.C.’s wait list—only about one-third of which are related to the recent pause.

Unfortunately, last week’s announcement suggests that “Patients already on the waitlist are waiting significantly longer than they would have prior to COVID-19; approximately two months longer.” This is unfortunate since, even before COVID, British Columbians waited a median of 12.7 weeks for a specialist visit after seeing a general practitioner, and an additional 11.3 weeks to receive treatment after consultation with said specialist (for a total of 24 weeks).

So while the recent progress is commendable, the fact is that these huge efforts will (at best) likely only get us get back to the pre-COVID status quo of long wait times for medically necessary health care.

There are, however, a few lessons the government will hopefully carry forward after the pandemic.

Along with the development of clinical guidelines that have improved the efficiency of performing surgery under pandemic conditions, the backlog has somewhat helped reframe the role of private clinics in the eyes of the government. Though barely mentioned in Minister Dix’s recent update, the province embraced some private clinics as key allies in recent efforts to tackle the COVID-related backlog—which we applauded. Our position on this has not changed. That being said, we know from experience that the wait time successes demonstrated by similar endeavours (including the Saskatchewan Surgical Initiative), though significant, will likely be temporary without additional reforms.

In reality, countries such as Germany, Australia and Switzerland, which all boast universal access and shorter elective surgery wait times than Canada, have more fully embraced their private sectors as either an alternative for (or partner to) their public systems.

If the B.C. government is truly interested in tackling not just the current but much larger annual backlog of elective surgeries, it could start with a more serious and longer-term vision for reducing wait times by moving beyond the current temporary partnerships and committing to long-term collaboration with private clinics after the pandemic has passed. It should also abandon its historical practise of persecuting private clinics and health-care entrepreneurs. These are entities who have, despite being treated poorly in the past, acted as partners during the renewal process by providing valuable health-care services to patients failed by the provincial system.

Without fundamental reforms long wait times will continue to plague B.C.’s health-care system. This renewal strategy represents a chance to fundamentally improve the provincial surgical program far beyond the window of this outbreak. The opportunity should not be wasted.