Summary

• Private delivery of surgical procedures is a common feature of most high-performing universal health-care systems. However, the practice is highly controversial in Canada.
• The Saskatchewan Surgical Initiative (SSI), which was in place from March 2010 to March 2014, offers an informative case study of how publicly funded care provided by private clinics can contribute to more timely delivery of specific health-care services.
• While the Saskatchewan Surgical Initiative was in place, Saskatchewan went from having one of the longest wait times in Canada for clinical procedures to being one of the best performers. Furthermore, contrary to criticisms of the SSI, universal access to health care in the province was not compromised by outsourcing medical procedures to privately owned for-profit clinics.
• Outsourcing to private clinics was constrained by a range of requirements and regulations intended to protect patient access to publicly provided care and to control costs. 
• Over the period from March 2010 to March 2014, there was up to a 75% reduction in the number of patients waiting more than three months for surgery. While some reduction in wait times took place prior to the introduction of the Saskatchewan Surgical Initiative, there was a substantial acceleration in the rate of decline in the number of patients waiting more than three or six months between the time an operating room was booked and the time of treatment. Wait times then increased substantially after the SSI ended.
• A review of the SSI clearly demonstrates 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. Moreover, the contribution to improved patient access would likely have been even greater were it not for direct and indirect regulatory restrictions on the volume of services supplied by private, for-profit clinics.