Private clinics reduced waiting times in Saskatchewan by 47% between 2010 and 2014: study

An earlier initiative by Saskatchewan to outsource publicly funded medical services to private clinics could serve as a model for other provinces, a study says.

However, there is a risk that the lessons learned from improving the health system will be forgotten just a decade after they were introduced.

The study, released Thursday by the Fraser Institute, takes another look at the Saskatchewan Surgical Initiative 10 years after its completion. The initiative reduced the average wait time from referral to treatment from 26.5 weeks in 2010 to 14.2 weeks in 2014, a 47% reduction. In 2015, immediately after the initiative's completion, the wait time fell further to 13.6 weeks, the lowest recorded in any province that year.

During those four years, the median wait time between a patient being referred from their primary care physician to a specialist decreased to 14.2 weeks, giving Saskatchewan one of the longest wait times in the country and one of the shortest. Elsewhere in the country, wait times did not decrease during that time period.

The Saskatchewan Surgical Initiative used private clinics to perform publicly funded procedures, such as non-urgent but necessary surgical procedures such as knee and hip replacements. Outsourcing publicly funded treatments helped expand the province's surgical capacity.

These private contracts had many rules and regulations, such as that the cost of services had to be equal to or lower than that of the public health system. The initiative also included central pooling of referrals for surgical procedures and specific waiting time targets and guarantees.

While previous research from the Fraser Institute showed that procedures in private clinics cost 26 percent less than in hospitals, a more recent study by Second Street found that the cost per procedure in private surgical centers is between 35 and 45 percent lower than in public hospitals.

At the start of the initiative, 15,352 patients were waiting longer than three months. At the end of the initiative, only 3,824 patients were waiting longer than three months, a reduction of over 75%. During the initiative, the number of patients waiting longer than six months fell by 84%.

“After the elimination of SSI, wait times increased significantly,” the report says.

After the initiative was completed, the number of patients waiting more than three months increased by 575% between March 2015 and February 2020. The number of patients waiting more than six months increased by 1,171% over the same period. Even worse was the number of patients waiting more than a year and a half, with increases of 1,185% and 1,198% respectively.

The average waiting time for all patients from appointment booking to treatment fell from 49 days in March 2010 to 28 days in February 2015, a decrease of 43%.

The 90^th The percentage waiting time, a measure of how long it takes for 90% of patients to receive their treatment, fell from 332 days to 109 days between March 2010 and 2015, a decrease of 67%.

While wait times dropped significantly during the initiative, the report said this change was not due to a change in spending. When calculating the percentage change in inflation-adjusted per capita spending, the report found only an average annual change in the province's health spending of 0.8% between 2010 and 2014.

“The success of the Saskatchewan Surgical Initiative offers valuable lessons to policymakers across Canada – and hope to patients – that the unacceptably long wait times plaguing health care systems across the country can be significantly reduced through meaningful reforms,” said Nadeem Esmail, Senior Fellow at the Fraser Institute 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 a backlog of operations and long wait times could learn from Saskatchewan's approach by adopting it or implementing an “improved and bolder version of it.”

“What the SSI clearly shows is that even in a limited and constrained environment, private, for-profit clinics can have a positive and significant impact on the patient experience and can be an important partner in strategies to reduce wait times,” the report concludes.