Premier Doug Ford claims that patients in Ontario will pay “with their OHIP card, never their credit card,” for the surgeries that he is moving from public hospitals to private clinics. Ford claims that will take pressure off the public system, and that private clinics work more efficiently. He says he will start by transferring surgeries for hips, knees, and cataracts to the private sector. I have some recent experience with cataracts which convinces me that once again, Doug Ford is misleading us.
I noticed for some time that I was having a more difficulty in reading. Eventually, I could make out the larger headlines in newspapers and magazines but not the print in the body of the stories. I was also having trouble seeing highway signs in time to make decisions while driving.
I was told by an optometrist that I had cataracts. With a cataract, the eye’s natural lens becomes cloudy and causes things to look blurry and fuzzy. During surgery, the cloudy natural lens is removed and replaced with a clear artificial intraocular lens.
The optometrist said he would refer me to a surgeon and not long after I found myself at an eye clinic in a newer office building in Ottawa for a consultation. After undergoing some measurements and tests on my eyes, I was directed to a waiting room prior to seeing a surgeon.
The room contained a large television screen displaying slick videos saying that the clinic could provide guided laser surgery. It was described as superior to cataract surgeries that doctors have performed manually over the years. The video and the pamphlets that I found also praised what were described as premium lenses.
Candidate for surgery
When the young surgeon called me in, she reviewed the measurements and images that had been provided to her. I did have cataracts on both eyes, she said, and I was a candidate for surgery which could be done right at their clinic. She then ran through a variety of options. I could have laser surgery rather than the traditional surgery, where the surgeon removes the cataract using forceps or a sharp blade. She also said that the clinic could provide me with premium lenses.
Normally the intraocular lenses provided under the Ontario Health Insurance Plan (OHIP), provide a clear focus for distant vision, but you will need glasses for reading and probably for using your computer. The surgeon told me that the premium lenses would likely allow me to see well without eyeglasses.
The surgeon said that I should think about it and make a follow up appointment for more measurements. She then walked me down the hall to meet with someone called a refractive consultant. That person outlined the options provided by the clinic and their costs. Those ranged from $4,500 to $9,500 depending upon my choice for surgery (manual or laser), and upon what lenses I wanted to have.
The consultant gave me some literature and told me that I could inform the clinic of my preferred choices during my follow up appointment. I had not expected any of this when referred to a clinic by my optometrist. I thought I was going to see someone to arrange for surgery in a hospital with the costs covered by OHIP. Now I was being steered toward laser surgery and ridiculously expensive lenses.
Follow up research
In the following days I did some reading and research. I also talked to my wife and a variety of friends and acquaintances who had received cataract surgery. Without exception, everyone said their surgeries, performed in a public hospital and paid for under OHIP, had gone well and they were satisfied with the results. They continued to wear glasses for reading and close-up work, but I noticed in the clinic’s literature was careful not to guarantee that more expensive surgery and lenses would allow the client to do without glasses.
Follow up questions
When I next met the surgeon, I had a short list of questions. Did she perform cataract surgery in a hospital setting under OHIP if that was my preference? She did. Was she confident that she could perform the surgery successfully in the traditional manual way rather than its being laser guided? Yes, she was confident. Were the lenses paid for under OHIP good lenses? They were. But what about glasses, she asked? Did I want to continue wearing glasses? I said that was fine with me.
Surgery went well
That ended our brief, but pleasant conversation. She told me that they would set up a surgery date for one eye with a second to follow. When I did have surgery at the Eye Institute at an Ottawa hospital, it went well. My distance vision is fine and colours are deeper and more vivid than they had been in a long while. I have a new prescription for my glasses, and I can easily read the fine print in a newspaper or on my computer screen once again.
But let’s get back to Premier Ford. What of his claim about never having to take out your credit card when undergoing surgery in a private clinic? Hardly. If I had not insisted on having my surgery in a public hospital, I would have racked up $10,000 on my credit card.
The Toronto Star reports that 50 per cent of patients at one clinic surveyed opted for the more expensive lenses. Why? Perhaps they did not know about the OHIP option. In my first visit to the clinic, there was no mention of simply using the surgical option covered by OHIP. Or, it may be out of fear, induced in the private clinics, that the lenses available under OHIP are second best or even inadequate. You might call it upselling in what has become a medical marketplace.
The same story in the Star said that Ontario’s auditor general reported in 2021 about complaints from patients “being charged after receiving a publicly funded cataract surgery because they were misinformed of their right to receive standard surgery, free of charge through OHIP, without any add-ons.”
Fact checking Ford
To those critics who said that moving surgeries to private clinics would mean beggaring the public system, the premier claimed surgeons would perform additional surgeries in their spare time. I did not get that impression. Surgeons are already busy people. There were about four other patients in the pre-op room when I had my surgery and there were more arriving as I had my orange juice and cookies before leaving. I doubt whether my surgeon would work in the hospital all day and in the private clinic only at night and on weekends.
The premier has said on various occasions that the private sector is more efficient than the public. The staff in the hospital that I visited appeared efficient to me. I also assume that the doctor who performed my surgery is equally efficient wherever she works.
There is a sequel to this. I do not know why my optometrist referred me to a private clinic, but I have since dumped him. Who knows? Ontario voters may do the same to Premier Ford next time around.
As usual you never go off halfcocked and do your research homework.
You are absolutely right on all counts. Ford’s, and the Private Eye Clinics, are very misleading.
However, first I want to say a word on “private clinics” outside public hospital setting.
There are some procedures that become routine when performed in great numbers, such as cataract surgery and some orthopedic procedures and of course hernias. The well known hernia facility near Toronto is a good example. Doing one procedure in one facility can become very efficient. One of the legitimate complaints that orthopedic surgeons have is that they only have access to the OR one day, or less per week. They have a lot of down time. Facilities outside their main hospital can be one answer. This seems OK if it is still in a public facility such as the public hospital in Kemptville and all costs are covered by OHIP, and of course patients are prepared to travel out of town.
What you have is a different story on many counts. It is clearly a money making scheme by an avaricious enterprise. Cataract surgery is NOT “brain surgery”, to use a common expression. It can be performed on an assembly line set up that maximizes efficiency (and profit). Secondly, the people whom you encountered remind one of used car salespersons (with apologies to used car salesmen). They are pushing for unnecessary additions to the procedure that bring in big bucks to the organization. The things they are selling add very little benefit. Lastly, I am astonished at the cost of even these items.
A decade ago one could opt for the questionably preferable lens for a few hundred dollars. [I had the cheaper lens (covered by OHIP)in one eye and 6 months later had the fancier lens installed in the other eye. I can’t see (pun intended) any difference. I think I paid about $200 for it. Can inflation account for the prices you quote???
Your observations need to be made public. While Doug Ford may claim that your credit card covers everything it is obvious that his pushing private clinics opens the door for unethical and unscrupulous practices. The public must be made aware.
Finally I am glad that you are seeing better now. It is like cleaning a dirty windshield on your car.
All the best.
Thanks Bob for your perceptive comments. Other readers may not know that you are a retired physician. It is always good to hear from you.
Great piece. Thanks !
Henri, thanks for reading and your comment. Always good to hear from you.
Thanks for sharing your experience re cataract surgery. I worry about the growing private for profit, gov’t sanctioned enterprises and the erosion of public health care. You are right. Many seniors do not know that there is still the avenue for publicly funded cataract surgery.
Thanks Marlene for reading and sharing. Yes, unless one is familiar with the system you might feel pressured into accepting an expensive private treatment when a perfectly adequate public service is available. It’s always nice to hear from you.
I’m curious how long you had to wait for your in-hospital surgery. One of the arguments I hear for having it done privately in my area is that your don’t need to wait as long. I’ve been told I have a cataract developing in one eye.
Thanks Anne for reading and your comment. I contacted the surgeon in December 2020. I had my surgical consultation early in January and was to have surgery in one eye in May. That got cancelled at the last minute. I then had the surgery in late August and the second eye in late November. I believe I could have gone in October but we were away. So, an eight month wait for the first and less tan three months for the second. I did not ask about the comparative wait times in the private clinic versus the public hospital because I did not want surgery at the clinic. In your case, if the cataract is developing but not debilitating, you may well have time to stage it conveniently.
Well done, if choice re public private happens, great pressure to spend in private clinic will go up!
That’s if choice ends,
Thank you for this.
Are there private eye clinics that operate solely within the OHIP. billing structure? ie don’t ‘upsell’ out-of-pocket options?
Another way of asking the question: Does ‘private’ eye clinic mean the same thing as ‘for-profit’ eye clinic?
Thanks for your note. I am not sure if any private clinics have been operating solely under OHIP, but I woudl suspect not. Certainly, the one that I visited was not, or at the least they did not say anything to me about OHIP as an option. Premier Ford has claimed that in his plan cataract surgeries farmed out to private clinics will be paid under OHIP. It may be that that OHIP pays the base rate and that people pay for any added options, such as premium lenses. In that case, the important thing will be to ensure that people are not pressured into taking the more expemsive options, as the auditor general’s report indicates they are today when they go for a consultation at a private clinic. The government talks about putting into place “guardrails” to ensure that upselling does not occur. But if we look at how the province has failed to regulate long term care homes, I think we can be sceptical about the enforcement of those potential guardrails.
Thank you. One more question for now. I was told that OHIP is paying doctors $450 (approx) per
eye surgery done in hospital and $605 (approx) for the same surgery done at a private eye institute. Are you aware of this? Is this true? How would one fact-check it?
The CBC says the government is proposing to pay clinics $605 for each cataract surgery. I am assuming that if someone “buys up” they would pay whatever the cost is above that. The private clinic where I was sent quoted me a price range (for surgery only) of between $2,275 and $4,750 per eye, depending on what lens I would have wanted. I would have had to pay extra for the lenses. Of course, I chose none of the above. I don’t understand why the surgery cost varies depending upon the choice of lens, but that is what I was quoted. Here is a CBC link to the story in general: https://www.cbc.ca/news/canada/toronto/ontario-doug-ford-surgery-wait-times-private-sector-clinics-1.6715340
Just read your piece on cataract surgery in Ontario. I had this surgery in Apr. 2022. It was at a private clinic ‘Prairieview Surgical Centre’ one of 3 places that does this procedure in Saskatoon, including City Hospital. I didn’t get to choose and was assigned the ‘Surgical Centre” I had seen the surgeon at his office/clinic twice and had the lenses explained to me. Sask Health provided ‘basic’ lenses completely covered by the province. I would need glasses for reading. Also available were special lenses to correct my astigmatism at a cost of $1500 each. I still would need glasses for reading. I felt I could afford the special lenses thinking that no astigmatism would be pretty great. There were more options at even greater cost! I opted for the special lenses and wow, my distance vision was amazing – but I still needed glasses to read. I thought I would get progressives with clear glass for distance and mid-range and close up. My optometrist said she could still make a small correction in the distance vision so I said OK. I walked away with $3000 lenses and progressive lenses . When I remove the glasses and look to the distance I can’t tell any difference. I have since found that I will need another pair of glasses for music reading! The surgeons that work in private clinics are definitely up-selling to their patients because they make it sound like you could have even more perfect vision if you go for the more upscale procedures. I think it is dishonest and people need to be aware of this. My surgeon works at his own clinic and does surgeries at 3 other centres. I think specialized surgical centres are a good idea but only if they are all administered by the public health authority. We are on a slippery slope.
Thanks Barbara for your detailed comment. There is a huge imbalance in the power and information relationship between health professionals and patients. In your case and mine this involves providers of cataract and other optical surgeries, and yes, upselling is worrisome. I am pleased that I did some research and pushed back, but not everyone can or will. Thanks again.