Two years ago, Mitchell Tremblay moved to Guelph, having spent a brief stint on the streets of Toronto after losing his home in the pandemic. Then he started to lose his vision.
The 41-year-old advocate for people living with disabilities had already been having problems going outside, due to agoraphobia, social anxiety, and PTSD.
“Not being able to see made things so much worse,” he says. “I knew if I didn’t get help for it, I was going to be stuck not being able to see two feet in front of me. That’s how bad it was. Faces at the grocery store were just flat lumps of clay. I couldn’t see facial definition, and I couldn’t read any signs. Life just became kind of a blurry nightmare.”
After a consultation with his doctor, Tremblay was informed he would require a cataract surgery — the most common surgical procedure in Canada. But, like thousands of Ontarians, he found himself on a wait-list that had ballooned since the early days of the pandemic.
“I was told there was a two-year wait,” he says.
Then the Ford government announced that it would be addressing this wait-list by dedicating additional public funding for cataract surgeries performed in private, for-profit clinics.
Mitchell Tremblay is an advocate for people living with disabilities. (Courtesy of Mitchell Tremblay)
As a high-risk patient, Tremblay was told his surgery had been fast-tracked to the Oakville branch of the Prism Eye Institute, a private clinic with three locations across the GTHA.
However, Tremblay says his experience with Prism quickly turned sour, as he found himself on the receiving end of an experience that advocates say has become increasingly common in private clinics across the province. He alleges he was upsold hundreds of dollars in uninsured services and suspects his surgery was delayed when he refused to pay.
A new study adds weight to such suspicions. Analyzing six years of patient data, it has found that a disproportionate number of surgeries performed by private clinics since the province’s new funding allocation have gone to the wealthiest Ontarians.
The treatment divide
Dr. Robert Campbell is an ophthalmologist at Queen’s University and the chief author of a new study in the Canadian Medical Association Journal that analyzes the impact of this additional funding for cataract patients across the province.
For years, those who did not want to wait for a cataract treatment in the public-health system went to private clinics, where patients could pay to get the surgery sooner.
“You can’t actually charge patients for cataract surgery, because of OHIP,” says Campbell. “But [these clinics] would have OHIP pay for the cataract surgeries and charge patients for other services in a way that would cover their costs and left a profit.”
During the pandemic emergency, when the province faced a growing wait-list for these surgeries in public hospitals, the government stepped in to divert those patients to these clinics in an attempt to reduce the backlog.
“We wanted to see if this was working,” Campbell says. “Because you would assume that people from all socioeconomic strata would be able to access care at these centres, not just those who could pay extra. So that’s what motivated us.”
Campbell and his team analyzed patient data from 2017 to 2022 and data from Statistics Canada to see how access to these surgeries changed as of 2020, when the provincial government first began to subsidize them in private clinics.
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“What we did is divide people into five different strata by socioeconomic status and compare their rates of surgery before and after this policy change,” Campbell says. “To put it bluntly, access did go up, but only for one group — and that was the group that could afford to pay extra.”
In fact, the team found that surgeries for those in the highest socioeconomic strata went up by nearly 25 per cent in private clinics. For those in the lowest, however, they fell by 8.5 per cent.
While it is difficult to say what precisely is driving this change, Campbell says it likely comes down to two major factors.
“The first is the continued request for payment from patients who are seeking care in private centres … The second is these clinics keeping separate wait-lists for people who are willing to pay extra versus those who aren’t,” he says. “That allows them to sell, essentially, the ability to jump the line. Extra lenses and whatnot might have some value to them, but the real value is in jumping what is perceived as a really long queue.”
The cost of hidden fees
In that queue are patients like Mitchell Tremblay, who entered Prism Eye Institute and found himself immediately confronted by the payment department.
“It’s a whole different section,” he says. “You’re not waiting; you’re not at the front desk. They’re real quick to come get you and go through everything. Every time I sat down with them, they kept highlighting and circling these figures.”
Eventually, they told him he would have to pay close to $600 for additional, uninsured services.
“It was only my doctor who said I didn’t need them,” Tremblay says. “Every other person — behind the desk, at the front, or in the payment department — pushed this on me, this $595 that I would have to crowdfund because I’m on ODSP.”
After a month of in-person meetings that saw him travelling between Guelph and Oakville, the institute eventually waived the fees.
In a statement to TVO Today, a spokesperson for Health Minister Sylvia Jones wrote that Ontario is “making it easier and faster for people to access the publicly-funded surgeries and procedures they need by further leveraging community surgical and diagnostic centres to eliminate surgical backlogs, including for cataract procedures, and reduce wait times.”
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According to the Integrated Community Health Services Centres Act, “No person shall refuse to provide or refuse to continue to provide an insured service to an insured person for any reason relating to the insured person’s choice not to pay, or not to provide a direct or indirect benefit, for any product, device or service offered at the integrated community health services centre.”
Tremblay ended up waiting another year for his two cataract surgeries, which were finally completed last month.
The Prism Eye Institute did not respond to multiple requests for comment from TVO Today.
“The whole thing was equal parts unnerving and a miracle,” he says. “The most terrifying thing was seeing them interacting with 80-year-olds who were confused, worried, and just wanted their vision back so they could see their grandkids. These people were accepting those fees left and right.”
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