Yesterday, Ontario Health Ministry spokesman A.G. Klei confirmed the proposal is under consideration, but said no formal decision has been made.

Patients would stay at the North Toronto hospital to undergo surgery and do physiotherapy. The moneyed would not be able to jump the queue and patients wouldn't notice any difference from the public hospital system, Ms. Rasmussen said.

Don Mills Surgical is one of three surgical hospitals that operate under the province's Private Hospitals Act. Also known as Don Mills Surgical Centre, it was allowed to continue private operations in Ontario after the public health-care system was introduced. The 44-year-old hospital does cosmetic surgery and unfunded prostate cancer therapy in addition to provincially financed cataract and orthopedic services such as knee arthroscopy and cataract surgery.

Gilbert Sharpe, a health lawyer who is on the board of directors of Alegro Health, said public dollars that go to a private hospital for publicly funded procedures must be audited, and the private facility must also sign an accountability agreement.

The Ontario government has been working feverishly to reduce some of the lengthier queues. Although progress has been made -- waits for knee replacement, for example, have dropped by 18.9 per cent or 83 days since August/September 2005 -- queues remain staggeringly long.

Specifically, 90 per cent of patients requiring knee replacements had them done in just under a year -- within 357 days -- according to Ontario figures for October and November of 2006.

But waits vary dramatically by hospital. Ross Memorial Hospital in Lindsay, Ont., has one of the shortest waits in the province, with 90 per cent of patients being operated on within 90 days. Compare that with York Central Hospital in Richmond Hill, north of Toronto, where 90 per cent of patients get their surgery within 366 days, during the October-to-November, 2006, time period.

The problem is not limited to Ontario: Queues for joint replacements have been a chronic issue in Canada. In December of 2005, the federal government set the maximum length of time patients should wait for treatment in five priority areas, saying the wait for joint replacements should be not more than six months.

If Ontario approves this proposal, it will follow in the steps of British Columbia, Alberta and Manitoba -- all of which have contracted publicly funded health-care services to private surgical facilities in an effort to reduce waiting times for cataract surgery, knee and hip replacements, and other services.

Early last month, the Maples Surgical Centre, another private facility, signed a contract with the Winnipeg Regional Health Authority to perform day surgery and other procedures for adults and children.

In all, the centre will perform 1,800 publicly funded procedures under the contract, said Mark Godley, president and founder.

"It's a very important step in trying to bring competition to the health-care arena," Dr. Godley said in a telephone interview from Winnipeg yesterday.

"Private facilities want to be efficient and there's definitely that motivation to provide good care because a contract can always be taken away."

The Calgary Health Region recently renewed its contract for a five-year term with the Health Resource Centre. The 37-bed inpatient surgical facility does about 1,000 orthopedic procedures a year for the Calgary Health Region, primarily hip and knee replacements, said Don Stewart, manager of media relations for Calgary Health Region.

"It has been tremendous. We're not suggesting that there aren't wait times," Mr. Stewart said in a telephone interview from Calgary. "It does reduce the wait considerably."

Back in Ontario, Ms. Rasmussen said performing 1,500 joint replacements would help reduce Ontario's waiting list as at least five orthopedic surgeons from the public system would bring their patients to the facility.

If the proposal goes ahead, Don Mills Surgical would require renovations, including the addition of a third operating room. Ms. Rasmussen wouldn't say how much money was involved in the health-care pitch, made in January, but she did say it would not cost the public system any more than it pays for the operations now.

Currently, community hospitals that perform a total knee replacement are reimbursed $6,882 per operation, Mr. Klei said.

If the proposal is accepted, Toronto orthopedic surgeon Paul Wong estimates he could double his operating room time and do twice as many knee replacements. His patients now wait three to four months for a total knee or total hip replacement.

"It's long overdue," Dr. Wong said. "It's the ideal model for me. We can have the best of both worlds."

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