Proposed changes to Alberta Health Act require reassessment
Bankruptcy of for-profit Calgary clinic portends worse, more costly system
By Diana Gibson, Freelance June 3, 2010
In the same month as the Alberta Government launched consultations on a new Alberta Health Act, one of its prodigal private surgery centres, the Health Resources Centre in Calgary, declared bankruptcy. Before consultations have even begun, the Alberta Health Act initiative has been seriously undermined because the Act is all about that style of private for-profit delivery.
The only documents to emerge on the new Act to date are "A Foundation for Alberta's Health System" and the online survey. These documents are drowning in warm sounding rhetoric about patients, families, quality and access. However, hidden within are chilling terms like flexibility of delivery and personal responsibility. Flexibility of delivery is often code for increasing for-profit health care, and individual responsibility means moving away from universality and public responsibility and in some cases penalizing individuals for unhealthy behaviours.
Of greater concern is the behind-the-scenes agenda for the Health Act. That agenda is clear in the submission from Alberta Health Services CEO, Steven Duckett, which states the goal as, "Recognize the role of private and non-governmental organizations in service delivery within the Canada health framework."
Even more telling is the submission from the Calgary Chamber of Commerce, which has been advocating for a long time for this form of legislative change. Specifically it asks for the repeal of the Health Care Protection Act and stripping Alberta Health and Wellness of its role in regulating private surgeries and clinics.
Their submission also advocates for increased direct competition between private for-profit providers and public providers while at the same time allowing private providers to benefit from any economies of scale and other advantages of the public sector through a "levelling of the playing field and co-operation in the distribution of resources."
The HRC bankruptcy reveals the folly of that approach. Albertans and Canadians should be alarmed and should watch the health act initiative closely.
Certainly there are serious challenges to be dealt with on the delivery side of health care. Hospital stays are becoming much shorter, and community or day-surgery alternatives have been growing. That sector is fragmented and mostly outside of the public health system and protections of the Canada Health Act.
Services such as rehabilitation services that were previously offered in hospitals are being offered in communities and homes. Long-term care is being downgraded to assisted living, and the sector is becoming increasingly dominated by for-profit providers.
On the flip side, the province has under-funded hospitals for many years, causing shortages of beds, nurses and physicians and has not adequately funded quality public services for seniors needing long-term care.
The growth of the for-profit involvement in those service areas has come at a cost, Albertans now have the highest out-of-pocket spending on health care in the country.
Not only has this path been costly, but it means lower quality. A number of academic studies have shown that care in for-profit institutions is often lower in quality than in not-for-profit institutions.
Findings include higher death rates in private hospitals and dialysis clinics, more quality deficiencies and less nursing care in nursing homes and less care for the dying in for-profit hospices.
The Alberta government pays a lot of lip service to best evidence. Best evidence shows for-profit providers deliver poorer results at higher cost. It is time to learn from our mistakes and stem the tide. To this end, the Alberta Health Act initiative should not proceed as planned.
Certainly, there are challenges in health care, not only the fragmented delivery system that is increasingly for-profit but also the lack of attention to prevention and the social determinants of health such as poverty and inequality.
The act will not address these problems; the barriers to reform are political not legislative. Without the political will to account for the health impacts of social policies, without the political will to fund adequate public health services, and without the political will to limit the profits of pharmaceutical companies, pharmacies, doctors and private insurers, legislative changes will not significantly improve health care outcomes or sustainability in Alberta.
The public health system is now paying to bail out the HRC and surgeries are at risk.
Alberta can afford better and should invest in making the HRC back into a non-profit hospital and bring it under the public umbrella. Beyond that, the health-act plans should be shelved and the government should get down to the business of delivering health care that is public, universal and affordable.
There is room for a new health act, but it needs to be one that limits for-profit involvement in health care and strengthens the public system which delivers the most cost effective, most accessible and best quality health care.
Diana Gibson is the research director at the Parkland Institute. This opinion piece is based on a new series of reports by the Institute on the proposed Alberta Health Act.
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