December 10, 2020
Surgical wait time initiative announcements leave Albertans with more questions than answers
In a press conference this morning, Health Minister Tyler Shandro announced the government’s plan to reduce surgical wait times in Alberta. The minister confirmed that the planning for the surgical initiative was informed by the Saskatchewan Surgical Initiative (which ultimately failed to solve wait-time issues in Saskatchewan) but was unable to clarify the lessons that this government is taking from its failure.
Despite the effort with which Minister Shandro tried to mask the true underlying ideology of the initiative – namely privatization – the true intent was clear. What’s worse is that today’s announcement came with no monetary figures, no timelines, and no details. “Just as we’ve seen with previous conservative governments, the minister is once again asking Albertans to accept major changes to their health care system on faith alone, without revealing any of the details as to how this will affect costs or the quality of care to patients,” says Sandra Azocar, executive director of Friends of Medicare.
As we have said before, contracting out is not benign: it distorts the motivation of those providing health services and those determining the allocation of resources in the public system. “We don’t need private solutions to public problems like wait times,” says Azocar. “When integral parts of our health care system are contracted out to private companies, the public loses our right to see exactly what Alberta Health Services is paying, or the added costs incurred from contracting out integral parts of our health care as in the case of home care, seniors care, diagnostic imaging and surgeries”
As we have seen before, via examples like the Saskatchewan Surgical Initiative amongst others, and existing facilities within our own province, the privatization of surgical services does not benefit our public health care system. In fact, attempts to privatize Alberta’s surgical services is nothing new: in 2010, Alberta Health Services under then-President Stephen Duckett, began contracting out cataract surgeries in Edmonton, despite Edmonton Medical Director for Opthomology confirming that there was capacity for them at the Royal Alex Hospital Regional Eye Center.
In an article from 2014, Duckett pondered the reasons why our health care costs are high, and claimed that looking at privatization may be a good start: “The ‘unusual’ method of tendering these contracts encouraged providers to bid high. Instead of giving contracts to the low bidder, Alberta Health Services took all the bids, set a uniform price by averaging the costs in the tenders, then made ‘everyone a winner’ by contracting the service to all of the submitting companies.”
In the same article, Duckett explains that when he looked at the costs of publicly-funded procedures compared to those performed by the private Health Resource Centre, the same orthopaedic work was being done in public hospitals for considerably less: $486 less for a hip arthroplasty, and a staggering $1,814 less for a foot and ankle procedure.
Triaging patients with the least complex health needs to non-hospital facilities, as was central to in today’s announcement, means that private surgical facilities are able to incur the highest profit. In fact, the most privatized area of our surgical system – ophthalmology – also garners the highest income for its surgeons: provincial statistics show Alberta ophthalmologists received average gross payments of $1.12 million in 2015-16. Interestingly enough, it is also the area that performs worst compared to national wait time benchmarks.
The myth of private care is that it is supposed to serve more patients quicker, but they make the problem worse. Financial incentives for procedures lead to patients who are upsold and over-referred in place of those who are truly in need. Health care staff are a finite resource, and when doctors are enticed to perform expensive procedures for-profit, they aren’t helping patients in the public system.
Friends of Medicare are not advocating for the status quo. Albertans need systemic changes that will address issues of wait times, but they must be in line with the vision of improving on the solid foundation that we have within our public system. “Our health care system has the capacity to provide the best care possible. What we are faced with is the problem of how to properly manage our resources in order to improve and expand our health care, and to ensure quality and timely care for all Albertans,” states Azocar. “Contracting out will only add to the complexity and inequity of the system.”
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