Proponents of increased private health care in Ontario, and elsewhere in Canada, should take note: Expanding private health care in Alberta has not decreased wait times for surgeries and other procedures.
Mostly, it has had the opposite effect.
That’s the conclusion of a new study entitled “Failing to Deliver” from the independent, Edmonton-based Parkland Institute .
In 2019, the United Conservative Party (UCP) government of Alberta announced the Alberta Surgical Initiative (ASI), the purpose of which was to expand access to surgeries through greater reliance on the private sector.
Then, in 2020, the UCP government allocated $400 million for medical procedures in private sector entities called “chartered surgical facilities.” The stated goal was to increase the share of private sector procedures from 15 per cent to 30 per cent provincewide.
By 2022, the Parkland report shows, Alberta had the “worst wait times performance for priority procedures in the country”.
The Institute’s researcher Andrew Longhurst used data obtained through access to information and from the Canadian Institute for Health Information (CIHI).
His report concludes that Alberta “has prioritized for-profit surgical delivery rather than system improvement.”
Notably, Alberta is not “fully utilizing the nearly 30 per cent of unused public operating room capacity.”
Poor Alberta results based on Canadian benchmarks for wait times
The Parkland Institute says the data it gathered “suggest that the expansion of private chartered surgical facilities has diverted resources away from public hospitals and, in turn, reduced provincial surgical volumes.”
In other words, privatization has meant there are now fewer rather than more surgeries.
“Between 2018-2019 and 2021-2022, surgical volumes in [private] chartered surgical facilities increased by 48 per cent while surgical activity in public hospitals declined by 12 per cent.” (Note that the public sector is much bigger than the private, so the decline in public sector activity, in absolute figures, is far greater than the increase in the private sector.)
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The provinces, territories and federal government established common wait time benchmarks for medical procedures nearly two decades ago.
Based on those standards of care, Alberta’s private care expansion has been a failure.
In 2021, following the darkest days of the pandemic, a number of provinces increased surgical activity, including all of the Maritime provinces and British Columbia. Not Alberta.
The Parkland report notes that in Alberta, from 2019 (the start of the ASI) to 2022, wait times for hip and knee replacements increased significantly, and more precipitously than the Canadian average.
In 2022, the report tells us, 38 per cent of Alberta hip replacement patients received their surgery within the benchmark, compared to a far higher Canadian average of 57 per cent.
Since the start of the ASI, the Alberta [private sector] Surgical Initiative, the share of patients meeting the Canadian benchmark has declined to the 2022 38 per cent rate. Previously it was 64 per cent. That, says the report, is “the second-largest decline among the provinces.”
It is the same story for knee replacement surgeries. In 2022, only 27 per cent of Alberta knee replacement patients received their surgery within the benchmark. The Canadian average was nearly double, 50 per cent.
Since the start of the ASI, the share of knee patients meeting the benchmark declined to 2022’s low figure from a high of 62 per cent.
Overall, the Parkland report shows that Alberta’s massive increase in outsourcing has jeopardized “efforts to reduce surgical wait times over the long term, especially for patients requiring complex surgeries only performed in the public system.”
A lesson for Ontario?
Expanded use of the private sector has had the perverse effect of creating competition between public and for-profit sectors “for a limited pool” of healthcare workers and professionals.
What has happened in Alberta is what many fear will happen in Canada’s largest province, now that the Doug Ford government has chosen to expand the private, for-profit system in Ontario.
In Alberta, Parkland reports, the private sector has offered health professionals “reduced workloads, less complex patients”. And that strategy has worked.
Private entities have succeeded in attracting – or would it be better to say poaching? – healthcare workers from the public system.
The result: “Surgical activity in public hospitals has declined while for-profit facilities focus on lower-complexity procedures, destabilizing the public hospital system.”
The Alberta report also points to other dangers of expanding private health care.
Data is limited, but Parkland suggests there is evidence privately provided procedures cost more than public ones.
As well, there is the issue of conflict of interest.
In order to increase their profits private providers could be motivated to recommend unnecessary procedures. The report notes more data will be needed to evaluate this risk fully.
Also related to the profit motive are the issues of patient safety and quality of care.
“When health-care facilities are profit-motivated, they must find ways to reduce costs and return profits to investors. The primary strategy among for-profit hospitals, ambulatory care facilities, and long-term care homes in Canada and the U.S. is to maintain lower staffing levels and fewer highly-skilled personnel per patient,” the report reads.
To a large extent the current Alberta election campaign has focused on leadership more than on policy.
Former premier and NDP leader Rachel Notley has argued that based on her penchant for conspiracy theories and weak grasp of the constitution and the law, United Conservative Party (UCP) leader and current premier Danielle Smith is simply not qualified to govern.
For their part, UCP folks point to what they characterize as the NDP’s dreary economic record when Notley was premier.
During the NDP’s one term of office Alberta experienced record declines in revenues and employment, although, in fairness, the Notley government was largely the victim of external factors not of its making.
Apart from general leadership issues, huge dark clouds of noxious wildfire smoke hang over the Alberta campaign like a dark omen.
The Parkland report shines a light on a signature and ideologically-driven policy of Alberta’s UCP that precedes Danielle Smith. But it might get short shrift in the current literally heated environment.
But this report should not only be of interest to one province.
The rest of Canada, and especially Ontario, should pay close attention to what Parkland has to tell us about the validity of the idea of resorting to the private sector to cut healthcare wait times.
The bottom line is that the private health care appears to be a false Messiah when it claims it can miraculously cure what ails our public health system.
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