The UCP government’s making a big deal about contracting out publicly insured surgeries to chartered surgical facilities. The basic idea is that the province outsources publicly insured surgeries to private clinics instead of doing them in a hospital.
If you’re waiting for a surgery, you probably just want it done and aren’t too concerned where it happens, as long as it is safe and done by accredited professionals. That’s understandable.
Rather than simply increasing funding for hospitals to perform more surgeries, the UCP will use public funds to outsource surgeries to for-profit surgical facilities. This has the potential to hurt the public system, not help it. In other words, this bad medicine might make our public health care system worse, not better.
Governments outsourcing public surgeries to private clinics is not new in Canada, but the track record of these clinics are spotty. In Alberta, the conservative government also outsourced public surgeries, but stopped after the private corporation went into bankruptcy in 2010. Also in 2010, the government of Saskatchewan outsourced public surgeries to private clinics but stopped after wait times increased. Saskatchewan now outsources patients to the private clinics here in Alberta, but only if patients can pay for queue jumping by paying for transportation costs.
Cutting corners on wages and benefits
The surgeons and anesthesiologists who do the surgeries at chartered surgical facilities are paid in the same way they would be if they were doing surgeries in a hospital (known as a fee-for-service (FFS) model). The nurses and administrators are paid by the corporations that run them, so one of the ways these for-profit clinics make money is by cutting corners of the costs of these workers. For example, nurses and administrators don’t have their employer pay for pensions or other benefits as they would if they worked for Alberta Health Services (AHS).
Simple surgeries on healthiest patients
Another way they make money is by only doing simple surgeries over and over again. Charter surgical facilities are only set up to handle specific procedures, such as cataract surgery. If there’s a complication during the surgery, the patient will likely have to be moved to an actual hospital.
This is also why chartered surgical facilities take only the healthiest patients. Unstable or high-risk patients who require a higher level of care have their operations in a hospital.
Public-system staff constraints
There are great concerns about health care worker burnout. The jobs in health care are tough, but they are so important to our communities. If you feel like you’re experiencing burnout, or if you’re just interested, we recommend watching this Alberta Health Service video and blog.
There are labour shortages in the public health care system from burnout, retirement, illness, or other reasons.
Chartered surgical facilities are staffed by certified professionals, but those professionals could be doing surgeries in a public hospital. In their contracts, chartered surgical facilities promise to “use all reasonable efforts” not to negatively impact surgeries in publicly-funded hospitals. That means, if a public hospital needs surgeons or anesthesiologists, they get pulled from the chartered surgical facility. The system falls apart.
Rich people can pay for better care
Chartered surgical facilities can and do charge people for surgeries. If you have the money, you can pay to get your surgery done and jump the queue. That feature has been around for a while.
The UCP uses chartered surgical facilities for publicly insured surgeries. You don’t have to pay for the surgery if it is publicly insured, but if you’re wealthy you can buy extra services.
This is known as ‘upselling’ and critics fear that it further erodes our public health care system by introducing a profit motive.
The government reports that chartered surgical facilities raked in an additional $1.6 million dollars in 2019 – 2020 through upselling. This figure will likely expand as the government expands its use of privatized surgical facilities.
Public dollars, private facility
It’s very difficult to get an accurate idea of how much money goes to these surgical clinics. In their announcements, the UCP seem to avoid talking about costs. What little financial information we do have is that there are maximum amounts – ceilings – for payment from AHS to these clinics is in the hundreds-of-millions range.
Detailed financial information is scrubbed from chartered surgical facilities’ contracts. The doctors are paid by Alberta Health Services the same as they would be in a public hospital. The government, through AHS, pays for the operating room, the nurses and administrators, and, of course, the profits of the private operators. Instead of these funds going into the public system, it’s going to the capital, operations, and profit of a private facility.
Bad medicine could make the public system worse
There’s no doubt that our public health care system needs more funding support and more staff. The system is so strained currently that there are rolling facility closures, especially in rural Alberta. Staff illness and burnout just creates additional pressures on the system, especially when there are no replacements for lost workers.
Chartered surgical facilities are not the solution to these systemic problems. There simply isn’t enough workers to balance the surgeries in hospitals and surgeries in this parallel system. There’s also more and more funding going to the parallel chartered surgical system – funds that could be going to surgeries in public hospitals. The healthiest patients get skimmed off and have the opportunity to pay for extra services, if they can afford it, in the chartered surgical facilities.
Understandably, if a patient waits a long time for a medically necessary surgery, their top considerations are about getting the procedure done as soon as possible, but unless steps are taken to actually address surgical wait times in public hospitals, over-relying on chartered surgical facilities to drive wait times down may make the public system sicker.