Provinces using investor-owned for-profit clinics to cut wait times heading towards predictable failure

The symptoms of Canada’s strained health care system are well known by now. We see headlines about the shortages of doctors, nurses, and allied health professionals. Burnout rates, already a problem before COVID-19 hit, are reaching new highs. For patients, delayed or missed health care services resulted in 4,000 excess deaths in the second half of 2020 alone.

Decades of austerity cuts, underfunding, and neglect by conservative governments have not left Canada’s healthcare system prepared for the pandemic’s sustained pressures. In response to a crumbling system, Canada’s right-wing establishment is prescribing more of the same failing treatment: private health care.

We’re seeing a new wave of pro-privatization discourse in the media as provinces move their privatization agendas forward. Alberta, Ontario, Saskatchewan have all announced plans to outsource surgeries to private providers, a strategy already in use by the B.C. NDP-led government to clear its surgical backlog.

Private for-profit hasn’t worked

Contracting out surgical services to private companies is at best a short term measure, but evidence shows it to be counter-productive in the long run.

Evidence shows that outsourcing surgeries to private for-profits leads to:

• Higher costs for the public to as compared to the public system where profits margins are not factored in. Back in 2016, BC’s plan to pay for-profit clinics for MRIs was nearly twice as expensive as the same service within the Vancouver Island Health Authority.
• Lower quality and less safe services. Both Canadian and international experience shows that private for-profit facilities often cut corners to reduce costs, including hiring fewer and less skilled personnel.
• A rise in inappropriate surgeries, when a clear profit motive drives recommendations for more and more expensive surgeries. Private, for-profits also have an incentive to take on easier surgeries, leaving the public system with more complex cases.
• A drain of health human resources from the public system, as profit incentives pull from the same limited pool of health professionals.
• No improvements to wait times. The 2010 Saskatchewan Surgical Initiative, which made use of chartered facilities, showed a slight reduction of wait times in the short run but an overall increase in wait times in the long run.

In summary, private facilities are a band-aid measure for a strained public system. Heather Smith, president of  the United Nurses of Alberta, cuts to the heart of the matter: “You pull staffing, resources, and you further hamper the ability of the public system to deliver… Then you say, the ‘public system has failed, and we have no choice’”.

Public policy works

Decades of bad public policy have led to the erosion of our healthcare system. While pro-privatization pundits argue this is because of government’s inherent inability to build a functioning healthcare system, it can also be seen as a story of policy that was very successful in achieving intended outcomes.

In a recent opinion piece, Dr. Brian Day, the private surgeon who has lost a legal challenge to B.C.’s ban on extra billing, user fees, private duplicate insurance, admits that today’s shortage of doctors and nurses is the result of an intentional policy direction dating back to the 1990s. The flawed opinions at the time suggested that rising health care costs were due to the over-supply of healthcare services.

The proposed solutions – closing nursing schools, cutting medical school admissions, reducing hospital beds, closing hospitals, and denying immigrant doctors the right to practice – were highly successful in shrinking the supply of healthcare services.

The real winners of these policies have been doctors. With the supply of doctors restricted, the medical profession was able to maintain a powerful hold over the health care system. Demand for their services meant they could maintain the prestige and high incomes of their profession. Today they still continue to use this power to push for policy that protects their profits, such as extra billing, user fees, and private duplicate insurance.

Time for a public sector strategy

If our goals are to ensure equitable and timely access to health care services, then we already know what policy solutions will get us there.

We need a health human resources strategy to recruit, train, and retain health professionals for our public system. This should include the full team of health care providers. Diagnostic imaging technologists, prehabilitation and rehabilitation staff are as essential to the surgical journey as surgeons and nurses. In B.C. these professions have been chronically understaffed.

While no research shows that introducing for-profit health care into a public system works, there is solid evidence in support of proven public solutions, including:

• Fully utilizing existing public operating rooms
• Adopting a “first available surgeon” waiting list management model
• Scaling up innovative pilot projects like the Richmond Hip and Knee Reconstruction Project
• Expanding “one stop shop” patient assessment clinics that make use of multi-disciplinary teams
• Improving access to community and home care

Governments have been gutting the public healthcare system for decades, creating the scenarios that, on the surface, seem to justify allowing private actors to save the day. To fix this, we need a new set of government policies that will reverse the trend by investing in a systematic human resources and capital investment plan, bringing our public system’s capacity back to sustainable levels.