Andrew Longhurst: For-profit surgeries won’t reduce wait times or cut costs

Health care is top of mind this election, and rightly so. 

There is no question the stakes are high this election when it comes to public health care.

One issue that has the potential to dramatically remake the BC health system is a major expansion of for-profit health care. In particular, the BC Conservatives propose to “pay for patients in the public system to receive quality health care services in non-governmental clinics for specific priority procedures and diagnostic services.”

While it may seem that opening more private facilities to offer surgeries increases capacity and reduces wait times, Canadian evidence shows the opposite.

The Alberta experience is sobering. In 2019, the Alberta UCP government made similar claims that an expansion of outsourcing publicly funded procedures to for-profit providers would reduce wait times.

Drawing on data obtained by Freedom of Information, I found that in the first three years of the “Alberta Surgical Initiative”, the provinces total surgical activity actually declined. 

Fewer total surgeries were performed in 2021-2022 (268,335) than in 2018-2019 (285,945), that is, pre-pandemic and before the initiative. Between 2018-2019 and 2021-2022, total provincial surgical activity declined by 6 per cent. Between 2018-2019 and 2021-2022, surgeries delivered in for-profit settings increased by 48 per cent while public hospital volumes declined by 12 per cent.

This reduction in AHS surgical volumes cannot be explained by the pandemic alone, since surgical activity in for-profit clinics increased between 2018-2019 and 2021-2022, and even as other provinces like BC successfully increased hospital surgical capacity. 

The data also show government starved funding for public operating rooms at the same time government was signing multi-million dollar contracts for new and expanded for-profit facilities. Alberta data reported by the Canadian Institute for Health Information found that the province, in fact, reduced its public operating room workforce between 2020-21 and 2021-22 by 0.2 per cent while BC increased it by 7.8 per cent.

In other words, the expansion of for-profit surgeries in Alberta has come at the direct expense of public hospitals and the workforce.

Why?

There is a finite pool of qualified surgeons, nurses, and allied health professionals. Right now, the vast majority of public operating rooms in Canada are not funded or staffed to perform surgeries during evenings or weekends. In most cases, we don’t lack the physical space to perform surgeries, we lack the workforce. Paying for-profit providers a premium – often 2-3 times the funding that hospitals receive for the same procedure (as CBC revealed through freedom of information in Ontario) –  simply diverts limited staffing from hospitals to the for-profit sector.

A recent expose published in three Alberta newspapers paints an alarming picture of the personal and financial costs of these policy choices for patients waiting for surgery. It tells the story of a woman in Calgary who felt she had no choice but to pay $54,000 to have both of her hips replaced as she was told it would be years before she would get the procedure done in Alberta’s public system. 

While some politicians may be attracted by the idea of increasing for-profit surgeries, like Alberta, it will prove to be a costly mistake. Expanding the for-profit sector is unlikely to reduce waits over the long-term — capacity depends on the availability of qualified staff, which is unchanged by the addition of profit. 

The provinces with the greatest amount of for-profit surgical outsourcing – Alberta, Saskatchewan, and Quebec – generally have the longest wait times in the country for knee and hip replacements and cataract surgeries. For example, Alberta contracts nearly 4 times the share of private surgeries than BC (19% compared to 5%) and has longer wait times for hip, knee and cataract surgeries.

Instead, BC politicians would be wise to focus on policy strategies based on research evidence, including centralized waitlists and team-based care models, staffing our existing public operating rooms that sit idle most evenings and weekends, increasing access to seniors’ care in order to reduce surgery delays, and public health measures that prevent illness and reduce health system strain. 

Andrew Longhurst is a health policy researcher, PhD candidate at Simon Fraser University, and author of multiple reports on surgical wait times.