Surgery centre is worth trying

Anew surgical centre will open next month in View Royal, and already the battle lines are being drawn. The clinic is privately owned, by Calgary-based Surgical Centres Inc. It will perform day-surgery procedures such as arthroscopies, hernia repairs and gallbladder removals. The facility will also handle screening colonoscopies. About 5,750 patients will be treated each year.

As these procedures are being conducted through a contract with Island Health, they’re insured under our public health-care system, meaning patients don’t pay.

But critics of private medicine, such as the province’s NDP health critic, Judy Darcy, aren’t satisfied. She pointed out that in 2015, 18 per cent of operating rooms at local hospitals weren’t regularly staffed.

The proper solution, she suggested, would be to make better use of existing facilities rather than turn to the private sector.

There are arguments on both sides of this issue. Opponents might protest that a private health-care operator is being allowed to cherry-pick the simplest cases, while leaving the more expensive and complex procedures to a beleaguered public system.

This is one of the concerns about private-sector involvement in health-care delivery — the potential to turn a profit while performing only routine work. Dr. Brian Day’s Cambie Surgery Centre in Vancouver, being sued by the province for extra-billing among other things, follows this model.

The View Royal clinic will also benefit, at no cost to the owner, from Island Health’s extensive investment in data systems, clinical-practice guidelines and patient recordkeeping, all of it taxpayer-funded.

Lastly, there is the danger that facilities of this kind will take away staff by providing a better work environment. The procedures are relatively simple. The patients are pre-screened to ensure that complications are unlikely. There are no middle-of-the-night emergency cases. Those are all attractions that acute-care hospitals cannot guarantee.

In short, private facilities offer a deceptively appealing choice that masks deeper issues that should concern us.

However, supporters also have a case to make. Island Health estimates the new clinic will enjoy a 16 per cent cost advantage on comparable cases.

That’s possible because the nursing staff will not be paid union wages and benefits, and because the company has lean management and limited overhead.

In addition, the cost of constructing the facility is borne by the owner. That frees Island Health’s capital budget for other priorities, such as purchasing expensive equipment.

There is one further benefit. At present, surgeons in the capital region suffer from a shortage of operatingroom hours. That matters because they are paid on a feefor-service basis. If they aren’t given sufficient operating time, their income suffers.

The additional procedures allocated to the clinic should reduce this concern, as surgeons will be able to gain extra hours working there.

This might sound like an odd argument. After all, as Darcy noted, there is unused capacity in existing hospitals.

However, the issue is more complex than it seems. Some operating rooms stand idle at night (emergencies aside) because late shifts are unpopular. And with its relatively high cost structure, Island Health cannot run its surgical suites at full capacity. The View Royal clinic can.

It is possible that farming out procedures to private operators will eventually undermine the foundations of our universal health-care program. On the other hand, we know that as things stand, our hospitals are drowning in backlogs and long wait times.

On balance, this is an experiment that should be tried. But vigilance will be required to make sure it functions only as a safety valve for the public system, and not as a replacement for it.