Notley's health bill worthwhile, but private care can't be excluded
Alberta NDP Leader Rachel Notley recently introduced a private member's bill, the Public Health Care Delivery Standards Act, that contains some worthwhile initiatives, but one provision would significantly reduce available choices to reduce wait times and costs.
The proposed bill would establish publicly reported and tracked service standards for primary care, emergency medical services and essential surgeries (which is already provided by Alberta Health Services in its public reports) and it would require governments that miss the public targets to develop a plan of action to address problems. These are important and worthwhile initiatives.
However, the proposed provision that medicare services must be “publicly delivered” would put Alberta offside with every other country in the developed world. The Canada Health Act requires that services are publicly administered, but it does not prohibit the private delivery of medicare services. In other words, Alberta patients are already using privately delivered services that are paid for by the government. As part of its Alberta Surgical Initiative, AHS has engaged partners to increase surgeries, such as hip and knee replacements, that are desperately needed by Albertans.
Privately delivered services are often provided in clinics. A 2022 report by the Ontario Medical Association recommended that less complex and non-acute procedures — like same-day surgical care, diagnostics and preventive procedures — should be performed in free-standing facilities that are operationally separate from hospitals since they “can provide surgery or procedure times that are shorter, with faster recoveries, lower infection rates and efficiency gains ranging from 20 to 30 per cent.” The off-site facilities may be public, private or not-for-profit.
Private clinics also offer advantages to governments. Contracts between the government and clinics can specify the number of procedures to be performed, the time frame and the costs; the clinics also can provide the facilities and hire the staff.
Clinics offer medical professionals a 9-to-5, Monday-to-friday work week, which experience has shown can bring some health-care professionals out of retirement. They can also utilize operating rooms that are not in use, especially in rural areas.
The other advantage to contracting out service delivery is better accountability; governments can focus on developing and enforcing the highest standards for care, providing strategic oversight, and holding those who deliver services to account for providing quality, timely services at a competitive cost.
Moreover, private clinics can operate more efficiently since they are focused on specific procedures and are not encumbered by collective agreements that add costs and complexity to delivering services. Independent studies have documented how some union contracts in Alberta make it more difficult to provide timely cost-effective health care.
For example, in 2019, KPMG reported that the Alberta nurses' contract uses “double time for overtime, while in Ontario and Quebec the rates are 1.5 times the regular rate and for statutory holidays, the overtime rate in Alberta was 2.5 times the basic rate compared with two times the basic rate in Ontario and Quebec.” Similarly, Ernst and Young's review of Alberta Health Services found that other provisions of the nurses' collective agreement, such as the designated day of rest for part-time nurses, “impede sustainability without providing any patient benefit.”
Thus, depending on the specific circumstances, private clinics under our single-payer system can be an effective option for health-care service delivery.
What is most important is that healthcare authorities have the freedom to choose, depending on the specific circumstances, whether public, private or not-for-profit service delivery would provide quality, timely services to patients at a competitive cost to taxpayers. Just as it would be problematic for the government to dictate that all services should be privately delivered, it is problematic to legislate that all services need to be publicly delivered.
Hence, the Opposition leader should amend her otherwise worthwhile legislation to provide for public, private or not-for-profit service delivery.