Will wait times need public funds for private care?
Since the beginning of the COVID19 pandemic, all provinces restricted access to surgeries that were not life or limb. This was done to protect the health and safety of patients, their families and health-care providers.
Now, billions of taxpayer dollars will be spent by governments to reduce surgical wait times. Ontario, Alberta and B.C. have already announced hundreds of millions in new spending to reduce backlogs, and private surgical centres may soon provide relief to wait-listed patients.
The demand for elective surgery will escalate with people's confidence that hospitals are once again safe, and recent data show there are already prolonged wait times in several provinces. Fewer than one-half of patients in Nova Scotia, New Brunswick, Manitoba and Alberta are having their hip or knee replacement within the recommended wait time of 26 weeks.
Waiting for surgery can be painful and disruptive, so should we risk expanding private for-profit health care to speed up surgery for some? If the answer is yes, we should be clear about the rules as private surgical capacity is now being considered by many provincial governments.
In the public model of health care in Canada, this step means that private surgical centres would be contracted for elective surgeries that are paid for by governments and provided at no cost to the patient.
This public-private model is no stranger to our provinces.
Most practising physicians are paid through their own private forprofit corporations and many homecare companies are for-profit even though they provide care at no cost to the resident. Provinces such as Quebec and Saskatchewan have been “experimenting” with private diagnosis and surgical facilities, and Alberta has been very vocal about expanding privately delivered elective surgery.
If this is the future of health care in Canada, there are four steps provinces should take if they contract private surgical centres to reduce wait times: First, the contracts should be transparent regarding how much they pay for each surgery. This may seem obvious, but the costs of surgery are often unknown by hospitals. Tabulating each surgery's cost will allow governments and the public to know whether privately delivered surgery is cost-efficient or whether “traditional” hospital-delivered care would be a better use of public funds.
Second, the government should include publicly reported quality measures that are comparable with the surgical quality information already produced by public hospitals. This includes surgical site infection rates and readmission rates. Quality information will allow the province to know whether private surgeries are more or less safe than public hospitals. Provinces should also stipulate who pays if a patient at a private surgical centre develops complications requiring more treatment. Tracking patients between private surgery centres and their hospitalizations would allow provinces to recoup the costs of cases that were too complex for private centres in the first place.
Governments should also mandate the collection of health outcomes for patients treated in private surgical centres.
Patients' symptoms should be measured before and after surgery to measure gains in health resulting from surgery. This will allow the government to measure whether patients are improving and if taxpayers are getting a good return on the investment in private care.
Finally, provinces should have control over who is treated at private surgical centres. Managing which patients are treated where will ensure that private surgical centres don't accept only the easiest cases, leaving public hospitals with the most complex and costly cases.
There are other options for reducing wait times that don't involve outsourcing to private centres. Governments could invest in building larger hospitals and hiring permanent surgical staff. This might be a feasible approach if wait lists are seen as a “forever” problem.
Although for provinces seeing longer wait times due to COVID, temporary surge capacity with private surgical centres might be a less costly option.
There is an incoming tidal wave of demand for surgeries across Canada. Provinces are likely to pursue private solutions to help with abysmal wait time statistics made worse by COVID. If this comes to pass, governments must ensure that guardrails are in place so that patients get their surgery safely and swiftly while also providing good value to our health system for the money spent.
Jason Sutherland is a professor at the Centre for Health Services and Policy Research in the Faculty of Medicine at the University of British Columbia, and program head of Health Services and Outcomes at the Centre for Health Evaluation and Outcome Sciences in Vancouver. Pierre-Gerlier Forest is a professor at the School of Public Policy, University of Calgary.