One day after the Alberta government proposed a new bill that would accelerate approvals of private clinics in order to get more surgeries done, people in the health sector are reacting to how the process could affect health care across the province.
On July 6, the UCP government introduced Bill 30, the Health Statutes Amendment Act, saying it would help reduce wait times in the province and modernize the public health system while giving residents more say in their health-care options.
“Our proposed changes will provide more voice and choice to Albertans and physicians,” Health Minister Tyler Shandro said Monday, prior to introducing the bill in the house.
“They will strengthen the roles, responsibilities and accountability of our health partners, and this modernization sets us on the path to meet our commitment to build a sustainable, accessible public health system.”
However, some health-care advocates worry it could create an unfair system. Friends of Medicare’s executive director Sandra Azocar said the bill could spur a class system in the province that would see the wealthier population cared for more quickly.
“This omnibus bill actually sets the legislative framework to increase the role of private health care in our public health-care system,” she said.
“Our public health-care system should be there for absolutely everybody, not just based on the size of your wallet or how much money you have to pay.”
It’s a concern shared by Lorian Hardcastle, an associate professor at the University of Calgary’s Cumming School of Medicine.
“What we may eventually find ourselves with, if we don’t help things now, is a system where people are accessing care on the basis of their ability to pay, rather than on the basis of their medical need,” Hardcastle said.
“We may get to a point where people are able to pay to jump the queue.”
Hardcastle added that despite the government’s claim this new bill will help reduce wait times in the province, she doesn’t believe it will solve Alberta’s current backlog of surgeries.
“If you have a finite number of doctors in Alberta and they’re already working close to capacity, regardless of whether they’re working in public hospitals or these private clinics, if they don’t have spare capacity, then the backlog isn’t going anywhere,” she said.
There are currently 43 private clinics in Alberta — most of them in Edmonton and Calgary — performing 15 per cent of surgeries in the province.
Hardcastle also noted that a rise in private practices could contribute to a hike in surgery prices across the province.
“Private clinics are given a rate for, say, performing a hernia surgery or a hip replacement that corresponds to the average cost to do that procedure in the public system,” she said. “The effect of that will be to drive up costs because they will be taking the easier cases, but getting the average cost to do that kind of surgery.
“So this could potentially drive up private health-care costs.”
When asked about the concern, the press secretary to the Minister of Health said private facilities do not compete with the public system.
“Independent providers don’t compete with the publicly funded health system, they add capacity so the system can treat more patients,” Buick said in a statement sent to Global News on Tuesday. “Their services are managed by AHS as part of an integrated system.
“They help make the public system more efficient in two ways: their costs are lower and they specialize, so they get more efficient at the services they’re contracted to do.”
According to the province, the new bill also states that legislation will be modernized so physicians have more options on how they are paid, including making it easier for doctors to enter into alternative relationship plans for compensation — another concerning provision for some in the medical community.
“I think it’s come to a point where Albertans need to ask themselves what kind of public health-care system they want to see in this province and in this country.”
Shandro has promised to explore different ways to pay doctors in keeping with a commitment to keep funding for physician compensation around the current $5.4-billion level.
While Hardcastle has concerns, she noted that she believes some of the proposed changes associated with the bill could serve the province well.
“A potentially positive change in the legislation is it does expand the mandate of the Health Quality Council,” Hardcastle said.
“The Health Quality Council originally focused primarily on quality issues in hospitals and from physicians, but this potentially gives more room for looking at the health-care system more broadly and taking a more patient-centred focus.”
The bill also calls for participation from public members of health professional college committees to increase by 25 per cent.
“Potentially, it could get the public more of a voice,” Hardcastle said.
“The only concern is that the government is the one who appoints those public members. So the question will be whether the appointees are more political in nature, or whether there are truly people who have an interest in the health-care system and the expertise to help improve the protection of the public and quality of care.”
President of the Alberta Medical Association Christine Molnar also gave her take on the bill. In a statement Wednesday, she noted the AMA was not consulted by the government before the new legislation was brought forward.
“The lack of any meaningful consultation with the public and physicians on legislation that will have a significant impact on health care in Alberta raises questions about good governance,” Molnar wrote.
“These impending legislative changes will have consequences for the profession and how we practice, as well as our freedom to advocate for our patient’s needs.
“The patient-physician relationship is at risk.”
She added that several concerns have been raised by AMA members, including the alternative payment plans brought forward by the government and the “commercialization of medical services.”
— With files from the Canadian Press