Privatization fears enter health care debate
By: By Lauren Den Hartog
| Posted: Saturday, Nov 06, 2010 06:00 am
While Alberta’s new Health Act will establish a set of guiding principles under which the province’s health system will operate, including the creation of a health advocate, critics say it could open the door for more private health care delivery and does nothing to address the current crisis in emergency rooms.
Last week, paramedics were the latest group to voice their concerns over the province’s emergency medical services.
The Health Act, which passed first reading last month, also includes a health charter, which will guide the actions of regional health authorities, provincial health boards, operators, health providers, patients and any other persons specified in the regulations.
It also allows Health Minister Gene Zwozdesky to designate “any other persons as health providers.”
When asked during an Oct. 28 press conference who “other” health providers might be, Zwozdesky wouldn’t elaborate.
“You can’t speculate on who might be future health care providers with any degree of crystal ball accuracy,” Zwozdesky told reporters.
“It’s simply a provision that says it might be a need and so we’ll allow the minister the opportunity to work with the public to determine those,” he added. “It could be that there are other forms of medicine that might have to be looked at.”
Zwozdesky reiterated that the province is committed to delivering the “best performing, publicly funded health system in Canada.”
Guy Smith, president of the Alberta Union of Provincial Employees said the health act needed further clarification.
“For example, do ‘health providers’ include increasing the presence of private delivery in the province?” he said in a statement earlier this month.
Smith also said the act made no reference to protecting the public delivery of health care in Alberta.
But Zwozdesky said the province isn’t talking about privatization.
“I don’t know what you’ve bought into but this is not about privatization. I’m not sure how much clearer I can make that for you,” he told reporters.
Alberta’s health care system already allows for some surgical procedures to be performed in private facilities. Earlier this year, 1,400 hip and knee replacements were performed in a number of private surgical facilities, including Calgary’s Health Resource Centre (HRC).
However, HRC is expected to close its doors in the wake of a government effort to move those surgical procedures to the McCaig Tower at Foothills Medical Centre in Calgary.
Liberal opposition leader Dr. David Swann said that, while the Health Act included many good principles and ideas, it’s nothing new.
“The question is when are we going to see more beds, more nurses and more relief for the emergency rooms?” he said.
Swann said the Liberals do not support the private delivery of surgical services.
“It has clearly shown that it’s going to cost more and shows no extra benefits or quality. In fact, there is evidence it may reduce the quality of care when people cut corners to increase profits,” Swann said.
The Wildrose Alliance this week unveiled its health care policy, which calls for a dismantling of the health superboard and establishing a publicly funded, publicly administered system with competitive delivery that would allow patients to choose where they receive treatment, including out of province if necessary.
“If Albertans get the treatment they need, when they need it, they really don’t care whether it’s delivered in a public facility or a private one,” said Wildrose Alliance leader Danielle Smith, in a news conference on Wednesday.
Smith argued that such a system would create the incentives for people to become more efficient, offer better service and reduce their price.
This type of system was used in the United Kingdom about a decade ago, according to Dr. John Church, an associate professor in the University of Alberta’s School of Public Health.
He said groups of physicians were given budgets to purchase services on behalf of patients.
“The problem with this is the transaction costs of doing these kind of deals ended up being high and some hospitals ended up not being competitive enough to be financially viable and the government ended up stepping in to prop them up,” Church explained.
“I’m quite skeptical that something like that is going to be able to work effectively in a province that is fairly sparsely populated and just doesn’t have a larger overall population from the point of view of markets,” he said.
While some are apprehensive of the increased role that privatization, be it through de-insuring some services or delivering some through private, for-profit facilities, Church said Alberta’s health care system wouldn’t function properly without a large contribution from the private sector.
“We wouldn’t be able to afford the system if we did not have private operators participating in it. What is being talked about now is really extending the range of things that private providers do in the health care system and where they do them,” he said.
“But we’re still, at this point, talking about publicly funding things. Whether things are performed in a private facility or a public facility, if it’s publicly funded then it still is within the boundaries of the Canada Health Act.”