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Ontario embarks on Alberta's failed for-profit surgery scheme

New report out of Alberta shows that province’s efforts to cut surgical wait times with for-profit outsourcing didn’t reduce wait times (in fact, it lengthened some) and didn’t increase surgical capacity in hospitals (in fact, it reduced it) — and this is the road Premier Doug Ford’s Conservatives are taking Ontario down 

A western Canada health policy researcher said the idea of for-profit surgeries that was put in place in Alberta three years ago has been a failure.

Andrew Longhurst has authored a new 68-page report on the Alberta Surgical Initiative (ASI) titled Failure To Deliver, which examines the impact of the out-sourcing policy that began in 2020 when the Government of Alberta decided to finance for-profit surgeries with an eye to reducing wait times. The report was released on Tuesday. 

The report said the Alberta Surgical Initiative represented a significant expansion of for-profit corporate health care in Alberta with the province committed to spending $400 million and doubling-up the number of outsourced surgeries over three-years from 15 per cent to 30 per cent of surgeries provincewide.

But the data, Longhurst found, shows not only did the initiative not achieve its goals, it had no impact on wait times (and in fact increased some); it didn’t increase the province’s surgical capacity (it actually reduced it), and; it diverted resources away from public hospitals.

The report might draw considerable interest in Ontario since the Doug Ford Conservatives are moving in the same direction in much the same way with Ontario Bill 60, the Your Health Act, which was passed on May 8.

NDP opposition health care critic France Gélinas said she plans on tabling a copy of the Alberta report in the Ontario legislature because she said it is robust and definitive evidence that shows the Ontario plan is doomed to fail, just as the Alberta plan has. 

"The findings in Alberta are exactly the same as the findings everywhere else this has been tried," said Gélinas. 

"It has been tried in the UK. It has been tried in different parts of Australia. Everywhere you try it, you end up with the exact same result. And that's what they got in Alberta," said Gélinas.

The Alberta plan, which is now in its third year, has not worked, Longhurst wrote. He is a researcher from Simon Fraser University who has written extensively about the spatial, political-economic, and social dimensions of health care policymaking.   

His study has disputed many claims made by the Alberta government about the effectiveness of the Alberta Surgical Initiative in reducing wait times and the role of for-profit surgical outsourcing.

"This report finds that Alberta has among the worst performance in reducing surgical wait times in Canada," Longhurst wrote.

Also, contrary to government claims that outsourcing for-profit facilities had increased provincial surgical capacity, data suggest that the expansion of chartered surgical facilities (CSFs) has diverted resources away from public hospitals and, in turn, reduced provincial surgical volumes, said the report.

"Under the Alberta Surgical Initiative, provincial surgical activity has failed to increase from pre-pandemic levels, and public hospitals face reduced capacity and operating room funding," said the report.

Among the findings in the report, Longhurst wrote the Alberta government should shift away from the for-profit model, and added that a significant policy shift is required.

“The movement towards a private, for-profit hospital sector will undermine the evidence-based policy solutions needed to reduce public wait times and protect the integrity of a public health-care system," the report said.

No Surprises

Gélinas said the report from Alberta did not surprise her.

"Nope, no surprise whatsoever that there was unlawful extra billing all the time; that it ended up costing the government more all the time; that there were quality concerns all the time; that they destabilized public hospitals all the time, that's where the staff comes from. So no, no surprises," said Gélinas

If anything, Gélinas said she was disappointed. 

"The people of Alberta now have to wait a whole lot longer for the surgery they need and pay a whole lot more to their taxes for the same service."

Gélinas said Ontario's Bill 60 is almost an exact cut and paste of the Alberta law enacted in 2020. She said there is now solid proof that a public health care system in Canada will fail once the idea of corporate greed is added to the system. 

The Alberta report further said that health systems that rely heavily on private finance, such as the U.S., do not provide equitable access based on medical need.

Another finding in the report said there are numerous policy strategies available to provincial governments to reduce wait times, but governments have tended to focus on short-term increases in surgical activity. Longhurst wrote that international evidence has shown that short-term funding for temporary additional capacity is unlikely to reduce wait times over the long term.

In his concluding remarks, Longhurst was clear: Alberta’s plan not only failed, it did the opposite of what it was intended to do.

“The Alberta Surgical Initiative, with its focus on for-profit surgical delivery, has failed to increase total provincial surgical activity to pre-pandemic levels. Alberta’s wait times for priority procedures are among the longest in Canada.

“Despite claims that the Alberta Surgical Initiative would increase the surgical activity in the province, an evaluation of the first three years of the initiative suggest that funding and staffing have been diverted to chartered surgical facilities at the expense of public hospitals.” 

The full text of the Longhurst report can be found here.

Len Gillis covers health care and mining for

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Len Gillis

About the Author: Len Gillis

Graduating from the Journalism program at Canadore College in the 1970s, Gillis has spent most of his career reporting on news events across Northern Ontario with several radio, television and newspaper companies. He also spent time as a hardrock miner.
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