[CUPE healthcare list] Public versus profit; Alberta's new health reform agenda - Edmonton Journal

[Irene Jansen <ijansen@cupe.ca>]

Public versus profit; Alberta's new health reform agenda has a distinctly Calgary flavour as private, for-profit clinics take hold
Edmonton Journal
Sun Feb 28 2010
Page: E1
Section: Sunday Reader
Byline: Sheila Pratt
Dateline: EDMONTON
Source: Edmonton Journal

InSt. Paul's United Church last Tuesday night, a crowd of 250 Edmontonians throws some tough questions at Conservative MLA Fred Horne, the government's point man on developing the new Alberta Health Act.

>From the front of the room, Horne reassures people that whatever reforms lie ahead, Alberta will have the best publicly funded health-care system in Canada. That's Premier Ed Stelmach's commitment.

At the back of the hall is Liberal MLA Kevin Taft, listening closely to the discussion and those key words "publicly funded." But he sees things differently.

The new health minister, Gene Zwozdesky, is from Edmonton, but this health-reform agenda is all about the Calgary model of health services -- contracting out to private clinics, encouraging for-profit medicine and funnelling taxpayers' dollars to investor-owned clinics, Taft says.

"This is essentially driven out of Calgary by entrepreneurial doctors and investors who've got their hand in the system," says the Liberal health critic, a health-policy analyst.

"But there is no particular support for for-profit health care in Edmonton or rural Alberta."

Under the former Capital Health Authority, Edmonton had a "highly successful, publicly delivered service that was cheaper and more efficient," says Taft. Unfortunately, that system took a blow when Capital Health Authority was dismantled two years ago.

This month, Taft says, he saw another sign of support for Calgary's model: to relieve the backlog of surgeries, the government found $8 million in the spring budget, most of which went to Calgary's for-profit clinics. Edmonton's public hospitals got a fraction of the work.

About 750 cataract surgeries were awarded to private facilities in Calgary, while 175 surgeries were awarded to Edmonton's Royal Alexandra Hospital. (All eye surgery in Calgary has been done in for-profit clinics since 1998).

Another 180 hip and knee surgeries will be done at the for-profit Heath Resources Centre in Calgary, and only 37 will be done in Edmonton public hospitals.

Also last week, Alberta Health Services did not renew special funding for bone and joint surgery at the Grande Prairie hospital, says Taft.

"Are they trying to steer hip and knee surgery to the for-profit sector?" he asks." It feels like the game is being joined very quickly in place."

Calgarian Ken Hughes, chairman of the health superboard that oversees hospital services in Alberta, says the decision to award more surgeries to Calgary is not an attempt to support for-profit clinics in Calgary over public hospitals in Edmonton.

It's just that private surgical centres there have more capacity available at shorter notice than the public hospitals here, he says.

"At this stage, there is no policy in place to encourage public or private providers," he says. "We are making the most of the talent and providers that are available."

Hughes acknowledged there was a difference between the two cities in their approach to health care under the regional health authorities. "That's history," he says.

In Calgary, the health authority contracted (at a 10-per-cent premium) with for-profit clinics for hip and knee surgery. Two public hospitals were sold to private investors, and all eye surgery was handed over to private clinics.

Edmonton kept its public hospitals, concentrated on a different model of making public facilities work more efficiently and did not contract out to private providers.

"Most Albertans are indifferent as to whether (surgery is done) in a public or private facility. Most important is the fact the surgery is publicly funded," said Hughes.

Alberta Health Services went to each hospital and private clinic to see how much work they could handle to reduce the waiting lists and it happened quickly, said Hughes.

"The signal went to everyone that we want to reduce wait times."

But it's not that simple, says Taft. The Royal Alex in Edmonton, for instance, had already laid off two anesthetists after budget cutting by Alberta Health Services last spring. That forced the hospital to reduce surgeries by 15 per cent and anesthetists found work in private clinics.

"So surprise, surprise, there's more capacity in the private clinics," said Taft.

The trouble is, for-profit clinics need to earn a return for their investors, and so need to constantly expand their business, he says. That can distort demand for services.

Meanwhile, it's unclear who provides services cheaper. Stephen Duckett, CEO of Alberta Health Services, promises to provide such an analysis in future.

Alberta Health Services says the Royal Alex can do hip and knee surgery for $4,500, while the cost at the for-profit Heath Resources Centre is $14,000. But AHS says there are "hidden costs" in the public system that must be taken into account.

That prompts Edmonton health economist Richard Plain to ask for the details.

The big question is which facility can do the procedures cheaper, he says.

"So what are those (hidden) costs?" says Plain. "Where is the cost analysis to show the savings in private facilities?" Plain suggests an independent agent like the auditor general be brought in to do that kind of analysis so the public has confidence in the numbers.

"Where do you get the best bang for the buck? That's the question."

Hughes says the shift to activity-based funding in hospitals will help answer that question.

In 2011, Alberta will be the first jurisdiction in Canada to adopt that Australian model for hospital funding.

Previously, regional health authorities were given block funding, lump sums of cash they would allocate as they needed throughout the year.

Under activity-based funding, each medical procedure done in a hospital will be assigned a cost and hospitals will be paid on the basis of the number of procedures they do.

"Activity-based funding will ensure there is the same discipline in the public system and in the private system and will create a level playing field," says Hughes.

Plain, however, says it's difficult to see how there could be a level playing field when comparing specialty private clinics that do only hip and knee surgery to public hospitals that must provide a full range of medical services, including emergency care.

If private surgeries are allowed to " skim off" the more straightforward hip and knee surgeries, public hospitals will be left with complex costly cases, says Plain.

In that case, for-profit clinics may well be able to under-bid public hospitals, he says.

That will encourage specialization, said Plain. "How many people here want to drive to Calgary (for hip and knee surgery)?"

Taft says he's worried activity-based funding will hurt smaller rural hospitals that can't do a large volume of some surgeries.

That has been the case in Australia and the U.K. where there is competition between public and private hospitals for government contracts.

Taft notes that all eye surgery in Calgary is done in for-profit clinics, radiologists now mostly work in the private sector, and more and more anesthetists are moving to for-profit clinics. If hospitals lose more of those key specialists, they can't provide a full range of health care.

Plain says it's unclear where the province's health system will end up after the next round of consultation on the proposed Alberta Health Act and patient charter.

Most key legislation that governs hospitals, health insurance and long-term care will be reviewed by a committee led by Fred Horne. Public consultation is expected to start this spring through community meetings and the Internet.

"We're not a rogue province like we might have been in Ralph's day" says Plain, referring to former premier Ralph Klein's push to defy the Canada Health Act and introduce a two-tier, health-care system where those with the cash could jump the queue.

"But we're looking at a whole new set of rules for hospitals based on competition, not co-ordination," says Plain.

Taft says public funding and private delivery of health services will end up costing more.

"It's going to be a really expensive management fad that gives mixed results and accelerates the drive to market-driven medicine," says Taft.

"Most of the public wants a well-run, public system with public services and lower costs. Once it's gone, we won't get it back."

spratt@thejournal.canwest.com

Illustration:
• Graphic/Diagram: Journal Graphic /
• Colour Photo: Taft
• Colour Photo: Hughes

Edition: Final
Story Type: News
Length: 1326 words
Idnumber: 201002280108