Health care bill could make matters worse for some patients, says Alberta health law expert

Increasing the number of private clinics within the province's health-care system will have an impact on patient wait times, but an Alberta professor of health law says it might not be the change the government is hoping for.

An increase in private facilities doesn't go hand-in-hand with an increase in the number of doctors — but could mean fewer in the public system, said Lorian Hardcastle, a law professor who works with the University of Calgary's Cumming School of Medicine.

And if private clinics choose to limit their practices to patients with straightforward problems, that will create a backlog in the public system of patients with complicated health challenges,  Hardcastle told CBC Radio's Edmonton AM on Tuesday.

"One of the concerns is that when you do something like open private clinics, it doesn't increase the number of doctors," she said. 

"You end up with this two-tier system where doctors pick up the easier, less complex cases through private clinics, leaving those more complex cases in the public system to potentially wait longer than they might have waited under the current system," she said.

Bill 30, introduced in the legislature on Monday, proposes nine specific changes to Alberta health laws but would have two main impacts: allowing private clinics to provide more surgical services and offering doctors an alternative to how they are paid.

Paying private clinics to do surgeries or other procedures has been identified by the provincial government as a way to reduce wait times. 

In December, the government announced a new provincial surgical care initiative, which would fund 80,000 additional procedures by 2022-23 and move lower-risk procedures out of hospitals.

About 300,000 surgeries are currently performed in Alberta each year. 

Implementation of the plan, which would see the government spend $500 million over three years, was delayed by the COVID-19 pandemic.

The approach is similar to a Saskatchewan program that ran between 2010 and 2014 to whittle down wait times.

Bill 30 will allow Alberta Health to streamline the approval process for opening private facilities.

There are 43 such private clinics in Alberta — most of them in Edmonton and Calgary — performing 15 per cent of surgeries, mainly knee and hip replacements, and cataract removals. The bill is paid by the provincial government under medicare.

Many of those surgeries are recommended to be done within four months, but too many are taking longer, Health Minister Tyler Shandro has said.

The legislation would reduce what Shandro calls needless administrative duplication to get the private clinics approved.

"Private clinics will be paid to provide services to patients within the public system," Hardcastle said. 

"So, instead of getting your knee replacement, for example, at Foothills Hospital or at the Misericordia, you instead would go to a private clinic that the government has contracted with and that private clinic would provide that service."

While Saskatchewan's program did show apparent success in lowering surgical wait times, Hardcastle said, the benefit was artificially boosted by the Saskatchewan government's  subsidies of the clinic operational expenses.

"Once the government pulled that funding, wait times for those services crept back up. So it wasn't really the private clinics that were shortening wait times, it was that the government was subsidizing them," she said.