Increased private-sector involvement may push health-care system over the edge, Manitoba experts say

The province said it intends to increase public-private partnerships in health-care to reduce patient wait times during last week's throne speech, drawing criticism from the opposition and raising eyebrows among health-care experts.

But what do these partnerships mean for Manitobans?

Maples Surgical Centre, Western Surgical Centre, Winnipeg Clinic and Manitoba Clinic are all examples of privately-owned facilities which provide publicly-funded care to provincially insured individuals.

"I'd say there's a distinction between St. Boniface hospital and its foundation, and the contracts that are written up for private surgical centres like Maples or Western," Thomas Linner, provincial director of the Manitoba Health Coalition, told Radio-Canada on Friday.

These kinds of partnerships are not new to the province, he says, but they are complex.

Funding for capital expansions at St. Boniface comes from the hospital's foundation and the province. In contrast, private surgical centres build their own facilities, set their own hours, have their own shareholders and have profit margins to meet, he said.

Linner's organization campaigns against the privatization of care in the province. He worries that the throne speech announcement will make Manitoba's health-care system further dependent on private clinics.

"Then what kind of charges, or extra fees are they going to demand to be able to charge?"

Following the throne speech, Dr. Candace Bradshaw, head of Doctors Manitoba, said she will withhold her opinion of the province's plan until further details are released.

Linner says a lack of details around the plan creates confusion.

"Are we talking about surgical centres? Are we talking about very specific kinds of clinics? Are we talking about new, private hospitals? I don't know the answers to those questions," he said.

Staffing issues

Linner says the province's desire for an expansion toward private health care is "missing the moment."

"You open up these private clinics — where is that staff supposed to come from, when we actually have a staffing crisis in Manitoba?" he asked.

"The only place that staff can come from is the already existing public system."

The province told Radio-Canada that it has been partnering with private providers for surgical and diagnostic medical services for decades, and the public system currently employs the majority of health-care workers in the province.

The province said an exhaustive list of private facilities that provide publicly-funded care to provincially insured people in Manitoba is not available, but it continues to ensure costs are comparable to publicly provided care.

PPP agreements are also determined on a case-by-case basis and may be kept confidential to ensure business interests of third parties, the province said.

But things weren't always that way.

In 2012, the NDP government passed the Public-Private Partnerships Transparency and Accountability Act. The law required a detailed analysis of the risks and costs before the conclusion of a PPP, as well as public consultations.

The PC government announced that it would repeal the act in 2016 because it "discourages the use of such innovative funding partnerships." The act was officially scrapped in 2017.

'It's going to collapse'

"That throne speech is not a surprise — it's the inevitable consequence of what happened in 2016 and the decisions that have been made," former NDP Health Minister Sharon Blady told Radio-Canada.

Although her government used PPPs in the past, Blady says publicly funded health care is more cost effective since citizens pay their taxes directly into the system and there is no one in the middle to take a cut.

"Once you start going into privatization, that's where your costs start going up," she said, because it invites the person in the middle to start making a profit to cover other costs.

Privatization is the final step before the health-care system starts to break down, she said.

"When you've gutted a system, it's going to collapse."

A Probe research poll conducted last March found that 68% of Manitobans would rather invest in public healthcare than give contracts to private companies to deal with service delays.

"That's because we all understand how important medicare is to us," said Linner. "What we really need is to bolster that public system."

Linner says longstanding contracts with the private sector — as well as recent expansions toward out-of-province services and private health-care to deal with the surgical and diagnostic backlog — take away resources which could have been invested into the public system.

"All along here, we are seeing the government make decisions that are based upon private profit and the ability to contract out, rather than to invest deep within our system," he said.

The closure of Rivera's Parkview Place Long Term Care Home is a recent example of the consequences of privatization of health care, he said.

"Those 200-some personal care home beds are just gone from the system because a private company decided that it wasn't worth it to them to invest more in those beds."

The PC provincial government has a long history of making deep cuts into the public health-care system, creating chaos, he said.

"And then, suddenly, the best thing that we could ever possibly do right now is to privatize more parts of our health-care system," he said. "It just seems a bit convenient that it is always the call from this government — move to the private sector."

"We know that is not what Manitobans want to see."