06 Mar March 6/12 Op-Ed- Pay More, Get Less: Private health care wrong way to go
Published in The Chronicle Herald March 6th, 2013
By John Hutton and Adrienne Silnicki
It is disappointing that NDP Health Minister Dave Wilson has chosen to renew a government contract with Scotia Surgery. The contract, worth $1 million to the for-profit clinic to perform 500 surgeries per year, raises a lot of unanswered questions. Beyond the questionable ethics of making medically necessary care a for-profit business, one has to ask if renewing the contract, intended to reduce wait lists, is an efficient use of the public’s health care dollars. Given the poor track record of private-public partnerships in Canada, intense scrutiny and broad public consultation are warranted.
Signed in 2008 and renewed a year later, the Scotia Surgery contract is a holdover from the Progressive Conservative government of Rodney MacDonald. The for-profit facility, which focuses on oral surgery, general dentistry and plastic surgery, devotes two days per week to orthopedic surgeries from the public wait list. The doctors performing the surgeries come from the public system, while the company rents space to Capital Health and provides auxiliary staff.
To be sure, having more operating rooms for surgeries will reduce wait lists. However, any reduction in wait times would be despite the private-sector involvement, rather than because of it. Private health-care providers seek to maximize profit, which does not mean maximizing efficiency. If a clinic is making money, it is almost certainly by charging more for health services than the public sector does or reducing the quality of care.
The actual profit margins at Scotia Surgery are not available to the public, which also raises questions of accountability and transparency. Nova Scotians deserve to know how many of their health-care dollars are being pocketed as profit instead of providing care.
There is a wealth of peer-reviewed studies, Canadian and international, showing that private health care costs more. Even the Albertan government — which often favours the privatization of public services — has admitted that private care is the more expensive option. But what should really concern all of us is that these same studies have shown that the profit motive has led to a decreased quality in health care and a higher chance of dying after surgery. Our government’s short-sighted focus on spending less this year means we’re all paying more and getting less in the long term.
And what happens when private clinics close or go bankrupt, as recently happened with Calgary’s Health Resources Centre? The Alberta government relied on private clinics to deliver medically necessary services and when HRC declared bankruptcy, Alberta Health Services was forced into receivership while leaving hundreds of patients in limbo. This is only one of hundreds of public-private partnerships that have failed, been abandoned or went into bankruptcy, leaving taxpayers to clean up the mess and in many cases pay hefty legal fees.
Wait times can be reduced with improved management practices, collaboration and co-operation across the delivery path, and through the implementation of best practices that are already being successfully implemented across the country. The “small, focused” model used by Scotia Surgery and other for-profit clinics has also been used in the public sector, such as a specialized orthopedic clinic that opened in Edmonton in 2012. By reducing administrative, management and monitoring costs as well as not including profit extraction as a budget line, service is expanded and wait lists shorten. Innovation comes from the specialized, focused nature of these clinics rather than the fact that investors own it.
The most common argument for privatization is that removing patients from the public queue will shorten it. However, it also removes health professionals from the public system, slowing down public delivery and causing the queue to grow even longer. A study from the University of Manitoba found that cataract patients whose surgeons worked in both the public and private sectors waited 23 weeks for surgery, more than double that of patients whose doctors only worked publicly.
In the case of Scotia Surgery, Nova Scotians should be asking: If it is our tax dollars, our health workers, and we’re paying the rent, why do we need private owners and why can’t this type of facility be part of the public system? Private health care costs more, provides lower quality of care and does not have the transparency and accountability that we deserve and expect. Instead of endlessly signing contracts with Scotia Surgery, the government should invest in expanding public health care for the best possible value and service to Nova Scotians.
John Hutton works for the Nova Scotia Citizen’s Health Care Network, and Adrienne Silnicki is the national health-care campaigner for the Council of Canadians.