Edmonton, AB — A new research report evaluating the effectiveness of the Alberta Surgical Initiative (ASI) in reducing wait times has found that the emphasis on for-profit surgical delivery has resulted in a reduction of provincial surgical volumes and capacity in public hospitals.
Failing to Deliver: The Alberta Surgical Initiative and Declining Surgical Capacity, a study conducted by Andrew Longhurst for the Parkland Institute, analyzed data obtained through Freedom of Information requests, statistical analysis, and a review of the research literature.
The report shows that the initiative, which outsources publicly funded surgeries to for-profit facilities, has diverted resources away from public hospitals and failed to increase provincial surgical activity from pre-pandemic levels.
With the exception of cataract surgeries, the increase in for-profit surgical delivery brought upon by the ASI has failed to improve wait times for all other kinds of surgical procedures. Contrary to government claims that outsourcing to for-profit facilities increases provincial surgical capacity, data suggest that the expansion of chartered surgical facilities has diverted resources away from public hospitals and, in turn, reduced the number of surgeries performed in the province. “Alberta has now among the worst performance in reducing surgical wait times in Canada,” says Longhurst.
A new set of problems
Rather than providing a solution, the growth of the for-profit sector is creating a whole new set of problems. For one thing, it contributes to exacerbating AHS staffing shortages and constraining surgical activity in public hospitals. “There is a limited pool of specialized healthcare professionals,” says Longhurst. “Outsourcing surgeries leads to competition between public and for-profit sectors for the same professionals.”
This destabilizing effect on the public system, combined with reduced public operating room funding, changed the landscape of surgical delivery in Alberta — and not in a good way. Since the introduction of the ASI in 2019, the number of contracted surgical procedures performed in Chartered Surgical Facilities has jumped from 29,052 to 43,078, an increase of 48 per cent. In the meantime, AHS facilities — which were already operating at only 70 per cent of their capacity — saw the number of surgeries performed decline by 12 per cent. “The province has prioritized for-profit surgical delivery,” says Longhurst, “rather than fully utilizing the nearly 30 per cent of unused public operating room capacity.”
Extra-billing — the practice of private billing for medically necessary procedures that are covered by public healthcare — is another problem with for-profit surgical delivery. “Evidence shows that for-profit clinics and surgical chains are entrenching two-tier health care in Canada through unlawful extra-billing practices,” says Longhurst, citing as an example the new evidence presented in his report that Calgary-based Surgical Centres Inc. was engaged in unlawful extra-billing in BC during the same time it held outsourcing contracts with AHS and B.C. health authorities.
The Alberta government claims that surgical outsourcing will reduce costs because the per-procedure costs are lower in CSFs. However, previous research and the experience of other provinces have shown that surgeries performed in the public sector are more cost-efficient than in for-profit clinics. Studies in B.C., for example, reported instances of for-profit clinics charging nearly four times more for the same surgery when offered in a public health setting. In April 2023, government data obtained under Freedom of Information revealed that Quebec paid up to 2.5 times more for procedures performed in for-profit clinics compared to those performed in public hospitals in 2019-2020.
Based on the research evidence, the report recommends that the provincial government shift away from for-profit surgical delivery and fully commit to public system improvement. Surgical wait times within public facilities can be reduced by a combination of research-informed policy strategies, which include prioritizing the use of single-entry and team-based referral models; maximizing public operating room capacity and expanding acute care capacity; increasing access to seniors’ home and community care to reduce hospital overcrowding; reducing the overuse of clinically inappropriate medical imaging and surgeries; and adopting a “vaccines-plus” public health strategy to reduce health system strain and delayed surgical care due to the pandemic.
“A significant policy shift is required,” concludes Longhurst. “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.”
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For the full study, visit https://www.parklandinstitute.ca/failing_to_deliver
For more information or to arrange an interview, please contact:
Parkland Institute Communications Coordinator