Misleading Narratives

An abridged version of this article was published in the Calgary Herald on August 23, 2024. 

In an opinion piece published in the Calgary Herald on August 10, 2024 [“Sick, injured Albertans left waiting while health ministers dodge responsibility”], Mr. G. Barry Brett shares an experience many Albertans empathize with: long waits to access much-needed health care.

Unfortunately, this is not a new story. Various Alberta governments have experimented with increased private delivery to reduce wait times since the days of Klein, Stelmach, and Redford. While only some of these initiatives ended in spectacular failure (Health Resources Centre, I’m looking at you), none resulted in a long-term, sustainable reduction in wait times.

The primary reason for that, as Mr. Brett’s letter implies, is a failure of provincial leaders to acknowledge that they have contributed to the problem they are ostensibly trying to solve. Increasing private, for-profit health-care delivery to reduce pressures and delays in the system is like trying to douse a fire with water in one hand while adding gasoline with the other.

Contrary to claims made in the article, the Alberta government does pay for patients to receive surgical procedures in private facilities in-province. While there are currently no facilities in Alberta that are wholly private-pay, public dollars are paid to for-profit companies (Chartered Surgical Facilities or CSFs) to perform a quota of hip, knee, and cataract surgeries. In Budget 2024, $305 million was allocated to cover up to 310,000 surgeries in the province, of which 60,000 to 65,000 will be contracted to CSFs. An additional $313 million in capital funding is being offered to encourage CSFs to build private, standalone facilities or to upgrade operating rooms in AHS hospitals to lease them out.

Patients do not have to leave the province to access publicly funded, privately delivered procedures. In 2021, the UCP government developed a scheme to put orthopedic patients and their surgeons on commercial flights to British Columbia to utilize private surgical facilities there. The scheme was later rejected as it was considered costly, risky, and logistically unfeasible (which was surprising, as these caveats have never stopped them before or since). Instead, over the last five budgets, the province has worked to more than double the volume of surgeries performed privately.

The wait, however, remains well beyond the benchmark — not despite this parallel system of delivery, but because of it. Research from Parkland Institute in 2023 found that, while the volume of surgeries performed by CSFs had increased 48% from 2018–19 to 2022–23, that increase came at the expense of the public system. Surgical volumes in public hospitals dropped 12% over this same period as funding and health-care workers were diverted to the private CSF stream.

More incredibly, the total number of surgeries performed in the province dropped by 6% overall, while the percentage of patients receiving treatment for knee and hip replacements within the benchmark dropped further. These findings are consistent with similar initiatives in other provinces. The investment of public dollars to enable a private for-profit delivery stream did not achieve either of its most basic objectives: increase surgeries and reduce wait times.

What does reduce wait times? Ensuring adequate staffing and sustainable working conditions. Promoting the efficient use of operating room (OR) space. Establishing a centralized referral and single queue system. Providing team-based care and support for non-surgical treatments when appropriate and improving access to safe long-term care and home-based care (freeing up hospital capacity and reducing falls that require surgery). In contrast, diverting public funds to private providers further exacerbates these challenges.

What, then, is Mr. Brett asking for? He, and others, can have their procedure performed in an AHS OR or a private facility, with no out-of-pocket costs, or they can travel and pay a private facility out-of-pocket. We have a social contract to be upheld, but it is not one of pay-to-play entitlement. It is, instead, the right to accessible, equitable care based on medical needs.

As a (predictable) result of short-sighted and ideological decision-making, our health-care system has been deprived of the resources it needs to provide that care when it is needed most, and the costs are being borne by patients, health-care workers, and taxpayers.

While it is important to validate Mr. Brett’s experiences and the very real pain and disruption such delays have imposed on him and patients like him, it is crucial to recognize the misconceptions, missing pieces, and misleading narrative this framing promotes. Rather than asking, “Why won’t Alberta pay for the private clinics to replace my hip?”, Albertans need to hold their policy-makers to account. There are evidence-based measures to reduce surgical wait times within the public system. Why are they being ignored?

Rebecca Graff-McRae

Parkland Institute's research manager Rebecca Graff-McRae completed her undergraduate and doctoral studies at Queen’s University Belfast (PhD Irish Politics, 2006). Her work, which interrogates the role of memory and commemoration in post-conflict transition, has evolved through a Faculty of Arts fellowship at Memorial University Newfoundland and a SSHRC post-doctoral research fellowship at the University of Alberta. She has previously worked with the Equality Commission for Northern Ireland and Edmonton City Council.

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