Island Health is negotiating with a private Calgary-based firm to deliver 55,000 surgical and diagnostic procedures over the next five years. The work will be conducted at free-standing clinics, initially in Victoria, and later in the mid-Island.
While the health authority has previously made use of contractors, this is a significant expansion of privately delivered medicine in our community. And it is by no means a temporary expedient. Staff with Island Health believe this is the permanent way of the future.
The directive to proceed in this manner, and the justification for doing so, both come from the provincial government. In a statement this year, the Health Ministry laid down the new policy: “Health authorities will continue to move appropriate surgical procedures … from in-patient care to day care or short-stay care, and to private surgical centres using public funds.”
While several reasons were given for the shift to private facilities, a central justification was “extremely limited future capital investments.”
Almost nothing about this policy can be defended, and some of it might violate the Canada Health Act. Let’s start with the government’s rationale.
Surgical waitlists have been growing, but public funds aren’t available to set up additional operating rooms and equipment. Hence the decision to get corporate players involved.
But that only makes sense if their price is no greater than the public system pays. Yet how can that be, since companies must make a profit?
Part of the answer is that private clinics won’t have to pay union salaries. That means the owners can pay nursing staff less, ignore seniority and set their own rules for sick leave.
In effect, the government is creating a parallel delivery system to circumvent its own collective agreements.
But part of the answer is also that the ministry doesn’t know, with any precision, what it costs to deliver the services that will be contracted out.
Ontario’s hospitals, with support from their ministry, have worked out the price of every procedure. That includes both the direct costs, such as nursing salaries and diagnostic tests, and indirect costs such as overhead and depreciation, which can add 30 per cent to the bill.
But B.C. hasn’t invested in such a system, and health authorities are hamstrung by this failure. Island Health can quantify some of its inputs for individual procedures, but not all.
In contrast, it is essential that private-clinic operators do know these details. They live or die by such precision. And they will take advantage of their superior knowledge at the bargaining table.
In effect, health authorities are playing poker with an opponent who knows better than they do what cards they are holding.
Then there is the matter of the Canada Health Act, which stipulates that all insured hospital services must be operated by a public authority.
But the operator of these new clinics is indisputably a private company. And the chief administrator on site — the medical director — is an employee of the company. How can that be considered “operated by a public authority”?
The province could argue that by setting quality standards and paying for each service, the ministry remains in charge. But setting standards is the role of a regulator. And paying for a service is the role of a purchaser. Neither is the role of an operator.
There are no easy solutions. Managers in the ministry and Island Health must cope with a stagnant economy. For several years now, funding has failed to keep up with expenses.
But the central premise of Canada’s health-care system is public delivery. That is an abiding Canadian value the government would do well to reflect on, before turning to private clinics.
