The Alberta legislature on March 22, 2020. IAN KUCERAK / Postmedia, file
On July 6, the Alberta government introduced Bill 30, which opens up the health care system to increased privatization and deepens the rift between doctors and the province.Other amendments risk eliminating expertise and independence from key health-care institutions, particularly given the government’s propensity for cronyism and control.
When the government refused to participate in binding arbitration to resolve this compensation dispute, the AMA filed a lawsuit alleging a violation of the constitutional right to freedom of association. The Supreme Court of Canada has interpreted this right to require a meaningful dispute resolution mechanism such as arbitration.According to the government, Bill 30 will make it “easier for physicians to enter into alternative relationship plans,” which deviate from the traditional way of paying doctors a fee for each service that they provide. Alternative relationship plans, which can be effective in some contexts, may not improve either quality of care or efficiency in other care settings. Although many support their availability, given the government’s current approach to physician pay, the terms contained in these agreements may be so unfavourable as to make them unappealing to doctors and to hinder physician recruitment.
Bill 30 also allows the government to contract with physicians directly, thereby bypassing the AMA. Given the vocal support that many Alberta doctors have shown for the AMA and the distrust that they have expressed for a government that is willing to unilaterally terminate an agreement, this legislation will cement the contentious relationship between doctors and the government. Because the bill allows for the proliferation of private operators, the government may be transferring responsibility for physician compensation to private corporations.Since the election, the Alberta government has pursued an agenda of privatizing and corporatizing health care, including the privatization of laboratories, the conscription of fast-food restaurant employees into mask distribution, and facilitating Telus’ health-sector growth through the adopting its virtual care platform Babylon.
Bill 30 adds momentum to this shift towards privatization by enabling the “government to contract with a range of organizations to operate medical clinics” and streamlining the approval process for private surgical facilities. The government’s stated goal is to have 30 per cent of surgeries delivered in private facilities, which it claims will reduce wait times in the public system. In reality, without an influx of health professionals, these private facilities will likely skim off the least complex cases, thereby leaving those who are sicker to wait longer for care in the public system.
Because these less complex cases are cheaper to treat, private clinics may also drive up costs. In a past experiment with privatizing the delivery of orthopedic procedures in Alberta, it cost more to treat cases in the private system than in public facilities, despite the latter taking the more complex cases. Privatization initiatives have sometimes involved an infusion of public funds into the operational costs of private facilities that may have been more effectively spent in the public system.There are also concerns that quality of care may suffer when medical care is delivered in corporate-owned facilities due to incentives to cut corners to maximize shareholder profits. We have already seen this tragically play out in the context of for-profit nursing homes.
Although private delivery of surgical services is concerning, Bill 30 could be a mere stepping stone toward two-tier health care in Alberta. The recent Fair Deal report criticized the Canada Health Act, which helps prevent patients from paying to jump the queue, for stymying “innovation” in health-care delivery. Before it is too late, Albertans need to ask themselves whether they want a health-care system in which the wealthy, who tend to be healthier, can buy faster access to care, or whether health-care services should be allocated on the basis of need rather than the ability to pay.
Lorian Hardcastle is an associate professor in the Faculty of Law and Cumming School of Medicine at the University of Calgary; Ubaka Ogbogu is an associate professor in the Faculty of Law and Faculty of Pharmacy and Pharmaceutical Sciences at the University of Alberta, and a Pierre Elliott Trudeau Foundation Fellow.