Op-eds | February 07, 2011
Wildrose leader’s private model a flawed remedy for health care
News of Ed Stelmach eventually stepping down as premier raises a variety of questions about the direction of policy in Alberta, no less so with the government being seriously challenged by the Wildrose Alliance from further right on the ideological spectrum.
Health care is a perennial concern of Albertans; and the Wildrose's leader, Danielle Smith, has made it a central plank of her party's platform. Their platform is couched in moderate-sounding rhetoric, but actually focuses on increased privatization.
Danielle Smith holds up the Health Resource Centre (HRC) private surgery clinic in Calgary as her shining light, her beacon of quality and affordability.
"A Wildrose government," Smith declared in a speech, "would encourage more of these facilities to contribute to the system."
She is not deterred by the obvious challenge: HRC went bankrupt.
Albertans were left holding the bag for up to $4 million to keep the insolvent HRC operating until a public clinic opened last November.
The Wildrose Alliance regularly asserts that, as long as they operate safely, "it shouldn't make a difference whether an operating room is run by a public hospital or a private surgical centre."
"That is the essence of the Wildrose health plan for Alberta," Smith emphasized in a speech.
But their caveat about safety is critical and should not be overlooked.
A wide range of international peer-reviewed research published in renowned medical journals like those of the Canadian and American Medical Associations demonstrate that for-profit health care is associated with lower quality of care and comes with additional risks for adverse health events.
Those findings apply across the spectrum from private hospitals to long-term care facilities.
The studies even found that forprofit hospitals have higher death rates post-surgery.
But that hasn't kept Smith from arguing in a Calgary Herald interview that, "If we want to fix our public health system, we need many more HRCs, not less."
Smith justifies her position with the fact that the HRC's per-surgery costs are lower than the provincial average. This, too, is very misleading.
When HRC signed its first contract for private surgeries with the province in 2004, their costs were actually higher than the public system. HRC's costs were later reduced, but this was in spite of -- not because of -- its for-profit model.
The HRC's costs fell because it was included in a $20-million publicly funded research project that revolutionized how hip and knee surgeries have been managed since 2005.
For that reason, when Danielle Smith compares HRC's outcomes and costs to the provincial average, she is comparing apples to oranges. Apples-to-apples would be comparing HRC to the public clinics also included in that same publicly funded research project. It would also mean including all of the costs associated with private contracts and administration.
There was no indication of any differences in per-surgery costs or the quality of outcomes in the clinics involved in the publicly funded research project, regardless of whether they were public or private, but the HRC's costs would be higher with inclusion of the legal costs of negotiating the contracts and the added administration and oversight costs of managing an outside private contractor.
Smith and the Wildrose Alliance also pledge to reduce the barriers to private, for-profit businesses that wish to provide assisted living and long-term care in Alberta. Once again, the evidence clearly warns against such an approach.
As a careful study by Montreal's Institute for Research on Public Policy recently concluded, there is sufficient empirical evidence in the peer-reviewed literature to demonstrate that "providing public funding for residential long-term care to forprofit facilities is likely to produce inferior outcomes.
"It would therefore be prudent," the researchers write, "if public policy reflected this evidence."
Unfortunately, if her party gets elected, Smith will have allies within Alberta Health Services (AHS).
AHS insists there is "value to the public" in privatizing health care services and promised last February to produce a "public benefit analysis" justifying the costs of using facilities like the now-bankrupt HRC.
This report has still not seen the light of day, most likely because such a case cannot be made.
In the meantime, Smith should declare herself and her party to be on one side or the other of the issue.
There is a clear choice to be made between for-profit health-care delivery on one side and access, quality, and affordability guarantees for the public on the other.
Smith and her Wildrose Alliance cannot stand for both.
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