The United Conservative Party’s Alberta Surgical Initiative to outsource publicly funded surgeries to private facilities is an expensive flop that has diverted resources away from public hospitals and reduced provincial surgical capacity, says a damning report released this morning by the Parkland Institute.
The so-called surgical initiative, introduced in 2019 under then-premier Jason Kenney, continues to be touted by Premier Danielle Smith as a way to increase the province’s surgical capacity.
But data found by health researcher and political economist Andrew Longhurst through freedom of information requests and statistical analysis indicates the opposite is happening.
With the sole exception of cataract surgeries, the increase in for-profit surgical delivery generated by the ASI “has failed to improve wait times for all other kinds of surgical procedures,” Longhurst said. “Alberta has now among the worst performance in reducing wait times in Canada.”
Indeed, according to his report, "Failing to Deliver: The Alberta Surgical Initiative and Declining Surgical Capacity," surgical volumes data obtained through freedom of information requests reveal that the ASI is failing to meet its stated objectives.… The province’s total surgical activity declined in the first three years of the ASI.”
No surprise, since it was predicted by large numbers of experts, the study concludes that pouring public money into so-called “chartered” private surgical facilities (meaning, presumably, deemed worthy of being subsidized by public funds) has made the notorious staff shortages in Alberta Health Services hospitals worse and reduced the total number of surgeries performed in Alberta.
“There is a limited pool of specialized health-care professionals,” Longhurst explained. “Outsourcing surgeries leads to competition between public and for-profit sectors for the same professionals.”
The declines in total provincial surgical capacity can’t be explained away by the pandemic, the report notes, since surgical activities in private facilities increased between 2018-19 and 2021-22.
Total provincial surgical volumes fell 6 per cent between 2018-19 and 2021-22, according to the latest data available. In the same time period, “public hospital surgical activity declined 12 per cent as the public sector faced reduced capacity and operating room funding.” Also in the same time period, surgeries in private facilities soared almost 50 per cent.
In 2022, Alberta had close to the worst performance for priority procedures in Canada, the report says. The trend from 2019 to 2022 indicates that wait times for hip and knee replacements “have worsened significantly, and more precipitously than the Canadian average.”
Since the start of ASI, the share of patients needing hip replacements meeting the Canadian Institute for Health Information benchmark for timely surgery plummeted to 38 per cent from 64 per cent, the report says. This compares to the Canadian average of 57 per cent. This was the second-largest decline among Canadian provinces.
Similarly, the share of knee replacement surgeries meeting the CIHI benchmark fell from 62 per cent to 27 per cent. The Canadian average is 50 per cent. This was the third-largest decline among Canadian provinces.
Looking back over a longer range, the report points out, since 2010-11, the three greatest reductions in hospital surgical volumes took place in the first three years of the ASI.
In addition to the competition for the few available skilled professionals, the report also suggests “chartered” surgical facilities will further destabilize the public system, already in a state of crisis, and create the potential for unlawful extra-billing.
Naturally, given the data uncovered by Longhurst, his report recommends “that the provincial government shift away from for-profit surgical delivery and fully commit to public system improvement.”
This, of course, is unlikely to happen as long as market fundamentalist ideologues dominate the provincial government.