Alberta’s ‘experiment’ to expand private health care is doomed, experts warn

Some health experts say they are concerned that the new law designed to expand private health care in Alberta was not properly planned and is missing important protections for the public health system.

Bill 11 was introduced into the legislature on Monday and if passed, it would pave the way for a “dual practice” model in Alberta, allowing doctors to work in both the public and private systems.

Under the plan, patients can pay for health care in the province, including surgeries such as hip and knee replacements. The government argues that this will reduce pressure on the public system, potentially reducing waiting times.

The Alberta Medical Association, which represents doctors in the province, Said it was not consulted on on legislation, and it wants a seat at the table as further details are laid out.

“Any reform needs to be informed by the best evidence. It really takes experts,” Dr. Brian Wirzba, chair of the group, said in an interview with CBC News.

“Most places where this has been tried have encountered problems. …It would be really important to lay out the details really well.”

In a press release, the Alberta government said the dual practice model is “widely used in countries with top-performing health systems, including Denmark, the Netherlands, the United Kingdom, France, Germany, Spain and Australia.”

Dr. John Meddings, a retired gastroenterologist and former dean of the University of Calgary’s Cumming School of Medicine, said he’s not opposed to the idea of ​​a private pay option in Alberta, but the devil is in the details.

“It’s an interesting experiment worth trying,” he said.

“If it’s successful – wonderful… My concern, though, is that it’s not well thought out (and) it hasn’t had a lot of consultation.”

Part of our problem in Alberta is that we don’t have enough physicians to run two systems.– Dr. John Meddings

He believes that the dual practice system will inevitably take some doctors, who are already in short supply (such as anaesthetists), away from the public system and, as a result, will not reduce waiting times.

“All the examples that have been used about why it works elsewhere are comparisons to countries that don’t really have a system like ours and, most importantly, actually have many more physicians than us,” he said.

“Part of our problem in Alberta is that we don’t have enough physicians to run two systems. So, I’m concerned about that.”

Meddings said the use of surgical facilities chartered by the Alberta government for publicly funded procedures was supposed to address already long wait times.

“The problem is still here. They haven’t fixed it. I would question why,” Meddings said. “And why do more of the same thing – maybe changing the payer – why is it going to be better.”

Government is planning to provide consultation

The Alberta government is planning to move family doctors out of the dual practice model, at least initially. It also states that emergency care, including surgery and cancer treatment, will remain fully publicly funded.

According to the provincial government, security measures will also be taken to protect public order. This may include limiting the number of procedures performed by a doctor in a private system or limiting private surgeries to evenings or weekends.

,An emailed statement from the Ministry of Primary and Preventive Health Services said any future changes in which doctors can participate in the dual model will be made through a ministerial order.

“The same approach applies to the implementation of guardrails, with decisions informed by policy priorities, evidence and stakeholder input to ensure patient safety and system integrity.”

According to the statement, the government plans to consult with a number of organizations, including the Alberta Medical Association, the College of Physicians and Surgeons of Alberta, Acute Care Alberta, Alberta Health Services, Covenant Health-operated facilities and chartered surgical facilities.

“Prior to introducing the legislation in the House, the Government of Alberta consulted confidentially with health care system stakeholders,” the ministry said.

Safeguards need to be ’embedded in law’: Prof

Lorien Hardcastle, who teaches in the Faculty of Law and Medicine at the University of Calgary, has an eye for what’s missing in the law.

“The concern here is that there is not much in the way of protection of public order,” he said.

He is concerned that the government is leaving specific safeguards in place, and allowing them to be added or changed through ministerial orders, which Relatively easy to execute. Hardcastle said that unlike statutes, they do not require debate or multiple readings in the legislature.

“If we’re talking about what the basic protections are to secure access, I don’t think we want something that can be changed with the stroke of a pen,” he said.

“Those are things that should be included in the law that are more permanent (and) more sustainable.”

Meddings, meanwhile, believes that for such a plan to work, limits on medical school training sites would have to be eliminated.

“The reason we don’t have enough physicians is because we don’t train enough,” he said, “and that’s because the government limits medical schools in what they can do.”

He said government funding could increase, or the formula could be changed to allow more students.

“If you really want private enterprise, why doesn’t the government say to medical schools, ‘You are free to train as many medical students as you are willing to pay for?’