What Alberta’s public-private doctor plan could mean for insurance, physician burnout, nurses and more

Alberta Premier Danielle Smith’s plan to allow physicians to work in both the public and private systems at the same time would be a first in Canada, and has received a mixed response from critics and supporters alike.

This has also raised many questions.

Adriana Lagrange, Minister of Primary Services and Preventive Health Services, would not elaborate Legislation Before presenting it.

And the government did not comment on when the bill might be introduced. The legislative calendar indicates the fall meeting will end next week.

LaGrange said in a statement that the government “is committed to“Ensuring that no Albertan, under any circumstances, has to pay out-of-pocket to see their family doctor or receive the medical treatment they need.”

In a statement, Dr. Brian Wirzba, president of the Alberta Medical Association, said the announcement lacked details “about how this will be done.”

He said he has received assurances from Lagrange that the AMA will be involved in the development of these rules.

So what could be the implications of this bill?

Has any province also done something similar?

While the Canadian Medical Association (CMA) has confirmed this will be a first, in a statement it compared Quebec’s model to how that province has worked. Strict action was taken to stop the increasing pressure on doctors in the private sector.

This year, the Quebec government enacted an act Law requiring new med school graduates They will have to work in the public sector for five years before being allowed to move to the private sector.

Quebec has More doctors are working in private system That’s more than all other provinces combined, according to the CMA.

Dr. Martin Potter worked in the public system for two decades before opening a private clinic, where he says he has more freedom to hire whomever he wants and see the patients he wants.

“I see a lot of patients who already have a family doctor, but they can’t see them in a timely manner, so they make an appointment with me and I’m happy to help them,” Potter said.

“People who don’t believe in personal care won’t come and see me. But the people who do see me… most of them are very happy.”

Quebec cardiologist Dr. Christopher Labose said the desire to go private has become common water cooler chatter.

“What used to be a casual topic of conversation has now become almost commonplace when doctors ask each other, ‘Hey, are you thinking about going private?'” Lebos said.

Are doctors interested?

Under the plan outlined by Smith and Matt Jones, Minister for Hospitals and Surgical Health Services, surgeons will be required to perform a set number of procedures within the public system before choosing to perform additional private surgeries.

Smith said the law could potentially limit private surgeries to weekends or after-hours.

Dr. Margot Burnell, president of the Canadian Medical Association, said physicians are already reporting in the organization’s national surveys that they are burned out.

Burnell said, “I don’t want a surgeon to operate on me at the end of the day or at night. I want them when they are fresh, eager and well-rested.”

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Red Deer orthopedic surgeon Dr. Keith Wolstenholme agrees that burnout is a common complaint. He’s not sure how many people have the capacity to take on more work.

“NowThat doesn’t mean surgeons won’t take advantage of the opportunity to do the same job for more money,” Wolstenholme said. “Absolutely, everyone will take advantage of that opportunity.”

What does this mean for nurses?

The Alberta government has not yet said what the legislation for nurses might include.

“Surgery doesn’t happen alone with just the patient and the surgeon — you need a team,” Burnell said.

They worry Alberta’s plan would deplete the public system of team members like anesthetists and nurses.

“If you allow more and more private clinics to operate, they will start poaching personnel from the public system,” Labos said.

It’s a concern shared by the United Nurses of Alberta, which represents more than 30,000 registered nurses in the union province.

“The number of physicians and nurses and other health care providers in the system is limited,” said Danielle Larrivee, the union’s first vice president. “There is no magic wand that we can wave to increase the number of health care providers.”

She is concerned that this could open the way for more nurses to move from the public to the private system, saying this is already happening as nurses choose to work in chartered surgical facilities for example.

Larrivee said the union wants to see the government back down from the proposal.

“This is a movement in the wrong direction,” he said. “If they move forward, it is a complete declaration of war against the Canada Health Act.”

This leads us to our next path.

Is it against the Canada Health Act – and what difference does it make?

The Canada Health Act does not allow physicians to charge for services that are already publicly insured.

Lorien Hardcastle, An associate professor of law and medicine at the University of Calgary says the act is essentially a funding model between the federal government and the provinces. Violations would normally result in Ottawa stopping health transfers.

“But the federal government is often quite slow to withhold money and tries to work with the provinces so the money doesn’t have to be withheld,” Hardcastle said.

At the same time, he said the federal government “doesn’t have that much power” because its share of the funding is less than what the province covers.

“Given the relationship between Alberta and the federal government and some of the tensions there, I don’t think the province would be shaken by the federal government threatening to withhold funding,” he said.

Then, there is a possibility that the matter will go to court.

Burnell said the Canadian Medical Association needs to look at what the law actually says, ,“Judicial review may result.”

The legal challenge could be an “uphill battle,” Hardcastle said.

“Canadian courts have taken an approach where (they don’t) let the government interfere with your rights, but (they also don’t) force them to do things to further your rights, like provide you with a certain standard of health care,” Hardcastle said.

How will insurance be included?

In his video promoting the idea, Smith suggested that the additional cost of privatized surgery could be covered either out-of-pocket or through patients’ insurance.

Jason Sutherland, director of the Center for Health Services and Policy Research at the University of British Columbia, wonders whether this will lead to more private insurance companies entering the market, offering insurance that runs parallel to public health care.

Andrew Ostrow, CEO and founder of insurance startup PolicyMe, calls the move a positive for the insurance industry.

“The more patients pay out of pocket, the greater the need for private insurance,” Ostrow said.

“I know it will all be down to implementation and rollout, but I’m really optimistic about what this model can represent.”

He hopes other provinces will follow suit, and it will result in shorter wait times and improved patient care.

Ostrow said if that happens, his company will adjust the plans it offers customers in Alberta.

Benefit plans offered by employers may also change to cover these private procedures, he said. It will come at a cost, but he said it could be a way for companies to attract or retain employees.

Alberta Blue Cross, the largest benefits provider in the province, said in a statement.“We will assess any future impacts to our benefit plans and our customers as more information becomes available.”

In an email to CBC News, the Canadian Life and Health Insurance Association said, “It will take some time for insurers to fully understand the details and we look forward to reviewing the legislation when it is introduced.”