Advocates of B.C.’s public health care system say a steady increase in contract surgeries in the private sector threatens to exacerbate hospital workforce shortages while providing dubious long-term benefits. Health policy researcher Andrew Longhurst, with the Canadian Center for Policy Alternatives and BC Health Coalition, says BC health authority contracts for publicly funded medical procedures with for-profit surgical and diagnostic imaging clinics have increased by 57% between 2016 and 2021, from $47.8 million to $75.4 million, respectively. Growth was sharpest in contract surgery, rising from about $5 million in 2016 to about $28 million in 2021, according to Longhurst’s report, “The Alarming Rise of Corporate Medicine.” The contracts aim to smooth out waiting times by allowing private clinics to carry out publicly funded procedures (usually non-urgent, such as for orthopedics, cataract or hernia repairs). However, it appears that health authorities are becoming more dependent on them, Longhurst said. The issue, he says, is private clinics taking staff away from hospitals — at a time when the Department of Health is facing closing emergency rooms across the province. “The main issue right now,” Longhurst said, “is the health workforce.” The economies of scale that hospitals can offer are diminished, not enhanced, with such increased reliance on private facilities, Longhurst argued. “We do have dual delivery systems and the private sector is trying to outcompete staff. you are pulling this limited pool of specialist health professionals from the public system into the private delivery system. And this couldn’t have happened at a worse time in BC,” Longhurst said. “It makes it difficult to schedule full seats in our audience [operating rooms]if you have staff working increasingly in private facilities where they can be paid a higher hourly wage,” Longhurst, a PhD candidate in the geography department at Simon Fraser University, told Glacier Media. In addition, “we know that the costs associated with outsourcing tend to be higher for a number of reasons, one of which is the built-in profit margin. And then, on top of that, we have evidence to suggest that outcomes are worse as a result, because if you’re motivated by profit, you find ways to cut costs on your most expensive operating expenses,” Longhurst argued. In his report, Longhurst also raises questions about the provincial government handing out contracts to facilities that have been fined for “overcharging” — the illegal practice where clinics bill patients privately for medically necessary procedures covered by the public health system. care. For example, the False Creek Healthcare Center received $6.18 million in public procurement for 2020-21, despite the BC government finding it a “significant” source of surcharges in previous years, according to Canada’s annual report Health Act for 2019-20. Kamloops Surgical Center received $15.4 million in health authority payments between 2016 and 2021, “despite the fact that the clinic was audited by the BC government and found to be involved in illegal overcharging,” the report notes. “Instead of confronting illegal overcharging head-on, the province’s strategy has been to increase outsourcing to private surgery clinics, but condition those contracts on compliance with provincial and federal law. In other words, we are using one form of privatization (outsourcing or contracting) to limit another (two-tier health care where those who can afford it pay privately),” Longhurst said in a statement on Aug. 24. As for solutions to understaffed hospitals, Longhurst says the ministry needs to attract as many health professionals as possible, not the other way around, as the rise in outsourcing shows. This means, according to Longhurst, increasing public surgical and diagnostic capacity, scaling back central waiting lists and reducing the need for hospital care with a greater emphasis on primary and community care, such as for the elderly. Longhurst acknowledged that the ministry has taken steps to reduce medical imaging wait times. According to the Times Colonist, the ministry has been buying up private clinics to absorb them into the public administration. The only two private surgical centers on Vancouver Island — View Royal Surgical Center and Nanaimo’s Seafield Surgical Centre, operated by Surgical Centers Inc. — were absorbed by Island Health last month, at a cost to the province of about $11.5 million. Health Minister Adrian Dix threw cold water on the report’s claims at a press conference on Wednesday afternoon. “The suggestion that we support private health care is completely inaccurate,” Dix said. He said last year’s spending on private clinics amounted to 0.23% of all health authority spending and contract operations accounted for 4% of all surgeries. He said the purchase of these two clinics should mean the increase in such surgeries will decrease and “I expect them to decrease.” Dix did not commit to eliminating the process entirely. The health minister said the system has increased diagnostics by about 120,000 a year since about five years ago. Last year, the system ran 294,000 diagnostics, he said. The system now has three new MRIs and operates 18 MRIs seven days a week for 16 hours each day. Dix added that the False Creek clinic had its original contract canceled after it was found to have overcharged patients. He now has a new contract with compliance commitments, he said. Therefore, the previous cases of surcharge do not lead to a ban on new contracts. [email protected]
