Some health experts say they’re worried new legislation designed to expand private health care in Alberta was not properly planned and is missing key protections for the public health system.
Bill 11 was introduced in the legislature on Monday and, if passed, will pave the way for a “dual practice” model in Alberta, allowing doctors to work in both the public and private system.
Under the plan, patients could pay for health care, including surgeries such as hip and knee replacements, in the province. The government argues this will relieve pressure on the public system, potentially decreasing wait times.
The Alberta Medical Association, which represents doctors in the province, said it wasn’t consulted on the legislation, and it wants a seat at the table as further details are hammered out.
“Any reform needs to be informed with the best evidence. It needs experts to actually weigh in,” the group’s president, Dr. Brian Wirzba, said in an interview with CBC News.
“Most places that have tried this have run into problems. … It’s going to be really important to have the details really well laid out.”
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, United Kingdom, France, Germany, Spain and Australia.”
Dr. Jon 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 to try,” he said.
“If it succeeds — wonderful … My worry, though, it is not well thought out [and] it has not received a lot of consultation.”
Part of the problem that we have in Alberta is that we don’t have enough physicians to run two systems.– Dr. Jon Meddings
He believes the dual practice system will inevitably draw some doctors, already in short supply (such as anesthetists), away from the public system and, as a result, it will not reduce wait times.
“All of the examples that have been used about why this works elsewhere are comparisons to countries that actually don’t have the same system as us and, most importantly, actually have many more physicians than we do,” he said.
“Part of the problem that we have in Alberta is that we don’t have enough physicians to run two systems. So, I worry about that.”
Meddings said the Alberta government’s use of chartered surgical facilities for publicly funded procedures was already supposed to address long wait times.
“The problem is still here. They haven’t fixed it. I would question why,” said Meddings. “And why doing more of the same thing — simply changing the payer perhaps — why that’s going to be any better.”
Government plans to consult
The Alberta government plans to exclude family doctors from the dual practice model, at least to start. It has also said emergency care, including surgeries and cancer treatment, will remain entirely publicly funded.
Safeguards to protect the public system will also be put in place, according to the provincial government. This could include limiting the number of procedures a doctor can perform in the private system or restricting private surgeries to evenings or weekends.
“Any future changes to which doctors can participate in the dual model would be made through ministerial order,” a statement emailed from the Ministry of Primary and Preventative Health Services said.
“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.”
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, facilities run by Covenant Health, and chartered surgical facilities, according to the statement.
“Prior to the legislation being tabled in the House, Alberta’s government consulted confidentially with stakeholders within the health-care system,” the ministry said.
Safeguards need to be ‘built into the legislation’: prof
Lorian Hardcastle, who teaches in the faculties of law and medicine at the University of Calgary, has her eyes on what’s missing from the legislation.
“The concern here is that there’s not a lot in the way of protecting the public system,” she said.
She’s worried about the government leaving out specific safeguards, and allowing them to be added or changed through ministerial orders, which are relatively easy to execute. Unlike legislation, they don’t require debate or multiple readings in the legislature, Hardcastle noted.
“If we’re talking about what are the fundamental protections in place to preserve access, I don’t think we want that to be a thing that can be changed at the stroke of a pen,” she said.
“Those are things that should be built into the legislation that are more enduring [and] more durable.”
Meanwhile, Meddings believes in order for a plan like this to work, caps on medical school training spots would need to be eliminated.
“The reason we don’t have enough physicians is because we don’t train enough,” he said, “and it’s because government limits the medical schools as to what they do.”
He said government funding could increase, or the formula could be changed to allow for more students.
“If you really wanted private enterprise, why wouldn’t the government say to the medical schools, ‘You are free to train as many medical students as are willing to pay for’?”
