Last Updated:Friday - 09/24/2010

A shift to private hospitals

Perhaps Premier Ralph Klein should be taken at his word when he states that he does not want to "impose" a private, two-tier health care system in Alberta. Klein's plan to allow regional health authorities to contract with private health-care operators to provide virtually any sort of surgery would still ensure that taxpayers foot the bill. It would, we hope, also ensure that people of wealth are not allowed to jump the queue and receive their surgery before people of lesser resources.

Still, if the government is not imposing a private health-care system, it is certainly nurturing one, slowly creating the climate for such a system to take root. First, we had the massive funding cutbacks of the mid-1990s, cuts which closed hundreds of hospital beds and created long lineups for some forms of surgery - the same lineups the premier now believes only private hospitals can eliminate. Those cuts took place at the same time as health-care regionalization which got the government off the hook for making the dirty decisions about what to cut. Now the government opens the door to private hospitals which, to compete economically, will have to have lower costs for labour and capital.

The devil will be in the details of such a plan. Will the private health-care facilities be forced to bear their fair share of the necessary red tape? Or, will the plan leave all the bureaucracy with the large public hospitals, deliberately creating an uneven playing field with the public hospitals at a disadvantage? And, if the latter is the case, how quickly will we move to a system of privately-owned hospitals with few public or voluntary facilities?

Private health facilities will be centralized in Calgary and Edmonton with regional health authorities contracting with those facilities to provide the necessary services. Of course, the government won't be to blame for the continued shift of health care from rural areas to the cities - the decisions will be made by the local authorities.

The government wants us to believe that its reforms are aimed at making the system more efficient and cost-effective. However, privatization doesn't even win on the efficiency factor. American studies indicate that for-profit hospitals are more costly to operate than non-profits and that they provide lower quality care.

Here, it's worth taking a look backwards. Health care in Alberta was established not by the government but by the churches. Religious orders, in particular, played an enormous and now nearly-forgotten role in establishing hospitals in this province. This is true throughout the Western world. Government involvement is a 20th-century innovation; the Church's health care ministry dates back to the time of the Apostles.

Yet the choice we are now being asked to make is one between government bureaucracy and so-called private efficiency. But it's a phony choice. There is the third option of voluntary health care, one that lives on in a still sizable number of Church-run health-care facilities, some in the cities, others in smaller centres. Like other hospitals, they have been starved for funds the last five years. And while private enterprise is an efficient way of providing goods and many services, not all services are best delivered on a competitive, for-profit basis.

The Alberta government has certainly made allowances for voluntary hospitals to continue to fulfill their mission within its new regional structures. But the government is stuck in narrow old-line thinking which sees private and public as the only options. It fails to take the voluntary sector seriously as a third option. Health care in Edmonton, for example, would benefit from restoring the Misericordia and Grey Nuns hospitals to their pre-1994 glory. Private health care facilities are not the only, nor the best, way to eliminate long lineups for surgery.

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