Last Updated:Friday - 09/24/2010
March 13, 2000
No need for private hospitals
The Alberta government's proposal to allow so-called private surgical clinics has been met with widespread consternation. The reticence of the public to accept this innovation is entirely understandable even if not for the reason most commonly stated.
Many fear that these clinics will lead directly and inexorably to a two-tier medical system. However, the government has pledged to respect the principles of the Canada Health Act and it has stated that all payments to the private hospitals will be made by the medicare system. Private hospitals (that's what they ought to be called) will not be allowed to extra bill patients, charge them directly or allow queue jumping. It's only fair to assume that the government will try to live up to its commitments.
Nor is there any reason to drive all profit-making from the medical system. Many aspects of the medical system are already privatized and a system of fully socialized medicine is not being seriously proposed.
However, we ought to be concerned by further privatization. It is worth recalling that Church groups, primarily orders of Catholic religious women, established the first hospitals in Alberta. They did this to serve the needs of suffering, vulnerable people and they did it efficiently. The nuns provided patient care no matter what the cost - although the cost in early days was more in the form of hours of work than in dollars and cents.
The medical system has changed enormously since those early days but patient care, not financial efficiency, still ought to remain the central value. The government believes patient care will not be jeopardized by further privatization. Perhaps not. But it should at least be aware that the more control passes into private hands, the less is the government's ability to set standards.
There is a line that, if crossed, will make the profitability of private hospitals an equal or higher value than that of the care of at least some patients. When that line is reached, we will have a two-tier medical system, regardless of whether the tiers are established by patients' wealth or some other factor.
As well, private hospitals are supposed to provide services not readily available through the public system. Yet if the total amount spent on health care does not increase proportionately, then private hospitals can only function to the detriment of public hospitals. It is the lower priority types of surgery that are most likely to be farmed out to private hospitals because it is those where the longest waiting lists are to be found. Funneling money away from the public hospitals to lower-priority surgery at private hospitals will thus be a barrier to the public hospitals doing some of their most important work. Private hospitals may cut waiting lists for hernias, but diminish public hospitals' ability to provide serious surgery.
If waiting lists on lower priority services are the issue then the solution is to provide better funding, not to create a new form of institution.
The treatment of workers in the health system is also a concern. Private hospitals will only be able to make a profit by operating with lower labour costs than public hospitals. It may be that the private hospitals make more efficient use of a smaller number of staff. However, it is likely that the staff at private hospitals will be non-unionized and that efforts will be made to keep unions out.
This raises the issue of whether the government's real agenda is an anti-union one. One can only speculate because the union issue, as obvious as it might be, has received scant public attention.
In that context, the Catholic Church's teaching needs to be reiterated - workers have a right to form unions and, whether they are unionized or not, they have a right to decent pay and working conditions. We may not agree with all strikes and all tactics of unions, but our Church has a clear teaching respecting workers' right to bargain collectively for their mutual benefit.
The government's goal of trying to run an efficient health care system is a laudable one. But it is hard to see how private hospitals will achieve that goal without creating larger problems. Alberta has a good health care system. The government should not throw out the baby with the bath water.
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