Kenney reforms may reduce health-care wait times, like in Saskatchewan

At a recent press conference, Alberta Health Minister Tyler Shandro announced his plan to implement bold reforms to improve Alberta’s health-care system. Expressing concern for record high wait times in the province, the minister promised to put “the needs of patients before ideology” and rely on “private and public partners to achieve fundamental system improvements.”

Specifically, the minister plans to expand surgical capacity by increasingly using private clinics to deliver publicly-funded care. Although this reform is certainly bold, it does not change the nature of our universal health-care system—in fact, it just might save it.

The idea to use private clinics in the public health-care system isn’t new. In fact, it was a key part of Saskatchewan’s successful health-care reforms.

Launched in 2010, the Saskatchewan Surgical Initiative (SSI) was a policy response to increasing wait times in the province. Among other reforms, the SSI (quite controversially) contracted with private for-profit clinics to deliver publicly-funded day-surgeries, quickly expanding the province’s surgical capacity and freeing up resources in public hospitals.

The SSI also created a centrally administered surgical registry, which pooled all referrals for medical treatment so patients could be matched with specialists with shorter wait times. This opened the door for a web-based portal that allowed patients to make informed decisions based on accessible wait time information.

The result?

Saskatchewan went from having the longest median wait time from referral by a family doctor to treatment nationally in 2008 (28.8 weeks) to the shortest in 2015 (13.6 weeks), just one year after the end of the SSI. Moreover, the private clinics not only provided less-expensive procedures (26 per cent cheaper, in fact) than their public-sector counterparts, patients rated their experiences in the private clinics consistently high.

Clearly, Alberta hopes to mirror Saskatchewan’s successful wait time-reduction by implementing similar policies. For example, according to Minister Shandro, Alberta will also create a “centralized electronic referral system that triages every person waiting for surgery so that they see the right specialist in the shortest time.”

While this is encouraging, Saskatchewan’s story contains a note of caution.

Despite the undeniable success of the SSI, wait times in Saskatchewan have begun to creep up again. According to this year’s wait time survey, patients in the province face a 26-week median wait for medically necessary treatment (after referral by a family doctor)—a far cry from its top-ranking performance in 2015.

The reason? While the policies pursued by Saskatchewan (and now Alberta) provide temporary relief, they must be followed by additional reforms to promote lasting change. In reality, Saskatchewan’s system (and Canada’s more generally) still operate in stark contrast to other more successful universal health-care systems.

For example, countries such as Switzerland, the Netherlands, Germany and Australia embrace private insurers and providers as fundamental parts of their universal systems. They also expect patients to share the cost of treatment, something that’s explicitly prohibited in our country by the Canada Health Act. The Netherlands, for example, requires patients to pay a deductible before coverage starts, while Switzerland additionally requires patients to pay 10 per cent of the cost of treatment. Of course, vulnerable populations are either exempt or subsidized, and annual payments for everyone are capped to ensure that they don’t pose a financial burden.

Finally, these countries also fund their hospitals based on activity to incentivize treatment. By contrast, Canada’s hospitals are mostly funded with “global budgets,” which impose limits on the number of procedures that can be performed, even if capacity is available.

Minister Shandro’s recent announcement represents a bold step for Alberta, which hopes to emulate the success of its neighbour. If implemented correctly, Alberta has a good shot at reducing wait times in the short term. However, as the Kenney government begins to implement these new initiatives, it should also plan for further reforms based on other successful universal health-care systems, for the benefit of Alberta patients.