'It's a big concern': Private delivery of public health care grows yet again in B.C.

B.C.’s Ministry of Health is continuing its multi-year trend of paying millions more dollars each year to private surgical centres for the delivery of public health care, CTV News has learned.

While the trend started with the BC Liberals, when the New Democrats took power they continued outsourcing surgeries to for-profit clinics in order to clear backlogs: In the 2017-18 fiscal year, 2.9 per cent of all surgeries in B.C. were performed under private contract. This proportion grew to 5 per cent in the 2021-22 fiscal year.

That year, $33.5 million from taxpayers went to for-profit private clinics, compared to $27.2 million the previous fiscal year, a 23-per-cent surge.

CTV News raised the issue with the health minister on Wednesday, asking why he wasn’t being more transparent about the growth in private delivery of public health care.

“When I announced the surgical renewal plan, I said it was all hands on deck, that we'd cancelled and delayed tens of thousands of surgeries (due to COVID-19 waves) and we were going to do everything we could to get people the surgeries we need,” said Dix. “We delivered on that in the pandemic, reducing wait times.”

That claim is disputed by the province’s orthopedic surgeons, who say patients are waiting longer than they did before the pandemic. Many have stopped seeing new patients at all, raising further questions about the accuracy of the wait-list figures.

A NATIONAL TREND

The Ministry of Health pointed out that contracted surgeries represent a small number relative to overall surgeries (16,777 out of 338,348 last year) and a miniscule portion of the provincial health budget, emphasizing the patients do not pay anything, meaning the government is “abiding by the principles of Canada’s universal health-care system defined by the Canada Health Act.”

The governments of Ontario and Alberta have been blunt and unapologetic about their use of private surgical centres to catch up on surgical backlogs, constantly reiterating that there is no cost to the patient.

“To be clear, when we talk about private surgery, just as we talk about how primary care offices are effectively privately held, it's public insurance,” said Dix of the payment system. “We strongly support public health care and we’ve expanded public surgeries.”

In the 2018-19 fiscal year, there were 331,163 surgeries performed in the province of British Columbia and in 2021-22 that has grown to 338,348, so there are more overall. While most surgeries contracted to private surgical centres are ophthalmological, with two-thirds done outside public hospitals, more orthopedic surgeries are also taking place outside the health authority system: 1,301 in 2020-21 compared to 1,525 the following year.

HARMFUL IN THE LONG RUN?

Critics argue the for-profit delivery of health care hurts everyone in the long term because it continually undermines the public system, where the most complex, labour-intensive procedures take place and also require the most recovery time; for example, full joint replacements and cardiac procedures of all kinds.

“When you’re trying to have the same workforce in two places at once, it can really lead to shortages in your public system, and that’s exactly what we’re seeing today,” said Simon Fraser University health policy researcher Andrew Longhurst.

He pointed out private surgical centres offer better pay and working conditions, without requirements for overtime and shifts on evenings and weekends.

“That’s why it’s a big concern, relying on and increasing the role of private clinics,” said Longhurst. “You tend to shift your resources out of the public system, and then, in turn, it becomes harder to staff up your public system.”

Dix said he's comfortable with his approach because it’s such a small percentage and he’s mindful of the “silver tsunami” of aging baby boomers who’ll need joint replacements and cataract surgeries in growing numbers.

“We're committed to the public system,” he insisted. “You bet we are, and we're also committed to providing people the surgeries they need when they need them.”