In a new @NUPGE report, I analyze how Bill 30 (Alberta)—along with recent policy reforms—paves the way for primary/community care & acute care privatization—& the potential implications for Canadian Medicare.
Short thread below.
Report: nupge.ca/sites/default/… #abpoli #cdnpoli
Short thread below.
Report: nupge.ca/sites/default/… #abpoli #cdnpoli
In February 2020, the government-commissioned Ernst & Young review of Alberta Health Services (AHS) recommended contracting out surgeries, including those that require an overnight stay or longer. #abpoli
This recommendation received little attention: “AB Health could consider reviewing criteria for delivery of procedures in non-hospital surgical facilities to identify opportunities to deliver additional services, including potential those that require overnight stays.” #abpoli
With the exception of several other recommendations, the Alberta government accepted all the recommendations from the review, making it clear that it favours moving in this direction and transforming the role of private surgical clinics into hospital-like facilities. #abpoli
The government announced in the spring budget that it would spend $400 million on contracting out surgeries to private surgical facilities, and invest $100 million in public sector operating rooms. #abpoli
The govt committed to doubling the number of contracted-out surgeries over three years–from 15% to 30% of total surgeries province-wide. This represents a big shift of surgeries from the public sector, & very significant amount of public $ flowing to for-profit sector. #abpoli
With this context in mind, Bill 30 makes many significant amendments to existing legislation in AB that relate to regulation of private surgical facilities, and how physicians/surgeons are paid by the public purse. #abpoli
A key change to AB Health Care Insurance Act gives Minister power to “enter into agreements or establish arrangements” with physicians directly (rather than via the Physician Master Agreement) and private corporations. This is an unprecedented change. #abpoli
Under these arrangements, physicians can be paid directly by corporations, not by public plan (govt). This opens the door for govt to entrench corporate hospital-like facilities, primary/community care clinics, virtual care platforms, such as Telus Babylon. #abpoli
Changes to this Act (s20.1 & 20.2) represent the most significant change in how MDs pay is structured in Canada, by allowing MD payment via corporate structures and not directly by government. Corporations can bill the public plan directly. #abpoli
Bill 30 amends the Health Care Protection Act to be consistent with the Alberta Health Care Insurance Act in granting power to the Health Minister to contract with corporations for the provision of publicly funded (insured) services. #abpoli
Bill 30 creates the “chartered surgical facility” as a new class of surgical facility into legislation. Note the language of "charter" like private "charter schools" that receive public funds but are not accountable to the public. #abpoli
Chartered surgical facility is defined as “a surgical facility that is designated under Part 2, Division 1 or 2, as the context requires." This definition provides the Minister with broad powers to designate chartered surgical facilities “as the context requires”. #abpoli
Until regulations are made public, it's not known exactly what is contemplated. Based on Ernst & Young recommendation accepted by govt & plan to x2 no. of private surgeries, reasonable to assume chartered surgical facilities may be stepping stone to for-profit hospitals. #abpoli
Despite language that prohibits “private hospitals” in AB, govt could use its new-found control over AB College of Physicians/Surgeons to make changes to definitions of major & minor surgical services, thus expanding procedures that may be considered "minor" surgeries. #abpoli
The government could also simply repeal that section of the existing legislation that prohibits "private hospitals" at a later date. #abpoli
This direction would seem to be consistent with the AHS’s Request for Expressions of Interest process that closed earlier this year which stated a desire in determining "market interest" for expanding the types, and volumes, of surgical procedures to be outsourced. #abpoli
That Request for Expressions of Interest stated: “AHS has identified the […] specific procedures for potential expansion, but is also interested in understanding the market capacity in procedures not listed[.]” #abpoli
Important language that protects public delivery and the integrity of the public system is repealed: “The Min shall not approve a proposed agreement unless the Min is satisfied [it won't] have adverse impact on publicly funded & publicly administered health system in AB.” #abpoli
The subsection requiring the Minister to only approve contracting out if the Min is satisfied that there is “efficient use of existing capacity” will also be repealed. This is a safeguard to require that govt fully use and optimize existing public-system capacity. #abpoli
Another repealed section: AHS must have “an acceptable business plan in respect of the [contract] showing how [AHS] will pay for the...services...” This would necessarily require a cost analysis to demonstrate how contracting is more cost-effective than public delivery. #abpoli
Spoiler: The weight of the academic evidence & Cdn experience shows that private, for-profit health care delivery is more expensive, lower quality and less safe, can lead to more clinically unnecessary procedures, and can destabilize the public system. #abpoli
A new section is added to the Regional Health Authorities Act that governs AHS: “Agreements for planning and provision of services". New language opens the door for the Min to require AHS contract with a private corporation/consultancy in to meet ministerial expectations. #abpoli
E.g, this language could be used to undermine the public administration of Alberta’s health system and the public servants working within AHS by requiring that AHS contract with private sector consultants who favour privatization and ending direct AHS service provision. #abpoli
Seems to be what govt has in mind w/ new "Health Contracting Secretariat" to provide direction to AB Health & AHS in how to encourage privatization of public services (see below thread) and reduce barriers for corporations to enter this new market. #abpoli
Much has yet to be clarified based on the regulations (yet to be publicly released), but the legislation provides an expansive legal template for major privatization of acute care and primary and community care services. #abpoli #cdnpoli #cdnhealth
With BC, Alberta, Saskatchewan, and Manitoba moving simultaneously to outsource surgeries, the concern is that market will become large enough to attract much larger corporate players like for-profit US or English hospital chains to enter the market. #abpoli
Turned out not be a short thread, which speaks to the wide-ranging and significant legislative reforms contained in Bill 30. Note that this report was drafted prior to that last-minute amendments introduced by the government. Bill 30 was passed in the wee hours Wednesday morning.
