Cash, charge or health card? Alberta moves ahead with dual practice medical model for several surgeries

The Alberta government announced Thursday doctors can now bill private and public insurers for some surgical procedures.

Alberta is moving ahead with a dual practice medical model this September.

It means doctors will be able to bill surgeries to both public and private systems.

Allowable surgeries include hip and knee replacements, cataracts, some ear, nose and throat procedures, gynecology, dermatology and plastic surgery.

These surgeries can be performed in private facilities.

Emergency and life-saving care, like cancer surgery, will remain exclusively in the public system.

The province says surgeons will still have to work in the public system, and electronic records will be shared.

The minister says the move is necessary.

Acute Care Alberta will set minimum public surgery hour requirements in the coming months.

The province says the move will lead to shorter surgical wait times.

“Doing more of the same will not reduce Alberta’s surgical wait times,” said Alberta Premier Danielle Smith in a media release issued Thursday. “Dual practice is one of several reforms that will help expand surgical capacity, improve access to care and ensure Albertans can get the procedures they need sooner.”

Alberta Minister of Hospital and Surgical Health Services Adriana LaGrange says the move is necessary.

“It’s important we get this right, which is why we have built strong safeguards and only allowed specified surgeries to protect access to the public system. We will closely monitor dual practice and make changes if needed to ensure shorter waits, more choice and better access for Albertans.”

AMA responds

The Alberta Medical Association reacted to the announcement, saying there were still details that need to be addressed.

AMA President Dr. Brian Wirzba told CTV News the AMA provided the government with a list of safeguards on April 30, some of which were addressed in Thursday’s announcement and some which were not.

“Specifically with regards to some of the decisions that will be made around which physicians can participate – just as an example, how many hours in the public system do they need to commit to in order to participate in this model?" Wirzba asked.

“What type of reporting is going to take place? How transparent is that entire process going to be?”

“We submitted those safeguards to the premier on April 30 and received notification this morning thanking us for supplying them. During that time we had no further conversation with regards to the details or the writing of the regulations.

“We had hoped to have a bit more input with regards to some of those regulations and I don’t know if there is still going to be opportunity. We have not heard either way from the government.”

Wirzba said the government has implemented some of his organization’s suggested safeguards.

“Some (of our safeguards) were taken seriously. As an example, the mandatory public service requirements are in there,” he said. “Again, the details regarding how much public service will be required, will physicians need to participate in afterhours care or on-call care or will it simply be daytime public service?

“We were pleased to see enhancements in reporting requirements and ensuring that surgical reports will be available throughout the system so those were some of the things that were adopted.

“But we continue to have concerns,” he added, “with regards to oversight, and an auditing body that would look at what services are being delivered, what type of quality is being maintained with those services and most importantly, how are we going to be made aware of whether the public system is actually improving or whether it’s deteriorating?

“We already have challenges in knowing exactly what the wait times are for many of the non-hip/knee/cataract surgeries – are those surgeries that are still provided in the public system going to have shorter waitlists or are those going to get longer and how is that going to get reported?"

‘Absolutely no evidence’: Friends of Medicare

Meanwhile, public health advocacy group Friends of Medicare said in a media release that they disagree with the province’s move.

“There is absolutely no evidence that this will increase capacity or shorten wait times, it just creates a way for the wealthy to jump the queue, while the rest of us wait longer or are forced to go without,” said executive director Chris Galloway.

“In fact, as Albertans have repeatedly seen, this government’s failed privatization strategy has already reduced public capacity to life-saving surgical care.

“This will only further undermine our publicly delivered health care.”

Galloway accused the province of dismantling public health care “bit by bit to make it easier for private health care companies, shareholders and the private insurance industry to profit off the growing care needs of Albertans.

“Health care is not a business, it is an essential public good. Telling Albertans to choose between cleaning out your retirement fund and waiting years in pain for a needed surgery is frankly insulting, and goes against the principles of equitability and universality on which our public medicare system is founded.”

Edmonton-area NDP member of Parliament Heather McPherson said in a press release Thursday she was “disturbed by (the) announcement from the Government of Alberta to introduce American-style for-profit non-emergency health care in our province.

“This fall, how much someone earns will dictate how quickly they can see a doctor. It is unacceptable.”

Alberta NDP responds

NDP MLA Sara Hoffman, the party’s shadow minister for hospitals and surgical services slammed the move.

“Albertans need access to care when and where they need it,” Hoffman said in a release. “Albertans want ambulances that are there when they call, emergency rooms they don’t have to wait in for hours, and access to a family doctor,” said Sarah Hoffman, Shadow Minister for Hospitals and Surgical Services.”

“Instead of addressing the very real priorities of Albertans, this UCP government is taking further steps toward an American-style, for-profit, privatized health-care system,” continued Hoffman. “Today’s announcement does not increase the number of physicians, expand workforce capacity, or address the longest surgical wait times – driven by complex procedures like cancer surgeries."

Friday afternoon, Alberta NDP leader Naheed Nenshi issued a statement as well. In it, Nenshi said he has written to Prime Minister Carney, asking the federal government “to intervene under the Canada Health Act and protect public health care in Alberta.

“Alberta’s public health-care system is being steadily eroded by the UCP government as they barrel forward with their plans to introduce a two-tier, American-style, for-profit system here in our province,” Nenshi said. “It’s not just wrong, it’s incompetent, because it will do nothing to improve services for Albertans.

“Their plan is missing the most basic safeguards: there are no clear limits on how doctors divide their time between public and private care, they’re opening the door to privately paid care inside public hospitals, and they still haven’t set out a clear, workable framework for how any of this is supposed to function.

“One of the many things that make Canada a great place to live is the promise of public health care — a promise that provincial governments are mandated in law to uphold. However, this UCP government continues to abandon that mandate in their pursuit of health-care privatization."

With files from CTV Edmonton