Last March, the Quebec government tabled Bill 15, which should become a law and considerably reform the health system while promoting much greater participation by for-profit organizations.
Although the Quebec government already funds surgeries administered by the private sector, Bill 15 is a source of new and serious concern because it creates a legal framework for what is likely to become a separately owned hospital sector. entirely to private investors. However, as a political economist and health policy researcher from British Columbia, I wish to warn Quebecers about the effects of surgical privatization. Quebec is pursuing a privatization plan similar to that of Western Canada which, in Alberta, has failed to offer more surgeries and better access.
In 2020, the Alberta government launched theAlberta Surgical Initiative, which included new legislation and planned to award contracts to for-profit surgical facilities. The government saw this as a way to reduce wait times and increase access for patients. However, my recent evaluation of this initiative shows that the opposite has happened.
Total surgical volumes in the province have declined since the start of this initiative to lower levels than in 2014. Fewer surgeries were performed in 2022 than in 2019 — that is, before the pandemic and before the start of the initiative. Total surgical procedure volumes decreased by 6% between 2019 and 2022, as public hospital staffing levels moved to for-profit establishments in large numbers.
Meanwhile, these private facilities increased the volumes of the most profitable interventions, leaving more complex work to the strained public system. The expansion of for-profit surgical provision has thus come at the expense of hospital staff and resources, which have declined on a per capita basis.
Clearly, the government of Alberta — like that of Quebec — presented a law which, by supporting the growth of the hospital industry and offering guarantees to investors, risks consolidating the business chains present in the sector care. Already present in British Columbia, Alberta, Saskatchewan, Ontario and Quebec, they will draw from the same limited pool of health professionals already in shortage.
Canadian and international evidence indicates that for-profit establishments aggravate staffing shortages in public hospitals with the consequence that they destabilize these establishments and lengthen waiting times. Quebec only needs to look at its own experience and the way in which private employment agencies have drained labor from the public sector, forcing the government to gradually abandon these agencies. A parallel private surgical delivery system has the same effect, and it will likely get worse under Bill 15.
The Alberta government has been so stubborn about investing in its underperforming initiative that it appears unwilling to turn things around and adopt sensible solutions. However, it could take full advantage of the almost 30% of unused operating rooms in public hospitals, set up centralized waiting lists and increase operating hours in struggling public hospitals by hiring more staff.
The expansion of privately administered surgeries also comes as new data from Quebec shows higher costs of for-profit delivery — up to 2.5 times more expensive than public hospitals. In British Columbia, illegal patient billing is a pervasive and ongoing problem in for-profit facilities.
The Quebec government should learn from Western Canada’s experience and scrap Bill 15. Evidence-based solutions to reduce wait times and increase surgical capacity are not new , but require political will on its part.