Resources in the public system are likely to shift toward care paid for out of pocket, physician says.Todd Korol/The Globe and Mail
Alberta’s proposal to open up private billing for surgery could be lucrative for some providers, but it is unlikely to create much new capacity in the system, according to physicians who study the province’s health work force.
The provincial government introduced a bill in late November that would allow surgeons to bill both public insurance plans and patients directly. The United Conservative Party government asserts the change will create new business opportunities that help attract physicians to the province and increase available services.
This would be a new model in Canada. Generally, provincial and federal law dictates that doctors can only bill publicly or privately, but not both at the same time. Most doctors choose to operate only in the public system.
There are, however, many loopholes. The Canada Health Act’s stipulations are only for “medically necessary” services and not elective surgeries. As well, physicians are generally allowed to either travel to another province and bill privately there, or have out-of-province patients travel to them.
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Alberta’s plan to allow in-province physicians to privately bill in-province patients could be lucrative for some providers, according to Stephen Kwan, a Lethbridge-based orthopedic surgeon and president of the Alberta Orthopaedic Society.
“It’s exceedingly attractive if you get operating time in both the public as well as private systems,” Dr. Kwan said.
Fees are unregulated and patients may pay tens of thousands of dollars for an operation.
Maddison McKee, spokesperson for Alberta Minister of Primary and Preventative Health Services Adriana LaGrange, said the government believes surgeons will perform more surgeries if they have the option of billing privately.
“Some Alberta-registered physicians, particularly orthopedic surgeons, currently leave the public system to perform private surgeries in other provinces; allowing dual practice here encourages them to stay, contributing to the public system while also providing private care at home,” she said in an e-mail.
But Dr. Kwan cautioned there are still serious resource constraints, particularly among other health care professionals who are essential to operations.
“What I’ve seen through my 30 years is that there have been periods where we’ve lost all anesthesia and nursing and we’ve been only able to operate once per week,” he said.
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Those limited resources mean that overall capacity in the system is unlikely to grow, according to Braden Manns, a physician at the University of Calgary who has studied the province’s workforce challenges.
Instead what is likely to happen, Dr. Manns said, is that resources in the public system are likely to shift toward care paid for out of pocket.
“The people that are forced to stay in the public system, those people who need the supports of a hospital, those people who can’t afford to pay that – they’re going to wait longer,” he said.
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Ms. McKee, the minister’s spokesperson, said the government has been working to recruit more physicians to the province. She pointed to registration numbers that showed the number of physicians increased by 643 people this year to 12,769, as of Sept. 30.
“Of course, supply is tight, but the health workforce and the overall health system constantly expands,” she said in an e-mail.
The government has been working to recruit more physicians to the province, a spokesperson says.Todd Korol/The Globe and Mail
Dr. Manns said that increase is in line with population growth in the province. He also said the number of registrations may not match the number of practicing physicians in Alberta because some doctors leave the province, but maintain their registration with the college in case they ever decide to return.
Dr. Kwan said his organization is concerned that any new surgeons coming into the province will only stay temporarily.
“The problem with itinerant surgeons is that they come, they operate, they leave,” he said. That leaves any follow-up work, including complications, to the surgeons who stay there permanently.
Dr. Kwan said Alberta surgeons are already feeling strain from on-call shifts. He pointed to the Royal Alexandra Hospital in Edmonton, which last year had to limit surgical hours because of a dearth of on-call availability among surgeons.
He said his organization is suggesting itinerant surgeons should also provide call coverage for hospitals.
David Urbach, the head of the department of surgery at Women’s College Hospital in Toronto, who has studied the growth of private health services in Canada, said most opportunities for private providers have been in specialties such as cataract surgery or orthopedic surgery.
“It’s really like niche areas of practice where there are these markets that have developed, where you can develop profitable opportunities to provide those select services,” he said.
He said that means the number of physicians who would be most enticed by Alberta’s offer is likely to be limited.
“Surgeons are not that mobile, and they’re unlikely to just pick up and move just for an opportunity to work in a private environment,” he said.