Alberta Premier Danielle Smith's plan to allow doctors to work in both the public and private systems would be a first in Canada and has drawn mixed reactions from critics and supporters alike.
This also raised a number of questions.
Adriana Lagrange, minister of primary and preventive health care, did not go into detail. legislation before it is submitted for consideration.
However, the government did not answer when the bill might be submitted for consideration. The legislative calendar indicates the fall session will wrap up next week.
LaGrange said in a statement that the government is committed to “ensuring that under no circumstances will any Albertan have to pay out of pocket to see their family doctor or for the treatment they need.”
In a statement, Alberta Medical Association president Dr. Brian Wirzba said the announcement lacked details on “how it will be done.”
He said he had received assurances from LaGrange that the AMA would be involved in developing these rules.
What consequences could the bill have?
Have any provinces done something similar?
While the Canadian Medical Association (CMA) confirms this will be the first time, in a statement it drew comparisons to the Quebec model, noting how the province strict measures have been taken to stop the drain of doctors to the private sector.
This year the Quebec government passed a law law requiring new medical school graduates work in the public sector for five years before they are allowed to move to the private sector.
Quebec has more doctors work in the private system more than all other provinces combined, according to the CMA.
Dr Martin Potter worked in the public system for two decades before opening a private clinic, where he says he has more freedom to hire who he wants and see patients as he pleases.
“I see a lot of patients who already have a family doctor and they can’t see one on time, so they make an appointment with me and I’m happy to help them,” Potter said.
“People who don't believe in private care won't come to me. But the people who do see me…most of them are very happy.”
Quebec cardiologist Dr. Christopher Labos said the desire to go private has become common water-cooler talk.
“What used to be a taboo topic of conversation is now almost commonplace: Doctors asking each other, 'Hey, are you thinking about going private?'” Labos said.
Are doctors interested?
The plan, outlined by Smith and Matt Jones, the hospital and surgical health minister, would require surgeons to perform a certain number of procedures within the public system before they decide to take on more private surgeries.
Smith said the legislation could potentially limit private transactions to weekends or after business hours.
Dr. Margot Burnell, president of the Canadian Medical Association, said doctors are already reporting in the organization's national surveys that they are burned out.
“I don't want a surgeon to operate on me at the end of the day or at night. I want them to be fresh, energized and rested,” Burnell said.
West of the center45:49Isn't it time to destigmatize the word “privatization”?
Red Deer orthopedic surgeon Dr. Keith Wolstenholme agrees that burnout is a common complaint. He's not sure how many of them are capable of taking on the extra work.
“Now“That doesn't mean surgeons won't jump at the opportunity to do the same work for more money,” Wolstenholme said. “Absolutely, everyone will take advantage of this opportunity.”
What does this mean for nurses?
The Alberta government has yet to say what the legislation might mean for nurses.
“Surgery is not done in isolation between the patient and the surgeon—you need a team,” Burnell said.
She's concerned Alberta's plan will deplete the public system of team members such as anesthesiologists and nurses.
“If you allow more and more private clinics to operate, they will start to lure staff away from the public system,” Labos said.
Those concerns are shared by the United Alberta Nurses, the union that represents more than 30,000 registered nurses in the province.
“There are a limited number of doctors, nurses and other health care providers in the system,” said Danielle Larivee, first vice president of the union. “There is no magic wand that we can wave to increase the number of health care providers.”
She worries that could open the floodgates to more nurses moving from the public to the private system, which she said already happens, for example, when nurses choose to work in charter surgical facilities.
Larivee said the union wants the government to back down from the proposal.
“This is moving in the wrong direction,” she said. “If they go any further, it will be a full-fledged declaration of war on the Canada Health Act.”
This brings us to the next path.
Does this conflict with the Canada Health Act—and why does it matter?
The Canada Health Act does not allow doctors to charge fees for services that are already publicly insured.
Lorian Hardcastle, The University of Calgary associate professor of law and medicine says the legislation is essentially a funding model between the federal government and the provinces. Violating this rule usually results in Ottawa denying health benefits.
“However, the federal government is often quite slow to withhold money and try to work with provinces so they don't have to withhold money,” Hardcastle said.
Additionally, she said the federal government “doesn't have a lot of teeth” because its share of funding is less than what the province covers.
“Given the relationship between Alberta and the federal government and some of the tension there, I don't think the federal government threatening to withhold funding is going to get the province to budge,” she said.
Then there is a chance that the case will go to court.
Burnell said while the Canadian Medical Association needs to know exactly what the legislation says, “The result could be a judicial review.”
Litigation could be an “uphill battle,” Hardcastle said.
“Courts in Canada have generally taken the approach that [they don't] let the government invade your rights, but [they also don't] force them to do something to protect your rights, like provide you with a certain standard of health care,” Hardcastle said.
How will insurance affect the situation?
In her video promoting the idea, Smith suggested that the additional costs of privatized operations could be covered either out-of-pocket or through patient insurance.
Jason Sutherland, director of the Center for Health Services and Policy Research at the University of British Columbia, wonders whether this will lead to more private insurers entering the market offering coverage that runs parallel to public health care.
Andrew Ostro, CEO and founder of insurance startup PolicyMe, calls the move a positive development for the insurance industry.
“The more patients pay out of pocket, the greater the need for private insurance,” Ostro said.
“I know it will all depend on implementation and adoption, but I am very optimistic about what this model can be.”
He hopes other provinces will follow suit, leading to shorter wait times and better patient care.
Ostro said if that happens, his company will adjust the plans it offers to customers in Alberta.
He said benefit plans offered by employers could also change to cover more of these private procedures. It will come with a cost, but he said it could be a way for companies to attract or retain employees.
Alberta Blue Cross, the province's largest benefits provider, said in a statement: “will evaluate any future implications for our benefit plans and our customers as soon as additional information becomes available.”
In an email to CBC News, the Canadian Life and Health Insurance Association said, “It will take some time for insurers to fully understand the details and we look forward to reviewing the legislation once it is enacted.”
