Quebec poised to follow western Canada’s failed private surgery experiment

In March of this year, the Quebec government introduced Bill 15, which is expected to become law and significantly overhaul the health system and encourage much greater for-profit involvement.

While publicly funded, privately delivered surgeries are not new in Quebec, the way in which Bill 15 creates a legal framework for what is likely to become a full-blown investor-owned hospital sector is a new and serious concern.

As a BC-based political economist and health policy researcher, I am writing to warn Quebecers about the effects of surgical privatization in western Canada. Quebec is pursuing a similar privatization scheme that has failed to deliver more surgeries and better access in Alberta.

In 2020, the Alberta government embarked on similar reforms. The “Alberta Surgical Initiative” included new legislation and contracts with for-profit surgical facilities. The government claimed that this policy direction would reduce wait times and increase access for patients – but my recent evaluation of the initiative shows that the opposite occurred.

Total provincial surgical volumes declined since the beginning of the Alberta Surgical Initiative, to levels below those of 2014. In fact, fewer surgeries were performed in 2021 than in 2018 – that is, pre-pandemic and before the start of the initiative.

Stunningly, total surgical volumes declined by 6 per cent between 2018 and 2021 as public hospitals were hemorrhaging staff to for-profit facilities. Meanwhile these investor-owned facilities were focusing on increasing volumes of the most profitable procedures, and leaving the more complex work for the strained public system.

The Alberta government’s focus on expanding for-profit surgical provision came at the expense of hospital staffing and resources, which fell on a per capita basis.

To support the growth of this industry and create certainty for investors, the Alberta government – like Quebec – introduced legislation that risks entrenching corporate chains that will pull from the same limited pool of health-care professionals already in short supply. Now that there is a large corporate chain – with a presence in BC, Alberta, Saskatchewan, Ontario, and Quebec – the risk of entrenching a for-profit hospital industry in this country is real.

The Canadian and international evidence indicates that for-profit facilities worsen public hospital staffing shortages by drawing on the public-sector workforce, destabilizing public hospitals, and making wait times longer. Quebec need only look at its own experience with how private staffing agencies have hollowed out the public sector workforce, forcing the government to phase these agencies out. A parallel private surgical delivery system is having the same effect, and it will likely get much worse under Bill 15.

The Alberta government has become so stubbornly invested in its poorly performing initiative that it seems unwilling to correct course and adopt sensible policy solutions. These would include making full use of the nearly 30 per cent of unused public operating room capacity, adopting single-entry models and centralized wait lists, and increasing public operating room hours by staffing up struggling public hospitals.

The expansion of privately delivered surgeries also comes as new data from Quebec show higher costs of for-profit delivery – as much as 2.5 times more expensive than public hospitals. In BC, unlawful billing of patients and the public purse has been a pervasive and ongoing problem with for-profit facilities.

Instead, the Quebec government should learn from the experience in western Canada and scrap Bill 15. The evidence-based policy solutions to reduce wait times and increase surgical capacity are not new, but require political will on the part of government.

Unfortunately, the Quebec government is poised to follow western Canada’s failed experiment with for-profit surgical delivery.