Should governments look to public-private partnerships (P3s) to cure all that ails healthcare? Manitoba says “no” and Nova Scotia says “maybe” but then along came the Supreme Court, throwing a wrench in the works with a decision that’s widely seen as a threat to the public healthcare status quo. Whatever the provinces decide to do, it looks certain that these businesses will be playing an ever-bigger role in treating Canadians in the days to come.
Would you look askance if a businessman said he wanted to sell you something at cost? Well the Manitoba government did just that when they decided that the private Maple Surgical Centre’s offer to perform not-for-profit surgeries for the province sounded a little too good to be true. “We’re trying to help,” says Don Copeman, the CEO of Surgical Spaces Inc, Maple Surgical’s parent company. This February, when the firm offered to reduce Manitoba’s waiting-list for day surgeries by supplying operating rooms, nursing care & surgical supplies to the government at cost, their offer was greeted first with silence and then it was unceremoniously rejected.
“Maple Surgical has made various proposals to us on a number of occasions,” says Joel Hildebrand, communications officer for Manitoba Health. “None of them have made financial sense.” Mr Hildebrand believes that Manitoba has no lack of surgical space, but a lack of doctors to use the existing space. Manitoba Health hasn’t completely refused to contract insured health services to private companies it continues to contract out cataract surgeries to Western Surgery Centre, another private facility in Winnipeg but doesn’t believe that more P3s would save money in the long run.
“We believe that through the public system we can provide better care and better care sooner to Manitobans,” says Mr Hildebrand.
So what of that doggedly controversial question should the provinces move from a purely public system to one that relies more on private firms for delivery of essential health services? Well, Alberta unsurprisingly embraced healthcare P3s with their acceptance of the Premier’s Advisory Council’s Framework for Reform in 2002, and BC and Ontario have moved into significant use of private facilities in recent years, however many governments still regard private overtures with great caution.
NOVA SCOTIA’S P3 OFFER
In Halifax, Nova Scotia, Dr Dan Belliveau, an ophthalmologist and assistant professor at Dalhousie University who runs his own private surgery clinic, recently made a proposal to the Nova Scotia government to have cataract surgeries done at his clinic. He believes he can deliver this service at approximately 70% of the cost of the same procedure when done in a hospital.
“Premier Hamm, who’s a doctor himself here in Nova Scotia, said about three weeks ago that if the current rate stays the same… in twenty years, 100 percent of the budget would be going toward delivering healthcare,” says Dr Belliveau. “I’m a taxpayer too,” Dr Belliveau continues, “and I don’t like it when I go into a hospital and see that it could be done more effectively.” Dr Belliveau believes that the provinces that have embraced P3s are on the right track, and hopes that his own home province will take a look at moving in that direction.
Cheryl Doiron, the deputy minister of Health for Nova Scotia, hasn’t seen Dr Belliveau’s proposal yet, but is reluctant to take a firm stance on P3s until her department’s discussion paper on private sector involvement in the public healthcare sector is produced at the end of June. At that time, her department will seek input from all appropriate stakeholders.
A DOOR AJAR
“To say that we would be against any kind of public-private relationship is probably too extreme,” says Ms Doiron, but she does express concerns about maintaining control of quality of service and equitability of access if insured services are delivered by private facilities. “We do not believe that the way to improve our wait times is to see the private sector go out there and set up business on a for-profit basis, and it’s not our intention to improve our wait times by going down that road,” Ms Doiron says.
Dr Belliveau and Mr Copeman are in complete agreement that private-sector involvement in healthcare is here to stay. They believe that governments should take a proactive approach to management of public-private partnerships now, and that government fears of loss of quality control and private sector involvement leading to a two-tiered system are unfounded.
2-TIER ALREADY HERE?
“We have a two-tiered system now,” says Mr Copeman, “with the US being the second tier.” He’s referring to Canadians who can afford to pay for their own surgeries across the border rather than wait their turn in Canada. He also fears that the aforementioned decision just reached by the Supreme Court may throw Canadian doors wide open to private healthcare American style. The Court heard an appeal from Dr Jacques Chaoulli and Mr George Zeliotis, insisting Quebec’s laws prohibiting private insurers from covering health services, currently insured by government, violates a person’s right to life, liberty and security of the person guaranteed by Section 7 of the Canadian Charter.
The court sided with the challengers, so it appears that Canadians will have the right to purchase health services on their own, which might open a whole new can of worms.
“I don’t support widespread privatization,” Mr Copeman says, “but governments like the one in Manitoba are turning away, when they should be planning on how to integrate private enterprise into the system.”
For now it looks like Manitoba is closing the door on more P3s in healthcare delivery and Nova Scotia’s health ministry may be giving any gift horses that come their way a good dental exam.