Guest Column: Health care: What’s wrong with private if efficiencies occur and waits are reduced?

By Medicine Hat News Opinon on March 2, 2019.

When it comes to our health-care system, the sight of these two words – private and profit – will turn half of the readers of this column apoplectic. They will argue that this speaks of a two-tier health-care system and an inevitable rise in health-care costs. The exact opposite is true.

Although there are many hard working, dedicated and even avid public sector workers in our health-care system, the system is not designed to be efficient or provide good value for input. There are too many overpaid administrators whose main goal is simply to ensure that they protect their jobs and ensure that many decisions that could efficiently be delegated remain in their job descriptions. This ensures that their position is deemed important to the system. Decision making should be delegated to the people closest to the action so that the choices are made quickly with all the best information.

As we progress through the system, we get to the public sector union staff people. Again, many of these people are ambitious and dedicated but many are not. Those who seek to do well and get ahead are discouraged from working too hard or too fast for fear of making the others look lazy. The union rules also prevent the most deserving from rising to the top as they are unable to pass over those with more seniority.

There is no financial incentive in the public sector to save money. There are no incentive bonuses for saving money or introducing more efficient methods and the money that is being spent is perceived to belong to “no one.”

Introducing the private sector into health-care system does not have to result in a two-tier system. There can still be a single payer for all of the health-care services. Where there is a backlog in the system, the private sector can find ways to efficiently address those waiting lists quickly while making a profit through volume and efficiency. In fact, there are already areas in our health-care system where these methods are in effect.

There are times when the only reason for long waiting lists is the lack of funding for the system. If the funding was available to address waiting times, the private sector would provide those services, reduce those backlogs, and make a profit in the process. Waiting lists simply put off what should be done and paid for today instead of adding pressure to tomorrow. Profit is considered by many to be a dirty word but it is much more desirable to see money benefiting people through profit than watching it being wasted through an inefficient and incestuous bureaucracy.

A while back in this province, there was a nine- to 10-month waiting list for cataract surgeries. Some of the reasons were lack of operating rooms, and funds. In an inefficient system it can take an hour or more to complete one eye surgery. AHS at that time decided to contract out a number of surgeries to a private doctor who had operating facilities in his clinic. He set up his clinic with adequate staff and was able to complete one surgery on an assembly line every 15 to 20 minutes. When questioned, the doctor commented that he would rather do surgeries in his own office rather than a hospital because he knows that the facility has been properly sterilized between procedures. He was not so confident that this was true in the hospital setting.

Some might question that the private sector might itself become incestualized through unnecessary referrals and procedures. Some might argue that has already happened in the areas of the health-care system that have already been privatized. I can certainly acknowledge that this risk does exist and it is an area that even now needs to be monitored more carefully to ensure that certain private health facilities and pharmaceuticals are not being over patronized by some practitioners.

There is no perfect system but when we spend about one-third of our tax dollars on a health-care system we should be focusing a significant amount of those resources on ensuring efficiency and value for money. That means that we need to spend resources monitoring the system for efficacy and financial accountability. It might also mean spending some of those resources on profit for the private sector. There is no doubt in my mind, I would much prefer some deserving person making a little profit for providing superior services rather than watching money wasted through inefficiency while people suffer waiting for service.

Paul McLennan moved to Alberta more than 20 years ago as a member of the RCMP. He remained in Alberta after retirement in 2002, taught driving part time and settled in Medicine Hat in 2011.