June 6, 2002

Private Surgery Centres

The False Creek Surgical Centre achieved a major public relations coup by quickly responding to a suffering patient whose plight was portrayed on Vancouver's Global TV. The patient, who hadn't been able to move off of his living room floor for two months, was up on crutches and free from pain. The quick response was not the result of the doctors' settlement, but the result of the intervention by a private surgery centre that performed the procedure for free. Of course, that act of kindness also produced a major follow up story on Global TV where a spokesperson for the centre declared that it would be pleased to enter into a contract with the province to help eliminate surgical backlogs.

Health Minister Colin Hansen has floated a trial balloon saying he is ready to explore the idea. Don't hold your breath if you are on a surgery wait list. CBC has quoted Hansen as saying "we don't have the kind of structure that allows us to make a quick decision". Maybe Hansen really knows that the answer will be no.

Private surgical centres already perform procedures for ICBC and WCB. Many people probably wonder why MSP doesn't use the centres. If you could walk into a private surgery centre and have the cost billed to MSP, costs to government would increase because more procedures would be performed. Government would lose its ability to ration the number of procedures that are performed. Also, the speed with which patients got care would be considerably slower than the case that was dramatized on Global TV. Why? Because unlimited access to private surgery centres would make them just another part of the overall health system and the resulting flood of cases would make them share the backlog. Instead of being a vehicle for queue jumping the centres would then share in servicing the entire public waiting list.

Of course, if government really wanted to shorten waiting lists it would not have to divert resources to private surgery centres. It could simply provide the health authorities with more money to open operating rooms and wards. But what about the nursing shortage, some would say. There is a shortage of certain specialized nurses, e.g. operating room and emergency room nurses; both private surgery centres and public hospitals have difficulties recruiting those nurses. The public system is enormous compared to the miniscule number of private surgery centres. It could attract those scarce nurses just as well as the handful of private surgery centres. It could also pay to train additional specialized nurses. The issue is not public or private. The issue is rationing access to care or opening it to meet the demand.

Government does not want to lose its ability to ration access to care. It does not want more surgery centres going into business until supply and demand found a marketplace balance with public health insurance paying the price. Some would say that public health insurance eliminates the market, but in the US the various models of care all receive payments from both public health insurance and hundreds of private forms of health insurance. The existence of insurance affects but does not eliminate the market. It is freedom of entry to provide any service, not user fees, that is the defining difference between the US and Canadian models.

According to the news story following the publicized free surgery, the phones were ringing off the hook at the False Creek Surgery Centre with people making enquires. Perhaps that is the real media relations coup. More people now know that they can queue jump by using one of the three financial plans mentioned on the Centre's website. It is the ability to queue jump that gives the Centre its value. The only way to eliminate that is to make the public system so good that no one would want to pay to use any alternative. Don't count on that happening in the New Era.