Push for competition won't bring two tiers, Smith says

Wildrose Leader Danielle Smith fended off accusations Friday that her party's push for more competitive health care would create a two-tiered system that would see top doctors move to private facilities and wealthy patients receive better care.

Smith said the system already features private operators, including family physicians and clinics that do cataract surgery.

Her party wants to encourage more independent facilities, creating a greater mix of public and private that would create incentives among all providers to reduce costs and bring wait times down, she said.

"If we can have additional choice in our health-care system, it will create best practices that can filter into the public hospital environment so they can become higher performing," she said at Calgary's Fountains of Mission seniors home.

"I look at this as saving our public health-care system. Our priority is to have a public system that works. But in the meantime, we can't afford to have our seniors waiting years for the system to magically get its act together doing the same things it's always done."

Rival parties jumped on the Wildrose position, arguing the health-care system should not be forced to survive in a competitive market.

NDP Leader Brian Mason said he's so concerned by Smith's approach that his party will make the defence of public health care the focus of its election campaign.

"This is going be the thrust and the theme of our campaign from now on. We need to make sure that this election is about health care," Mason said in Edmonton.

"Danielle Smith has thrown down the gauntlet, and we'll pick it up."

Voters can't trust Conservative Leader Alison Redford to protect public health care, given the track record of previous Tory premiers such as Ralph Klein and Ed Stelmach, Mason said.

"This PC party, to its very marrow, believes in private health care. All (Redford) will say is that she wants publicly funded health care," Mason said. "What does she mean? She means that we will use taxpayers' money to fund their friends in private business to deliver health care."

Liberal Leader Raj Sherman said he's also worried about the PC and Wildrose platforms.

It's clear both right-of-centre parties don't understand how the health system really works, he said.

Redford denied her party has a hidden agenda for further privatization. Alberta already has a system in which doctors can have their own offices "but that's about as far as we go," she said. The Tories are planning more long-term and continuing care with different types of accommodation, yet every senior will receive the same level of health services in those facilities, Redford said. Earlier this week, she argued the Wildrose approach of encouraging more private delivery and competition goes too far.

"What does competition look like in a system like that? You're going to end up with a system where people are going to find opportunities to create a different set of health services for people that can afford to pay, and people that can't afford to pay are going to end up suffering."

Smith said the Wildrose plan would ensure medical treatments are publicly funded, no matter where they are done.

Private operators wouldn't be allowed any extra billing and would be paid for procedures at the same rate as the cost in a public hospital.

Some health policy experts suggest there would be nothing to stop private clinics from offering patients nonmedical services that could accompany their surgery. This would allow the clinics to make extra money, potentially letting them pay doctors and nurses more than the public system offers.

They also tend to focus on the easiest, cheapest types of procedures, leaving the more complicated and costlier surgery to hospitals, some experts say. They also may not pay union wages.

This leads to concerns such advantages will push the top doctors and nurses to work at independent clinics.

"There's not enough frontline staff as it is. Opening a private, shadow system would only take those limited resources away from public system," said Guy Smith, president of the Alberta Union of Provincial Employees.

His union represents between 35,000 and 40,000 health-care workers in the public sector.

"I think it's a very dangerous move for the Wildrose to do this, but at least they're showing their true colours."

Smith said her expectation is that many health practitioners would wind up working for both public and private operators.

She said a number of doctors want more surgical time than they receive in hospitals and would welcome the opportunity for more. As well, part-time nurses could get additional hours at private facilities.

Political scientist John Church, who studies health-care policy at the University of Alberta, questioned if costs and quality can be controlled under the Wildrose policy.

He also wants to know if it would actually lead to quicker access to a new range of services.

Even if capacity is added, and competition is encouraged through public and private delivery, there's still a limited supply of health-care workers, Church said.

Becoming overly reliant on private operators can be a problem, he added, if the company suddenly goes out of business or other complications ensue.

Edmonton Journal, Sat Apr 7 2012
Byline: Keith Gerein and Marta Gold and Kelly Cryderman