By Monika Dutt and Ryan Meili
December 9, 2011
When it's done right, moving simpler medical procedures out of hospital settings can expedite services and reduce costs, an advantage everyone can appreciate.
The devil is in the details, however. And without careful planning, the Saskatchewan government's decision to turn to third-party private clinics to provide surgery to patients in the public system could undermine long established strengths of our healthcare system.
To ensure this does not happen, Canadian Doctors for Medicare uses four criteria to assess changes to health-care delivery. They are: equity; high-quality care; delivery of effective and clinically indicated services; and effective planning and integration.
Based on statements from the Health Ministry, it seems that the first three criteria are likely to be met under the government's new model.
However, care must be taken to prevent the for-profit clinics from using their access to patients in the public system as an opportunity to recruit for other services, as frequently occurs.
There must also be regulations in place to ensure that initial commitments do not erode over time to allow for the queue-jumping, creamskimming (only treating the healthiest patients), extra billing and worse clinical outcomes that have characterized for-profit facilities in other provinces.
The last criteria, planning and integration, will be the most challenging to attain. The private clinic must collaborate with other health-care institutions. This includes collecting and sharing information in a secure manner, and linking patients with appropriate community services, as would be expected in a public, nonprofit setting.
It also needs to be shown clearly that the existence of the private surgical centres will not exacerbate staff shortages in existing facilities or jeopardize funding of the most clinically necessary services.
The government insists that using private clinics is a temporary measure to address current waiting lists. Our group is concerned that this action will lead to a long-term strategy of using private delivery.
The better solution would be to investigate means of strengthening the long-term capacity of the public system, both in and out of hospitals. It's a solution that is less expensive in the long run than the use of private clinics, and would remove the concern that for-profit priorities could harm the health of Saskatchewan people.
Dutt is a Saskatchewan board member of Canadian Doctors for Medicare and Meili is vice-chair of the group.