Use of private clinics is not end of public health care
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There may be more than one reason why the Manitoba government is looking to expand the use of private clinics for surgeries, such as hip and knee replacements and cataracts, and it has nothing to do with ideology.
The Stefanson government in its throne speech Tuesday said it plans to further explore the use of private clinics to shorten hospital wait times for Manitobans. The issue probably got more attention than it deserved: there is only one sentence, maybe two, in the entire 18-page speech that references private health care.
“Other provinces have demonstrated that a blended public-private delivery system works,” the speech said. “We will continue to secure partnerships to ensure we explore any and all avenues to get Manitobans the help they need now.”
That led the Opposition NDP to light its hair on fire, which it usually does any time a Conservative government uses the word “private” when talking about health care.
“Today we heard Premier Heather Stefanson, who cut our health-care system as health minister, now come back as first minister to say that the only path forward is to privatize health care,” NDP Leader Wab Kinew said following the speech.
That’s not exactly what she said. Stefanson said the province plans to build more capacity in the system, in part, by using more private providers. The Manitoba government already uses a wide range of private companies to deliver health care, including in areas such as home care, surgical services, blood and other testing and walk-in clinics. The NDP, when it was in government, used the same blend of private and public heath care. It’s not new.
It’s also not the only way the Stefanson government is adding capacity to the system. Government is expanding or upgrading a number of public hospitals, including the addition of a fifth operating room at Concordia Hospital for orthopedic surgery.
The question that’s been raised is: why not simply add more capacity to the public system instead of contracting out more services to private providers? It’s a good question. Once all the overheated political rhetoric is cleared away, there are some interesting discussions going on behind the scenes that provide insight into that debate.
Government can often buy surgical services at a lower marginal cost in the private sector than in the public system. There are many reasons for that, including that in some cases, public hospitals may be performing more complicated cases. Take cataract surgery, for example. Misericordia Health Centre does the bulk of the publicly delivered cataract surgeries in Manitoba. They also handle some of the more complicated cases, which may be more expensive. At the same time, the province contracts out thousands of cataract surgeries a year to Western Surgery Centre, a private clinic in Winnipeg that performs some of the simpler cases, which may be less expensive. The trick is finding the right balance between the two while expanding capacity, controlling costs and maintaining quality. Western Surgery is now doing far more cataracts per month (460, on average, in 2022) compared with what it did prior to the COVID-19 pandemic (121 per month from 2017 to 2019). It has helped clear the pandemic backlog for cataract surgeries.
There are similar opportunities for orthopedic surgery. Manitoba is now doing more day surgeries for hip and knee replacements, owing to advances in medicine. Right now, those procedures are all performed at publicly run facilities. Where overnight stays are not required, procedures could be done at private clinics, adding to the province’s overall capacity and potentially reducing costs.
There’s another reason for considering that option: a 2017 wait-time reduction task force report found the demand for orthopedic surgery in Manitoba would peak between 2031 and 2036, based largely on the province’s aging population. After that, demand is expected to decline. The less the province invests in expensive bricks and mortar at public hospitals to meet today’s growing demand (by contracting out to private facilities), the less surplus space it might be stuck with once demand begins to fall in a decade or less.
As with cataract surgery, the goal is to find the right balance between the two. None of that should have anything to do with ideology.
Tom has been covering Manitoba politics since the early 1990s and joined the Winnipeg Free Press news team in 2019.