Things are not going well in Alberta’s health system—especially when it comes to timely access to surgeries. But with the many spoilers of COVID-19, the “refocusing” of AHS into new agencies and now the procurement scandal that the Alberta NDP have been calling “CorruptCare,” diagnosing what exactly is going wrong isn’t easy.

Health policy researcher Andrew Longhurst’s new report for the Parkland Institute, Operation Profit: Private Surgical Contracts Deliver Higher Costs and Longer Waits, attempts to make some sense of the mess. The Progress Report sat down with Longhurst for an interview after his report was released last week so he could walk us through his analysis.

Data on surgical costs appears to support the “CorruptCare” allegations

The provincial government claims that its privatization program, the Alberta Surgical Initiative (ASI), which was introduced in 2019 by then-premier Jason Kenney, is reducing costs and wait times for surgeries here. But according to Longhurst, that’s not what the data shows at all. Wait times for critical procedures, including surgeries for cancer patients, have gotten longer under the ASI, not shorter. And while wait times are going up, the price the government is paying for the surgeries is rising, too.

The volume of surgeries provided by private chartered surgical facilities (CSFs) is going up, but the price they’re charging is going up even faster

Longhurst notes in his report that the average cost of contracted-out procedures increased by 52 per cent between the 2022/23 and 2023/24 fiscal years, which he attributes to “higher negotiated contract prices.”

“The magnitude of this increase is unusual; it cannot be explained by inflation or other reasonable hikes in input costs,” writes Longhurst in the report. “It is also unlikely that there was a change in CSFs performing more complex procedures that attracted a higher rate, since these facilities only perform routine, lower-complexity procedures.”

Those negotiated contract prices are at the heart of the still-boiling procurement scandal, first reported by the Globe and Mail, in which former Alberta Health Services (AHS) CEO Athana Mentzelopoulos alleges that UCP insiders pressured her into approving abnormally juicy contracts for politically-connected private operations, including two companies part-owned by MHCare CEO Sam Mraiche, who hosted multiple cabinet ministers at his private box during the Edmonton Oilers’ playoff run last year.

But, according to Longhurst, costs and wait times were already rising before that latest batch of contracts were negotiated. Alberta’s metrics were looking pretty grim, even prior to the period covered by Mentzelopoulos’s allegations.

Wait times for crucial surgical procedures in Alberta are going up, not down

“I would go back to the wait time performance—and what we're also hearing from the front lines in terms of the impacts it's having on inpatient care and hospital-based surgical care,” says Longhurst.

“The fact that these allegations have come out in public through the wrongful dismissal suit has really shone a light on these issues.”

The Alberta government is pumping chartered surgical facilities at the expense of the public system

The poor performance of the government’s privatization project is particularly glaring in consideration of how desperately the Smith administration seems to be trying to prop it up.

It’s not the case that the government is using CSFs to increase the total volume of surgeries in any way it can, dipping into privatization as a means to backstop the public system, says Longhurst. It’s more like one system is being deliberately positioned to cannibalize the other.

While the amount of surgeries delivered privately has increased dramatically since 2019—according to Longhurst’s figures, by more than 50 per cent—the amount of surgeries delivered by public hospitals actually decreased by one per cent.

This heavy lean into privatization was not something that pandemic pressures justified, Longhurst added. Other jurisdictions went another way.

“In B.C., there was a much greater effort and investment in increasing surgical delivery through public hospitals and public operating rooms. B.C., in comparison, did a much better job of working down the pandemic surgical backlog,” said Longhurst.

“In addition to that, we see that those investments were not made in a similar way like B.C. but we also on top of that saw that Alberta was one of the most resistant to using public health protections that preserved the health system and on acute care services from COVID-19. 

“When you're not willing to use a number of those tools in the toolbox to preserve and protect health system capacity in hospitals, that has a whole number of knock-on effects in terms of your inability to move patients through the system for scheduled surgical care,” Longhurst explained.

The ongoing dismantling of AHS into four separate agencies for primary care, acute care, continuing care, and mental health and addictions, is unlikely to improve matters, he added.

Cracking AHS into multiple agencies and shopping surgeries off to the private sector appears more ideologically than fiscally motivated to Longhurst, who points to the underfunding of the public system as proof.

“You already have operating rooms. This is infrastructure already built and ready to go. All you have to do is fund the activity and staff it appropriately to be able to perform more surgeries and increase your volume,” he said. 

The B.C. government, Longhurst added, used the delay of surgeries early in the pandemic as an opportunity to provide a “significant injection of public funding” for health care as a means of reducing the surgical backlog and improving volumes. 

The Alberta government, by contrast, are engaged in a “relentless attempt to demonstrate that the for-profit facilities are delivering,” despite evidence to the contrary, he said.

“That's what is so befuddling about this whole experiment,” said Longhurst. “It is very much an ideological initiative by this government to demonstrate that private for-profit activity is effective and performs better than the public system, and yet they're spending so much time and money and getting worse results.”

Longhurst’s full report is available online from the Parkland Institute.