Success of surgical wait times initiative hangs on long-term commitment, health minister says
Minister Shandro says investment needed beyond next election, while experts warn efforts are misplaced
Alberta's health minister says his government's efforts to shorten wait times for surgeries could have a precarious future and will need investment beyond the next election.
"There's no denying that we have to spend more money to be able to get more surgical capacity," Minister Tyler Shandro said in an exclusive interview.
"And if a government, a future government, decides to spend less money on surgeries, obviously anything that we do to address our wait times in this term could be undone by just not spending that future money."
This year, the provincial government committed $100 million to upgrade operating rooms. It's the first injection of funding for the United Conservative Party's (UCP) platform promise to reduce surgical wait times. An additional $400 million will eventually go toward beefing up capacity in rural facilities and private clinics.
Many Albertans spend longer on the waitlist for surgeries than the Canadian average, and the timelines for several procedures in the province are well below B.C., Ontario and Quebec's benchmarks, according to data from the Canadian Institute for Health Information.
But experts warn that while this UCP initiative will boost capacity in the short term, there will be nothing to show for it in the future.
"The initial investment tends to lower wait times in the short term. And then we watch them creep back up as the system simply absorbs the capacity," Tom McIntosh, a political science professor and health policy expert at the University of Regina, said.
The party has promised to reduce average surgical wait times to four months by the next election in 2023 and reduce the list of those waiting longer than three months by 75 per cent.
They're aiming to add 80,000 additional surgeries by that year, partly through doubling the percentage of procedures contracted out to private clinics to 30 per cent.
Shandro says the health care system could ramp up surgeries to 150 per cent of pre-pandemic volume in the new year if needed. The province performs about 285,000 procedures each year.
Saskatchewan: An inspiration or a warning?
The party says this will be possible by replicating elements of the "highly successful" Saskatchewan model — one policy researchers say is plagued with problems and should be used as a cautionary tale, not as inspiration.
"It's unfortunate, a lot of the changes that are being made in Alberta, because it's not actually going to reduce wait times in the medium or long term," Andrew Longhurst, a health policy researcher with the Canadian Centre for Policy Alternatives, said.
The Saskatchewan Surgical Initiative funnelled $176 million into efforts to reduce the waitlist between 2010 and 2014. The funding was boosted by another $60 million in 2014. At the time, that project resulted in 98 per cent of patients getting their surgeries within six months.
But since that money has dried up, the list has ballooned again.
In the last five years, average wait times in Saskatchewan have more than doubled from 88 days to 202 days, according to the program website. The list of people waiting longer than three months has increased by 34 per cent since 2010. And, once again, surgical wait times have become an election issue in that province.
One of the pillars of that policy was the intention to have short wait times be sustainable into the future. The experts say the design of this policy makes it incapable of meeting that long-term goal.
McIntosh said wait times can't be eliminated for good with the current model of delivery because the need will expand to fill whatever capacity you free up. In Saskatchewan he said doctors move quickly to fill empty spaces with patients, so capacity often gets absorbed in a matter of months.
Plan for private facilities irks NDP opposition
Shandro says this initiative has pre-eminence in his portfolio and it will be supported more with money.
"It's about priorities at the end of the day. Our government has said our priority is on surgeries, and so we're focused on making AHS (Alberta Health Services) more efficient so we can have those dollars being spent on what our priorities are, which includes surgeries."
David Shepherd, the NDP's health critic, says shortening wait times is a noble goal but the approach is ineffective. The opposition takes particular issue with contracting surgeries to private facilities. Those procedures would still be covered under medicare.
"We've seen clearly that in the past this has not yielded better results for Albertans," Shepherd said. "We believe these dollars would be far better spent building up our capacity in the public system."
The NDP says Alberta should learn from Saskatchewan's issues, not replicate them. Shepherd says investing in rural hospitals and supporting primary care are ways to relieve the burden on the health system without relying on private enterprises.
However, one doctor sees merit in addressing the short term problems, even if more fixes will be needed down the road— and he doesn't mind the private facilities jumping in.
"As long as patients are not being charged, as long as this is being done within the letter of intent and the spirit of intent of medicare, there's nothing wrong with using non-surgical facilities," Dr. Tom Noseworthy, a professor of health policy at the University of Calgary and a former associate chief medical officer with AHS, said.
The pandemic created a huge backlog of about 25,000 surgeries, most of which have been worked through. Noseworthy added the government's surgical initiative is a good way to blow through an accumulation, but that it won't result in any structural fixes to the problem.
"You get a light switch-like effect," he said.
"There's no question that if you increase the volume of services, you will put more patients through, but it does not result in a sustained reduction in waiting times over the long run. It just doesn't work."
Sustainable changes are politically challenging
All three health policy experts CBC News spoke to agreed the only way to permanently eradicate long surgical waits is an overhaul of the system.
Noseworthy and Longhurst suggested a single entry model would help drive down waits, meaning that a surgeon is assigned a day to do surgeries rather than patients waiting for the specific doctor referred by their family physicians.
The researchers say addressing the long-standing problems with surgical wait times need years of bi-partisan cooperation and can't be accomplished by one party over a single political cycle.
"The response has traditionally been, well, we'll just buy more capacity and do the same thing, but more of it. And the evidence says that you actually need to reorganize the way people flow through the system," McIntosh said.
He added that's a very difficult political move.
"It's easy to point the finger at government and say 'you should be doing this.' It's hard. It's really hard to do. And it will create a lot of disruption in the system when you do it."
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