Health reform lessons from the Land of the Living Skies

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Appeared in the Calgary Sun, May 12, 2016

Albertans may forget that it was the Saskatchewan NDP, not the Conservatives in Alberta, that led the way to balanced budgets in the early 1990s. Saskatchewan is again showing its proclivity for innovation and leadership, this time in the area of health-care reform. Alberta has much to learn from the positive experience of its neighbouring province.

Towards the end of the 2000s, there was increasing recognition of the marked problem of wait times for medical treatment in Saskatchewan. In 2008, for instance, the median wait time (from GP referral to treatment) for Saskatchewanians was 28.8 weeks—the longest in the country. In response, the government decided to launch a rather bold program of reform aimed squarely at reducing the remarkably long wait times for medical procedures in the province.

The Saskatchewan Surgical Initiative (SSI) was introduced in 2010 with an explicit commitment that no patient in the province would wait more than three months for surgery by 2014. A number of bureaucratic changes were introduced including fostering a more collaborative decision-making process and more intently focusing on patients rather than the interests of providers.

There were also process changes, which included pooling all referrals for medical treatment and providing clear information online regarding wait times for different doctors. A web-based system allowed patients to make more informed decisions about their doctors and wait times.

Most critically, however, in order to expand surgical capacity and free up resources in public hospitals the SSI included the contracting out of select day-surgeries to private for-profit clinics. The government recognized that the use of private clinics, including for-profits, was accepted in many OECD countries with universal health care and contrary to popular belief did not violate the Canada Health Act.

The government imposed strict delivery guidelines on the providers, prohibited any additional billing for services, and mandated an integrated approach with the public health-care system.

The results were stunning.

Saskatchewan went from having one of the longest wait times, on average, for medical treatment (measuring the time from GP referral to treatment) to having one of the shortest by 2014. The government’s own wait time data indicated a 75 per cent decline in the number of patients waiting three months or longer for surgery.

While not a central concern of the government, the use of private for-profit clinics also resulted in a decline in costs per procedure. A recent study documented the SSI and cited work showing that on average, private clinics in the province delivered procedures at 26 per cent lower costs. For example, in 2012, Regina Surgical Centres Inc. provided cataract surgeries at a cost of $618 per procedure compared to $1,273 in public hospitals in the Regina Qu’Appelle regional health authority. Similarly, in 2011 Saskatoon Surgical Centres Inc. performed ACL repair surgery for $2,500 per procedure compared to a cost of $3,212 in public hospitals in the Saskatoon region health authority.

As provinces like Alberta struggle with long wait times for treatment while simultaneously experiencing increasing pressure on their health-care budgets, better value-for-money will be essential in maintaining and improving health-care services for patients. The experience from Saskatchewan shows private for-profit clinics can and should be part of any reform agenda.

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