Alberta Hospital and Surgical Health Services Minister Matt Jones announced on April 21 that the province is considering introducing a surgery voucher program for patients who have waited longer than is recommended. The program would allow those patients to go to any approved or accredited provider in Alberta for their surgery.

“The proposed surgical voucher program would be intended to allow patients who are waiting beyond clinically recommended wait times, and whose procedures are lower acuity and lower complexity, to receive publicly funded surgery at a different approved location within Alberta where wait times are shorter,” Kyle Warner, press secretary for the Ministry of Hospital and Surgical Health Services, told Medscape News Canada. Surgeries would be performed at chartered facilities that are accredited by the College of Physicians and Surgeons of Alberta and approved by Acute Care Alberta. All surgeries provided through the program would be publicly funded.

“This program would improve transparency around wait times, helping patients and providers identify where care may be available sooner and, in some cases, provide care closer to home or family supports,” Warner added. “The program has a phased rollout planned, initially focused on lower acuity, lower complexity knee and hip arthroplasty, and cataract surgeries, with the potential to expand to other procedures over time.”

As the proposal is in its initial stages, details are lacking about when it would take effect, which surgeries would be involved, what process would be used to determine priority for surgical patients, and what safeguards would be put in place to ensure that the public system is maintained.

“Since we don’t have any of this information, we’re trying to assess what this might look like, based on other jurisdictions,” Brian Wirzba, MD, president of the Alberta Medical Association (AMA) and doctor of internal medicine at Gray Nuns Community Hospital in Edmonton, told Medscape News Canada. “Some European models have voucher systems in which surgeries are completely paid for. In Alberta, we don’t know if the voucher is public money that would be used to pay for private surgery, which would still technically be considered publicly funded. If a patient has to pay a top-up on that, a two-tier system is created in which, with adequate funds, they can jump the queue.”

The mixed private-and-public healthcare system is “here to stay,” Wirzba noted. While the AMA does not oppose private care, it sees the purpose of expanding it as improving public access and holds that safeguards are needed to ensure that the public system is maintained. Also, appropriate metrics are needed to identify the impact of any changes, including issues related to training, privileging, and record keeping and sharing, said Wirzba. The AMA has provided the government with a list of 70 safeguards to help support the public system in any transition.

Health experts are speculating that the program might resemble the voucher model used in the US. Critics of the proposal are concerned that it would dismantle public services and establish a two-tier healthcare system without reducing wait times. “This sounds more like an effort to subsidize private surgical clinics by driving business to them when improvements to public sector health services would be more efficient and of higher quality,” Heather Smith, registered nurse and president of the United Nurses of Alberta, said in a statement. “Albertans need to know immediately what the government is planning and who it has been talking to about how these plans would be implemented.”

Impact on Surgeons

According to Friends of Medicare, a nonprofit, nonpartisan coalition of seniors’ organizations, labor organizations, community groups, and physicians and patients, vouchers would only facilitate moving healthcare professionals from the public system into the private system, further compromising public capacity. “We could improve access by centralizing our wait lists or by expanding underutilized public capacity. We don’t need a convoluted voucher scheme to do that,” said Chris Gallaway, executive director, Friends of Medicare, in a statement. “Instead, we have operating rooms sitting empty and unused every single day because this government would rather double down on its failed privatization strategy than ensure that our public hospitals are funded and staffed properly,” he added.

Surgeons want more operating room time and would avail themselves of the opportunity to perform surgery at a smaller rural hospital for a few days each week or month, Wirzba contends. If the proposal focuses on the private system, then it raises concerns about anesthesia volume, as opposed to the surgery itself. “Do we have enough anesthesiologists to support [anesthesiologists] leaving the publicly funded hospitals and going to private ones? We’ve been advocating for greater utilization of the operating rooms in both smaller communities and urban centers. We’d like to see them used 7days a week,” he concluded.

Wirzba and Warner reported having no relevant financial relationships.

Evra Taylor is a widely published freelance medical writer and reporter with 20 years’ experience covering a broad range of therapeutic sectors, including family health, cardiology, psychiatry, ophthalmology, and dermatology.