Globe and Mail
Dawn Walton
Tuesday, October 15, 2002 – Page A6

CALGARY -- Stephen Miller doesn't look like the bogeyman.
But since opening a for-profit surgery centre in Calgary five years ago, that is how this button-down and bifocal-wearing doctor says he has found himself portrayed.

With Alberta's recent approval to turn his facility, Health Resource Centre, into the province's first private provider of major surgery that requires overnight stays, Dr. Miller faces renewed attacks.

Left-leaning political parties, unions and some health-care workers are worried that Dr. Miller's clinic yanks another brick from an already shaky foundation of Canada's universal medicare system.

The federal Health Minister has chastised Alberta for allowing HRC's expansion only weeks before Roy Romanow releases his royal commission's report on the state of health care.

While Dr. Miller insists that HRC helps in the delivery of public health care, it is his other motive that worries some.
"Profit is a good word in every industry except health care," says Dr. Miller, HRC's medical director. "Why is it that profit is such an ugly thing? There has got to be an awakening here for people."

That sentiment does have high-profile allies. Action Démocratique du Québec Leader Mario Dumont wants to see more hospitals run privately, as does Canadian Alliance Leader Stephen Harper.

HRC has 37 beds and three operating rooms and occupies 2,500 square metres on the third floor of what was once a maternity hospital.

The colour scheme is earth-tone. Carpeted floors avoid the institutional squeak of tiles. Patients have high-speed Internet access in their rooms.

This place does not have the feel of a big, not-for-profit hospital. But it is increasingly doing work that was once not done except in public institutions.

About 5,000 surgical procedures have been performed at HRC. The centre's startup cost was about $4-million, all from private investors. Dr. Miller won't talk profitability, but notes: "We're still here."

Indeed, HRC has found a home in market-driven Alberta, where the Conservative government has given it the green light to add to its menu total hip, knee and shoulder replacements, spinal laminectomies and spinal fusions.
These are more complex procedures than the breast implants and joint work that HRC has been doing, and they require overnight stays. The HRC soon will perform the first of its newly approved procedures; 441 will be allowed each year.

These procedures fall outside the rubric of the Canada Health Act.
Patients would include members of the Armed Forces, clients of the workers compensation board and RCMP officers. Residents of other provinces and territories can go to HRC, but no Canadian can pay directly for these procedures; their insurance providers would have to agree to pay the tab.

Alberta taxpayers will not foot the bill, Health Minister Gary Mar promised in making the announcement.
While the change is unique to Alberta, it's not a first for Canada.

In British Columbia, the Cambie Surgery Centre has been performing procedures, such as knee replacements, that require overnight stays since 1996.

It cannot perform all the operations that HRC is permitted, but it also operates on patients outside the confines of federal legislation.

In Thornhill, Ont., physicians at the Shouldice Hospital have been performing hernia surgery since 1945. Patients are required to stay for four days and, in some cases, the provincial health-care system pays.

The for-profit work at Shouldice was "grandfathered" because it existed before the introduction of medicare.
There are thousands of these kinds of surgical facilities in the United States, but just a handful here. (Canada does have hundreds of private day-procedure facilities for procedures such as oral and plastic surgery.) In the U.S., private-sector surgery has become a competitive industry.

"The future will be these facilities. We will no longer see this institutionalized health-care delivery in large, monstrous hospitals," says Mark Godley, medical director of the private, for-profit False Creek Surgical Centre in Vancouver, where patients can be kept for up to 24 hours to recover from surgery such as complex ankle and knee work.
He points to growing waiting lists for treatment in Canada as reasons to give private health care a larger role.
Waiting times between referrals and treatments from specialists have risen to 16.5 weeks in 2001-02 from 16.2 weeks in 2000-01, according to the Fraser Institute's survey of specialists. It notes a 77-per-cent jump in waiting time since 1993.

While the institute's methodology has been criticized, the number of public hospitals is shrinking despite an aging and growing population base.

According to the Canadian Institute for Health Information and Statistics Canada, there were 1,233 hospitals in Canada at the end of fiscal year 1984-85. Now there are 753.

There were 177,008 hospital beds in 1984-85. Now there are 117,102.

About 3,500 people were treated at Cambie last year, medical director Brian Day says. Some patients were from other provinces and countries, but most were British Columbians.

"If we didn't exist, there would be 3,500 people last year who were on the wait list," says Dr. Day. "We're not creating illness. We're not creating injuries. Those patients would otherwise be tagged on the back of the public wait list."
The thought of surgical entrepreneurs paring down the queue scares a lot of Canadians who grump about it but have grown used to lineups.

Wendy Armstrong, a spokeswoman for the Alberta Chapter of the Consumers' Association of Canada, said she has found no evidence that private surgery centres curb the cost of health care or the queue.

"The reason is you've got the same person servicing both lines. It's like one worker at McDonald's and two windows. It's deceptively appealing," Ms. Armstrong says.

In terms of health care, she worries that those waiting at the private-sector window will be served first because they pay more.

Dr. Miller hopes the Romanow report will expand the role of the private sector, but says he's not talking U.S.-style user-pay. "You don't see anyone in there using a credit card buying their care."
His critics fear that, one day, you will.

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