What Danielle Smith’s 2021 pitch to contract out hospital services is all about | CBC News

The Alberta NDP raised concerns Wednesday about a 2021 video of UCP Leader Danielle Smith speaking at a conference about potential reforms to the health system, with the NDP characterizing it as a “shocking” revelation that Smith plans to sell public hospitals to private operators.

Even if the UCP points to its “public health-care guarantee” — which states that no Albertan will have to pay out of pocket to see a family doctor or to get medical treatment — what was Smith talking about, and what would it actually mean if implemented?

All of this revolves around privately delivered, publicly funded health care, which has existed for years in Alberta. We’ll explain all of that in a moment, but let’s get into the details of the video first.

2021 video

The clip in question starts a little more than 30 minutes into her talk at the FreedomTalk conference in October 2021. Smith turns to a discussion of major hospitals in Alberta.

In the video, she laments the arrangement under which Alberta Health Services operates hospitals but also evaluates their own performance. 

AHS has various performance metrics they are required to report on publicly.

“Guess what they say? They say, we’re doing fantastic. Now, think about splitting these roles,” Smith said. “You give money to Alberta health insurance. It’s a separate entity. It’s a government entity, so it’s publicly administered.”

Smith goes on to pitch the idea that the Alberta Health Quality Council, a provincial agency focused on improving health service quality in Alberta, could serve as a sort of auditor. 

It would determine whether or not AHS should continue to run hospitals like the Peter Lougheed Centre or the Rockyview General Hospital.

“If they can’t meet the terms that we want them to, we can do an [request for proposal], and then the Alberta health insurance can give a different contract to a different group of doctors and a different group of patients and a different entity to run all of our hospitals. That is completely compliant with the Canada Health Act,” Smith said.

She also said she had presented her plan to Alberta’s health minister, who at that time was Jason Copping, but said the UCP government under Jason Kenney at the time did not act on her suggestions.

At a press conference Wednesday, Kathleen Ganley, the NDP candidate in Calgary-Mountain View, called the video “part of a defined pattern of extreme views” from Smith.

“Danielle Smith thinks you can sneak around the Canada Health Act to sell off our hospitals to private individuals and corporations,” Ganley said.

Public vs. private

It’s important to remember that Alberta already has privatized health care, and has for years. There are various publicly funded, privately delivered options.

Under the Canada Health Act, charges for “medically necessary” services, provided in a hospital or by a doctor, can’t be charged back to a patient.

But when it comes to publicly funded health-care arrangements with private corporations, Alberta has plenty, including privately run, publicly funded surgical facilities, as well as privatized community lab services.

Those arrangements have their fair share of detractors, who worry about profit motivations for companies with limited transparency. They also have supporters who feel as though such arrangements might be able to drive efficiencies in the system.

When it comes to this latest resurfaced video from Smith, Fiona Clement, a professor who specializes in health policy in the department of community health sciences at the University of Calgary, says there’s not much new to pick up on.

“She’s absolutely correct in her interpretation that provincial governments can contract with any different entity that they wish to deliver health care,” Clement said. 

“It’s the same kind of model as the private surgical delivery system. I mean, she’s absolutely correct in her interpretation of what’s allowable and what’s possible.”

That’s not to say that such a move would be simple.

AHS is accustomed to delivering care in Alberta, Clement said. They have an infrastructure, an organizational structure, a governance structure, relationships — things that organizations need to run.

Asking an entity to run a hospital, for example, is a complicated task, and one that AHS is very experienced in handling.

“Logistically, thinking about what other kinds of groups are out there that could run a hospital, that’s not an obvious answer to me,” Clement said.

AHS has also made massive investments into electronic medical records, which means that patients who visit AHS facilities have all of their data available to care providers.

“Any private provider would either have to negotiate sharing that system with AHS or opt out, which would not be great from a patient perspective,” Clement said.

Delivering health-care services is a hard job, with a lot of components out of the system’s control, Clement said. And as to whether another delivery service could do it better? 

Clement said she seriously doubts it, though added it all comes back to reporting, transparency and accountability.

UCP has made public health-care guarantee

CBC News requested more information from the UCP in regards to whether or not any of what Smith discussed in 2021 might be possible under a re-elected UCP government.

Dave Prisco, director of communications with the UCP, didn’t answer that question specifically, but did make reference to the UCP’s “public health-care guarantee,” which states that no Albertan will have to pay out of pocket to see a family doctor or to get medical treatment. He also referenced an agreement signed by Alberta with Ottawa worth $24 billion over 10 years.

“The NDP are doubling down on their fear and smear tactics, because they have no real plan for anything,” he wrote.

“The UCP has a plan to improve Alberta’s public health-care system for all Albertans, and that plan is working. The NDP has no plan for anything — just old videos.”

When asked by a reporter Wednesday what would be the major issue with private hospitals being publicly insured, Ganley said it revolved around private health-care providers being able to choose the least complicated patients with the least complicated cases.

“That puts a lot of pressure on our public system. I think we can look south of the border and we can see fairly clearly what the results of this sort of health-care are. They’re incredibly problematic,” she said.