The Alberta government recently announced that it’s going to “de-privatize” community-based lab testing in Calgary and the southern regions of the province.
The move is eyebrow-raising for a couple of reasons.
First, the United Conservative Party is ideologically enthusiastic about privatization, and this is a significant climb down. The about-face comes just eight months after Alberta signed a 25-year deal with Dynalife, a private, for-profit company that has been providing these same services in Edmonton and northern regions of the province for decades. (And doing it well.)
Most lab tests are paid for publicly. So, not much should have changed for patients – except better service, hopefully. But since the privatization last year, the waits for tests and results have skyrocketed, and the public’s impatience has grown, forcing the government’s hand.
Practically, what will happen is that Alberta Precision Laboratories, a government-run service that already oversees much lab testing in the province, will take over staff, equipment and facilities from Dynalife.
The initial deal was touted as a big money-saver, between $18- and $36-million a year, and while it’s unclear how much this de-privatization will cost taxpayers, it will certainly be a bundle. Clearly, more staff and facilities are needed.
It’s also not a given that the problems that exist will be easily resolved. Regardless of ownership, public or private, there are still significant shortages of lab workers, the demand for testing continues to grow, and laboratory testing is just one puzzle piece in an overwhelmed and sometimes dysfunctional health system.
Laboratory services are a labyrinth in almost every province and territory, the issue just hasn’t exploded into the public realm elsewhere as it has in Alberta. Yet.
So what larger lessons have we learned from the Alberta experience?
One is that contracting out services to private companies (which is commonplace) is not inherently good or bad. As mentioned, Dynalife has been overseeing lab work in half the province for a long time, and doing so efficiently.
But private companies do not automatically deliver efficiencies either. The promise of “enhanced services at lower cost,” as was touted when Dynalife got its big new contract in 2022, is often fanciful nonsense.
A report a few years back from Alberta’s provincial Health Quality Council estimated that private lab services cost 10 per cent to 15 per cent more than publicly run ones.
The Health Quality Council also recommended building a provincial superlab. The NDP government of Rachel Notley acted on that recommendation and invested millions in the project, which was also a response to a promise of mass privatization by the prior government of Jim Prentice. The former Conservative premier had awarded a 15-year, $3-billion lab services contract to the private Australian company Sonic, which the Notley government cancelled. But then, when the NDP lost power, the Conservative government of Jason Kenney nixed the superlab, and embraced decentralization again.
The saga has been dizzying and driven largely by ideology.
An important lesson here is that this constant flip-flopping and futzing around serves no one. We need to get the petty politics out of health care. And we need to recognize that stability is important, especially for workers.
There is a lot that needs fixing in Canadian health care – lab services, but also primary care, emergency rooms, surgical wait times, electronic health records, long-term care, and so on and so forth.
But there’s a lot that works. We don’t need to blow things up, Alberta-style. We can make change thoughtfully. For all the problems and challenges that exist, we shouldn’t forget that much of the health system works well. We can scale up our successes, or at least leave them alone.
Alberta has an odd mix of community-based lab services delivery – private in the north, and public in the south. It worked relatively well, for whatever reason. Tradition? Culture?
And then, ideologically- and politically-motivated change messed everything up.
The reality is, we already have a mix of private and public delivery of publicly funded services in Canada. (Private funding is a different issue.) We need to try and get the mix right.
Reform needs to be driven by clear goals, from improving access to value for money. There need to be clear metrics to measure if those goals are being met, and accountability.
Which entity delivers a service – in this case, the publicly owned Alberta Precision Labs, or the privately owned Dynalife – matters little to patients.
What matters is timely, efficient service: In this case, getting an appointment conveniently and quickly, and getting the results promptly.
That’s where we need to keep our focus: the quality of care.