Failing to Deliver The Alberta Surgical Initiative and Declining Surgical Capacity

Announced in 2019, the Alberta Surgical Initiative (ASI) represents a significant expansion of for-profit, corporate health care. In February 2020, the Alberta government announced it would spend $400 million outsourcing surgeries to for-profit facilities and committed to doubling the number of outsourced surgeries over three years, from 15 per cent to 30 per cent of total surgeries provincewide. These publicly funded surgeries would be paid for by Alberta Health Services and the Alberta Health Care Insurance Plan, but performed in private, for-profit facilities. While only three years of data are available so far, the significant costs and risks to Alberta’s public health-care system are already apparent. Through Freedom of Information requests, statistical analysis, and a review of the research literature, this report evaluates claims made by the Alberta government about the effectiveness of the Alberta Surgical Initiative in reducing wait times and the role of for-profit surgical outsourcing. This report finds that Alberta has among the worst performance in reducing surgical wait times in Canada. The province has prioritized for-profit surgical delivery rather than system improvement and fully utilizing the nearly 30 per cent of unused public operating room capacity. Contrary to government claims that outsourcing to for-profit facilities increases provincial surgical capacity, data suggest that the expansion of chartered surgical facilities (CSFs) has diverted resources away from public hospitals and, in turn, reduced provincial surgical volumes. Under the Alberta Surgical Initiative, provincial surgical activity has failed to increase from pre-pandemic levels, and public hospitals face reduced capacity and operating room funding. And yet, investor-owned surgical facilities are expanding through substantial contracts with the government. Between 2018-2019 and 2021-2022, surgical volumes in chartered surgical facilities increased by 48 per cent while surgical activity in public hospitals declined by 12 per cent.