Health region could not prove cost advantage
One of Saskatchewan’s largest unions is claiming a partial victory after challenging a provincial government initiative to shorten surgical wait times by contracting out some surgeries and dental procedures to third parties.
CUPE sought an expedited arbitration last month after the Regina Qu’Appelle Health Region signed a contract with Omni Surgery Centre, a private surgical clinic in Regina, to perform up to 500 knee and dental surgeries by the end of this fiscal year. The health region also announced plans to sign a longer term contract for CT (computer axial tomography) scanning and surgical procedures.
The provincial government, which has directed its health regions to look at third parties to ease wait times across Saskatchewan, said knee surgeries would cost $179 less at Omni and dental procedures would be $76 cheaper.
“We were in a unique position to challenge this decision,” said CUPE national representative Suzanne Posyniak. “The Saskatchewan Party government wants to introduce third party health care. We challenged the assertion that it can be done at a lesser cost.”
Posyniak argued the contract with Omni would cost more and that under the terms of the collective agreement, the health region could only contract out health services if it would “significantly increase the cost effectiveness and maintain the quality of health services provided.”
Arbitrator Daniel Ish sided with the union but agreed to allow the health region to continue contracting out surgeries and diagnostic tests until 2013.
In his ruling, he noted the government’s Saskatchewan Surgical Initiative pledge that stipulates by 2014 no resident will have to wait more than three months for surgery. He agreed with the health region’s position that it is operating at full capacity and could only reduce the present backlog by contracting out some surgeries and procedures.
However, Ish ruled the health region did not demonstrate that third party contracts are less costly than doing the work in-house.
“Even if additional capital expenditures have to be made, in the long term there is little doubt that the internal costs of carrying out both surgical and CT procedures would be less than the costs associated with the provision of those services by a third party,” he wrote in his decision.
The costing methodology was crucial to his decision and, ultimately, to whether employing a third party in this case breached Article 6.02 of the collective agreement.
Ish said the union had effectively called into question a number of uncertainties in the costing including the number of minutes attributed to direct staff costs for each procedure, the data used to calculate salary and benefits savings, the subsidizing effect of clauses in the third party contracts relating to information technology and EMS transport, and the lack of costing for oversight of the contracts.
Ish said a more accurate costing would be necessary to make a precise comparison between the cost of in-house procedures and third party costs in the longer term.
Posyniak was pleased with his assessment, but not with the decision to allow the current third party contracts to continue.
“We would have been happier if (he) had acknowledged there was capacity in public hospitals,” said Posyniak. “For example, with CT scans, the region never books appointments in the evening or on weekends. But (the decision) has put the provincial government on notice to tread carefully.”
The health region has disputed the union’s claims over capacity and said other factors, such as the availability of qualified staff to run these machines, play a role in the current backlog.
CUPE’s collective agreement covers five of 12 health regions in Saskatchewan.
