University of Calgary Associate Professor, Lorian Hardcastle, speaks with Alberta Primetime host Michael Higgins about the provincial government’s plans to create urgent care centres.
This interview has been edited for clarity and length.
Michael Higgins: With Alberta’s population continuing to grow, how do you view this as a move to build capacity within the system?
Lorian Hardcastle: I think it is an important need that we have in the system. Of course, the long wait times in ERs are well known, and being able to send patients somewhere other than the emergency room helps things.
I think we’re also seeing more and more patients who don’t have family doctors or other primary care, who end up needing somewhere to find care if their conditions get bad enough, and they become sick enough. So certainly this fills the gap there.
MH: Is it a stop gap measure? How do you see the proliferation of urgent care centres factoring into Alberta’s health delivery model moving forward?
LH: In some ways it can be a stop gap if we’re running into situations where patients don’t have primary care, or don’t have a family doctor, and are waiting and getting sicker, and their situation is getting bad enough that they require urgent care.
That, of course, is not ideal at all, and we don’t want people to be turning to urgent care centres because they don’t have primary care. But if you have someone who, for example, does have primary care, but has an urgent health care need arise on a weekend or in the evening when their family doctor isn’t open, this can be a good place for them to get services that isn’t going to the ER.
MH: The government says the centres will be run by AHS and publicly funded. Now, with the overhaul of health care, AHS also being transitioned from sole health authority in the province to a contracted service provider. How do you see that changing dynamics around contracts to run urgent care centres?
LH: It isn’t clear if AHS will continue to run all of these urgent care centres, or if we may see other entities delivering urgent care, just as we’re starting to see for profit entities operating surgery facilities.
That said, I think probably the economics of privately delivering surgical services is more appealing to those for-profit providers, than is operating urgent care. There’s a lot of uncertainty in urgent care, and these sorts of things, that make it perhaps less financially appealing to deliver those kinds of services privately. I do think probably we would continue to see AHS operating these facilities.
MH: How precedent setting is it that there is a private contractor driving development around the urgent care facility in Airdrie?
LH: I think it’s unexpected, perhaps, and something that we haven’t seen there already, though, is private delivery walk in clinics. So walk in clinics that are operated by groups of family doctors or even chains in some cities.
Those are currently private delivery and so there is some precedent for it at the walk in level, maybe less so in the urgent care space.
MH: How far will this go to filling a health care gap in a city the size of Airdrie, where there is already an urgent care facility but there isn’t a hospital? Could this free up the province from having to build a hospital in a city the size of and growing 80,000 plus?
LH: I think there’s always these cost benefit analysis in terms of when is the population big enough and its health care needs acute enough to need a hospital? When can we get by with just urgent care?
The other conversations that we can sometimes see are, you know, if there is going to be urgent care centres, are they going to be 24 hours? What are their hours? There have been tragic situations in the not so distant past where patients thought that urgent care facilities in some of the communities around Calgary were open 24 hours and went to get care there and found out they weren’t, so there’s issues around how many urgent care centers, and what hours they have.
The other issue is, of course, the staffing issue. You can open facilities, you can build hospital beds, but do you have the staff to operate them? If we’re going to open these facilities, where are the doctors coming from? Are we pulling them from the community where they’re treating patients as family doctors? Are we pulling them out of the hospitals?
We also have to think about where those physicians are using their time, and what we might be taking them away from if we open these facilities.
MH: Are there signals to be read here where hospital infrastructure is concerned? There was reference in the recent provincial budget to an April 1 shift in ownership of hundreds of health facilities resulted in columnist headlines asking if public hospitals are to be sold off.
LH: I think that we’re going to see a period of transition over the next few years with AHS becoming more of just an operator of acute care and hospitals, and not in other parts of the health care system.
Then will we also see other people get into the hospital space? Will we see more Covenant facilities? Will we see other facilities?
We don’t know what hospitals are going to look like in a few years, but it is clear that they’re having serious capacity issues. And so the more that we can do downstream with urgent care, with making sure everyone has a family doctor, potentially easing some of that burden, is useful.
