FREDERICTON -- New Brunswick's privately operated ambulance services lack oversight and underserve rural communities, the province's auditor general said in a report released Tuesday.

Kim Adair-MacPherson says the government's contract with Medavie Health Services New Brunswick gives a financial incentive to the company to understaff its operations.

Between 2007 and 2019, the province paid the company $8.8 million because of paramedic shortages. Adair-MacPherson said the company shouldn't have an incentive to keep staffing low.

"It obviously impacts the quality of the service when you don't have these paramedic vacancies filled," Adair-MacPherson said in an interview. "You want to put performance measures in place that do not negatively impact the service and motivate the contractor appropriately."

As of 2019, Medavie Health Services said there were 96 permanent paramedic positions vacant.

The report also noted that the performance-based payment system allowed Medavie Health Services to be paid fully even though it failed to meet service targets in some rural communities.

Adair-MacPherson's office reviewed the company's response times in fiscal years 2017-18 and 2018-19 and discovered, "out of 67 communities, 19 fell below the 90% performance expectation in responding to emergencies, non-emergencies or both."

But the company still received full performance-based payments, she said, because it combined its urban response times with rural response times, increasing its overall performance.

Health Minister Dorothy Shephard told reporters Tuesday her department will review the recommendations but said, "I don't want to come to a conclusion until we have bigger conversation about where we can take this."

"I think that we really need delve into some of what she said," Shephard said. "I can't ignore the fact that recruitment and retention has been a significant challenge in health-care sector throughout our province and throughout Canada."

The auditor general issued a slew of recommendations, including that the provincial government modify performance targets so the private operator is incentivized to deliver better services to citizens.

Adair-MacPherson said she was "encouraged" by the province's response to the report.

"I hope that the parties involved will agree to revisit the contract and address the issues and the sooner the better if it will improve the service," she said.

This report by The Canadian Press was first published Oct. 20, 2020.