Last week, Alberta Minister of Health Jason Copping dismissed me and other members of the board of Alberta Health Services, the provincial health agency tasked with delivering health services to Albertans. I am OK with that. We knew we weren’t being fired for doing a bad job. Quite the opposite.
The real problem is that AHS, an administrative body, cannot fix problems on its own. That often requires policy changes, which are the responsibility of Alberta Health, the government department where Mr. Copping is minister. It sets policy, legislation and standards for the province’s health system.
The government’s decision to shift from a part-time board to a full-time administrator reporting to the premier and minister of health provides a golden opportunity for significant reform to deal with current stresses in the health care system.
These stresses are not new. Government after government — whether Progressive Conservative, NDP or United Conservative — has failed to fix the system. As a 2019 report documented, despite being the country’s second highest per capita spender on health care (after Newfoundland & Labrador) Alberta has mediocre health results.
After receiving that report, the province did adopt a number of efficiencies, such as contracting out non-essential services, digitizing records and optimizing assets to bring per capita costs down to the average of the four largest provinces. It also held the line on salary increases. The NDP had frozen non-unionized staff salaries beginning in 2015, though, not surprisingly, that has made it hard to hire non-unionized professional staff. In any case, the result of these efforts is that Alberta has now brought its per capita spending down to levels similar to those in other provinces.
But then the pandemic created new stresses. It laid bare the underinvestment in acute care beds over the years to save on costs. Whether by luck or prescience, the Kenney government increased the number of acute care beds just months before the pandemic hit. But it was not enough so AHS doubled ICU capacity. With doctors and nurses pressed to deal with COVID, wait times for surgeries soared. COVID hospitalizations are now way down but illness and early retirement have created labour shortages. Mandatory vaccination, now abandoned, also didn’t help.
Like other provinces, Alberta has too few doctors and nurses, especially in rural areas. Ambulance crews often wait for hours to transfer patients to under-staffed emergency wards. There are fixes for these problems but they often require policy changes, which is not part of the AHS mandate.
The province could alleviate shortages by training more doctors and nurses in its post-secondary institutions. But the costs of doing so are high so the government would have to move funds from other areas to universities. Or the province could import more health professionals from other provinces or abroad but that would require a sea change recognizing foreign credentials.
More doctors and more efficient use of operating space and surgical teams’ time could reduce wait times for surgeries. AHS has already centralized surgical bookings, reduced wait times for consultations and expanded partnerships with non-profit and for-profit clinics. It could do much more — for instance, easing the pressure on hospitals by contracting-out more services to primary care operations.
If Albertans took their non-emergency health problems to clinics or their doctors more often, hospital emergency services could be improved. More paramedic teams are needed in rural areas, where ambulance teams often aren’t available 24/7. Incentive-based policies — for example, a penalty charge on hospital budgets for delaying transfers beyond a set time — have been found to reduce EMS transfer times dramatically.
When I served on the 2014 federal task force on health-care innovation, consultations made it clear that Canada’s health-care system, second worst among 12 countries according to Commonwealth Fund studies, suffered from insufficient focus on patient care as well as a lack of integration of Medicare and non-Medicare services.
Canadians understand health care’s Soviet-style central planning model has to change. Some analysts favour a shift to European-style systems with better integration of public home care, long-term care and dental care, as well as parallel private integrated systems. Others argue for a single-payer system with more opportunities for privately operated primary care and clinics, which many provinces already have. In 2002, Alberta’s Mazankowski report recommended the same kind of co-payments many European countries use as incentives to encourage better use of medical services.
Maybe Albertans anxious about their health-care system are more open to radical changes. At the very least, and less controversially, governance could be improved. As many AHS workers have argued, decision-making should be decentralized — though without restructuring AHS into regional bodies. More contracting out of services to clinics and further digitization of both services and records would provide significant benefits.
Real reform will require big policy and governance changes. I wish new AHS administrator John Cowell, Minister Copping and Premier Danielle Smith every success in finally fixing health care. It won’t be easy but if they do succeed, all Canadians could benefit, for Medicare’s problems are nationwide.