HILL AND BARUA: Meaningful healthcare reform for Alberta?

In the wake of COVID-19, a panel led by Preston Manning last week delivered a report recommending changes and additional legislation to better prepare Alberta for future public emergencies. It includes a detailed discussion of how the province can improve the capacity and performance of Alberta’s healthcare system more broadly, which has the potential to lead to some meaningful reforms.As the report explains, Alberta is a relatively high spender on healthcare, yet has relatively poor access to important healthcare resources, which includes growing wait times to receive essential services.Alberta’s provincial health spending ranked second-highest per person (adjusted for age and sex) among provinces in 2021, the latest year of available data. At the same time, Albertans faced lengthy wait times — from doctor referral to treatment — that were 6.5 weeks longer than the national average (25.6 weeks.) More broadly, Canada is a relatively high spender among universal health-care countries, yet ranks near the bottom for the availability of medical technologies and hospital resources while Canadian patients also suffer some of the longest delays for access to care. Put simply, Alberta is a relatively high spender — and poor performer — in a relatively high spending and poorly performing healthcare country.Although the new report primarily focuses on guiding the response to future public emergencies, it also includes several recommendations that could help Alberta improve healthcare delivery more generally. Most notably perhaps, it suggests replacing the current funding model for hospitals (where hospitals receive a set budget each year, regardless of services/care provided) to what’s called “activity-based funding.” Activity-based funding pays hospitals based on the care and treatments they provide, so money follows the patient. In other words, rather than treating patients as costs to be minimized, there’s a clear incentive for hospitals to deliver care to more patients. This funding model is common in many universal health-care countries — including Australia, Switzerland, the Netherlands and Germany — which often outperform Canada on many key measures including wait times.The report also recommends expanding and maximizing the use of chartered facilities. Alberta has already taken some steps in the right direction by expanding the use of chartered private clinics to perform publicly-funded surgeries. A similar policy was part of an initiative in Saskatchewan that helped reduce wait times in that province from 26.5 weeks in 2010 to 14.2 weeks by 2014. And these private clinics in Saskatchewan delivered surgeries at a cost 26% lower (on average) than their public-sector equivalents. The health minister in Quebec has also cited the positive impact of contracting with private clinics to help reduce health-care wait lists.Given the dire state of Alberta’s health-care system, the province has a long way to go to improve care, access and services for Albertans. This recent report includes some important first steps to fix a broken system.Tegan Hill and Bacchus Barua are analysts at the Fraser Institute.

HILL AND BARUA: Meaningful healthcare reform for Alberta?

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