EPOCH TIMES COLUMN: Alberta’s New ‘Activity-Based’ Health Care Funding is a Game Changer

When something’s been broken for decades and you’re dead-set on fixing it, what should you do?

Try one thing, watch it fail, then try it again… and again… and again?

Or look to someone else who has already dealt with the problem you’re facing and copy what they’re doing?

Finally, a Canadian premier is doing the latter on health care. Instead of simply shovelling more money into a broken system, Alberta Premier Danielle Smith is making a sweeping change that will make the system better and is already used in Europe, Australia, and other countries with better universal health-care systems.

Smith recently announced a great new health care policy: that her province would be switching to what she calls “patient-focused funding,” which is also known more commonly as activity-based funding.

To sum it up simply, Smith’s announcement means that hospitals will no longer receive a big cheque at the beginning of the year and then be asked to do their best. Instead, they will receive funding each time they help a patient.

This subtle difference completely changes the way the health system looks at patients.

Instead of being seen as an obligation, patients are now an opportunity. Hospitals will want to provide them care, since it means they’ll get more funding—which will also apply to non-profits and private clinics. This model will help drive innovation as providers compete to provide patients with the best care possible. And just like it is today, nobody will get a bill at the hospital.

It’s no surprise that countries that already use this model have better universal health care. Premier Smith pointed to Australia in her video, a great example, but Sweden, France, and many other nations also use activity-based funding. Quebec has been using the policy for a decade with good results.

Smith implementing it in Alberta is a huge step. It should help reduce surgical wait times, make health-care spending more efficient and, most importantly, save lives. But she and other provincial governments shouldn’t stop there.

So what’s next?

How about further looking to Europe for inspiration? In the European Union, patients have the right to travel to another EU country for care, pay for it, and then be reimbursed by their home government up to what it would have cost to do the procedure in their home country.

This opens up a world of opportunities. If the waitlist for hip surgeries is too long in Spain, a Spanish patient can go to Luxembourg, or Germany, or Poland, or anywhere where there’s extra capacity. And anytime a patient travels, the waitlist at home gets shorter by one patient. It’s a win-win.

It’s also effectively cost-neutral in the long run, since the government is only paying for what it would have cost to do the procedure locally.

So, for Smith, it’s an obvious next step that would further cut wait times and make care better for Albertans.

For the rest of the country, the next step is also obvious. Saskatchewan, B.C., and others should simply follow Smith’s lead. Roll out activity-based funding, watch the wait times drop, and then get on to further health reform.

It’s tough to imagine anyone having a problem with these strategies. Canada’s time-tested solution of shovelling more money into the system hasn’t worked. Spending on health care since 1993 has gone up well past the rate of inflation, yet care has gotten worse in every metric. Surgical wait times are higher than ever, more patients are dying on waitlists, and millions are without a family doctor.

So, two thumbs up to Premier Smith for doing something about it. But now is not the time to let up on the gas. Keep that pedal pressed down hard: it’ll make life better for Albertans, and hopefully inspire other provinces to follow suit.

Dom Lucyk is the Communications Director with SecondStreet.org, a Canadian think tank.

This column was originally published in The Epoch Times on April 15, 2025.
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Prevention – reduce demand in the first place

If Canadians lived healthier lives, we could reduce demand for emergency services, orthopaedic surgeries, primary care and more. 

For instance, if you visit the Canadian Cancer Society’s website, you’ll read that “about four in ten” cancer cases are preventable. The Heart and Stroke Foundation notes that “almost 80 percent of premature heart disease and stroke can be prevented through healthy behaviours.” A similar number of Diabetes cases are also preventable. 

Many joint replacements and visits to ERs and walk-in clinics could also be avoided through healthy living. 

To be sure, not all health problems can be avoided through healthy living – everyday the system treats Canadians with genetic conditions, helps those injured in unavoidable accidents and more.  

But there is an opportunity to reduce pressure on the health care system through Canadians shifting to healthier lifestyles – better diets, more exercise, etc. 

To learn more, watch our Health Reform Now documentary (scroll up) or see this column. 

Partner with non-profits and for-profit clinics

European countries will partner with anyone who can help patients. 

It doesn’t matter if it’s a non-profit, a government entity or a private clinic. What matters is that patients receive quality treatment, in a timely manner and for a competitive price.  

In Canada, governments often delivery services using government-run hospitals instead of seeing if non-profit or private clinics could deliver the services more effectively. 

When governments have partnered with non-profit and private clinics, the results have often been quite good – Saskatchewan, Ontario and British Columbia are just a few examples of where partnerships have worked well. 

Canada should pursue more of these partnerships to reduce wait times and increase the volume of services provided to patients.  

To learn more, watch our Health Reform Now documentary (scroll up) or see the links above. 

Make cross border care more accessible

In Canada, citizens pay high taxes each year and we’re promised universal health care services in return. The problem is, wait times are often extremely long in our health system – sometimes patients have to wait years to see a specialist or receive surgery. 

If patients don’t want to wait long periods, they often have to reach into their own pocket and pay for treatment outside the province or country. 

Throughout the European Union, we also find universal health care systems. But a key difference is that EU patients have the right to go to other EU countries, pay for surgery and then be reimbursed by their home government. Reimbursements cover up to what the patient’s home government would have spent to provide the treatment locally. 

If Canada copied this approach, a patient waiting a year to get their hip operation could instead receive treatment next week in one of thousands of surgical clinics throughout the developed world. 

Governments benefit too as the patient is now back on their feet and avoiding complications that sometimes come with long wait times – meaning the government doesn’t have to treat those complications on top of the initial health problem. 

To learn more, watch our Health Reform Now documentary (scroll up) or this shorter video. 

Legalize access to non-government providers

Canada is the only country in the world that puts up barriers, or outright bans patients from paying for health services locally. 

For instance, a patient in Toronto cannot pay for a hip operation at a private clinic in Toronto. Their only option is to wait for the government to eventually provide treatment or leave the province and pay elsewhere. 

Countries with better-performing universal health care systems do not have such bans. They allow patients a choice – use the public system or pay privately for treatment. Sweden, France, Australia and more – they all allow choice. 

Why? One reason is that allowing choice means some patients will decide to pay privately. This takes pressure off the public system. For instance, in Sweden, 87% of patients use the public system, but 13% purchase private health insurance. 

Ultimately, more choice improves access for patients. 

To learn more, watch our Health Reform Now documentary (scroll up) or watch this short clip on this topic. 

Shift to funding services for patients, not bureaucracies

In Canada, most hospitals receive a cheque from the government each year and are then asked to do their best to help patients. This approach is known as “block funding”. 

Under this model, a patient walking in the door represents a drain on the hospital’s budget. Over the course of a year, hospital administrators have to make sure the budget stretches out so services are rationed. This is why you might have to wait until next year or the year after for a hip operation, knee operation, etc. 

In better-performing universal health systems, they take the opposite approach – hospitals receive money from the government each time they help a patient. If a hospital completes a knee operation, it might receive, say, $10,000. If it completes a knee operation on another patient, it receives another $10,000. 

This model incentivizes hospitals to help more patients – to help more patients with knee operations, cataract surgery, etc. This approach also incentivizes hospitals to spend money on expenses that help patients (e.g. more doctors, nurses, equipment, etc.) rather than using the money on expenses that don’t help patients (e.g. more admin staff). 

To learn more about this policy option, please watch our Health Reform Now documentary (scroll up) or see this post by MEI.