second_street_canada_journalism_stories_people_politics_government_2
DONATE
Facebook-f X-twitter Instagram Youtube
DONATE

Read the Column

FINANCIAL POST COLUMN: Alberta takes the lead on health care reform

If we all resolve to be honest for the New Year, we can agree that no Canadian political party has done a good job on health care over the past 30 years. Liberals, Conservatives and NDPers have all had several turns running provincial governments yet no one has delivered acceptable results consistently.

Why? Because they’ve all largely done the same thing: spend more money and hope things work out. Canada is one of the higher spenders in the world on health care and yet we are in crisis pretty much coast to coast. Just think of the famous definition of insanity: doing the same thing over and over but expecting different results.

This is why it’s such good news that one province is finally going to break this cycle.

Alberta Premier Danielle Smith is moving the province’s health-care system closer to Europe’s systems, which measure their wait times in days, not months or years. When our organization has travelled to Sweden and France to study health care, experts in those countries have looked at us as if we were crazy when we described how Canadian patients often have to wait a full year for surgery.

One significant difference between Europe and here is that European systems fund health services for patients while most provincial governments in Canada, including Alberta, send a large annual cheque to a network or hospital and in effect ask them to do their best. That’s the equivalent of walking into a grocery store, handing over $300 and saying, “please give me lots of groceries.” No one would do that. There’s no accountability for what you’d actually get. Yet that’s what our health system does.

In contrast, most European countries use “activity-based funding.” Governments provide hospitals with money every time they deliver a service. When a hospital does a successful knee replacement, say, it might receive the equivalent of $15,000. That gives it the incentive to help more patients. Activity-based funding also incentivizes hospitals to spend money helping patients rather than hiring more admin staff or running their own Tim Hortons, which has caused one Ontario hospital to lose $3 million over the years. Part of Alberta’s plan is to move toward the European approach.

A second major change Alberta has announced is to allow more patients a choice: use the public system or pay for treatment at a private clinic, thus bringing Alberta’s system more in line with France, Sweden and other countries that allow such a choice.

We do have private clinics in Canada but they operate under crazy restrictions. For instance, the only private clinic in Canada offering a specialized type of back surgery is located in Calgary. Yet government barriers mean it may not serve Albertans, only those from outside the province. This kind of nonsensical barrier is common across the country, except in Quebec. Not surprisingly, many patients end up travelling to other provinces or the U.S. to get surgery that is being done on a regular basis in their own province. As a result of the changes Premier Smith has announced, however, Albertans will be able to get the treatment they need in Alberta. Welcome back common sense; we’ve missed you!

Finally, the Smith government is going to make it easier for patients to diagnose diseases earlier or even prevent them in the first place. Right now, a patient with a family history of a particular disease who wants an annual scan to detect it can wait for the public system or pay privately. Either way, a doctor’s referral is required.

Soon, however, patients willing to pay privately won’t need a referral. And if something serious is detected, the government will pay for the scan. Early detection could save both lives and resources, as it’s much easier to treat diseases caught early.

To be sure, not everyone likes these changes. Health-care unions, the third parties they fund and Alberta’s opposition leader are already trotting out the tired old fear-mongering of “Americanization.” If only they would travel to Europe to see firsthand how the new policies announced by the Smith government actually work, they’d understand Albertans have no need to fear “Europeanization.”

We will all have to wait and see how effectively the government implements these changes. But at least Alberta is trying something bold when it comes to health care. The status quo clearly isn’t working.

Colin Craig is president of the think-tank SecondStreet.org.

This column was originally published in The Financial Post on January 6, 2026.

Share on Facebook
Share on Twitter

You can help us continue to research and tell stories about this issue by making a donation or sharing this content with your friends. Be sure to sign up for our updates too!

GET UPDATES
DONATE

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.