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Facts about Health Reform in Alberta

The Alberta government is making the province’s health system more like universal, public health care systems in Europe.

What does this mean for patients?

SecondStreet.org has routinely documented and analyzed health care decisions made by the Alberta government. This includes noting both praise and criticism when deserved. We put this page together so Albertans know the facts about what’s going on.

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The Problem

For the past 30 years, provincial governments in Canada – NDP, Conservative, Liberal, and otherwise – have all failed to deliver acceptable health care services consistently.

Why? Because they’ve all done the same thing – throw money at the system and hope it helps.

Despite being among the highest spenders in the world, Canada’s system has some of the longest wait times ‒ for surgery, for emergency room care, to get a family doctor, etc. 

We need to do something different. We need to copy what works well in better-performing public, universal systems in Europe. 

Why Copy European Systems?

Left-of-centre and right-of-centre research organizations routinely conclude that public universal health care systems in Europe perform better than Canada’s system.

Systems in France, Sweden and many other EU countries have what Canadians want – a public system where everyone is covered, and quality care is delivered in a timely manner.

What Is the Alberta Government Doing to Make the Health System More Like European Systems?

There are three significant changes that the Alberta government has announced. This video provides a quick briefing:

The Alberta government has announced that, just like in Europe, it will soon be much easier for Alberta patients to have a choice – use the public system or pay for treatment at a non-government clinic.

Why? This will give Alberta patients more options locally instead of having to travel.

However, it also helps take pressure off the public system. Each time someone does decide to pay, everyone on the government waitlist moves up a spot.

The government refers to this change as the “dual practice surgery model” because what they’re doing is making it easier for surgeons to work in both systems instead of making them choose between one or the other. Under the current rules, surgeons were not allowed to work in the public system and use their spare time to treat patients privately. Thus, there are many stories of governments not providing surgeons with enough operating time in the public system, so instead of helping patients in their spare time, surgeons play golf or fly outside the province to earn extra income. All the while, patients suffer because of ideology.

Under the new rules, a surgeon will be able to work most of their time in the public system and perform surgeries on the side for patients who are willing to pay privately.

Right now in Canada, including in Alberta, most provincial governments provide hospitals with large cheques each year and then ask them to do their best.

This would be like giving $300 to a grocery store and asking them to give you “lots of groceries.”

There’s no accountability this way. Better-performing universal systems have moved away from this model.

What European systems often do is provide hospitals and clinics with funding each time they help a patient. For example, they might provide a hospital with $20,000 each time they finish a knee operation.

The European approach:

  • Incentivizes hospitals to help more patients because it means more revenue every time a patient comes in the door.
  • Results in hospitals focusing funding on doctors and nurses instead of bureaucrats and overhead.
  • Depoliticizes the public private debate by ensuring money follows the patient to wherever they need treatment – whether it’s a public hospital, or a private clinic contracted by government.

In Alberta, the government refers to their European-style funding approach as “patient-focused funding”, but it’s also known in other countries as “activity-based funding.”

To be sure, we will have to wait and see how well the government implements this shift, but it’s very encouraging to see this announcement.

To learn more, read this report by SecondStreet.org Research Director Bacchus Barua ‒ click here.

If you have a family history with a particular type of cancer or another disease, you may want to have regular diagnostic tests to make sure you’re healthy or able to catch the disease early.

Depending on the type of test, this generally means you need to visit a family doctor and get them to provide a requisition each time you receive such a scan – a system commonly referred to as “gate-keeping”.

The government is changing this so that patients will still have the option of receiving such a scan through the public system, but will also let patients pay for a scan at a non-government clinic without a doctor’s requisition. Moreover, if a significant medical condition is detected, the government will reimburse patients for the cost of the diagnostic test.

When SecondStreet.org visited Sweden and Japan in particular, we found they focus more on prevention.

To learn more – click here.

Other Questions

No. The government has stated that everyone will still be able to access the public system like usual and won’t have to pay for visits to their family doctor, for surgery, etc.

(Remember that even if the government wanted to charge patients, it would violate the Canada Health Act, and they would face funding cutbacks from Ottawa so this claim is highly unlikely.)

However, if someone doesn’t want to use the public system, they can pay for treatment at a non-government clinic.

 

Look at the chart below and see for yourself if Alberta will be more like European systems or the U.S.?

 

U.S.

Alberta

Europe

PUBLIC

X

✓

✓

PRIVATE

✓

✓

✓

Obviously, Alberta is moving closer to European models by switching its “X” in the private category to a “✓”. People who claim the government is “Americanizing” health care are trying to scare you.

It’s common in other universal health care systems to impose some restrictions on health care staff to ensure there are enough staff available to work in the public system.

For example, in Ireland, physicians must work a certain number of hours in the public system before working privately. In France, physicians who have contracts with a public hospital can earn no more than 30% of their income from private sources. Australia has a more flexible approach where contracts are negotiated – however, these often involve committing a certain minimum number of hours, and only undertaking private practice outside of regular working hours. In the United Kingdom, doctors who have contracts with the public National Health Service (NHS) must generally prioritize their duty to the public hospital. They must disclose private activity to their public employer, not discuss private treatment during a public consultation, ensure no conflict of interest – specifically that their private practice does not “result in a detrimental effect on NHS patients or services, nor diminish the public resources that are available for the NHS.”

The Alberta government announced they too will have safeguards in place to ensure there are enough staff to work in the public health care system as it allows dual practice. This is why they are also considering policy options such as requiring a dedicated number or ratio of surgeries in the public system to be eligible to perform surgeries privately, restricting the types of specialities where dual practice would be appropriate, and potentially only allowing private practice on evenings and weekends.

SecondStreet.org will update this section as more details emerge.

It’s not clear but the changes won’t happen overnight. Change may take a while depending on the policy in question.

For example, changing the funding structure to incentivize more output from health providers will take some time. Once it is implemented it will take a while before we see results.

Conversely, allowing non-government providers to offer private services (without having to opt-out of the public system) should be easier to implement. Non-profits and for-profit entities tend to move faster than governments.

Yes. 

We have critiqued and praised the Alberta government for various health care announcements, but the new changes we discuss on this site are positive for patients. 

They’ve been proven to work well in European countries and other developed countries like Japan, and it’s time they were implemented in Canada – Alberta is leading the way.

Change will take time, but the status quo is not an option. Far too many patients are suffering in this country. We need to improve our public system and increase the choices available for patients.

The Cross Border Directive: The government should also implement a policy from the European Union known as the Cross Border Directive.

In short, it allows EU patients to travel to another EU country for surgery, pay for it and then receive reimbursement from their home country. Reimbursements are up to the same amount the home country would pay for treatment locally.

This policy helps EU patients avoid long wait times in their home countries.

Right now, in Alberta, many patients don’t have time to wait for the government’s health care changes to take effect. This policy could help a lot of patients avoid the pain they are coping with right now.

Debbie’s Law: This policy is named after Debbie Fewster, a Manitoba patient who was told she needed heart surgery within three weeks, but died after waiting two-and-a-half months.

Her family has said that if they had known at the beginning that their mother’s life was at risk due to the long wait time, they would have taken her abroad for treatment.

Debbie’s Law is a policy that requires health care systems to inform patients, who are waiting for life-saving treatment (e.g. heart operations, cancer treatment, etc.), to inform patients at the beginning of their journey of the estimated wait time for surgery and the maximum recommended wait time for their particular case. This would allow patients to know if the health care system is putting their lives at risk or not.

Tracking and Disclosure of Waiting List Deaths: Governments routinely inspect private businesses and report on workplace injuries or mistakes made by the business. These reports can include even relatively trivial matters such as an employee getting bruised during a fall or a kitchen facility missing a paper towel holder.

Governments should hold themselves to the same standard and report on how many patients died each year because the government did not provide life-saving treatment in time. Currently, these stories tend to be made public because the family speaks out, not because governments are open and transparent.

The Alberta government should carefully track, analyze and disclose cases where patients die while waiting for appointments with specialists, diagnostic scans and surgery.

SecondStreet.org has travelled to Sweden and France to learn more about their systems. You can see our videos below as well as a video we did on Japan’s health care system:

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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.