Innovation in health care is not a bad thing. Health care in Alberta is suffering from inefficiency and outdated systems and has long been in desperate need of modernization. Alberta spends more than 8 per cent more per capita than the Canadian average on health. Yet its health care system consistently underperforms its peers in several critical areas.
Alberta’s per capita health spending more than doubled between 1993 and 2019, yet wait times for medically necessary surgeries saw a whopping 167-percent increase. In 2019, Albertans waited almost 20 per cent longer than the Canadian average to see a specialist from referral and almost 50 per cent longer to actually receive treatment after an appointment with a specialist.
While on a waiting list, quality of life is often poor. As reported by the Calgary Herald, Albertan Linda White took matters into her own hands when she was told she would be waiting a year for hip replacement surgery on top of the 10 months it had already taken to see a specialist: She travelled to the Cayman Islands and paid out of pocket. Ms. White is happy with her choice and recommends others in her situation follow suit.
Alberta needs to shake things up if we want reduced wait times and sustainable health spending. Both the August, 2019,
MacKinnon Report and the May, 2020, Fair Deal Report noted a need for innovation and creativity in health care delivery in the province, such as using private clinics to deliver publicly funded services.
Bill 30, which has now been adopted, is a step in that direction. The omnibus legislation amends current health legislation to streamline approval processes for chartered surgical facilities, bring innovation to physician remuneration and allow doctors to focus on patients rather than clinic administration, which often involves contracts with a variety of organizations. The legislation aims to improve patient and provider choice in the delivery of health care in Alberta.
Those comfortable with the status quo are quick to cry “two-tier” health care and the everpopular (and ever-erroneous) claim of Americanization of the health-care system. Such demagogic bluster ignores the decades-long trend in high-performing European universal health care systems to expand capacity precisely by partnering with entrepreneurial providers.
For example, France, the Netherlands, Sweden and Switzerland all allow the private sector to operate in a parallel system, including financing and delivering medically necessary hospital services. Universal access is strictly maintained, and outcomes are significantly better than in Canada. Those countries tend to have more hospital beds, more doctors and, as a result, shorter wait times than Canada, despite older populations.
In France, a third of hospitals are private and cost a quarter less than public hospitals to treat the same conditions. All French citizens can choose to be treated in the public or private sector, with the cost covered by public insurance. Contrary to arguments that a two-tier system will simply allow the rich to get better access or treatment, the private sector actually expanded service in poorer areas that had been neglected by the public system.
Sweden’s private management of the publicly funded Saint Goran Hospital illustrates that there is no contradiction between the private provision of care and equal access. Previously publicly run, Saint Goran now reports shorter emergency room wait times and hospital stays, treating patients not only faster but with better outcomes. The hospital remains accessible to all and costs the government 10 per cent less than publicly managed hospitals.
The Alberta government can adopt such measures unilaterally, as any reform to health care is almost entirely a provincial matter – and Albertans are ready for change. A recent Leger poll commissioned by the Montreal Economic Institute found that a large majority (63 per cent) think private entrepreneurs should provide more care, so long as services are still publicly covered, while 62 per cent believe patients should have the right to buy private health insurance to ensure timely treatment.
With a health care system that already eats up approximately 40 per cent of the government’s operating budget – and with lockdown deficits making public spending more difficult – increasing health care costs further without addressing the underlying structural issues is only a Band-Aid solution. Bill 30, by opening the door to more entrepreneurship in care delivery within the province’s universal health care system, is a step in the right direction. Despite opposition from the NDP, the Alberta government should continue full steam ahead and adopt further reforms to cut wait times and provide true patient-centred care.
Krystle Wittevrongel et Peter St. Onge sont respectivement chercheuse associée et chercheur associé senior à l’IEDM. Ils sont les auteurs de « Entrepreneurship and Universality: The Way Forward for Health Care in Alberta » et signent ce texte à titre personnel.