I am happy to fire Daniel Smith from the Alberta Health Services Board

Real health care reform will require major changes in policy and governance

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Last week, Alberta’s Minister of Health, Jason Copping, fired me and other members of the board of Alberta Health Services, the provincial health agency charged with providing health services to Albertans. I agree with that. We knew we weren’t going to get fired for doing a bad job. Quite the opposite.

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The real problem is that the AHS, which is a governing body, cannot solve the problems on its own. This often requires changes in policy, which is the responsibility of Alberta Health, the government department in which Mr. Copping is minister. Sets policy, legislation, and standards for the county health system.

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The government’s decision to shift from a part-time board to a full-time official reporting to the Prime Minister and Minister for Health provides a golden opportunity for major reform to deal with the current pressures in the healthcare system.

These pressures are not new. Government after government – be it the Progressive Conservatives, the National Party or the United Conservatives – has failed to reform the system. As documented in the 2019 report, despite having the second highest per capita healthcare spending in the country (after Newfoundland and Labrador), Alberta has modest health outcomes.

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After receiving this report, the province has adopted a number of efficiencies, such as contracting out non-essential services, digitizing records, and optimizing assets to lower per capita costs to the average of the four largest provinces. He also kept the salary increase limit. The NDP froze the salaries of non-union employees beginning in 2015, but not surprisingly, this made it difficult to hire non-union professional employees. In any case, the result of these efforts is that Alberta has now reduced per capita spending to levels comparable to those of other provinces.

But then the epidemic caused new stress. It exposed the lack of investment in intensive care beds over the years to save costs. Whether by luck or foresight, the Kenny government increased the number of acute care beds just months before the pandemic hit. But that wasn’t enough, so AHS doubled the ICU capacity. With the pressure on doctors and nurses to deal with COVID, wait times for surgeries have skyrocketed. Hospital admissions due to covid have fallen a lot, but illness and early retirement have caused labor shortages. Compulsory vaccination, which has now been abandoned, hasn’t helped either.

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Like other provinces, Alberta has very few doctors and nurses, especially in rural areas. Ambulance crews often wait hours to transfer patients to unstaffed emergency wards. Fixes exist for these issues but they often require policy changes, which are not part of the AHS mandate.

The province can ease the shortage by training more doctors and nurses at post-secondary institutions. But the costs of doing so are high, so the government will have to funnel money from other regions to the universities. Or the province may import more health professionals from other provinces or abroad, but that would require a radical change to recognize foreign accreditation qualifications.

More doctors and more efficient use of operating space and time for surgical teams could lead to reduced waiting times for surgeries. AHS has already centralized surgical bookings, reduced wait times for consultations and expanded partnerships with nonprofit and for-profit clinics. It could do much more – for example, relieve pressure on hospitals by contracting out more services for primary care operations.

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If Albertans took their non-emergency health problems to clinics or their doctors more often, emergency hospital services could be improved. More paramedic teams are needed in rural areas, where ambulance teams are not available 24/7. Incentive-based policies—for example, penalizing hospital budgets for delaying transfers after a specified time—have been found to reduce EMS transfer times significantly.

When I served on the 2014 federal task force on healthcare innovation, the advisory explained that Canada’s healthcare system, the second worst of 12 countries according to Commonwealth Fund studies, suffers from an inadequate focus on patient care as well as a lack of integration of medical services. and non-medical.

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Canadians understand that the Soviet-style central planning model for health care must change. Some analysts favor a shift to European-style systems with better integration of public home care, long-term care, and dental care, as well as parallel private integrated systems. Others advocate a single payer system with more opportunities for primary care and privately run clinics, which many counties already own. In 2002, the Mazankowski Report in Alberta recommended the same type of co-payment that many European countries use as incentives to encourage better use of medical services.

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Albertans worried about the healthcare system may be more open to radical changes. At the very least, and less arguably, governance can be improved. As many AHS staff have argued, decision-making should be decentralized – although AHS has not been restructured into regional bodies. More contracting of clinic services and more digitization of both services and records would provide significant benefits.

Real reform will require major changes in policy and governance. I wish new AHS Director John Quayle, Minister Copping and Prime Minister Danielle Smith every success in finally reforming healthcare. It won’t be easy, but if they succeed, all Canadians could benefit, because Medicare problems are widespread across the country.

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