How Alberta’s next premier can lead in health care

Worth A Look, Healthcare & Welfare, Frontier Centre

If contenders for Alberta’s Progressive Conservative leadership wish to lead the necessary health-care revolution in Canada, they and every Albertan will gain much by considering what an excellent health-care system should look like.

First, it would continue to be universal – every Albertan would have access without regard to their ability to pay; second, it would be patient-centred and offer the best quality of care and treatment outcomes possible; third, waiting times would be non-existent or at least significantly shortened compared to today; fourth, there would be a greater supply of health-care professionals including doctors, nurses and others; fifth, the health-care facilities, technology, and equipment would be among the best available; and, sixth, the health research facilities supporting the system would be among the best in the world.

For a country and province as rich as ours, we do not stack up well in international health-care comparisons. To compare Canada – not to the United States – but to other industrialized countries with universal access to health care, our model suffers.

Adjusted for age, Canada spends more on health care as a percentage of our economy than all but two countries with universal health care (Iceland and Switzerland). But it places 24th out of 27 for the number of doctors per 1,000 people, 13th of 22 in access to MRIs, 17th of 21 in access to CT scanners, seventh of 12 in access to mammographs, last of 16 nations in our access to lithotriptors, and 20th out of 27 in infant mortality.

Then there are waiting lists: In Alberta in 2006, the median wait time to receive a CT scan is four weeks, nine weeks for an MRI and 8 1/2 weeks between referral by a general practitioner and an appointment with a specialist. The Canada-wide averages are similar.

Are such lengthy queues inevitable? No. At least seven diverse OECD countries – Austria, Belgium, France, Germany, Japan, Luxembourg, and Switzerland – have shorter waiting times and better health-care outcomes in virtually every category.

What else do these seven countries have in common? All have cost-sharing for publicly insured specialists and/or hospital services, a competitive hospital sector within the public insurance program, fee-for-service remuneration for specialists, and a competitive parallel insurance sector to keep the government sector in check.

If the next premier of Alberta is willing to lead on health care there is a Western precedent. Alberta’s present universal, publicly administered health-care system did not originate with the federal government. It originated in Saskatchewan.

Here’s a short-list of innovative, necessary reforms starting with those that can be implemented within the current restrictions of the Canada Health Act (CHA).

  • Recall that the CHA does allow provincial governments to tap into the non-profit, private, or public sector for service delivery of health care.
    Most doctors’ offices, for example, are private. In practice, provincial governments contract most service delivery with public-sector institutions served by public sector unions. Innovation, flexibility, cost effectiveness, and merit are often discouraged rather than rewarded. And the public is held “hostage” in the event of strikes.
  • Alberta can and should use competition to break up the delivery monopoly of health care it pays for. For example, Alberta’s Ministry of Health and Wellness and local authorities should not only be encouraged to competitively contract for health services paid for with taxpayers dollars, but required to open themselves up to choice in service delivery.
  • Another reform could include facilitating the establishment of individual health-care savings accounts (the health care equivalent of RRSPs but with government and/or employer contributions) as recommended for consideration by Don Mazankowski in his report to Albertans.
  • Then there are needed reforms which require changes in federal legislation and policies: Amend the Canada Health Act to allow the provinces to increase freedom of choice on public and private options for health-care delivery, payment, and insurance. On the fiscal side, Ottawa should end federal transfers in support of health care and instead transfer the equivalent tax room to the provinces.
  • If our next premier chooses to lead on health care, there is a useful precedent for establishing a better division of responsibility between the federal and provincial governments. That precedent exists in the field of K-12 education, where it is no coincidence that Alberta has a very high standing in international comparisons.

    Alberta has used its exclusive jurisdiction in this area to provide parents with expanded freedom of choice. The province funds education in independent, charter, and at-home schools, as well as in the public sector – universal access to education but a mixed approach to financing and delivery.

    While Alberta actually spends less per capita on K-12 education than Newfoundland, and about the same as Saskatchewan, it excels in Canadian and international comparisons because it encourages responsible public-private competition and provides families with freedom to choose the best educational alternatives for their children.

    Consider the following 2003 figures from the OECD where Alberta tops all Canadian provinces – and most of the world – in K-12 educational achievement:

  • In the rankings on reading literacy, Alberta ranks not only ahead of all the other Canadian provinces, it ranks higher than any of the other 40 nations in the study save Finland.
  • In science, Alberta again ranks ahead of all the other provinces and is outscored only by Finland and Japan. In mathematics, Alberta again leads Canadian provinces, followed by British Columbia and Quebec. Only Hong Kong outranks Alberta.
  • If the next premier of Alberta will make the case for a relationship between the province and the federal government in the health-care field, similar to that which already exists with respect to K-12 education, he has an excellent argument and evidence to prove that respect for provincial jurisdiction combined with freedom of choice does in fact lead to superior social outcomes.