Alberta should learn from other higher-performing universal health-care systems

Alberta Health Services (AHS), which the Smith government plans to transform from a single overarching health authority to multiple authorities, was back in the news last week, this time for a memo about planned cuts in the face of a budget deficit.

Naturally, this had the provincial government, the official Opposition and health-care groups in a flurry with commentary about the importance of already strained patient care. What everyone seems to have missed is that smarter health policy remains the solution to avoiding these fears in the first place.

It’s important to realize that this apparent budget shortfall is happening in Canada’s second most expensive provincial health-care system (per person on an age- and sex-adjusted basis) in a country with one of the developed world’s most expensive universal access health-care systems.

At the same time, Albertans wait longer than the national average for access to medically necessary care. And the national average is nothing to be proud of either—Canadians endure some of the longest delays for access to care in the developed world alongside some of the poorest access to physicians, medical technologies and hospital resources.

Indeed, AHS’s desire to “continue to meet our high standard of care” is laughable when one recognizes that, despite years of relatively high and growing health expenditures (growing about 3 per cent per year per person on average between 2008 and the 2023 forecast), the average wait time for health care in Alberta grew from 18.5 weeks at AHS’ inception in 2008 to 28.0 weeks in 2019 before COVID to 33.5 weeks in 2023. Growing health expenditures bought Albertans a “high standard” of wait times that are now more than half a year on average.

If the money is already there, why do Albertan’s get such poor health care in return?

The answer is not the number of health regions in Alberta. It’s not the name of the administrator in charge or the makeup of the management team either. Neither is the answer spending even more money, as many in the health-care debate too often suggest.

The answer is to recognize that it’s the structure of the health-care system itself that is the problem. This is a policy structure, universal in name, that has proven to be entirely unable to deliver timely high-quality care with even a high price tag.

Meanwhile, as Albertans struggle to access health care and worry about a budget problem at AHS, patients in other developed countries such as Switzerland, the Netherlands, Germany and Australia enjoy more timely universal health-care services and greater availability of medical resources. The reason is simple—they chose a different structure for their health-care systems.

These countries all have private competition in the delivery of universally accessible hospital and surgical care rather than the monopolistic government-operated hospitals in Alberta. Those hospitals in these other countries are also paid for services delivered rather than through the budgets used here, which are not connected to ongoing patient care and actually discourage expansion in activity. In these other countries, patients are free to seek care privately if they wish and are not shackled to the governmental system. Finally, and just as importantly, patients in these countries must share the cost of their care, subject to reasonable limits and exemptions for some populations.

Here at home, advocates for the status quo decry each of these policies as anathema to the ideals of universal health care, and some of these policies (e.g. cost-sharing for patients) do indeed fall foul of the Canada Health Act’s rules and regulations. Yet all of these policies together are found in every country that delivers on the promise of universal access to high quality care in a time frame that provides comfort and peace of mind.

Simply put, these policies work. And while these policies have been working for decades elsewhere, Albertans have been suffering ever-expanding costs for health care alongside ever-expanding delays in access to care.

Albertans deserve much better than tired debates about the right number of health regions. And rather than worry about the impact of spending cuts, they should ask why the current high level of spending on health care isn’t translating into performance. The only way Albertans will get the high-quality care they pay for is through genuine health-care reform based on examples that actually work.