Unhealthy Move for Albertans; Third Way Transformed into Old Expensive Way

On Thursday, Alberta’s provincial government abandoned its plan to allow private access to health services and dual practice for physicians. While those opposed to sensible reform of health care based on the world’s most successful health care models have chalked up another victory, the losers are not (as some might suggest) the provincial conservatives. Rather, the real losers in this political battle are Albertans.

Compared to other provinces, Albertans are receiving nothing special in terms of health care from their provincial government. While Alberta ranks at or near the top in some areas of access to health care, it ranks well below the top in others. And that varied performance comes with a very high price tag: Albertans spent more on health care per person than citizens in any other province in the country in 2005.

While Alberta’s costly performance within our national borders is neither exemplary nor poor, Canada as a whole, turns in a dismal performance relative to other countries. Canada, on an age-adjusted basis, operates the third most expensive universal access health care system in the developed world (only Iceland and Switzerland spend more). In exchange for that high level of spending, Canadian governments provide some of the lowest levels of access to physicians and technology, while Canadian patients experience only satisfactory health outcomes, and suffer some of the longest waiting times. Even a decent performance in Canada is a poor performance overall.

For a time, it seemed that the Alberta government was willing to do something about this dismal performance. It realized that, despite the relative lack of physicians in Alberta or Canada, many spend a good deal of their time waiting for access to operating rooms or are unable to treat patients because of provincial quotas and limits. In other words, there are idle physician resources in Alberta that the public system is simply unable or unwilling to employ. Allowing private access to those resources would increase the quantity of services available to Albertans; reduce the number of persons in the public queue for treatment; and make better use of Alberta’s highly trained specialists.

The provincial government also seemed to realize, as reflected in its plan for private insurance, that access to private care is not necessarily affordable for all. Private health insurance provides citizens with quick access to care when needed in return for a regular premium payment prior to the onset of a condition. Insurance also allows those who might prefer paying an anticipated fixed premium over time to paying a higher and less predictable cost at the time they needed care to do so. Thus, private health insurance creates opportunities for those in lower income groups and allows people to tailor their expenditures to their own preferences.

Some of those opposed to the changes proclaimed, using selected studies from other nations, that allowing physicians to practice in both public and private settings would lead to fewer publicly available resources and a commensurate increase in waiting times. First, such a conclusion assumes that physicians are unable to provide more services than they currently deliver through the public program, which is simply not true. Second, the evidence from the UK and Australia showing that dual practice may lengthen waiting times is not as one-sided or as solid as was suggested to Albertans. Other studies show the opposite effect on waiting times or no effect at all. In addition, Australians experience shorter waiting times in their mixed system than Canadians do despite spending less on health care. And though Canadian waiting times are indeed shorter than those in Britain, the margin is not great and the Canadian model costs 47% more to operate than does the mixed British model.

Others opposed to the changes relied on the simpler statement that the Third Way was “chequebook medicine” and the abandonment of universal health care. These critics completely ignored the fact that every other developed nation (including Sweden and France) that has a universal health insurance program also allows individuals the opportunity to privately seek care the public program is unwilling or unable to deliver. Canada is alone in its prohibition of privately funded health care. Alberta’s proposals were a move towards the international norm.

Most important however is the reality that every top-ranking universal access health care program (be it one that outperforms Canada on measures of system performance; one that delivers access to care regardless of ability to pay without any queues; or one that does both) has a competitive private sector that is accessible to all citizens.

Sadly, the provincial government ultimately caved in to both the opposition’s ideological resistance, and the federal government’s ability to reduce transfers to those provinces who disagree with Ottawa.

With the loss of private access to health services and dual practice for physicians, Alberta’s Third Way has been transformed into a copy of what is happening in most other provinces: the continued tweaking of and increased spending on a program that just doesn’t work. That’s not a Third Way; it’s the old, expensive way. Albertans can say ‘goodbye’ to any hopes of a more patient-focused health care program that delivers quality on par with its cost.