Last April, Alberta voters gave Jason Kenney a mandate largely centred on fixing the province’s economy. But another key part of the UCP policy platform was its commitment to review and improve the province’s health-care system.

At $20.6 billion, health care is Alberta’s single largest budget item in 2018/19– representing 42.1 per cent of total provincial program spending. At $5,097 per person (in 2018), Alberta’s government also spends more than any other province on health care (except for Newfoundland & Labrador).

Unfortunately, this high level of spending has not translated into strong performance in the delivery of health services. For instance, Alberta ranks 5th among provinces for availability of physicians, 7th for nurses and 6th for hospital beds. Albertans also faced a median wait of 26.1 weeks (in 2018) for treatment after referral from a family doctor compared to the national average of 19.8 weeks (five provinces including Saskatchewan and British Columbia reported shorter wait times).

While Health Minister Tyler Shandro’s review of the Alberta Health Services is a good first step, wider reforms are needed.

Alberta should first follow the successful reforms enacted by Saskatchewan, which experienced a 75 per cent reduction in the number of patients waiting longer than three months for surgery between 2010 to 2014. Two reforms were key to Saskatchewan’s success—the creation of a centralized surgical registry to pool patient referrals, and the contracting of services to private clinics to increase capacity for health services. Strict delivery guidelines were imposed on the private providers, including prohibiting additional billing. And contracting out produced a lower per procedure cost than comparable public hospitals.

Fortunately, Dr. Janice MacKinnon, Saskatchewan’s former NDP finance minister who closely studied Saskatchewan’s success, was recently appointed Chair of the Blue Ribbon Panel on Alberta’s finances.

Alberta could also offer patients (and provincial coffers) a pressure valve by removing provincial restrictions on private parallel financing and delivery of medically necessary services. Allowing Albertans to pay out-of-pocket or obtain private insurance for the full cost of services could dramatically reduce the strain on the public system while potentially improving wait times. Such a reform, while contentious, would also reduce pressure on health-care costs.

The resulting two-tier system is the norm in many universal health-care countries including Australia, Germany, Switzerland and the United Kingdom. Further, to mitigate one of the main concerns about two-tier systems—namely physicians leaving the public sector—the province could remove current legislation that disincentivizes physicians from working in both the public and private sectors.

Finally, the province could also revisit what’s covered by the public system—one of the many recommendations provided by former federal finance minister Don Mazankowski during Ralph Klein’s tenure. Towards this, a discussion about how we define “medically necessary care” may be necessary. With limited resources, it’s worth examining whether we could provide better coverage for a narrower set of defined services instead of promising access to a broad range of services, but failing to deliver timely access to many of them.

During the election, the UCP famously proclaimed it would “[m]aintain or increase health spending and maintain a universally accessible, publicly funded health care system.” If, as Premier Kenney promised, Alberta must continue to maintain the most expensive health-care system in Canada, the reforms suggested here will help ensure it also delivers, commensurately, the best health care to Albertans.