Alberta needs fundamental reform to tackle health-care wait times

Alberta’s health-care system is crumbling. Much of 2022 was filled with stories of burnt out physicians, nurses leaving the frontlines and backlogged emergency rooms.

Unfortunately, the year ended with more bad news. According to an annual survey of physicians, patients in Alberta faced a median wait of 33.3 weeks between seeing a general practitioner and receiving treatment—that’s 5.9 weeks longer than the Canadian average (27.4 weeks) and more than three times longer than Albertans waited in 1993 when the Fraser Institute published the first nationwide estimates. In fact, wait times in the province have risen every year since 2018.

While these data reflect wait times for elective treatment (i.e. scheduled treatment, not emergencies), theses treatments are medically necessary and include colonoscopies, cardiac care and so on. And the waits can be agonizing for patients and families and often lead to poorer health outcomes. Of course, the pandemic and subsequent scale back (or outright cancellation) of certain surgeries affected wait times and the system’s ability to deliver care. However, the same survey reported a median wait time of 28.0 weeks in 2019. Clearly, the pandemic exacerbated—but is not the primary cause—of the province’s challenges.

This is not just an Albertan issue, but a Canadian one. In fact, Canada routinely ranks at the bottom for wait times for specialist consultations and treatment compared to 10 international peers including Switzerland, Australia and Germany. The Smith government has repeatedly promised to improve Alberta’s health-care system, but while it's unclear whether the Alberta Sovereignty Act will help the government usher in desperately needed reforms, the premier’s efforts to simultaneously secure more health-care dollars from Ottawa won’t fix the problem. Indeed, more money doesn’t necessarily mean a better health-care system.

Consider that before the pandemic, Alberta had the second-most expensive provincial health-care system in Canada on a per-person basis. While Alberta ranked roughly middle-of-the-pack among provinces for per-person spending on health care in 2022, Canada itself ranked as the 8th most expensive universal health-care system in the world (out of 30 countries) on a per-person age-adjusted basis in 2020. In other words, Alberta is an average spender in a very expensive universal health-care country.

So, what’s do be done?

The simple answer is to learn from other countries with similar or lower spending, but shorter wait times. For example, public-private partnerships would help align Canada with more successful international peers. Alberta has already taken some steps in the right direction by expanding the use of chartered private clinics to perform publicly-funded surgeries. This policy (in addition to centralizing patient referrals) has already been used in Saskatchewan and helped reduce wait times from 26.5 weeks in 2010 to 14.2 weeks by 2014.

In addition to more fully embracing the private sector, universal health-care countries such as Australia, Switzerland, the Netherlands and Germany also expect patients to share the cost of treatment to reduce demand for services and encourage people to seek care in more appropriate alternatives (with safety-nets for vulnerable populations). These countries also tend to incentivize the responsible use of their resources by funding hospitals based on activity (instead of Canada’s global budgets where hospitals receive a set allocation of funds each year).

It’s encouraging to see Premier Smith talk about improving health care, but it will take fundamental change to truly fix the system for Albertans. Fortunately, the provincial government can learn from the success of other jurisdictions.