Reform—not more money—will improve health care in Alberta

According to Alberta Health Minister Adriana LaGrange’s mandate letter from Premier Smith, “A primary focus of our government over the next four years will be to ensure Albertans have improved access to world-class health care when and where they need it.” This is a worthy goal given that Albertans are experiencing a family physician shortage, regular service disruptions in rural areas, and long wait times for non-emergency surgeries across the province. But to truly transform Alberta’s health-care system there must be structural reform.

Consider that in 2020, among provinces, Alberta reported a relatively mediocre (5th out of 10) result for physician availability (2.5 doctors per 1,000 population), with even poorer results (in 2019/20) for the availability of both MRI (6th of 10) and CT scanners (9th of 10). Given that Canada overall has relatively poor access to doctors and medical technology, these results are worrying. In 2020, Canada ranked 28th of 30 universal health-care countries on physicians, 23rd of 28 countries on care beds, 27th of 30 countries on CT scanners, and 26th of 29 countries on MRIs.

Moreover, wait times in Alberta (and in Canada) are significant and growing. In 2022, Albertans waited 33.3 weeks between a GP referral and medically necessary non-emergency treatment. (That’s about 5.3 weeks longer than Alberta’s 28.0 week wait in 2019, before the pandemic, and 5.9 weeks longer than the Canadian average of 27.4 weeks in 2022.)

Overall, Alberta’s health-care system is underperforming in a country that generally underperforms compared to its international peers. And it’s not a spending problem. In 2019, before the pandemic, Alberta had the second-most expensive provincial health-care system in Canada on a per-person basis. In 2020 (the latest year of available comparable data) Canada was the most expensive universal health-care system (as a share of the economy) in the world among our peers.

So, what’s to be done?

The provincial government is doing a few things right. But the health minister should expand the existing use of contracted delivery of publicly-funded surgeries through private surgical centres. The government could also expand existing programs such as the Alberta Facilitated Access to Specialized Treatment (FAST) program, which centralizes patient referrals and either assigns them to a specialist with the shortest wait list or allows the patient to choose a specific surgeon. Both of these approaches emulate parts of the Saskatchewan Surgical Initiative (SSI), a set of reforms introduced in Saskatchewan in 2010 (and ended in 2014), which helped reduce non-emergency surgery wait times.

Beyond expanding these existing programs, the government can implement reforms from other countries. For instance, many other universal health-care countries pay hospitals based on actual treatments provided. Currently in Canada, hospitals, for the most part, have operated on budgets based on past spending, not care provided, which means patients are treated as costs to be minimized. Switching to a system where hospitals are paid based on care provided means there would be a clear incentive for hospitals to deliver more care.

There are many reform options for Alberta, which, unlike higher spending, could actually improve health care for Albertans and their families.