Alberta premier sparks private health care worries with recent mandate letters

Some of the premier’s latest mandate letters, outlining the priorities for Alberta’s health ministers, are reigniting concerns the government is paving the way for even more private delivery of health care.

In letters released last week, the ministers responsible for Primary and Preventative Health Services, and Hospitals and Surgical Health Services, were given their marching orders along with their counterparts in Assisted Living and Social Services, as well as Mental Health and Addiction.

“This new era of care will deliver a modern health-care system Albertans can count on,” Premier Danielle Smith said in a news release.

“These mandates bring every part of Alberta’s health network into alignment to strengthen preventative and front-line care, reduce wait times and make a real difference in every corner of the province.”

The priorities have been set as the Alberta government forges ahead with its overhaul of the health system, which has splintered health care delivery into four separate ministries.

MRIs, CT scans

Primary and Preventative Health Services Minister Adriana LaGrange is directed to “pass legislation to allow Albertans more choice and access to preventative health services, including elective testing, screening and other diagnostic services.”

This is a key concern for Chris Gallaway, executive director of Friends of Medicare.

“We’re very worried when they talk about that. We’re unsure what new legislation would be required unless it’s enabling private, for-profit testing and diagnostics to have a hold in the health-care system,” he said.

University of Calgary health policy expert Fiona Clement said the intent isn’t entirely clear, but it it could signal a move to increase private delivery of publicly funded diagnostic services.

“If that’s the direction, I’m worried,” said Clement, the department head of community health sciences at the Cumming School of Medicine, pointing to Alberta’s failed attempt to privatize lab services with Dynalife.

“We already have some experience with standing up private surgical facilities and lab-based facilities and neither of those experiences went well,” said Clement.

LaGrange was not made available for an interview. In a statement, her press secretary told CBC News that providing more options is part of the government’s broader work to beef up access and reduce pressure on the public system.

“Alberta’s government is committed to maintaining a strong publicly funded health system,” Maddison McKee said in the emailed statement.

“Wait times for care are too long, and we’re working to provide more services and increase access.”

The statement says the legislation to allow more people to obtain elective services could include MRIs or CT scans.

Surgeries

Matt Jones, the minister responsible for Hospital and Surgical Health Services, is tasked with “fully implementing a competitive, activity-based funding model for insured surgical services to reduce wait times, improve patient experience and deliver better value for taxpayers.”

Dr. Brian Wirzba, president of the Alberta Medical Association (AMA), said the mandate letters raise more questions than they answer.

“I think there’s a lot of things where it certainly could open the door to more private care,” he said, adding doctors want to hear more details about the government’s plans.

According to Wirzba, the AMA sees room for publicly funded and privately-delivered care (like the procedures offered at chartered surgical facilities) within a well-funded and supported system.

“But we need transparency,” he said. “We need to make sure that outcomes are consistent. And we need to make sure that the life-and-limb types of surgeries — the type of care that you need at three in the morning — is still being provided.”

He said the letter doesn’t address concerns that Alberta’s traditional hospital system is losing staff to chartered surgical facilities.

“We have seen challenges with keeping ORs open when physicians, nurses, respiratory techs move from one care facility to another,” he said.

This directive comes at a time when chartered surgical facilities are under intense scrutiny due to a political controversy that includes allegations of conflicts of interest.

According to Clement, activity-based funding occurs when facilities are paid a set price for a service no matter how the case unfolds. 

“If you are really innovative and there’s a way that you can safely limit your OR time, safely ensure that the patient goes home faster and safely transition the person out of the hospital into the community more quickly, then more of the payment … is available to you for other things,” she said.

But she said strong accountability measures are key.

“One thing that happens in the U.S. with this kind of funding model is they discharge patients … before they’re ready because there’s a structure that motivates you to have everything as efficient as possible,” she said.

“And without those strong guardrails of quality and accountability in some cases, those decisions can be made without the patient at the centre of them.”

Jones was not made available for an interview.

In a statement emailed to CBC News, his press secretary, Kyle Warner, said the system will reward efficiency by ensuring the funding follows the patient and not the provider.

“The approach is provider-neutral. If a public hospital can deliver more surgeries, it will receive more funding, and the same applies to other qualified providers.”

He said safeguards are being built in to ensure patients’ needs are met and to address issues known as “skimming,” where providers pick and choose the patients with the lowest expected treatment costs.

Vaccines

The premier is also directing LaGrange to review government policy to ensure free vaccines are targeted to people who are “scientifically proven to be at substantial risk of adverse health outcomes should they remain unvaccinated.”

LaGrange is also expected to look at the possibility of funding additional vaccines for at-risk groups.

This comes at a time when the government has been criticized for its decision to charge most Albertans for the COVID-19 vaccine this fall.

LaGrange’s press secretary did not answer whether the government plans to further defund vaccines.

“The goal is to ensure publicly funded vaccines are directed to populations at greatest risk of serious illness and to explore opportunities to expand coverage for additional vaccines that could benefit Albertans,” McKee said.

Other directives include publishing wait times for common surgeries, improving access to care, and addressing staffing shortages.

The ministers are also tasked with working together on health issues that may fall under multiple health ministries, including moving patients who need alternate levels of care out of hospitals.