On Monday, Alberta Health Minister Dave Hancock indicated his support for a quality, universal health-care program, saying: "All Albertans should have access to quality care on a timely basis without regard to the bills they pay. It has to start and finish there."
Unfortunately, he also suggested that more private sector treatment and financing may not be the way to go for Alberta’s health-care system. A look at the international evidence suggests Alberta’s new government is heading the wrong direction -- a direction that will not bring Albertans closer to the laudable target of universal timely access to high quality care.
Let’s consider for a moment how well Hancock’s ministry is doing in achieving the goal of "access to quality care on a timely basis."
In 2006, the average Albertan in need of medically necessary elective surgery could expect a median wait time of 16.3 weeks from the time their GP referred them for treatment by a specialist to the time a specialist delivered that treatment -- a wait that was 55 per cent longer than in 1993.
While that was better than the national median of 17.8 weeks, it was substantially longer than wait times in other developed nations that also guarantee access to care for all citizens regardless of their ability to pay. Notably, seven of these developed nations have no waiting lists for medically necessary treatment in their public health-care programs.
Moreover, there are few doctors in Alberta to deliver the care Albertans are waiting for. Alberta ranks below the national average in the number of physicians per 1,000 population and behind all provinces except Saskatchewan, Manitoba, New Brunswick, and P.E.I.
Internationally, Canada ranks 24th in the age-adjusted number of physicians per 1,000 population among developed nations that guarantee access to care regardless of ability to pay. In terms of technology, while Alberta had more MRI machines per million population than any other province at the start of 2006, it had fewer CT scanners per million population than any other province except Ontario.
And what were Alberta’s taxpayers charged for this poor performance? In the latest year for which data is available, it was more than any of Canada’s other provinces per capita.
It is important to recognize that this remarkably poor performance with its steep price tag is the result of keeping out the private sector and private financing. The "Canadian Way" for health care has brought hardship to patients in need of treatment and left taxpayers footing the bill for a world class health-care system that is anything but.
The lessons that can be learned from those nations that have the very best universal access health-care programs are clear. There are nine leaders to consider as examples: Australia, Sweden and Japan outperform Canada on various measures of mortality related to health system performance. Austria, Belgium, France, Germany, Japan, Luxembourg and Switzerland have universal access health-care programs that deliver care to all citizens without queues for treatment.
Not one of these nations agrees with the perspective that the private sector should be kept out. Quite the contrary: each of these nations requires those who can afford them to pay user fees for access to publicly guaranteed services; allows private hospitals (both not-for-profit and for-profit) to competitively deliver publicly guaranteed health care services; and allows private payers and/or insurers to finance health care in those circumstances when individuals wish to seek care on their own terms with their own resources.
The economic theory and international evidence are clear: a world class health-care program cannot be created without such private competition and appropriate financial incentives. Locking them out of Alberta’s health-care program only condemns patients to a substandard health-care program, and taxpayers to large bills for poor service.
Hancock has reiterated the government’s desire to see that all Albertans, regardless of ability to pay, get timely access to high quality health care services. According to the international evidence, the only way to meet that target is through the responsibility that comes from cost sharing and the competition created by private provision and funding of medically necessary health care services.
While many held out hope that the government following Ralph Klein’s might finally accept this reality, it seems from last Monday’s statements that their hopes may have been misplaced.