Alberta Health Care is Mediocre at Best

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Appeared in the National Post, 2 July 2004

Alberta’s taxpayers are tossing dollars into the wind when it comes to health care. While they’re paying for the second-most expensive health care program in Canada (on an age and sex adjusted basis), they’re getting mediocre access to mediocre health care for patients when compared to other provinces.

In comparisons of access to technology, Alberta ranks first for MRI scanners and ninth for CT scanners. Access to physicians in Alberta is about average for family doctors, but well below for specialists.

Comparing waiting times, Alberta ranks third last for the time that passes between a GP’s referral to a specialist and the appointment with that specialist. After that, Alberta has the third-shortest waiting time between the appointment with a specialist and the delivery of treatment. Overall, Alberta ranks fourth with a total waiting time (GP referral to treatment) of 18.5 weeks, 81% longer than what it was in 1993.

This mediocre performance within Canada turns out to be a dismal performance when compared to other nations that share Canada’s goal of access to health care regardless of ability to pay. Canada, on an age-adjusted basis, operates the most expensive universal access health care system in the developed world (we’re tied with Iceland). In exchange for that high level of spending, Canadian governments provide some of the lowest levels of access to physicians and technology, while Canadian patients, on average, suffer some of the longest waiting times and experience only middle-of-the-road health outcomes. Put another way, Canadian taxpayers are paying for a world-class health care system, while getting service that ranges from mediocre to terrible. Even a decent performance in Canada is an unimpressive performance overall.

Alberta has, in fact, been at the forefront of incorporating competition and private initiative into the delivery of health care. Encouraging reforms, though presently quite small in their application, include contracting with innovative private primary care providers and private surgical centres for some patient care. While these are promising steps, most other reforms are much less impressive, in part due to the constraints imposed on Alberta by the Canada Health Act.

While many Canadians laud the Canada Health Act, it is in reality the greatest barrier to the creation of a world-class health care system. Provinces have little choice but to continue to follow the leadership of the federal government, defined by the Canada Health Act, or face punitive reductions in the substantial cash transfers for health care services -- transfers that are expected to total more than $14-billion this fiscal year. The drawbacks to the Canada Health Act are well understood: It constrains competition in insurance for health services and discourages (through reductions in transfers) the introduction of financial incentives for patients.

Both of these factors -- competition and incentives -- have been implemented with great success in other developed nations that also believe in access to care regardless of ability to pay. These policies are also necessary to eliminate the alarming disconnect between funding for health care and the services available to patients in Canada.

Though many had speculated that Alberta was on the verge of doing something big, even historic, with health care, the provincial government’s recent announcement was disappointing at best. While Premier Ralph Klein and Health Minister Gary Mar had been talking about radical changes, the plan contained only a bailout for the regional health authorities, new spending on health care and the introduction of statements for Albertans who use the health care system. None of which will make for a better health care program in Alberta.

Consider what other developed countries that are more successful at delivering universal access to health care are doing. Four countries manage to deliver higher quality care than Canada: Sweden, France, Japan and Australia. Seven countries manage to deliver that care without significant waiting times: Austria, Belgium, France, Germany, Japan, Luxembourg and Switzerland. Note that two countries (France and Japan) actually manage to do both, and at lower cost than Canada.

All of these countries that do a better job of delivering universal access health care require patients to fund some portion of the cost of the health services they consume and allow private hospitals to deliver at least some of that care. Both ideas seem radical in the Canadian context, as clearly noted by Messrs. Klein and Mar, but these ideas are commonplace among those countries that are most successful at delivering health care on the basis of need and not ability to pay.

What Canadians need to understand, more than anything else about health care reform, is that the current solutions being marketed in Canada (more money and a bigger monopoly) are not and will not ever be the solutions to medicare’s problems. The solutions to the dismal access to health services that exists, despite the high level of spending in Canada, will come from change that takes its lessons from economic research and international evidence. These lessons are quite clear: A better health care system is one that incorporates entrepreneurial initiative, competition (both inside and outside of the public insurance scheme) and responsibility for patients to cover some of the cost of their care.

What Canada needs is an Alberta government that takes heed of these lessons and makes a bold move towards implementing those policies that have been immensely successful elsewhere in the developed world, to the benefit of both patients and taxpayers. Other provinces could then observe the dramatic improvements that would result, and possibly mimic these changes to the benefit of even more Canadian patients and taxpayers.

An evidence-based discussion and an examination of how best to deliver universal access health care to Canadians will get us there. More funding and a greater commitment to what we have now will not.

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