Despite high spending, Alberta’s health-care system is failing

On Tuesday, Premier Smith and her fellow premiers met with Prime Minister Trudeau to discuss a possible increase in health transfers from Ottawa, although the Smith government has already announced it will move forward with reforms with or without the federal government, enacting “structural” change with an additional $600 million annually for Alberta’s health-care system. However, it’s important for Albertans to understand the depth of the problem and the need for fundamental reform. More money won’t fix Alberta’s “broken” health-care system.

Before the pandemic, Alberta had the second-most expensive provincial health-care system in Canada on a per-person basis, moving to the middle of the pack in 2022 (the latest year of available provincial data). In 2020, Canada had the eighth-most expensive universal health-care system in the world (out of 30 countries) on a per-person basis and the highest level of health-care spending as a share of the economy (both measures adjusted for age). In other words, Alberta is an average-to-high spender in a very expensive universal health-care country.

The big question is—what do Albertans get in return for their comparatively costly health-care dollars?

In terms of basic resources, the evidence is rather grim. For instance, Alberta achieved only a middling result for physician availability in 2020 at 2.5 doctors per 1,000 population (ranking 5th out of 10 provinces). Alberta ranked even poorer for CT scanners (9th of 10) and MRI machines (6th of 10).

The wait times data are equally disappointing. In 2022, Alberta patients could expect to wait a median of 33.3 weeks between seeing a general practitioner and receiving treatment—5.9 weeks longer than the Canadian average of 27.4 weeks.

And again, that’s in the context of an already failing Canadian system. Data from the Commonwealth Fund from 2020 and 2016 show that Canada ranks dead last among our international peers (including Switzerland, Australia and Germany) on the number of patients who see a specialist or receive non-emergency surgical care in a timely manner.

In fact, for years peer countries, with similar or lower spending on health care (as a share of their economies), have outperformed Canada on key measures including wait times while employing markedly different approaches to universal coverage. For example, Australia, Germany, the Netherlands and Switzerland all either partner with the private sector for the financing and delivery of universal care or rely on the private sector as a pressure valve when the public system is overburdened. To its credit, Alberta is expanding its partnership with private centres in an effort to increase capacity and reduce wait times.

Other successful universal health-care countries also finance their hospitals with “activity-based funding” based on services actually provided while Canadian hospitals mostly use “global budgets,” which are largely based on historical spending and less connected to the actual services provided.

Premier Smith continues to emphasize the need for fundamental reform to improve Alberta’s health-care system. The first step to any meaningful change is to understand where our system currently stands and learn from jurisdictions that serve patients better.