Alberta Premier Danielle Smith recently announced a significant shift in health care management, granting local health facilities increased decision-making authority. This decision comes amidst a sweeping and controversial reorganization of the province’s health care system. The intention is to manage variations in medical care and improve value, all on a limited budget, to be certain. The government plans to fund certain facilities based on the volume of procedures they perform, alongside safety measures, raising questions about the future direction of health care in Alberta.
The new amendments are clearly intended to target the removal of the centralized oversight that Alberta Health Services (AHS) had tightly controlled before. To replace it, they’ll create four new agencies. The restructuring has sparked fears over a looming privatization. Health professionals are rightfully concerned over how this significant change in policy will impact quality of patient care and access to service.
Local Empowerment and Funding Changes
Premier Smith underscored that going forward, each health facility will be led by a strong and accountable leadership team.
“Soon, each facility will have an empowered leadership team supporting our sites, responsible for hiring, managing resources, and solving problems without sending every request into the vortex,” – Premier Danielle Smith.
This bottom-up empowerment is designed to improve local decision-making, so that hospitals and their communities can better address the unique needs of their neighbors. The announcement signals a deeper, philosophical divide over how to best manage Alberta’s over-extended health budget.
The new funding model will take an activity-based perspective. In addition, facilities will be paid more or less depending on how many procedures they’re able to get done. Krystle Wittevrongel, director of research at the Montreal Economic Institute, was hopeful about this model.
“I think we’re going to see some actual change,” – Krystle Wittevrongel.
Health systems in Quebec, Canada and Australia have successfully implemented this approach. As a result, they have increased patient access and reduced costs per procedure. There are giant concerns still about how this model will play out in Alberta’s one-of-a-kind context.
Addressing Inconsistencies and Previous Failures
The new system is intended to address the inequitable delivery of medical treatment across the province, making sure every patient receives evidence-based care regardless of where they live. In the past, AHS’s heavy centralization led to a top down, one-size-fits-all approach. This unnecessarily hampered local hospitals’ ability to make the right decisions for their communities’ unique needs.
Local hospitals previously had autonomy over hiring decisions until a government freeze on health spending necessitated centralized approval processes. This alteration provoked anger among healthcare providers who were discontented with being restricted by bureaucratic shackles. John Church, professor emeritus of political science at the University of Alberta, expressed enthusiasm about the prospect of combining site-based decision making with activity-based funding.
“It’s always politically attractive to say to local communities ‘You’re going to have more power now,’” – Steven Lewis.
Other experts are skeptical about whether the government is really serious about empowering local areas. In response, health policy consultant Steven Lewis raised a key point. Under this new framework, it remains unclear what new decision-making authority and autonomy hospitals will gain.
Concerns Over Privatization and Future Implications
The announcement should be viewed in the context of ongoing fears over the threat of privatization within Alberta’s health system. As recently as 2023, the government was forced to backtrack on its decision to privatize lab services after private operator Dynalife went insolvent. This history has made many wary of these current changes, watching intently and with great skepticism.
Kyle Warner, press secretary to the minister of hospital and surgical health services, tried to reassure the public that private hospitals are still illegal in Alberta. He put that claim to bed when he said that there are no plans to do so.
“Private hospitals are illegal to own and operate in Alberta, and Alberta’s government has no plans to change that,” – Kyle Warner.
Warner to stomp on falsehoods that no Albertan will incur out-of-pocket, fee-for-service charges for medically necessary services. This spans from visiting a family physician to being treated in a hospital.
Many healthcare advocates fear eroding healthcare access due to impacts of increased local control over funding and resource allocation. The potential for unequal distribution of resources across communities has created concern that some patients will receive less than ideal care.
Dr. Braden Manns underscored the necessity of ensuring equitable access for all patients:
“We need to make sure that everybody gets care,” – Dr. Braden Manns.
