Alberta’s experiment with centralized health care appears to have been a cost-cutting success according to a national report card on Canadian hospitals, but it has been a never-ending political headache for the Progressive Conservative government.
Last week, after the Canadian Institute for Health Information (CIHI) published comparative hospital data for the first time, it showed Alberta spent the least on hospital administration of any province: just 3.5 per cent of its budget, or $338 million. Ontario, whose hospital executives have come under intense scrutiny since their salaries became public, spent the most: nearly six per cent of its budget, or $1.13 billion, went to administration.
On the basis of those numbers alone, one might expect Ontario to follow Alberta’s lead and abolish its regional health authorities, as the Prairie province did in 2008 in favour of a single “superboard” called Alberta Health Services. After all, the hospital reporting project shows that, with the single swipe of a pen, Alberta reined in administration expenses.
But Ontario Health Minister Deb Matthews has no plans to centralize the health care system because, she says, “a community voice at the table is important.” There are 150 hospital boards in the province, which makes comparing Ontario to Alberta “like comparing apples to oranges.” She may have a point, judging by the way Alberta’s $16-billion superboard has gone over in the province.
Alberta’s doctors have been in open revolt against the centralized system, saying it has led to ballooning wait times and emergency rooms on the verge of what one internal report warned was “catastrophic collapse.”
In February, Premier Alison Redford renewed a promise to call a public inquiry into allegations politically connected patients had jumped the queue for services. Then, a Health Quality Council of Alberta (HQCA) report found that long waits at ERs and “widespread intimidation and muzzling of physicians” were putting patients’ lives at risk. Trust between doctors and administrators has eroded since the creation of Alberta Health Services, and HQCA executive director Dr. John Cowell urged the province to create a task force to develop “a just culture” in the health care system.
Digging deeper, Alberta’s savings from amalgamation do seem less impressive. The CIHI figures show provincial spending on hospital administration actually increased after 2008, to $338 million in 2009 from $293 million in 2007. But the province also threw billions at the health care system, which meant administrative costs represented a smaller piece of the pie. Ontario, by comparison, spent $1.07 billion in 2008 and $1.04 billion the year before. And per capita health care costs, which include administrative costs, are way higher in Alberta than in Ontario: $2,647 per person for Alberta in 2009 (the latest year figures were available), compared to $1,464 for Ontario.
Yes, the Alberta government has seen some savings from the superboard, says John Church, a University of Alberta expert on health care reform. But he contends the move to abolish local boards was motivated by politics, aimed more at curbing the power of local hospital executives than saving money.
“It’s not all bad, it’s just that going too far with centralization for the wrong reasons is going to get you into problems,” he says. “They might be realizing greater administrative efficiencies, but they’ve got doctors and the public up in arms over what is going on in the health care system.”
With Albertans getting ready to head to the polls, all of the province’s opposition parties are promising to dismantle Alberta Health Services, while the Progressive Conservatives have pledged to hand more decision-making power to the regional health advisory councils they quietly created last year. The surging Wildrose party has promised to recreate local hospital boards.
Wildrose Leader Danielle Smith has also promised to expand private health care facilities that patients could turn to when public facilities don’t meet national wait-time standards.
Whichever party wins the April 23 election, Alberta’s centralized health care system seems poised for an overhaul—if it survives at all.
All this is likely to make health care amalgamation a non-starter in Ontario, where a Liberal government in its third term is hanging on to a shaky minority, and where comparing hospitals in Ontario to those in Alberta seems increasingly like comparing apples to a bushel of political hot potatoes.