Alberta Premier Danielle Smith now says she wants the government to retake ownership of as many as possible of the 106 hospitals Alberta Health Services runs and then lease them back to the agency – thereby creating the scenario in which the government could leverage its funding as a weapon of fear.JASON FRANSON/The Canadian Press
Alberta Premier Danielle Smith has proposed a novel tool for improving the performance of her province’s hospitals: fear.
Her idea, as she revealed on Aug. 17 in a members-only meeting with United Conservative Party faithful in Drayton Valley, Alta., is to hand over the operation of struggling hospitals that are currently run by Alberta Health Services to third parties.
Alberta has long allowed private clinics to perform certain surgeries, and Ms. Smith said she is prepared to turn some AHS hospitals over to Covenant Health, a faith-based health care provider that operates 11 hospitals and other facilities. This, she said, would create competition.
“When you’re dealing with a monopoly, and they believe that they can deliver any type of care, and there are no consequences, they’re going to continue to deliver bad service. And competition is one option. That’s why we’re offering chartered surgical centres and why we’re offering Covenant,” Ms. Smith said.
“But the other is the fear of having it taken away. That is going to be a very powerful competitive incentive for the managers to say, ‘Oh my goodness, if we continue to deliver terrible care in Drayton Valley, then somebody else is going to be chosen for the operator.’ ”
The notion of introducing market-like competition and fear into the delivery of public services no doubt has an appeal to many UCP voters.
Alberta’s per-capita health costs are higher than the Canadian average, but it still manages to suffer from the same ills as provinces that spend less: long wait times for surgeries, crowded emergency rooms, a shortage of family doctors, overworked hospital staff, a lack of mental-health supports...
Ms. Smith has redirected the public’s ire over these shortcomings at Alberta Health Services, the government agency that gets the lion’s share of the province’s health budget.
AHS is one of the biggest health care providers in Canada. It effectively has a monopoly on the delivery of health care in Alberta – or it did, until Ms. Smith announced last year that her government will break it up along four disciplines – primary care, acute care, continuing care and mental health – and leave only acute care in the hands of AHS.
Ms. Smith now says she wants the government to retake ownership of as many as possible of the 106 hospitals AHS runs and then lease them back to the agency – thereby creating the scenario in which the government could leverage its funding as a weapon of fear.
Would this save taxpayers’ money and guarantee them better service? There is absolutely no guarantee of that, and Ms. Smith has offered no evidence for it.
But there are concerns that a siloed health system would mean some patients will find themselves having to deal with four separate bureaucracies.
It is also worrying that Ms. Smith says hospitals could be turned over to Covenant Health, a Catholic care provider that does not allow staff to provide abortions, emergency contraception and medical assistance in dying, procedures to which Canadians are entitled.
Early-term abortions in Alberta are mostly done in AHS-funded clinics, not in hospitals, and MAID is available through palliative care services, in clinics or in patients’ homes. It’s possible, though, that handing hospitals to Covenant Health would reduce Albertans’ access to the care they need – which, in a word, would amount to underperforming.
The biggest issue, though, is the idea that a government would leverage funding as a threat against an incumbent operator that the premier of the day doesn’t seem to like much.
It could prove costly to transfer the operation of a hospital deemed to be underperforming to a different organization, only to discover that the issues that caused the alleged underperformance were endemic to Canada’s health care system in general – things like doctor and nurse shortages, government underfunding, aging populations and so on.
That’s the crux of the matter. Health care services are struggling everywhere across the country, and no provincial government has come up with a magic bullet. Ms. Smith would be wiser to try to understand the common causes of the current crisis and address those.
But that’s a lot more difficult than blithely labelling the province’s health managers as indifferent monopolists, and then ad-libbing a simplistic solution.