Alberta Premier Danielle Smith seems to enjoy swimming upstream while rocking the boat. She has set her sights on the most sacred of Canadian cows, the health-care system.
People had better sit up and pay attention to what Smith’s up to, as her success or failure in reforming Alberta’s health-care system will set the standard for other provinces.
Danielle Smith is not like other premiers. She is undoubtedly smart and experienced, but she is also prone to impulsive actions, as demonstrated by her disastrous choice to lead a mass floor-crossing from the Wildrose Party she led to the governing Progressive Conservatives in 2014.
She can’t be underestimated, though. After spending years in the political wilderness, she managed to resurface, win the premiership by taking the United Conservative Party (UCP) leadership, and then win a hard-fought election to entrench her role as the leader of the province.
Public-sector unions and health-care activist groups are sounding the alarm bells, as a mandate letter Smith gave to her health minister signals that a major shakeup to the system is coming.
One of Smith’s first actions upon becoming Alberta’s premier was to fire the entire board of Alberta Health Services (AHS) and replace it with one person. Alberta’s chief medical officer was dismissed, as was the CEO of AHS. Smith wants to make it clear she means business.
Smith’s mandate letter to Health Minister Adriana LaGrange directs the minister to work toward decentralizing the authority of AHS. Alberta’s health service management was bundled and centralized under one umbrella in 2008. Health-care provision has been plagued with inefficiency and ever-increasing wait times ever since.
But will decentralizing AHS into regional branches ease the problem of strained health-care resources?
Local administration can lead to more effective planning in regions with differing health-care needs and challenges. It may help end the practice of larger urban centres sniping emergency medical services from neighbouring rural municipalities, as has been happening.
However, moving back to a system of regional health authorities offers the risk of expanding an already-oversized bureaucracy in health management. Duplication of services and roles can occur, and local authorities can lose some of the purchasing power they had when it was a larger organization under one roof.
Decentralizing Alberta’s health-care administration could be a divide-and-conquer tactic on the part of the government as it prepares for more substantial reforms. While the Smith government has already cut the head off the AHS bureaucracy, there are many upper- and middle-level administrators remaining who will resist changes to the system. Breaking up the centralized health authority will offer the opportunity to change out many of the faces in the organization as it restructures.
Premier Smith has spoken of reducing the number of services currently done in the primary care settings of hospitals and having those provided in specialized units. Services such as midwifery, day surgeries, and long-term care could be delivered outside of hospitals and direct AHS management.
Smith is open about expanding the role of private health-care providers when it comes to the provision of non-acute services. Private capital could fund infrastructure and manage facilities. That is the most controversial reform she may pursue. Unions and progressive activists will strongly oppose any attempt to allow increased private health-care provision.
With a decentralized system, the Smith government could ease into the expansion of private services. An orthopedic surgery centre here, a dialysis clinic there. The government could spread out the reforms throughout the province and allow them to be tested on a micro level, while opponents would have difficulty targeting the actions.
The health-care systems in every province are currently overburdened. Wait times for emergency services, diagnostics, and specialized procedures continue to expand despite constant spending increases.
It’s clear Canada needs to examine its system, set aside the ideological attachments to the status quo, and examine substantive reforms.
Most if not all provincial leaders know the current system is unsustainable. They won’t pursue change for fear of political blowback.
Danielle Smith is used to—and unfazed by—torqued political reactions to her policies. She appears willing to take the chance and pursue serious health-care reforms. The mandate letter to her minister hints that the decentralization of AHS is just the beginning.
If Smith’s reforms succeed, other provinces will follow her lead. Alberta has a premier willing to stick her neck out with health reform, and it could lead to a domino effect of change across the country.
