Cory Morgan: Smith’s Plans to Reform Alberta’s Health System Could Have a National Impact

Alberta Premier Danielle Smith speaks about health-care reforms during a news conference in Edmonton on Nov. 8, 2023. The Canadian Press/Jason Franson

Commentary

Every province in Canada is struggling with its health-care system.

Although health spending has increased in every jurisdiction, waiting times for emergency and specialized services continue to climb while infrastructure and skilled labour shortages plague the systems. The root of the problem is within the Canada Health Act. While provinces are tasked with administering and delivering healthcare, federal legislation constrains the provinces in how they can operate. Premiers seeking reform must find ways to pursue changes without running afoul of the federal legislation.

Alberta Premier Danielle Smith has never made her intention to reform the health-care system a secret. She has mused about expanding private health-care provision options and setting up health-care savings accounts for citizens who may choose private or alternative medical options. That led to accusations of Smith wanting to privatize the public system, which is political blasphemy in Canadian politics. In the 2023 Alberta election, Smith was forced to repeatedly reiterate her commitment to a fully public health-care system.

With the pursuit of private care options off the table for now, Premier Smith has set her sights on reforming the health-care bureaucracy that operates as Alberta Health Services (AHS).

In breaking up the AHS bureaucracy, Smith is reversing a trend of centralizing the provincial health authorities since the 1990s. In 1994, Alberta had over 200 health boards that Premier Ralph Klein merged into 17 regional boards. In 2004, the 17 boards were reduced to nine. In 2008, Premier Ed Stelmach merged all the boards into one “superboard” for the entire province. Now, Smith is splitting AHS into four different organizations with different mandates.

Smith has bold health-care reform aspirations and she sees AHS as an impediment to making those reforms. One of her first actions upon becoming premier in 2022 was to fire the entire AHS board and replace them with Dr. John Cowell. Cowell is known as a proponent of health-care reform, and he released a long and damning report on the system in 2012 when he was the head of the Health Quality Council of Alberta. Under Cowell’s leadership, AHS CEO Dr. Verna Yiu was removed from her role over a year before her contract was set to expire.

Premier Smith is setting the stage for substantive health-care reforms and she has been carefully removing the gatekeepers and leaders within the bureaucracy. In breaking AHS into four parts, she will be able to clean house further as restructuring begins.

Critics of Smith’s actions claim the costs and inefficiencies will compound under a decentralized bureaucracy as duplication of roles and confusion over authority may set in. These could be valid concerns, but few would claim the existing AHS board had been operating effectively before Smith’s intervention.

Health service management will now be divided by function with primary care, acute care, continuing care, and mental health/addiction care all having separate divisions. While all those functions fall under the realm of health care, they all have different needs and require differing specialists. They could operate more efficiently as they may be managed by specialists in those fields rather than generalists under a superboard.

These new bureaucracies also have overlapping needs and could find themselves competing for health-care resources when they should be working cooperatively. There will surely be some instability as these new management systems establish themselves.

Premier Danielle Smith is playing a long game. She wants to apply broad and substantive reforms to Alberta’s health system but realizes she needs to neutralize her opposition first. The AHS bureaucracy was huge and effective at resisting changes from the health ministry. Now that AHS will be divided, Smith will be able to tinker with reforms in care provision and addiction treatment without battling the bureaucratic behemoth of the AHS superboard.

Smith’s plans could have a national impact. Other provinces will be watching Alberta’s health-care reforms closely. Smith is taking a political gamble that will pay off in spades if health-care reforms are effective in reducing costs and waiting times. Premiers will be emboldened to pursue reforms if Smith succeeds. It will be political suicide if the reforms fail, though, and consideration of health-care reform across the country will be put aside.

It’s hard to tell yet which reforms Danielle Smith will be prioritizing and how far she is willing to go. As she patiently deconstructs the structure managing the administration of the system, it’s clear she is looking farther down the road as she plays political chess.

Smith has big plans and the reforms will be substantial. It’s just a matter of when she feels the stage has been safely set to implement substantive health policy changes.

Views expressed in this article are opinions of the author and do not necessarily reflect the views of The Epoch Times.