While other provinces are moving to a single provincial health system like Alberta Health Services, Premier Danielle Smith appears to be moving to dismantle AHS. She hinted about significant changes coming to AHS’s structure. Rumours are running rampant — so let this column serve as a warning to Albertans who rely on our health-care system.
The evidence is clear. A 2017 report by Alberta’s auditor general noted that integration is a hallmark of a high performing health-care system. It improves care and outcomes and enables seamless movement of patients and information between all care providers. The report concluded that AHS’ structure created opportunities for integration, but that better integration of AHS and community physicians, and electronic integration was needed.
Health zones within an overarching structure such as AHS are critical to achieving integration and health-system priorities. Local decision-making, which Smith highlighted as important, can be achieved through AHS’s existing zones.
We should not forget the past. Quality concerns in a rural hospital, superbug outbreaks and inadequate equipment sterilization led to the potential exposure of 3,000 people to HIV and hepatitis. The Health Quality Council of Alberta report blamed a “strained working relationship” between the hospital and one of the nine health regions, confusion over accountabilities and the “lack of a widespread patient safety culture.”
These concerns, along with significant variation in care and outcomes across regions, unhealthy competition between regions for staff and physicians, and rapidly rising costs led to the creation of AHS. It has standardized care, improved outcomes and been less expensive than a decentralized system.
Having a provincial system has been good for rural and urban Albertans. Strokes, if untreated for too long, lead to paralysis and loss of speech. AHS was able to scale a program to deliver life-saving stroke care faster in rural areas. Stroke survivors across Alberta now have less disability, meaning one-third fewer need a long-term care facility.
Rumoured changes to AHS include separate governance in primary care, separate systems for addiction and mental health, and for continuing care outside of AHS, and program changes to critical supports such as procurement and IT.
Having a separate system with strong leadership for primary care makes sense and is long overdue. There are more than 1,000 primary care offices in Alberta, mostly independently owned. If you even have a family physician, the existing system has not set them up for success. Governance should be separate from (though ultimately accountable to) elected officials. Supported with funding, this will mean consistent priorities and better access.
The other rumoured changes will reduce integration. Most continuing care beds in Alberta are in private/for-profit facilities. Many are excellent, but several have had significant quality concerns. They all require ongoing safety and quality audits. For-profit facilities have strongly lobbied to move governance of continuing care outside AHS, assuming this will be good for their bottom lines. This should worry Alberta seniors.
Addiction and mental health services are critical and must be integrated with other health-care services. Simply wanting to ensure that all services are recovery-oriented is not justification for this change, which risks more fragmented care.
Smith’s government has not released all the details yet, but there seems to be no coherent strategy here. Breaking up the health-care system into silos that limit communication and co-ordination is the exact opposite of what other provinces are doing. Is this a nod to the Take Back Alberta movement, payback on a health-care system that implemented a vaccine mandate and continuous masking to keep patients safe?
Creating a co-ordinating structure to support primary care is a good move. Beyond that, this restructuring is a distraction. What’s needed is a consistent focus on improved access in primary care, and allowing AHS to improve access, care and outcomes for Albertans, including those living in rural areas.
Albertans, your health-care system is at risk. Your health is important and so is your voice.
Braden Manns is a physician and professor of medicine at the University of Calgary where he holds a research chair in health economics. He was an interim vice-president for Alberta Health Services until he resigned on June 11, 2023