Alberta
Alberta government should reform hospital funding to help shorten wait times
From the Fraser Institute
By Mackenzie Moir and Alicia Kardos
Other high-performing countries with universal health care (Australia, Germany, Switzerland) use “activity-based funding.” Under this model, hospitals receive funding based on the amount of care they provide.
Earlier this year, the Alberta Medical Association sounded the alarm on “rolling surgical outages,” patients diverted to other treatment sites, and the potential capping of services at major provincial hospitals. Unfortunately, the delays these problems create aren’t new to Albertans, as patients continue to face lengthy wait times.
According to the latest data, Albertan patients faced a median wait time of 33.5 weeks in 2022 for non-emergency medical treatment, a delay that was nearly six weeks longer than the national average, and three times longer than what patients in the province experienced in 1993 (when national estimates were first published).
When broken down, the wait in Alberta includes the first 16.4 weeks it takes for a patient to see a specialist after referral from their family doctor—then a second wait of 17.2 weeks to receive treatment after seeing that specialist. And these figures don’t account for the wait to see a GP in the first place, which is a significant issue in a rapidly growing province where remain without a family doctor.
Of course, we hear the predicable calls for more money. But in reality, spending more won’t get Albertans out of this problem. In a recent comparison of high-income countries with universal coverage, Canada (in 2021) was already one of the highest spenders on health care (as a share of their economy) while having some of the fewest doctors and hospital beds (after accounting for differences in population age among countries).
And when compared to nine other high-income countries in 2020, Canadians were found to have the longest waits for medical care. Specifically, Canadians were the least likely to report waiting under four months for non-emergency surgery (at 62 per cent) compared to higher-performing countries such as Australia (72 per cent), Switzerland (94 per cent) and Germany (99 per cent).
So what’s the solution?
In a word, reform. For example, Alberta could change the way it funds hospitals. Canada’s predominant approach is to provide hospitals a set amount of money each year, regardless of the level of services provided. This means that the money hospitals receive isn’t tied to the actual number of services they provide. This discourages hospitals from providing more care because each patient represents a drain on their budget rather than an opportunity.
In contrast, many other high-performing countries with universal health care (Australia, Germany, Switzerland) use “activity-based funding.” Under this model, hospitals receive funding based on the amount of care they provide. This creates a powerful incentive for hospitals to treat more patients, because each patient represents an opportunity for the hospital to earn more money.
Quebec decided in last year to fund all of its surgical procedures using this model, and now plans to expand the model to all hospital care by 2027/28. The Smith government has also taken some steps that lay the foundation for these types of reforms. This is good news for Albertans, if reform is actually on the way.
Across Canada, despite the availability of solutions, the status quo of long waits persists. Breaking from the past can be hard, but there may be hope on the horizon for patients in Alberta’s beleaguered and poorly performing health-care system.
Authors:
Alberta
AMA challenged to debate Alberta COVID-19 Review
Justice Centre President sends an open letter to Dr. Shelley Duggan, President of the Alberta Medical Association
Dear Dr. Duggan,
I write in response to the AMA’s Statement regarding the Final Report of the Alberta Covid Pandemic Data Review Task Force. Although you did not sign your name to the AMA Statement, I assume that you approved of it, and that you agree with its contents.
I hereby request your response to my questions about your AMA Statement.
You assert that this Final Report “advances misinformation.” Can you provide me with one or two examples of this “misinformation”?
Why, specifically, do you see this Final Report as “anti–science and anti–evidence”? Can you provide an example or two?
Considering that you denounced the entire 269-page report as “anti–science and anti–evidence,” it should be very easy for you to choose from among dozens and dozens of examples.
You assert that the Final Report “speaks against the broadest, and most diligent, international scientific collaboration and consensus in history.”
As a medical doctor, you are no doubt aware of the “consensus” whereby medical authorities in Canada and around the world approved the use of thalidomide for pregnant women in the 1950s and 1960s, resulting in miscarriages and deformed babies. No doubt you are aware that for many centuries the “consensus” amongst scientists was that physicians need not wash their hands before delivering babies, resulting in high death rates among women after giving birth. This “international scientific consensus” was disrupted in the 1850s by a true scientist, Dr. Ignaz Semmelweis, who advocated for hand-washing.
As a medical doctor, you should know that science is not consensus, and that consensus is not science.
It is unfortunate that your AMA Statement appeals to consensus rather than to science. In fact, your AMA Statement is devoid of science, and appeals to nothing other than consensus. A scientific Statement from the AMA would challenge specific assertions in the Final Report, point to inadequate evidence, debunk flawed methodologies, and expose incorrect conclusions. Your Statement does none of the foregoing.
You assert that “science and evidence brought us through [Covid] and saved millions of lives.” Considering your use of the word “millions,” I assume this statement refers to the lockdowns and vaccine mandates imposed by governments and medical establishments around the world, and not the response of the Alberta government alone.
What evidence do you rely on for your assertion that lockdowns saved lives? You are no doubt aware that lockdowns did not stop Covid from spreading to every city, town, village and hamlet, and that lockdowns did not stop Covid from spreading into nursing homes (long-term care facilities) where Covid claimed about 80% of its victims. How, then, did lockdowns save lives? If your assertion about “saving millions of lives” is true, it should be very easy for you to explain how lockdowns saved lives, rather than merely asserting that they did.
Seeing as you are confident that the governments’ response to Covid saved “millions” of lives, have you balanced that vague number against the number of people who died as a result of lockdowns? Have you studied or even considered what harms lockdowns inflicted on people?
If you are confident that lockdowns did more good than harm, on what is your confidence based? Can you provide data to support your position?
As a medical doctor, you are no doubt aware that the mRNA vaccine, introduced and then made mandatory in 2021, did not stop the transmission of Covid. Nor did the mRNA vaccine prevent people from getting sick with Covid, or dying from Covid. Why would it not have sufficed in 2021 to let each individual make her or his own choice about getting injected with the mRNA vaccine? Do you still believe today that mandatory vaccination policies had an actual scientific basis? If yes, what was that basis?
You assert that the Final Report “sows distrust” and “criticizes proven preventive public health measures while advancing fringe approaches.”
When the AMA Statement mentions “proven preventive public health measures,” I assume you are referring to lockdowns. If my assumption is correct, can you explain when, where and how lockdowns were “proven” to be effective, prior to 2020? Or would you agree with me that locking down billions of healthy people across the globe in 2020 was a brand new experiment, never tried before in human history? If it was a brand new experiment, how could it have been previously “proven” effective prior to 2020? Alternatively, if you are asserting that lockdowns and vaccine passports were “proven” effective in the years 2020-2022, what is your evidentiary basis for that assertion?
Your reference to “fringe approaches” is particularly troubling, because it suggests that the majority must be right just because it’s the majority, which is the antithesis of science.
Remember that the first doctors to advocate against the use of thalidomide by pregnant women, along with Dr. Ignaz Semmelweis advocating for hand-washing, were also viewed as “advancing fringe approaches” by those in authority. It would not be difficult to provide dozens, and likely hundreds, of other examples showing that true science is a process of open-minded discovery and honest debate, not a process of dismissing as “fringe” the individuals who challenge the reigning “consensus.”
The AMA Statement asserts that the Final Report “makes recommendations for the future that have real potential to cause harm.” Specifically, which of the Final Report’s recommendations have a real potential to cause harm? Can you provide even one example of such a recommendation, and explain the nature of the harm you have in mind?
The AMA Statement asserts that “many colleagues and experts have commented eloquently on the deficiencies and biases [the Final Report] presents.” Could you provide some examples of these eloquent comments? Did any of your colleagues and “experts” point to specific deficiencies in the Final Report, or provide specific examples of bias? Or were these “eloquent” comments limited to innuendo and generalized assertions like those contained in the AMA Statement?
In closing, I invite you to a public, livestreamed debate on the merits of Alberta’s lockdowns and vaccine passports. I would argue for the following: “Be it resolved that lockdowns and vaccine passports imposed on Albertans from 2020 to 2022 did more harm than good,” and you would argue against this resolution.
Seeing as you are a medical doctor who has a much greater knowledge and a much deeper understanding of these issues than I do, I’m sure you will have an easy time defending the Alberta government’s response to Covid.
If you are not available, I would be happy to debate one of your colleagues, or any AMA member.
I request your answers to the questions I have asked of you in this letter.
Further, please let me know if you are willing to debate publicly the merits of lockdowns and vaccine passports, or if one of your colleagues is available to do so.
Yours sincerely,
John Carpay, B.A., LL.B.
President
Justice Centre for Constitutional Freedoms
Alberta
When America attacks
Paul Wells interviews Alberta Premier Danielle Smith
It’s beginning to look a lot like statehood: Danielle Smith and more on the pod
Here’s Justin Trudeau, urging Pierre Poilievre to declare whether he stands with Canada or with “Danielle Smith, Kevin O’Leary, and ultimately, Donald Trump.” The great thing about a wedge is it can always do more wedging. Meanwhile Danielle Smith is still the premier of Alberta and she’s my first guest this week.
At one point in our interview — which makes Smith the third consecutive Alberta premier to appear on this podcast, so don’t be shy, François Legault — Smith says she asked Trump at Mar-a-Lago whether he’d like to buy more Alberta oil. We’re coming off a truly weird couple of weeks when people were falling over themselves to call Smith a traitor or sellout for that kind of talk. Which is odd for several reasons, including this: as my guest from two weeks ago, former US ambassador David L. Cohen, pointed out, Alberta already sells immense amounts of oil into the American market. So it’s not some deranged fantasy to imagine it might sell more.
I never liked the “Team Canada” talk that swept through this country like a bad fashion trend after Trump tweeted his threat of 25% blanket tariffs on Canadian and Mexican imports. I kind of don’t care who’s offside that sort of coerced and silly unanimity, or for what reasons: it will always be somebody, and the social capital you burn up in a futile attempt to enforce the party line will be a terrible, stupid waste. Kids, ask your parents about the Charlottetown Accord referendum. That it turned out this time to be the premier of the province with by far the most to lose from some counter-tariffs or, especially, from an oil export ban should not have been a big shocker. The party-line approach is also a strange response. There’s no Team America. Donald Trump will be challenged in court for everything he does for the rest of his time in office, often by state governors, and encouraging those natural divisions among our American friends makes more sense than forbidding natural divisions at home.
This may have something to do with why Louis St. Laurent, in his 1947 Gray Lecture, named national unity as the paramount value in Canadian foreign policy, ahead of liberty and the rule of law. “No policy can be regarded as wise which divides the people whose effort and resources must put it into effect,” he said, in one of the most enthusiastically ignored lessons in Canadian political history.
As it turns out, I think the air was already going out of the Team Canada balloon before Smith joined me on a Zoom call. Voices have been piping up, including economist Trevor Tombe on David Herle’s podcast, warning about substantial permanent economic cost in exchange for not much political gain.
I think I’ve made it pretty clear where I stand on all this. Smith makes herself pretty clear too.
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I added a second guest because I knew my time with Smith would be finite, and because we have so much to talk about these days. My second guest is Amy Greenberg, who’s one of the leading historians of the antebellum United States (1800-1860, the period leading up to the Civil War.)
She’s a former Guggenheim Fellow, an award-winning teacher, and the author of five books, many of which grapple with the notion of manifest destiny — the idea that the United States, as a historic vanguard of liberty, must keep growing until it filled a continent.
Manifest destiny is a founding American myth, a uniquely powerful intersection of messianism and acreage. You know who’d have a feeling for that sort of thing? A real estate man from Queen’s. But Greenberg, understandably, was reluctant to analyze anything Trump might be up to. She’s happy to stick to what she knows, but that’s fascinating enough: American expansionism as a project of zealots, but also of scoundrels eager for a distraction. The idea of annexing Texas, which became the Mexican-American War and thus the topic of Greenberg’s most prominent book, occurred to the hapless accidental President John Tyler while he was facing impeachment and after the Whigs’ congressional wing had kicked him out of the party. And as she points out in an earlier book with the intriguing title Manifest Manhood, the expansionist impulse is also an expression of a certain idea of robust and aggressive masculinity. Just remember, she’s not talking about Donald Trump.
You can listen to this episode on Apple Podcasts and a bunch of other platforms via the “Listen On” button that you can see at the top of this post when you view it on your desktop browser. If you listen on a podcast platform, hit “Like” and “Subscribe” buttons, and leave a good review, to help spread the word.
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I am grateful to be the Max Bell Foundation Senior Fellow at McGill University, the principal patron of this podcast. Antica Productions turns these interviews into a podcast every week. Kevin Breit wrote and performed the theme music. Andy Milne plays it on piano at the end of each episode. Thanks to all of them and to you. Please tell your friends to subscribe to The Paul Wells Show on their favourite podcast app, or here on the newsletter.
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