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Alberta

Alberta government should reform hospital funding to help shorten wait times

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4 minute read

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.

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Alberta

Early Success: 33 Nurse Practitioners already working independently across Alberta

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Nurse practitioners expand primary care access

The Alberta government’s Nurse Practitioner Primary Care program is showing early signs of success, with 33 nurse practitioners already practising independently in communities across the province.

Alberta’s government is committed to strengthening Alberta’s primary health care system, recognizing that innovative approaches are essential to improving access. To further this commitment, the Nurse Practitioner Primary Care Program was launched in April, allowing nurse practitioners to practise comprehensive patient care autonomously, either by operating their own practices or working independently within existing primary care settings.

Since being announced, the program has garnered a promising response. A total of 67 applications have been submitted, with 56 approved. Of those, 33 nurse practitioners are now practising autonomously in communities throughout Alberta, including in rural locations such as Beaverlodge, Coaldale, Cold Lake, Consort, Morley, Picture Butte, Three Hills, Two Hills, Vegreville and Vermilion.

“I am thrilled about the interest in this program, as nurse practitioners are a key part of the solution to provide Albertans with greater access to the primary health care services they need.”

Adriana LaGrange, Minister of Health

To participate in the program, nurse practitioners are required to commit to providing a set number of hours of medically necessary primary care services, maintain a panel size of at least 900 patients, offer after-hours access on weekends, evenings or holidays, and accept walk-in appointments until a panel size reaches 900 patients.

With 33 nurse practitioners practising independently, about 30,000 more Albertans will have access to the primary health care they need. Once the remaining 23 approved applicants begin practising, primary health care access will expand to almost 21,000 more Albertans.

“Enabling nurse practitioners to practise independently is great news for rural Alberta. This is one more way our government is ensuring communities will have access to the care they need, closer to home.”

Martin Long, parliamentary secretary for rural health

“Nurse practitioners are highly skilled health care professionals and an invaluable part of our health care system. The Nurse Practitioner Primary Care Program is the right step to ensuring all Albertans can receive care where and when they need it.”

Chelsae Petrovic, parliamentary secretary for health workforce engagement

“The NPAA wishes to thank the Alberta government for recognizing the vital role NPs play in the health care system. Nurse practitioners have long advocated to operate their own practices and are ready to meet the growing health care needs of Albertans. This initiative will ensure that more people receive the timely and comprehensive care they deserve.”

Jennifer Mador, president, Nurse Practitioner Association of Alberta

The Nurse Practitioner Primary Care program not only expands access to primary care services across the province but also enables nurse practitioners to practise to their full scope, providing another vital access point for Albertans to receive timely, high-quality care when and where they need it most.

Quick facts

  • Through the Nurse Practitioner Primary Care Program, nurse practitioners receive about 80 per cent of the compensation that fee-for-service family physicians earn for providing comprehensive primary care.
    • Compensation for nurse practitioners is determined based on panel size (the number of patients under their care) and the number of patient care hours provided.
  • Nurse practitioners have completed graduate studies and are regulated by the College of Registered Nurses of Alberta.
  • For the second consecutive year, a record number of registrants renewed their permits with the College of Registered Nurses of Alberta (CRNA) to continue practising nursing in Alberta.
    • There were more than 44,798 registrants and a 15 per cent increase in nurse practitioners.
  • Data from the Nurse Practitioner Primary Care Program show:
    • Nine applicants plan to work on First Nations reserves or Metis Settlements.
    • Parts of the province where nurse practitioners are practising: Calgary (12), Edmonton (five), central (six), north (three) and south (seven).
  • Participating nurse practitioners who practise in eligible communities for the Rural, Remote and Northern Program will be provided funding as an incentive to practise in rural or remote areas.
  • Participating nurse practitioners are also eligible for the Panel Management Support Program, which helps offset costs for physicians and nurse practitioners to provide comprehensive care as their patient panels grow.

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Alberta

Province considering new Red Deer River reservoir east of Red Deer

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Central Alberta reservoir study underway

Alberta’s government is moving forward a study to assess the feasibility of building a new reservoir on the Red Deer River to help support growing communities.

Demand for water from communities and businesses is increasing as more families, businesses and industries choose to live and work in central Alberta. The Red Deer River supplies water to hundreds of thousands of Albertans across the region and expanding water storage capacity could help reduce the risk of future droughts and meet the growing water demands.

Alberta’s government has now begun assessing the feasibility of building a potential new reservoir east of Red Deer near Ardley. A two-phase, multi-year study will explore the costs and value of constructing and operating the reservoir, and its impact on downstream communities, farmers and ranchers, and businesses.

“Central Alberta is a growing and thriving, and we are ensuring that it has the water it needs. This study will help us determine if an Ardley reservoir is effective and how it can be built and operated successfully to help us manage and maximize water storage for years to come.”

Rebecca Schulz, Minister of Environment and Protected Areas

Reservoirs play a vital role in irrigation, drought management, water security and flood protection. Budget 2024 allocated $4.5 million to explore creating a new reservoir on the Red Deer River, at a damsite about 40 kilometres east of the City of Red Deer.

Work will begin on the scoping phase of the study as soon as possible. This will include reviewing available geotechnical and hydrotechnical information and exploring conceptual dam options. The scoping phase also includes meetings with municipalities and water users in the area to hear their views. This work is expected to be completed by December 2025.

“Reliable water infrastructure is essential for Alberta’s growing communities and industries. The Ardley reservoir feasibility study is a vital step toward ensuring long-term water security for central Alberta. As we assess this project’s potential, we’re supporting the sustainability of our economic corridors, agricultural operations and rural economy.”

Devin Dreeshen, Minister of Transportation and Economic Corridors

“Water is essential to the agriculture industry and if the past few years are any indication, we need to prepare for dry conditions. A potential dam near Ardley could enhance water security and help farmers and ranchers continue to thrive in Alberta’s unpredictable conditions.”

RJ Sigurdson, Minister of Agriculture and Irrigation 

Once that is complete, the feasibility study will then shift into a second phase, looking more closely at whether an effective new dam near Ardley can be safely designed and constructed, and the impact it may have on communities and the environment. Geotechnical and hydrotechnical investigations, cost-benefit analyses and an assessment of environmental and regulatory requirements will occur. The feasibility phase will also include gathering feedback directly from Albertans through public engagement. This work is expected to be completed by March 31, 2026.

Quick facts

  • The Ardley dam scoping and feasibility study will be undertaken by Hatch Ltd., a Canadian multi-disciplinary professional services firm.
  • Once the feasibility study is complete, government will assess the results and determine whether to pursue this project and proceed with detailed engineering and design work and regulatory approvals.
  • Alberta’s government owns and operates several large reservoirs in the South Saskatchewan River Basin that help ensure sufficient water supply to meet demand from communities, irrigators and businesses, while also maintaining a healthy aquatic environment.
  • Water stored at Gleniffer Lake, the reservoir created by Dickson Dam, helps supplement low winter flows along the Red Deer River and helps ensure an adequate water supply for Red Deer and Drumheller.

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