Alberta
Alberta’s bureaucratic shuffle bears little resemblance to necessary health-care reforms
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From the Fraser Institute
Sometime soon, the Smith government will begin a major shift in the administrative structure of the province’s health-care system, switching from a single overarching health authority (Alberta Health Services) to multiple authorities each tasked with overseeing one area of the health-care system. Unsurprisingly, the usual defenders of the status quo were quick to decry the reform as unnecessary or problematic. To other critics, this seems a lot like a distraction tactic from the old playbook where the deck chairs on the Titanic are shuffled to make it appear as if the government is finally doing something about the province’s failing health-care system while nothing will really change.
Then again, it’s also possible that the provincial government is building the structure for some very positive reforms that will meaningfully benefit Alberta’s patients in the future. Alberta’s health-care system is not known for being efficient, effective or timely—and reforms are badly needed.
Among the provinces, Alberta’s provincial health spending ranked second-highest (after adjusting for age and sex) in 2021, the latest year of available data, while Albertans endure health-care wait times that are longer than the national average. Nationally, Canada is a relatively high spender among universal health-care countries, yet ranks near the bottom for the availability of medical professionals, medical technologies and hospital resources. And Canadian patients suffer some of the longest delays for access to care in the developed world.
Put simply, Albertans spend more and get less than their counterparts in other developed countries when it comes to universal health care. The solution to this problem is to learn from countries such as Switzerland, Australia and Germany, which all deliver more timely universal care with comparable health spending to our own.
So what do these countries do differently? They all have private competitive providers delivering universally accessible services within the public system, and payment for such care is based on actual delivery of services, known as “activity-based” funding. Alberta’s new bureaucratic shuffle appears to bear little resemblance to these higher-performing approaches pursued elsewhere. And if the bureaucratic shuffle is the entire goal, then this reform will likely generate little to no improvement.
But again, perhaps the Smith government is setting the stage for meaningful reform. Before moving from a government-dominated health-care system (like we have in Alberta and every other province) to a higher-performing model with competitive patient-focused delivery, governments must first separate and clearly define the roles of the purchaser of health care and the providers of that care. The Alberta Health Services, which the Smith government will soon begin to dissect, directly provides, oversees and pays for health-care services (e.g. surgeries) in the province. This leads to a lack of transparency and the politicization of health-care decision-making.
A shift to multiple health authorities focused on the delivery of care, accountable to other authorities and the provincial government, has hints of the more transparent and contractual relationships between payers and providers that have reduced wait times and enhanced health system efficiency in a number of European countries. If that’s indeed the government’s goal, Albertans could soon benefit from an improved health-care system.
In other words, if this reform, to move from one large health authority to multiple authorities, is really about more clearly defining government’s role as the purchaser and oversight authority for universal health care, with authorities and providers being transparently accountable for delivering timely quality care to patients, then Albertans may well be on the road to shorter wait times and a higher-quality health-care system.
However, if this is the provincial government working from the same old playbook, with another administrative shuffle to distract Albertans from the real problems in the health-care system, then nothing will really change and patients will pay the price.
Author:
Alberta
Open letter to Ottawa from Alberta strongly urging National Economic Corridor
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Canada’s wealth is based on its success as a trading nation. Canada is blessed with immense resources spread across a vast country. It has succeeded as a small, open economy with an enviable standard of living that has been able to provide what the world needs.
Canada has been stuck in a situation where it cannot complete nation‑building projects like the Canadian Pacific Railway that was completed in 1885, or the Trans Canada Highway that was completed in the 1960s. With the uncertainty of U.S. tariffs looming over our country and province, Canada needs to take bold action to revitalize the productivity and competitiveness of its economy – going east to west and not always relying on north-south trade. There’s no better time than right now to politically de-risk these projects.
A lack of leadership from the federal government has led to the following:
- Inadequate federal funding for trade infrastructure.
- A lack of investment is stifling the infrastructure capacity we need to diversify our exports. This is despite federally commissioned reports like the 2022 report by the National Supply Chain Task Force indicating the investment need will be trillions over the next 50 years.
- Federal red tape, like the Impact Assessment Act.
- Burdensome regulation has added major costs and significant delays to projects, like the Roberts Bank Terminal 2 project, a proposed container facility at Vancouver, which spent more than a decade under federal review.
- Opaque funding programs, like the National Trade Corridors Fund (NTCF).
- Which offers a pattern of unclear criteria for decisions and lack of response. This program has not funded any provincial highway projects in Alberta, despite the many applications put forward by the Government of Alberta. In fact, we’ve gone nearly 3 years without decisions on some project applications.
- Ineffective policies that limit economic activity.
- Measures that pit environmental and economic objectives in stark opposition to one another instead of seeking innovative win-win solutions hinder Canada’s overall productivity and investment climate. One example is the moratorium on shipping crude through northern B.C. waters, which effectively ended Enbridge’s Northern Gateway proposal and has limited Alberta’s ability to ship its oil to Asian markets.
In a federal leadership vacuum, Alberta has worked to advance economic corridors across Canada. In April 2023, Alberta, Saskatchewan and Manitoba signed an agreement to collaborate on joint infrastructure networks meant to boost trade and economic growth across the Prairies. Alberta also signed a similar economic corridor agreement with the Northwest Territories in July 2024. Additionally, Alberta would like to see an agreement among all 7 western provinces and territories, and eventually the entire country, to collaborate on economic corridors.
Through our collaboration with neighbouring jurisdictions, we will spur the development of economic corridors by reducing regulatory delays and attracting investment. We recognize the importance of working with Indigenous communities on the development of major infrastructure projects, which will be key to our success in these endeavours.
However, provinces and territories cannot do this alone. The federal government must play its part to advance our country’s economic corridors that we need from coast to coast to coast to support our economic future. It is time for immediate action.
Alberta recommends the federal government take the following steps to strengthen Canada’s economic corridors and supply chains by:
- Creating an Economic Corridor Agency to identify and maintain economic corridors across provincial boundaries, with meaningful consultation with both Indigenous groups and industry.
- Increasing federal funding for trade-enabling infrastructure, such as roads, rail, ports, in-land ports, airports and more.
- Streamlining regulations regarding trade-related infrastructure and interprovincial trade, especially within economic corridors. This would include repealing or amending the Impact Assessment Act and other legislation to remove the uncertainty and ensure regulatory provisions are proportionate to the specific risk of the project.
- Adjusting the policy levers that that support productivity and competitiveness. This would include revisiting how the federal government supports airports, especially in the less-populated regions of Canada.
To move forward expeditiously on the items above, I propose the establishment of a federal/provincial/territorial working group. This working group would be tasked with creating a common position on addressing the economic threats facing Canada, and the need for mitigating trade and trade-enabling infrastructure. The group should identify appropriate governance to ensure these items are presented in a timely fashion by relative priority and urgency.
Alberta will continue to be proactive and tackle trade issues within its own jurisdiction. From collaborative memorandums of understanding with the Prairies and the North, to reducing interprovincial trade barriers, to fostering innovative partnerships with Indigenous groups, Alberta is working within its jurisdiction, much like its provincial and territorial colleagues.
We ask the federal government to join us in a new approach to infrastructure development that ensures Canada is productive and competitive for generations to come and generates the wealth that ensures our quality of life is second to none.
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Devin Dreeshen
Devin Dreeshen was sworn in as Minister of Transportation and Economic Corridors on October 24, 2022.
Alberta
Premier Smith and Health Mininster LaGrange react to AHS allegations
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Alberta Premier Danielle Smith and Health Minister Adriana LaGrange respond to allegations of political interference in the issuing of health-care contracts.
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