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Alberta

Alberta and B.C. budgets represent two different approaches to government finances

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From the Fraser Institute

By Grady Munro and Tegan Hill

” for every $1 of additional revenue enjoyed by both provinces, the Eby government increased spending by more than $6 compared to 79 cents for the Smith government. “

In its recent budget, the Alberta government promised a new approach to provincial finances, with spending restraint and limited debt accumulation. While there’s still work to do, this is a far better approach than the reckless spending and massive debt accumulation of the British Columbia government.

The Smith government projects a $367 million surplus in 2024/25, followed by two more surpluses of $1.4 billion in 2025/26 and $2.6 billion in 2026/27. The government plans to use these surpluses largely to pay down debt, so although provincial net debt (financial assets minus liabilities) is expected to rise slightly in 2024/25 due to increased long-term capital spending (e.g. schools and highways), the debt is projected to decrease 4.1 per cent ($1.7 billion) from 2023/24 to 2026/27.

Alberta’s strong fiscal outlook is largely driven by historically high resource revenues. But while the government plans to increase program spending (total spending minus debt interest costs) nominally over the next three years, spending will grow at a slower rate than population growth and inflation—meaning spending will decline on an inflation-adjusted per-person basis.

The Smith government still must better align spending with stable revenues, but this is an important step in the right direction.

By contrast, B.C.’s 2024 budget projects a $7.9 billion deficit in 2024/25 followed by deficits of $7.8 billion in 2025/26 and $6.3 billion in 2026/27. These deficits, combined with borrowing for capital projects, will drive a projected $55.1 billion (74.7 per cent) increase in provincial net debt from 2023/24 to 2026/27. As a result, the level of net debt projected in 2026/27 ($128.8 billion) is nearly triple the level recorded in 2019/20 ($46.9 billion).

These deficits are due to a substantial increase in provincial spending by the Eby government. Indeed, similar to Alberta, B.C. has recently enjoyed an unexpected surge in revenues, but unlike the Smith government, the Eby government has shown no spending restraint.

From 2023/24 to 2025/26, revenues in B.C. will be a projected $2.0 billion higher than the government projected in last year’s budget, yet the plan for spending over that same period increased by $13.2 billion. For comparison, the Smith government also increased spending in these years relative to its 2023 budget, but did so by $2.1 billion less than the  increase in revenues.

In other words, for every $1 of additional revenue enjoyed by both provinces, the Eby government increased spending by more than $6 compared to 79 cents for the Smith government.

The consequences of B.C.’s approach are clear. By spending far outside its means, the Eby government will saddle future generations of British Columbians with tens of billions more in debt that must be financed through taxes. For perspective, debt interest payments will nearly cost a projected $1,000 per British Columbian by 2026/27—that’s taxpayer money no longer available for programs or services. Moreover, continued deficits weaken the government’s ability to deal with future challenges (such as an economic downturn) without taking on more debt and driving up interest costs.

The Alberta and B.C. budgets provide examples of two different approaches to government finances. While there’s more to be done, Alberta is moving in the right direction to help prevent debt accumulation. On the other hand, B.C. is massively increasing spending and debt, to the detriment of British Columbians now and in the future.

Alberta

Alberta takes big step towards shorter wait times and higher quality health care

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From the Fraser Institute

By Nadeem Esmail

On Monday, the Smith government announced that beginning next year it will change the way it funds surgeries in Alberta. This is a big step towards unlocking the ability of Alberta’s health-care system to provide more, better and faster services for the same or possibly fewer dollars.

To understand the significance of this change, you must understand the consequences of the current (and outdated) approach.

Currently, the Alberta government pays a lump sum of money to hospitals each year. Consequently, hospitals perceive patients as a drain on their budgets. From the hospital’s perspective, there’s little financial incentive to serve more patients, operate more efficiently and provide superior quality services.

Consider what would happen if your local grocery store received a giant bag of money each year to feed people. The number of items would quickly decline to whatever was most convenient for the store to provide. (Have a favourite cereal? Too bad.) Store hours would become less convenient for customers, alongside a general decline in overall service. This type of grocery store, like an Alberta hospital, is actually financially better off (that is, it saves money) if you go elsewhere.

The Smith government plans to flip this entire system on its head, to the benefit of patients and taxpayers. Instead of handing out bags of money each year to providers, the new system—known as “activity-based funding”—will pay health-care providers for each patient they treat, based on the patient’s particular condition and important factors that may add complexity or cost to their care.

This turns patients from a drain on budgets into a source of additional revenue. The result, as has been demonstrated in other universal health-care systems worldwide, is more services delivered using existing health-care infrastructure, lower wait times, improved quality of care, improved access to medical technologies, and less waste.

In other words, Albertans will receive far better value from their health-care system, which is currently among the most expensive in the world. And relief can’t come soon enough—for example, last year in Alberta the median wait time for orthopedic surgeries including hip and knee replacements was 66.8 weeks.

The naysayers argue this approach will undermine the province’s universal system and hurt patients. But by allowing a spectrum of providers to compete for the delivery of quality care, Alberta will follow the lead of other more successful universal health-care systems in countries such as Australia, Germany, the Netherlands and Switzerland and create greater accountability for hospitals and other health-care providers. Taxpayers will get a much better picture of what they’re paying for and how much they pay.

Again, Alberta is not exploring an untested policy. Almost every other developed country with universal health care uses some form of “activity-based funding” for hospital and surgical care. And remember, we already spend more on health care than our counterparts in nearly all of these countries yet endure longer wait times and poorer access to services generally, in part because of how we pay for surgical care.

While the devil is always in the details, and while it’s still possible for the Alberta government to get this wrong, Monday’s announcement is a big step in the right direction. A funding model that puts patients first will get Albertans more of the high-quality health care they already pay for in a timelier fashion. And provide to other provinces an example of bold health-care reform.

Nadeem Esmail

Senior Fellow, Fraser Institute
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Alberta

Alberta’s embrace of activity-based funding is great news for patients

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From the Montreal Economic Institute

Alberta’s move to fund acute care services through activity-based funding follows best practices internationally, points out an MEI researcher following an announcement made by Premier Danielle Smith earlier today.

“For too long, the way hospitals were funded in Alberta incentivized treating fewer patients, contributing to our long wait times,” explains Krystle Wittevrongel, director of research at the MEI. “International experience has shown that, with the proper funding models in place, health systems become more efficient to the benefit of patients.”

Currently, Alberta’s hospitals are financed under a system called “global budgeting.” This involves allocating a pre-set amount of funding to pay for a specific number of services based on previous years’ budgets.

Under the government’s newly proposed funding system, hospitals receive a fixed payment for each treatment delivered.

An Economic Note published by the MEI last year showed that Quebec’s gradual adoption of activity-based funding led to higher productivity and lower costs in the province’s health system.

Notably, the province observed that the per-procedure cost of MRIs fell by four per cent as the number of procedures performed increased by 22 per cent.

In the radiology and oncology sector, it observed productivity increases of 26 per cent while procedure costs decreased by seven per cent.

“Being able to perform more surgeries, at lower costs, and within shorter timelines is exactly what Alberta’s patients need, and Premier Smith understands that,” continued Mrs. Wittevrongel. “Today’s announcement is a good first step, and we look forward to seeing a successful roll-out once appropriate funding levels per procedure are set.”

The governments expects to roll-out this new funding model for select procedures starting in 2026.

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The MEI is an independent public policy think tank with offices in Montreal, Ottawa, and Calgary. Through its publications, media appearances, and advisory services to policymakers, the MEI stimulates public policy debate and reforms based on sound economics and entrepreneurship.

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