Alberta
Alberta taking back control of federal agreements
Alberta has introduced legislation requiring provincial entities to obtain approval before entering, amending, extending or renewing agreements with the federal government.
The introduction of the Provincial Priorities Act, 2024 will support Alberta’s government in pushing back against the federal government’s ongoing overreach into areas of provincial jurisdiction. Alberta’s government will ensure federal funding is aligned with provincial priorities, rather than with priorities contrary to the province’s interests. Under the legislation, agreements between the federal government and provincial entities, including municipalities, that have not received provincial approval would be invalid.
As an example, the federal government’s unrelenting and ideological push toward electric buses in Canadian cities including Calgary does not acknowledge mounting evidence of significant problems with their effectiveness during harsh Alberta winters. Alberta’s government believes the funds that Ottawa allocated for unreliable and impractical electric buses would have been better spent on Alberta priorities including strengthening the province’s economic corridors with improved roads and commuter rail, or advancing the province’s hydrogen strategy as an alternate clean-energy source for transportation.
If passed, the legislation would also support Alberta’s government in getting its fair share of funding when it comes to roads, infrastructure, housing and other priorities. Nowhere is this more apparent than in housing. In summer 2023, Alberta received only 2.5 per cent of the total $1.5 billion in federal housing funds, despite having 12 per cent of the country’s population and, by far, the fastest population growth.
The legislation would also work to prevent taxpayer dollars being wasted on duplicative programs like pharmacare and dental care when what the province really needs is envelope funding to expand existing provincial programs in these areas.
“It is not unreasonable for Alberta to demand fairness from Ottawa. They have shown time and again that they will put ideology before practicality, which hurts Alberta families and our economy. We are not going to apologize for continuing to stand up for Albertans so we get the best deal possible. Since Ottawa refuses to acknowledge the negative impacts of its overreach, even after losing battles at the Federal and Supreme Courts, we are putting in additional measures to protect our provincial jurisdiction to ensure our province receives our fair share of federal tax dollars and that those dollars are spent on the priorities of Albertans.”
Currently, the Government Organization Act requires intergovernmental agreements to be approved by the Minister of Intergovernmental Relations for Alberta government departments and some public agencies, such as Alberta Gaming, Liquor and Cannabis; Alberta Securities Commission; and Travel Alberta.
However, this requirement does not extend to all Alberta public agencies or broader public sector organizations including municipalities, public post-secondary institutions, school boards and health entities, which has created gaps that could result in federal agreements contradicting provincial priorities and investments. By introducing the Provincial Priorities Act, Alberta’s government is working to close those gaps.
Under the proposed legislation, provincial entities include Alberta public agencies and Crown-controlled organizations, as well as public post-secondary institutions, school boards, regional health authorities, Covenant Health, municipal authorities and housing management bodies.
“For years, the federal government has been imposing its agenda on Alberta taxpayers through direct funding agreements with cities and other provincial organizations. Not only does Alberta not receive its per capita share of federal taxpayer dollars, the money we do receive is often directed towards initiatives that don’t align with Albertan’s priorities. Albertans from all corners of the province expect our federal share of taxes for roads, infrastructure, housing and other priorities – not federal government political pet projects and programs in select communities.”
Currently, Quebec is the only other province or territory with similar legislation that requires provincial approval of intergovernmental agreements between a broad scope of public sector organizations and the federal government. During a federal-provincial-territorial meeting in November 2023, Premiers from across the country demanded that the federal government work with them, not around them when it came to agreements with municipalities. Additionally, the Premiers committed to exploring the need for provincial authorization on federal agreements.
Related information
Alberta’s government is introducing a new acute care funding model, increasing the accountability, efficiency and volume of high-quality surgical delivery.
Currently, the health care system is primarily funded by a single grant made to Alberta Health Services to deliver health care across the province. This grant has grown by $3.4 billion since 2018-19, and although Alberta performed about 20,000 more surgeries this past year than at that time, this is not good enough. Albertans deserve surgical wait times that don’t just marginally improve but meet the medically recommended wait times for every single patient.
With Acute Care Alberta now fully operational, Alberta’s government is implementing reforms to acute care funding through a patient-focused funding (PFF) model, also known as activity-based funding, which pays hospitals based on the services they provide.
“The current global budgeting model has no incentives to increase volume, no accountability and no cost predictability for taxpayers. By switching to an activity-based funding model, our health care system will have built-in incentives to increase volume with high quality, cost predictability for taxpayers and accountability for all providers. This approach will increase transparency, lower wait times and attract more surgeons – helping deliver better health care for all Albertans, when and where they need it.”
Activity-based funding is based on the number and type of patients treated and the complexity of their care, incentivizing efficiency and ensuring that funding is tied to the actual care provided to patients. This funding model improves transparency, ensuring care is delivered at the right time and place as multiple organizations begin providing health services across the province.
“Exploring innovative ways to allocate funding within our health care system will ensure that Albertans receive the care they need, when they need it most. I am excited to see how this new approach will enhance the delivery of health care in Alberta.”
Patient-focused, or activity-based, funding has been successfully implemented in Australia and many European nations, including Sweden and Norway, to address wait times and access to health care services, and is currently used in both British Columbia and Ontario in various ways.
“It is clear that we need a new approach to manage the costs of delivering health care while ensuring Albertans receive the care they expect and deserve. Patient-focused funding will bring greater accountability to how health care dollars are being spent while also providing an incentive for quality care.”
This transition is part of Acute Care Alberta’s mandate to oversee and arrange for the delivery of acute care services such as surgeries, a role that was historically performed by AHS. With Alberta’s government funding more surgeries than ever, setting a record with 304,595 surgeries completed in 2023-24 and with 310,000 surgeries expected to have been completed in 2024-25, it is crucial that funding models evolve to keep pace with the growing demand and complexity of services.
“With AHS transitioning to a hospital-based services provider, it’s time we are bold and begin to explore how to make our health care system more efficient and manage the cost of care on a per patient basis. The transition to a PFF model will align funding with patient care needs, based on actual service demand and patient needs, reflecting the communities they serve.”
“Covenant Health welcomes a patient-focused approach to acute care funding that drives efficiency, accountability and performance while delivering the highest quality of care and services for all Albertans. As a trusted acute care provider, this model better aligns funding with outcomes and supports our unwavering commitment to patients.”
“Patient-focused hospital financing ties funding to activity. Hospitals are paid for the services they deliver. Efficiency may improve and surgical wait times may decrease. Further, hospital managers may be more accountable towards hospital spending patterns. These features ensure that patients receive quality care of the highest value.”
Leadership at Alberta Health and Acute Care Alberta will review relevant research and the experience of other jurisdictions, engage stakeholders and define and customize patient-focused funding in the Alberta context. This working group will also identify and run a pilot to determine where and how this approach can best be applied and implemented this fiscal year.
Final recommendations will be provided to the minister of health later this year, with implementation of patient-focused funding for select procedures across the system in 2026.
From the Fraser Institute
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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