Fraser Institute: Time to fix health care in Alberta

Shortly after Danielle Smith was sworn in as premier, she warned Albertans that it would “be a bit bumpy for the next 90 days” on the road to health-care reform. Now, more than two years into her premiership, the province’s health-care system remains in shambles.

According to a new report, this year patients in Alberta faced a median wait of 38.4 weeks between seeing a general practitioner and receiving medically necessary treatment. That’s more than eight weeks longer than the Canadian average (30.0 weeks) and more than triple the 10.5 weeks Albertans waited in 1993 when the Fraser Institute first published nationwide estimates.

In fact, since Premier Smith took office in 2022, wait times have actually increased 15.3 per cent.

To be fair, Premier Smith has made good on her commitment to expand collaboration with the private sector for the delivery of some public surgeries, and focused spending in critical areas such as emergency services and increased staffing. She also divided Alberta Health Services, arguing it currently operates as a monopoly and monopolies don’t face the consequences when delivering poor service.

While the impact of these reforms remain largely unknown, one thing is clear: the province requires immediate and bold health-care reforms based on proven lessons from other countries (e.g. Australia and the Netherlands) and other provinces (e.g. Saskatchewan and Quebec).

These reforms include a rapid expansion of contracts with private clinics to deliver more publicly funded services. The premier should also consider a central referral system to connect patients to physicians with the shortest wait time in their area in public or private clinics (while patients retain the right to wait longer for the physician of their choice). This could be integrated into the province’s Connect Care system for electronic patient records.

Saskatchewan did just this in the early 2010s and moved from the longest wait times in Canada to the second shortest in just four years. (Since then, wait times have crept back up with little to no expansion in the contracts with private clinics, which was so successful in the past. This highlights a key lesson for Alberta—these reforms are only a first step.)

Premier Smith should also change the way hospitals are paid to encourage more care and a more patient-focused approach. Why?

Because Alberta still generally follows an outdated approach to hospital funding where hospitals receive a pre-set budget annually. As a result, patients are seen as “costs” that eat into the hospital budget, and hospitals are not financially incentivized to treat more patients or provide more rapid access to care (in fact, doing so drains the budget more rapidly). By contrast, more successful universal health-care countries around the world pay hospitals for the services they provide. In other words, by making treatment the source of hospital revenue, hospitals provide more care more rapidly to patients and improve the quality of services overall. Quebec is already moving in this direction, with other provinces also experimenting.

The promise of a “new day” for health care in Alberta is increasingly looking like a pipe dream, but there’s still time to meaningfully improve health care for Albertans. To finally provide relief for patients and their families, Premier Smith should increase private-sector collaboration, create a central referral system, and change the way hospitals are funded.

Bacchus Barua

Director, Health Policy Studies, Fraser Institute

Tegan Hill

Director, Alberta Policy, Fraser Institute

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Alberta

Low oil prices could have big consequences for Alberta’s finances

Published on April 26, 2025

Todayville

From the Fraser Institute

By Tegan Hill

Amid the tariff war, the price of West Texas Intermediate oil—a common benchmark—recently dropped below US$60 per barrel. Given every $1 drop in oil prices is an estimated $750 million hit to provincial revenues, if oil prices remain low for long, there could be big implications for Alberta’s budget.

The Smith government already projects a $5.2 billion budget deficit in 2025/26 with continued deficits over the following two years. This year’s deficit is based on oil prices averaging US$68.00 per barrel. While the budget does include a $4 billion “contingency” for unforeseen events, given the economic and fiscal impact of Trump’s tariffs, it could quickly be eaten up.

Budget deficits come with costs for Albertans, who will already pay a projected $600 each in provincial government debt interest in 2025/26. That’s money that could have gone towards health care and education, or even tax relief.

Unfortunately, this is all part of the resource revenue rollercoaster that’s are all too familiar to Albertans.

Resource revenue (including oil and gas royalties) is inherently volatile. In the last 10 years alone, it has been as high as $25.2 billion in 2022/23 and as low as $2.8 billion in 2015/16. The provincial government typically enjoys budget surpluses—and increases government spending—when oil prices and resource revenue is relatively high, but is thrown into deficits when resource revenues inevitably fall.

Fortunately, the Smith government can mitigate this volatility.

The key is limiting the level of resource revenue included in the budget to a set stable amount. Any resource revenue above that stable amount is automatically saved in a rainy-day fund to be withdrawn to maintain that stable amount in the budget during years of relatively low resource revenue. The logic is simple: save during the good times so you can weather the storm during bad times.

Indeed, if the Smith government had created a rainy-day account in 2023, for example, it could have already built up a sizeable fund to help stabilize the budget when resource revenue declines. While the Smith government has deposited some money in the Heritage Fund in recent years, it has not created a dedicated rainy-day account or introduced a similar mechanism to help stabilize provincial finances.

Limiting the amount of resource revenue in the budget, particularly during times of relatively high resource revenue, also tempers demand for higher spending, which is only fiscally sustainable with permanently high resource revenues. In other words, if the government creates a rainy-day account, spending would become more closely align with stable ongoing levels of revenue.

And it’s not too late. To end the boom-bust cycle and finally help stabilize provincial finances, the Smith government should create a rainy-day account.

Alberta

Governments in Alberta should spur homebuilding amid population explosion

Published on April 26, 2025

Todayville

From the Fraser Institute

By Tegan Hill and Austin Thompson

In 2024, construction started on 47,827 housing units—the most since 48,336 units in 2007 when population growth was less than half of what it was in 2024.

Alberta has long been viewed as an oasis in Canada’s overheated housing market—a refuge for Canadians priced out of high-cost centres such as Vancouver and Toronto. But the oasis is starting to dry up. House prices and rents in the province have spiked by about one-third since the start of the pandemic. According to a recent Maru poll, more than 70 per cent of Calgarians and Edmontonians doubt they will ever be able to afford a home in their city. Which raises the question: how much longer can this go on?

Alberta’s housing affordability problem reflects a simple reality—not enough homes have been built to accommodate the province’s growing population. The result? More Albertans competing for the same homes and rental units, pushing prices higher.

Population growth has always been volatile in Alberta, but the recent surge, fuelled by record levels of immigration, is unprecedented. Alberta has set new population growth records every year since 2022, culminating in the largest-ever increase of 186,704 new residents in 2024—nearly 70 per cent more than the largest pre-pandemic increase in 2013.

Homebuilding has increased, but not enough to keep pace with the rise in population. In 2024, construction started on 47,827 housing units—the most since 48,336 units in 2007 when population growth was less than half of what it was in 2024.

Moreover, from 1972 to 2019, Alberta added 2.1 new residents (on average) for every housing unit started compared to 3.9 new residents for every housing unit started in 2024. Put differently, today nearly twice as many new residents are potentially competing for each new home compared to historical norms.

While Alberta attracts more Canadians from other provinces than any other province, federal immigration and residency policies drive Alberta’s population growth. So while the provincial government has little control over its population growth, provincial and municipal governments can affect the pace of homebuilding.

For example, recent provincial amendments to the city charters in Calgary and Edmonton have helped standardize building codes, which should minimize cost and complexity for builders who operate across different jurisdictions. Municipal zoning reforms in Calgary, Edmonton and Red Deer have made it easier to build higher-density housing, and Lethbridge and Medicine Hat may soon follow suit. These changes should make it easier and faster to build homes, helping Alberta maintain some of the least restrictive building rules and quickest approval timelines in Canada.

There is, however, room for improvement. Policymakers at both the provincial and municipal level should streamline rules for building, reduce regulatory uncertainty and development costs, and shorten timelines for permit approvals. Calgary, for instance, imposes fees on developers to fund a wide array of public infrastructure—including roads, sewers, libraries, even buses—while Edmonton currently only imposes fees to fund the construction of new firehalls.

It’s difficult to say how long Alberta’s housing affordability woes will endure, but the situation is unlikely to improve unless homebuilding increases, spurred by government policies that facilitate more development.