Alberta
Tough times call for free access to mental health – Alberta NDP
From the Alberta NDP
NDP CALLS FOR ALBERTANS TO HAVE ACCESS TO FIVE PROVINCIALLY FUNDED MENTAL HEALTH SESSIONS
Alberta’s NDP Official Opposition is calling on the provincial government to help all Albertans get through the incredibly difficult COVID-19 pandemic by making five mental health therapy sessions available through the provincial insurance plan, with an online assessment tool to help connect them with a mental health professional.
“Albertans have endured incredible stress throughout this year, from job losses to social isolation to the loss of loved ones,” said Rachel Notley, Leader of Alberta’s NDP Official Opposition. “Heading into the holidays, I know how painful it is that we won’t be able to gather with our friends and extended family. For many, the holidays are always tough, and this year will be especially hard.
“Many Albertans need someone to talk to and help them process everything they’ve been through in a healthy way.
The Opposition is calling on the provincial government to launch a simple online tool to help Albertans assess their mental health needs and then connect them to five provincially insured sessions with a registered healthcare provider. Using the provincial health care plan means no out-of-pocket costs for anyone with a provincial health number. While the cost of the recommendation will depend on Albertans’ uptake of the program, the Opposition recommends the government make a commitment to fund up to $100 million worth of mental health support.
Dr. Keith Dobson is a Professor of Clinical Psychology at the University of Calgary, as well as a senior consultant for the Opening Minds program of the Mental Health Commission of Canada. He has been at the University of Calgary since 1989 in a variety of roles, including Head of Psychology and a member of the Board of Governors. He is a recognized expert in the field of mental health and the development and delivery of psychological treatment programs.
“Mental health needs were largely unmet before the pandemic and have grown considerably since,” Dr. Dobson said. “Estimates are that rates of anxiety and depression have at least doubled since early 2020, and that rates of alcohol use and domestic violence have also increased. We have evidence-based psychological and counseling services that have been, and can be, delivered using technology. The College of Alberta Psychologists has well developed standards for the provision of this service, and there is an available pool of trained and qualified service providers. This initiative is timely and needs serious consideration by the government.”
Dr. Judi Malone, CEO of the Psychologists’ Association of Alberta, said all Albertans, regardless of income, should have access to psychological services.
“The psychological health and wellness of Albertans can be substantively improved by enhancing access to appropriate mental health treatment,” Malone said. “Community and family supports are invaluable but when psychotherapy is warranted it needs to be provided by qualified professionals. Cost is a barrier to access as there are few publicly funded psychological services.
“COVID-19 has impacted the psychological health of Albertans who were already reeling from our economic downturn,” Malone added. “We can avoid a psychological pandemic by investing in the psychological health and wellness of Albertans. Access to necessary psychological support was difficult before – and that need for the services of registered psychologists continues to grow. Without policies, programs, and services in place we cannot meet this impending demand.”
A recent study from Morneau-Shepell, a human resources firm, said Albertans reported the highest increase in stress levels of all Canadians in November. Albertans have reported some of the worst mental health in Canada throughout 2020, and currently have the third-worst, ahead of Manitoba and Saskatchewan.
Yesterday, on Human Rights Day, the Alberta Division of the Canadian Mental Health Association, renewed its call for Albertans to have access to mental health care services in accordance with the five principles of Medicare: universal, comprehensive, accessible, portable and publicly administered. The expansion of services recommended by the Opposition would be an important step towards that goal in Alberta.
“The pandemic has made our lives much more difficult, and it’s also driven home how important it is to be proactive about our own health,” said Heather Sweet, Opposition Critic for Mental Health and Addiction. “This is an opportunity for the province to give Albertans the tools to do that. Over the past months, we have all gotten used to using an online tool to screen ourselves for the COVID-19 virus, and to be connected to testing services and health advice.
“Albertans should be able to assess their mental health at home, and have confidence that they will be connected to the help they need.”
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.
David Clinton
Contrasting the principle of equalization with the execution
Quebec – as an example – happens to be sitting on its own significant untapped oil and gas reserves. Those potential opportunities include the Utica Shale formation, the Anticosti Island basin, and the Gaspé Peninsula (along with some offshore potential in the Gulf of St. Lawrence).
So Quebec is effectively being paid billions of dollars a year to not exploit their natural resources. That places their ostensibly principled stand against energy resource exploitation in a very different light.
You’ll need to search long and hard to find a Canadian unwilling to help those less fortunate. And, so long as we identify as members of one nation¹, that feeling stretches from coast to coast.
So the basic principle of Canada’s equalization payments – where poorer provinces receive billions of dollars in special federal payments – is easy to understand. But as you can imagine, it’s not easy to apply the principle in a way that’s fair, and the current methodology has arguably lead to a very strange set of incentives.
According to Department of Finance Canada, eligibility for payments is determined based on your province’s fiscal capacity. Fiscal capacity is a measure of the taxes (income, business, property, and consumption) that a province could raise (based on national average rates) along with revenues from natural resources. The idea, I suppose, is that you’re creating a realistic proxy for a province’s higher personal earnings and consumption and, with greater natural resources revenues, a reduced need to increase income tax rates.
But the devil is in the details, and I think there are some questions worth asking:
- Whichever way you measure fiscal capacity there’ll be both winners and losers, so who gets to decide?
- Should a province that effectively funds more than its “share” get proportionately greater representation for national policy² – or at least not see its policy preferences consistently overruled by its beneficiary provinces?
The problem, of course, is that the decisions that defined equalization were – because of long-standing political conditions – dominated by the region that ended up receiving the most. Had the formula been the best one possible, there would have been little room to complain. But was it?
For example, attaching so much weight to natural resource revenues is just one of many possible approaches – and far from the most obvious. Consider how the profits from natural resources already mostly show up in higher income and corporate tax revenues (including income tax paid by provincial government workers employed by energy-related ministries)?
And who said that such calculations had to be population-based, which clearly benefits Quebec (nine million residents vs around $5 billion in resource income) over Newfoundland (545,000 people vs $1.6 billion) or Alberta (4.2 million people vs $19 billion). While Alberta’s average market income is 20 percent or so higher than Quebec’s, Quebec’s is quite a bit higher than Newfoundland’s. So why should Newfoundland receive only minimal equalization payments?
To illustrate all that, here’s the most recent payment breakdown when measured per-capita:
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For clarification, the latest per-capita payments to poorer provinces ranged from $3,936 to PEI, $1,553 to Quebec, and $36 to Ontario. Only Saskatchewan, Alberta, and BC received nothing.
And here’s how the total equalization payments (in millions of dollars) have played out over the past decade:
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Is energy wealth the right differentiating factor because it’s there through simple dumb luck, morally compelling the fortunate provinces to share their fortune? That would be a really difficult argument to make. For one thing because Quebec – as an example – happens to be sitting on its own significant untapped oil and gas reserves. Those potential opportunities include the Utica Shale formation, the Anticosti Island basin, and the Gaspé Peninsula (along with some offshore potential in the Gulf of St. Lawrence).
So Quebec is effectively being paid billions of dollars a year to not exploit their natural resources. That places their ostensibly principled stand against energy resource exploitation in a very different light. Perhaps that stand is correct or perhaps it isn’t. But it’s a stand they probably couldn’t have afforded to take had the equalization calculation been different.
Of course, no formula could possibly please everyone, but punishing the losers with ongoing attacks on the very source of their contributions is guaranteed to inspire resentment. And that could lead to very dark places.
Note: I know this post sounds like it came from a grumpy Albertan. But I assure you that I’ve never even visited the province, instead spending most of my life in Ontario.
Which has admittedly been challenging since the former primer minister infamously described us as a post-national state without an identity.
This isn’t nearly as crazy as it sounds. After all, there are already formal mechanisms through which Indigenous communities get more than a one-person-one-vote voice.
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