Alberta is steadily increasing control over key healthcare institutions to minimize opposition to controversial new legislation that creates opportunities for corporations to deliver health services and facilitates expanding the number and nature of surgeries delivered in private facilities. The targeted institutions are Alberta Health Services (AHS), the colleges responsible for self-regulating health professionals, the Alberta Medical Association (AMA), and the Health Quality Council of Alberta (HQCA).
Throughout the 1990s, most provincial governments shifted responsibility for governing and delivering health services to newly created regional health authorities. Provinces also delegated responsibilities for planning and integrating health services to the regional health authorities. As with many other provinces, Alberta reduced its number of regional health authorities over time, with AHS now acting as the sole health authority.
Prior to the recent legislative amendments, AHS had “final authority” for the following responsibilities: promoting and protecting the population’s health; assessing health needs; determining service priorities and allocating resources accordingly; ensuring reasonable access; and promoting service provision that is responsive to needs and supportive of integration. Under the amendments, AHS no longer has final authority and is now subject to accountability frameworks established by ministerial order. Also, AHS is now only responsible for planning and delivering health services, with the remaining responsibilities downgraded to mere purposes to be fulfilled in carrying out its responsibilities.
While these changes may seem subtle, they affect AHS operations in potentially significant ways. Given that AHS is a party to contracts with private surgical facilities, these changes may be intended to ensure that AHS does not act as a barrier to the government’s goal of doubling the private delivery of health services. This intent to control AHS is illustrated by recent discussions between the government, lobbyists and proponents of a large private surgical facility to keep AHS at arm’s length and pressure it into accepting a proposal that will divest human resources from the public provider.
The government is seeking to exert similar control over health professionals. Its relationship with physicians is under significant strain due to a protracted compensation dispute between the AMA and the government. With this dispute still pending, the government enacted legislative reforms allowing it to enter into health service contracts with corporations who can then employ or contract with physicians as a way of sidestepping the AMA.
The new rules will increase public representation from 25 per cent to 50 per cent on college councils (the governing bodies of colleges), complaint review committees and the tribunals that hear disciplinary cases. While this theoretically enhances the self-regulatory process by adding more diverse voices and improving public trust, given the government’s role in appointing public members, it may represent an expansion of government control to further its agenda of increasing private delivery. The cooperation of the College of Physicians and Surgeons of Alberta (CPSA) is essential to the success of private delivery, given its responsibility for accrediting private surgical facilities and designating major surgeries that cannot be provided in those facilities.
This government has already shown its willingness to exert authority over the CPSA. As a result of the acrimonious relationship between physicians and the government, a number of physicians have left the province or relinquished their hospital privileges. In response, the Minister of Health issued a directive to the CPSA to amend its policies in a manner that would make it difficult for physicians to leave the province. The government also recently circulated a proposal to amend the Health Professions Act that could further centralize government authority by assuming responsibility for various functions currently undertaken by self-regulated health professions, including registration and discipline.
The legislation also centralizes government control over the HQCA, an arms-length agency responsible for promoting and improving the safety and quality of health services. Prior to recent changes, the HQCA’s independence, objectives and governance structure were protected from government interference. Specifically, the board of the HQCA was appointed by the Lieutenant Governor in Council and the agency reported directly to the legislative assembly. Under the amendments, the HQCA will now report to the Minister of Health, who will appoint the HQCA board, approve its annual plan and issue directives to the HQCA. Given that HQCA recommendations have not always been consistent with the government’s political agenda, eroding its independence is possibly a means of increasing government control and suppressing opposition to privatization.
Although the government’s shift toward privatizing healthcare services has received a great deal of attention, equally important are these legislative changes that erode the independence of key institutions that may have served as barriers to this controversial agenda and acted to protect the interests of the public and health professionals.
Given that these institutions serve to shield vital operational aspects of the healthcare system from political interference, these legislative changes create a worrying distance between the health services Albertans receive and the professionals with the know-how to deliver the services.
The authors have no conflicts to declare.