The dismantling of Alberta Health Services (AHS) has begun. Premier Danielle Smith and Health Minister Adriana LaGrange have made it official: AHS will now be a less integrated health-care system, with acute care, continuing care, mental health and addictions, and primary care each becoming a new/re-branded organization.
First, the good news. The premier could have blown up AHS entirely, returning to independent health regions or hospital boards. Having an overarching structure helped standardize the care you get in hospitals and AHS specialist offices and clinics, wherever you live. Integrated care delivered by AHS meant one record for your care, helping move you and your health information between providers including specialists, hospitals, mental health and addictions providers, and continuing care. That will change now, and here is where the bad news starts to emerge.
Leadership and accountability for primary care is long overdue. Supported with funding, this could mean consistent priorities and better access. It’s unclear what new leadership will look like, but it doesn’t look like an independent organization. Government will have a tight rein on primary care, creating inaction and tension with physicians.
The premier has been espousing private health care since at least 2003, when she wrote an article in the Calgary Herald entitled “Market-based reforms are the only real health guarantee.” Leopards don’t change their spots, so expect more privatization.
For health care, the premier only has two tricks up her sleeve: privatize it and centralize power in government. She has spoken of a third trick called local decision-making. But announced changes don’t enhance that. Local decision-making could have been improved through existing patient and community advisory councils and AHS’ zones.
It’s likely that these are just the first of many changes to come. How long will the premier let AHS’ Population and Public Health program exist outside of her control? Maybe those services could be contracted out too? Calgary’s recent E. coli outbreak probably bought a little time for Public Health, but how much?
The remaining changes are ideological and the premier isn’t trying to hide it. Installing a former Conservative politician and three Alberta Health deputy ministers to a new seven-person AHS board makes controlling decisions much easier.
The new mental health and addictions organization will ensure that all programs are recovery-oriented. Yes, recovery is ideal, but not all people with addictions are at that point in their journey. Separating mental health and addictions from acute care stigmatizes and silos this care from the rest of the system.
If you or a loved one is in a continuing care facility, you should worry about the quality of care ahead. The new continuing care organization will be tasked with selling off facilities owned and operated by AHS, which tend to care for Alberta’s sickest seniors.
Many of Alberta’s continuing care homes are already private for-profit facilities. Some, often those owned by investor groups from outside Alberta, are focused almost solely on the bottom line. These owner groups will be one step closer to elected officials to lobby for a better deal. Minister, do I really need a nurse in-house 24 hours per day?
From a UCP government that prioritizes cost-cutting, but seems to have tossed out the concept of reduced government involvement, costs will certainly increase. Three new entities, three sets of executives, and three new boards.
Currently, Alberta has the lowest percent spend on health-care administration (despite Premier Smith’s constant rhetoric about too many middle managers). This will no longer be the case. There are also transition costs, which are (under)estimated at $85 million.
These changes will affect 250,000 workers. The premier rightly notes that staff are burnt out. More will leave the system when disruptive changes occur that won’t improve outcomes for patients or make life better for staff. The churn created by these changes will be the focus of health system leaders for the next 18-24 months rather than critical priorities like emergency and surgery wait times.
Premier Smith’s cabinet briefing noted severe risks of care fragmentation and service disruption. Unlike some of the other promised improvements, these will certainly occur. Why, at a time when other provinces are emulating the original AHS model, is Alberta creating more siloed care? It’s a step in the wrong direction for any Albertan needing care.
Braden Manns is a physician and professor of medicine at the University of Calgary where he holds a research chair in Health Economics. He was an interim vice-president for Alberta Health Services until he resigned on June 11, 2023.