Hospital-based decision making raises privatization fears, hope for efficiencies
The recent announcement by Alberta Premier Danielle Smith regarding the restoration of local decision-making in public health facilities has sparked a debate on the best approach to managing the province’s health budget. The premier emphasized the importance of empowering individual health centers to make decisions about hiring health-care workers and managing resources, rather than relying on Alberta Health Services (AHS) managers.
This shift is part of a broader restructuring of the health care system in Alberta, which involves dividing oversight of care into four new agencies and stripping AHS of decision-making authority. The government plans to implement “activity-based funding” next year, wherein funding for facilities will be based on the number of procedures completed and safety measures like readmission rates, rather than a fixed annual budget.
While Premier Smith believes these changes will lead to faster patient care, health policy experts have raised concerns about the potential implications. Some experts warn that the shift could pave the way for private, for-profit companies to take over the management of public hospitals, which could pose risks to the quality and accessibility of care.
Professor John Church, who has researched Alberta’s health system extensively, notes that the province previously moved away from local hospital control in the 1990s due to financial challenges and inefficiencies. He warns that the current shift could result in the privatization of health facilities or the contracting of private operators to run them, which could jeopardize public access to essential services.
On the other hand, some experts like Krystle Wittevrongel from the independent public policy think tank MEI are optimistic about the potential benefits of site-based decision-making and activity-based funding. They believe that competition can drive innovation and efficiency in the health care system, citing examples from Quebec and Australia where similar models have led to reduced wait times and costs for certain procedures.
However, Dr. Braden Manns, a health economics professor, remains skeptical of the government’s approach. He highlights past challenges with local hospital control in Alberta, including inconsistencies in medical treatments and escalating costs due to competition for health professionals. Manns argues that the focus should be on providing evidence-based care to all patients, rather than prioritizing competition and cost-cutting measures.
As the government moves forward with its plans, questions remain about the extent of decision-making authority that will be given to individual health facilities. Health policy consultant Steven Lewis notes that the details are unclear, and it remains to be seen how much autonomy hospitals will truly have in making critical decisions.
Overall, the debate over the restructuring of Alberta’s health care system reflects a broader philosophical divide on how to balance efficiency, affordability, and quality in public health services. It remains to be seen how the government’s changes will impact patient care and the overall health care landscape in the province.
