Op-eds | November 02, 2010

We need extra capacity, not vague Health Act

Parkland Institute

Last week, with Halloween just around the corner, the government introduced the new Alberta Health Act in the legislature. How appropriate that timing was, as the Act, like Halloween, requires Albertans to suspend their disbelief.

The principles being proposed for the Health Act include: quality and safety, timely and appropriate care, and access not based on ability to pay. Many of these principles are already being violated across the province before the Act even clears the house. Rural Albertans cannot access timely care and seniors across Alberta are accessing care based on ability to pay, not need. Just before the act hit the legislature, emergency room doctors went to the media with their fear of a collapse of timely emergency care in the province.

The Tory government created the current crisis in health care with a long-term campaign to privatize health services and financing, and cut spending on hospitals and long-term care. Hospital spending has plummeted from 44.7 per cent of health spending in 1975 to 27.8 per cent in 2009.

What doctors and the public have consistently told the government that Alberta needs is: emergency and non-emergency hospital beds and services; long-term-care facilities; and more health care professionals. What Albertans are getting instead is a vague set of unenforceable principles that faintly echo the Canada Health Act; a health charter with no teeth; the reiteration of already-existing emergency wait-time targets that the system has consistently failed to meet; private supported living instead of long-term care; and the shift to fee-for-service payments for hospitals. Each of these proposals requires a giant leap of faith by Albertans.

This crisis was long coming. Under the guise of sustainability and cost controls, the Alberta government has been cutting the corners on hospitals and long-term care to compensate for cost increases in other areas, such as private care, pharmaceuticals and new technologies. The current situation in hospitals is even worse, with "cots" between the beds in rooms designed for only two beds, increasing the load on already overloaded nursing staff and increasing stress for all three patients in the overcrowded room.

The common refrain is that "greater efficiencies" will solve the problems. However, we've been there, done that, and in truth it does boil down to capacity. You need a few "extra" beds in the system. A 10-car pileup does not happen every day and when it happens you need the capacity. But Canada operates with the least slack of all developed countries. Canada has the highest hospital bed occupancy rates in the OECD.

Despite our vast wealth, Alberta has fewer hospital beds than Canada's average and is in the bottom third of developed countries. The same applies for long-term care. Alberta has half the beds per capita that Manitoba has. Don't allow yourself to be fooled into thinking Alberta makes up for this by supporting those folks in their homes. Alberta also sits close to the bottom for home-care spending, again half that of Manitoba.

Alberta compares poorly on health-care professionals, too. Alberta has among the lowest number of nurses and licensed practical nurses per capita in the country. We are almost at the bottom of the OECD for medical school graduates. Despite these alarming numbers, in the last budget the provincial Tories cut funding to universities, which meant medical school tuitions increased and the number of seats in medical schools were cut.

What are the answers?

You cannot run hospital beds and long-term care beds without spending money and you cannot provide revolutionary new health-care technologies to patients without resources. At some point it does come down to resources. Alberta has brand new state of the art facilities sitting empty because of a lack of resources to staff and run them. Even the staffing issue boils down to money: university funding cuts mean cuts to medical school seats and fewer doctors.

Alberta can and should do better.

Alberta can afford to spend more on health care, and poll after poll shows Albertans are willing to pay more for quality health care. According to the OECD, Canada ranked in the bottom half of developed countries for the ratio of tax revenue to GDP. Alberta is by far the lowest in the nation.

Though the system needs new resources, that doesn't mean we can't spend smarter. Spending on prescription drugs is increasing 50 per cent faster than the overall health budget. Ontario has shown that pharmacies can be taken head-on to reduce the costs of drugs by getting rid of the kickbacks and incentive schemes that can amount to 60 per cent of the drug costs. Public delivery is another easy way to control costs -- profit involvement in health care is driving up costs.

There are answers, but the government is instead spending money and valuable time investing in new management fads and PR exercises while cutting taxes, closing hospitals (such as Alberta Hospital Edmonton) and privatizing long-term care.

Instead of finding the resources to fix the problems, or curtailing influential private interests, the government is asking Albertans to take a huge leap of faith that the problems with magically disappear. Albertans are smart enough to look beyond the costume and illusion.


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