Alberta moves to decentralize health care system after centralization through AHS

Alberta’s new health minister is being asked to decentralize the entire healthcare delivery system after the province worked to centralize it 15 years ago.

In a mandate letter, Premier Danielle Smith directs Health Minister Adriana LaGrange to reform the management and structure of Alberta Health Services (AHS) to spread out decision-making to improve front-line care.

Specifically, her letters ask LaGrange to develop “a series of reforms to the health care system that enhance local decision-making authority, improve health care services for all Albertans, and create a more collaborative working environment for our health care workers by incentivizing regional innovation and increasing our ability to attract and retain the health care workers we need.”

The letter also states that the minister is to support “primary care as the foundation of our health care system by assessing alternative models of care and leveraging all health care professionals.”

“This includes continuing the work of the Modernizing Alberta’s Primary Health Care System initiative, assessing alternative compensation models for family physicians and nurse practitioners, improving the management of chronic disease, and increasing the number of Albertans attached to a medical home,” the letter reads.

The decision on the AHS structure reverses government policy that began nearly 30 years ago when then-premier Ralph Klein combined more than 200 health boards and agencies into 17 regional health authorities.

Those authorities were later rolled into nine boards and then, in 2008, into the current stand-alone AHS.

During the COVID-19 pandemic, former premier Jason Kenney said the unified management structure allowed Alberta to get faster access and better prices for scarce supplies.

However, Smith has sharply criticized AHS as being too slow to respond to front-line needs, particularly during the pandemic, and last year fired its board and replaced it with a single administrator.

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Opposition NDP health critic David Shepherd said there is work to be done fixing issues within AHS, but questioned whether wholesale restructuring will fix it and whether Smith’s government has the capability to do it.

“We do need to find ways to work better with our partners across the system and ensure that all voices are being heard and considered,” Shepherd said.

“(But) if (Smith) thinks that she can go in and simply just rip apart the system at a time when it is already in chaos, in part due to so many of the decisions that were made by her government in its first term, I think we’re going to be in for — as (Smith) said previously — ‘a bumpy ride.”’

LaGrange’s mandate letter also directs her to continue working on reducing waits for surgeries, emergency care and lab testing.

“We have made it very clear to (private lab tester) DynaLife that they need to expand and pick up their socks and really do what needs to be done to make sure that Albertans have the quality lab service that they deserve,” LaGrange said.

“While we’ve seen some improvements, they’re not where they need to be.”

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WATCH: Alberta Premier accuses opposition of ‘spin’

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Chris Galloway, executive director of Friends of Medicare, says the letter isn’t addressing the staffing crisis with Alberta’s health care system, and now is not the time to throw things in “disarray.”

“Throwing Alberta Health and Alberta Health Services into disarray with talk of restructuring is not what our public health care system needs right now,” Galloway said in a news release.

“We are in an urgent situation that requires urgent action to deal with the widespread short-staffing, worker burnout, and closures impacting our entire public health care system. We need a credible workforce plan to first retain the skilled workers we have right now, and then recruit and train the health care workers needed to provide the care Albertans need and deserve.”

He says “privatization schemes” are costing the province, worsening health care, and exacerbating the current staffing crisis.

According to the AHS website, 34 sites are facing service disruptions.

Smith also asks LaGrange to work with the Minister of Mental Health and Addiction to ensure that “recovery from mental health and addiction and increasing the recovery capital of Albertans is a guiding policy in modernizing Alberta’s primary health care system.”

In addition, Smith’s long-standing promise to create health spending accounts has been downgraded. Last November, LaGrange’s predecessor was instructed by Smith to establish the accounts, but LaGrange is now tasked with exploring the “feasibility” of the program.

Health spending accounts were a core promise by Smith last year in her successful bid to become United Conservative Party leader and premier.

The accounts were to give $300 to every Albertan to spend on primary care suited to their individual needs not covered by medicare, such as on a chiropractor, naturopath or counsellor.

Shepherd said the downgrade is likely for the best, saying the UCP should not stretch itself on complex trail-blazing health programs given it is struggling to fix basic issues such as timely lab tests.

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However, Galloway says her “pet project” will add administrative complexity and additional costs to the healthcare system while “worsening inequity among patients.”

“A health spending account is nothing but a costly gimmick that doesn’t solve any of the issues facing our public health care system when it’s very clearly struggling,” Galloway said.

“This government is wasting precious time and resources on a project that will benefit no one but the most privileged among us — time and resources we should be devoting to implement the solutions we urgently need to fix our staffing crisis and improve universal health care for all.”

Smith first floated the idea of Health Spending Accounts in a 2021 paper she wrote for the University of Calgary School of Public Policy.

Excerpts from that paper and clips from a livestream the premier did in the summer of 2022 popped up on social media in November that year.

Many of her ideas at the time suggested people would be on the hook to pay for their own health spending accounts.