Once considered among the foremost advocates for two-tier health care in Canada, the Alberta government has released a report that calls for changes that could reshape the province's health system into a more public model.
Health Minister Gene Zwozdesky said on Thursday, however, that a new Alberta Health Act the province is developing, and other controversial changes to the health-care system already implemented, include no move to privatize.
"Make no mistake about it: [the AHA]will be in the parameters of the Canada Health Act, and it will reflect one of Albertans' central values - for a single-tiered, publicly funded health system."
The report released on Thursday, based on citizen feedback and produced by the province, urges in abstract terms that Alberta fundamentally reverse its approach to delivering patient care by "putting people first," rather than a current model that report stakeholders say prioritizes health professionals and institutions in determining levels of care. Effectively, it says Albertans believe funding and treatment should follow a patient, rather than a patient having to seek it out.
If adopted in the new Alberta Health Act, the system envisioned in Thursday's report would emphasize wellness over treatment - guaranteeing access to primary care, setting up multidisciplinary teams to provide it, developing performance standards, creating a Health Charter and hiring an advocate to enforce it.
Canada is facing a looming funding crisis in health care driven by an aging population and rising costs. The head of the Canadian Medical Association earlier this week urged a total rethink of the country's health system, and on Thursday praised Alberta's report.
Mr. Zwozdesky said the province is leading Canada in turning around the health-care model - no province has a Health Act as wide-reaching as that envisioned by Alberta, where health law is currently made up of about 30 individual pieces of legislation.
But critics worry it's part of an ongoing boondoggle that could lead to more private care.
"The devil's in the details," said Liberal Leader David Swann, a physician. "That's one of the challenges I think we'll have to watch closely as [the act]comes to the legislature. Is this another excuse for privatizing?"
While he praised the medical professionals who signed off on the report, Dr. Swann added that "overall, I guess I'd have to say we don't need more laws, we need better management of the health system."
Some observers say Alberta, which recently invested billions in health-related capital projects and consolidated its health boards, has abandoned its position as a proponent for some privatized care since the departure of former premier Ralph Klein.
The kind of primary care suggested in Thursday's report could include a broad range of preventive treatment typically not included in public care - funding front-line acupuncture, chiropractors (which Alberta has recently de-insured), and pharmacare-like streamlining of prescription drug access. One stakeholder suggested that even homeopathic care could be considered, though another said he'd oppose that.
No mention was made whether providers would be public or private.
Study author Fred Horne, a backbench MLA who entered politics after a career as a health-care consultant, was left defending his report Thursday amid early coverage suggesting it was too vague. However, he said he was not asked to come up with specifics, but rather report what Albertans want. Access was their top concern, leading to his recommendation of a fundamental shift.
"Pretty much all Albertans I talked to say we have an excellent health-care system. A lot of our issues are just getting in," Mr. Horne said. "It's up to the minister and the government to really reflect on what Albertans said and come back with a response."
In his report, which cost just over $1-million to produce, Mr. Horne recommended the AHA augment, and not replace, five existing pieces of provincial health legislation, contrary to what was initially suggested.
Jeff Turnbull, the president of the Canadian Medical Association, praised Thursday's report, telling The Globe and Mail the report "deals with many of the issues that we feel are important and that physicians across the country feel are important: patient-centredness, putting patients first, a focus on safety and quality."
William Tholl, who teaches health leadership at Royal Roads University in Victoria and who is one of the authors of the Canada Health Act as well as a past executive director of the CMA, said the report builds on the findings of the 2002 Commission on the Future of Health Care in Canada, which was led by Roy Romanow. And rather than undercutting the Canada Health Act, Mr. Horne appears to want to build on it, Mr. Tholl said. "So, on the face of it, it seems like its going in the right direction."
He said he was surprised that Alberta, which as recently as 2006 was hoping to expand private care, would take the lead on these types of issues. The province has some for-profit clinics that are publicly funded, and are larger than the most basic form of private, for-profit care: a family doctor's office.
The report was based on interviews with 1,300 Albertans and was requested earlier this year by Mr. Zwozdesky's Advisory Committee on Health (which Mr. Horne also sat on). The minister cautioned that the report is not binding, but he will review it before actually tabling the new health act. "The Act is a second step," he said.
Critics nevertheless worry the creation of a Health Charter could force the government to introduce more privatized care, as it could be liable if it cannot provide services.
"You give people a promise you don't intend to keep, and lo and behold you have to go private," said Michael McBane of the Canadian Health Coalition. "In other words, setting it up to fail."
Mr. McBane said the report was light on details, including "what implications it will have in terms of public versus private care, they are hiding that."
David Eggen, executive director of Alberta's Friends of Medicare advocacy group and a former New Democrat MLA, said Thursday's report lacks substance and likely won't lead to many changes.
"I just don't see the point of this exercise. Why do you need a statement of principles that's really a faint echo of the Canada Health Act, without having some ulterior motive in mind?" Mr. Eggen said.
A spokesman for federal Health Minister Leona Aglukkaq said Thursday that the her department will review Alberta's vision for health care. But the report had the support of a number of medical associations, including the College of Physicians and Surgeons of Alberta. Registrar Trevor Theman said the proposed changes are based on the principle that access must be "based on need and not the ability to pay."
"If they're implemented," Dr. Theman said, "I think we'll really see a fundamental difference in how health care is delivered in this province."
The Health Quality Council of Alberta also signed off on the report. Its CEO, John Cowell, said it's no Trojan horse for privatization.
"It's not about that at all," Dr. Cowell said. "It's about fundamentally reestablishing a philosophical approach to health care."
John Church, a professor at the University of Alberta's Centre for Health Promotion Studies, said he supports initiatives to focus on wellness-based care, and a creation of a Health Charter. He noted that since Mr. Klein left office, "we haven't seen a huge explosion in the development of private health care in this province."
Thursday's report could either be, as skeptics suggested, yet another study that will lead to inaction, or the latest step in Alberta's move to overhaul its health system as a model of public care.
"There are some potentially very positive things the government is looking at doing here, but it will all depend on how they make it operational," Prof. Church says. "They're certainly saying the right things right now, so we'll wait and see."
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