ESMAIL, MOIR: More choice means better health care for Albertans

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According to an announcement Thursday by the Smith government, starting in September some physicians in Alberta will be allowed to treat patients in both the public health-care system and on a privately-paid basis. Opponents of this reform will erroneously proclaim the demise of the province’s universal health-care system and a shift towards ‘American-style two-tiered’ health care.

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But in reality, this policy emulates the approaches of other more successful universal health-care countries. In fact, the Smith government is being overcautious, choosing a more regulated approach, which will limit the benefits of competition for patients.

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Let’s start with the basics of why this reform matters.

Much-needed reform

Currently, the government system limits the ability of physicians in Alberta to care for patients by restricting access to operating time and hospital beds. By allowing Albertans to pay privately and access previously unavailable medical resources in private clinics, the government will help increase the total volume of services, including services the government is unwilling or unable to provide.

For example, patients may not want to wait months for a joint replacement or hernia repair, or may want to access newer technologies and procedures. By allowing this private access, the government will help remove these patients from waiting lists, freeing up space for others to be treated sooner in the public system, and put competitive pressure on the government to adopt innovations and improve its own health-care delivery.

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Beyond this, the opportunity to earn more by working extra hours in a private clinic could entice physicians to treat additional patients privately. In other words, allowing physicians to work in both public and private sectors is a well-informed policy choice that makes better use of Alberta’s existing medical workforce.

And again, there’s nothing unique or unusual about this approach. The overwhelming majority of universal health-care countries allow physicians to treat patients in both the government system and private settings. And countries such as Switzerland, Germany, the Netherlands and Australia — which all use this approach — all routinely outperform Canada in key metrics, including wait times, while spending a similar or lower amount of money than Canada.

So, there’s no evidence to suggest the Smith government’s reform will lead to the dismantling of Alberta’s health-care system. In fact, the evidence strongly suggests this reform will improve the system for patients.

If there’s any real criticism of the Smith government’s reform, it’s that it doesn’t yet go far enough.

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More work to do

According to Thursday’s announcement, unlike in many other universal health-care countries, private clinics in Alberta will only be permitted to provide non-emergency services (including orthopedic procedures, hip and knee replacements, cataract surgery, etc.). Physicians providing services to both public and private patients must also meet “minimum public-service requirements.”

Primary care, life-saving and emergency services (including cancer care), and hospital-based surgeries are off the table, though the government is working on a plan to leverage underutilized operating rooms and add hospital-based care. This means Albertans will, at least for now, not fully benefit from the health-care options that innovative health-care entrepreneurs create for patients elsewhere around the world.

The Smith government’s latest reform is another step to more closely align Alberta health care with the approach of other more successful universal health-care countries.

Contrary to claims from opponents, the result will be greater access to health care for all Albertans.

Nadeem Esmail and Mackenzie Moir are analysts at the Fraser Institute.

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