Alberta’s premier has announced plans to decentralize decision-making authority within public health facilities, sparking a debate on the most effective approach to managing the province’s healthcare budget. Premier Danielle Smith emphasized in a recent online video that decisions regarding staffing and resource allocation should be made at the local level by individual health centers rather than by Alberta Health Services (AHS) managers. This move is part of a broader restructuring of healthcare in Alberta, which involves dividing care oversight into four new agencies and reducing AHS’s decision-making powers.
The government’s shift towards “activity-based funding,” set to commence next year, will link funding for facilities to the number of procedures performed and safety metrics like readmission rates, rather than providing a global annual budget. While the premier anticipates improved patient care efficiency through these changes, health policy experts express concerns about the operational implications and the potential for increased involvement of private, for-profit entities in managing public hospitals.
John Church, a political science professor at the University of Alberta, suggested that this shift may signal a return to a decentralized healthcare model in Alberta, similar to the pre-amalgamation era of health regions. He highlighted past challenges with local hospital control, citing financial constraints that led to centralized decision-making in the 1990s. Church speculated that the government might consider privatizing or contracting out health facilities to control costs, a move that he cautioned could pose risks to critical public services.
Krystle Wittevrongel, director of research at MEI, expressed optimism about the potential benefits of site-based decision-making and activity-based funding, citing examples from Quebec and Australia where similar approaches led to reduced wait times and cost savings for certain medical procedures. In contrast, Dr. Braden Manns, a health economics professor, raised concerns about the previous competition for healthcare professionals driving up costs under local control, cautioning against the notion that market competition necessarily leads to improved healthcare outcomes.
Health policy consultant Steven Lewis highlighted uncertainties surrounding the extent of decision-making autonomy that hospitals will have under the new framework. Questions remain about whether hospitals will be able to make independent program decisions and if new governance structures will be established at the local level. Despite assurances from government officials that no plans exist to privatize AHS facilities, concerns persist within the healthcare community regarding the potential implications of these changes on public healthcare delivery in Alberta.