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Opinion: Decentralizing Alberta Health Services is the wrong move

by Irma•July 24, 2023

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The minister of health received her mandate letter from the premier this week, instructing her to “reform the management and structure of Alberta Health Services (AHS) to better decentralize decision-making.” This directive is wrong-headed and represents an ongoing distraction to the changes actually needed in our health-care system.

To be fair, the government should be recommended for its focus on health-system priority areas over the past eight months, including emergency care and surgery. Building on pre-existing AHS work, evidence-based actions were implemented by AHS, leading to measurable improvements that were only possible because of Alberta’s provincially integrated health system.

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Truthfully, there are major gaps in our health-care system. Waiting times for elective surgery and CT/MRI are unacceptably long. There are real challenges with access to primary care, particularly in rural areas but this is the responsibility of Alberta Health, not AHS.

Let’s remember that AHS was created in 2009 after a long series of trial and error with hospital boards and health regions. It was created for many reasons, including significant variation in care across regions, meaning that your care (and the likelihood of a good health outcome) could differ significantly based on where you live.

There was unhealthy competition across regions for resources, staff and physicians (leading to different pay and benefits) and budgets were increasing by more than 10 per cent per year. Since AHS’s creation, progress has been made in these and other areas, and the annual increase in AHS’s budget was two per cent between 2016 and 2021.

Administrative costs are the lowest in the country, and it is simply not true that there are layers of unwanted management. Having a single integrated health system has enabled the spread and scale of innovations provincially, including a single provincial electronic medical record for all hospitals. It has saved hundreds of millions given AHS’s ability to buy medications, devices and services at a lower price, and it has resulted in the best provincial health data and measurement system in Canada. There are many areas where we lead the world in care and outcomes, including stroke.

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The advantages of a single integrated health system were clear during the pandemic when AHS needed to rapidly implement system-wide change and provide high-quality care for thousands of people hospitalized with COVID, enabling seamless transfer of critically ill patients across zones when ICUs were over-capacity.

Although Alberta experienced the second-highest number of cases of COVID-19 per capita in Canada, AHS had the third-lowest reduction in surgeries in Canada. Because of these advantages, many provinces have (Saskatchewan and Nova Scotia) or are moving (Newfoundland and Labrador, and Quebec) to a single integrated health-care system like Alberta’s.

AHS has five health zones, and most health-care decision-making occurs in these local zones, with AHS acting like an umbrella, making it easier for zones to work together to standardize and improve care. Zones interact with local communities and respond to local needs, and AHS receives input from multiple health advisory committees to ensure care is patient-centred. Links with local communities can undoubtedly be improved, but this can occur within the current AHS structure.

As we have seen repeatedly, reorganizing the health-care system impacts care-providers for a generation. Other provinces are moving towards the Alberta model and we seem to be abandoning it. What problem is the government wanting to fix through de-centralization? Why not task AHS leadership with fixing it? Governments should focus on efforts that only it can fix, including stabilizing the primary health-care system, creating a renewed comprehensive physician workforce plan, and training more physicians and allied health workers outside of major urban areas where they are desperately needed.

When governments are elected, the health system is often a target for disruptive change. Instead of blowing it up, AHS needs to be refreshed and return back to an independent governance board, allowing them to take a longer-range view than the four years afforded each new government.

Braden Manns is a physician and professor of Medicine at the University of Calgary where he holds a research chair in Health Economics. Dr. Manns was also an interim vice-president for Alberta Health Services until he resigned on June 112023.

Tom Noseworthy is professor emeritus, University of Calgary.

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