Is American-style health care on its way to Alberta with the United Conservative Party government passing Bill 30 earlier this week?
Jason Kenney’s government passed the Health Statutes Amendment Act in its third reading after a marathon overnight sitting on the final day of the spring session early Wednesday morning. The omnibus bill will introduce sweeping changes to Alberta’s health-care system, from changing regulatory councils to allowing private clinics.
According to government officials, the bill aims to give doctors more flexibility in how they administer care.
“Doctors can focus on providing care instead of focusing on administration,” Health Minister Tyler Shandro said in early July when the bill was first tabled. “Physicians will then have more flexibility to spend time with their patients, especially with those who have more complex issues.”
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But from its very inception, the bill has faced harsh criticism from the NDP opposition and medical professionals who warned that it will bring “American-style” private health care to the province.
Now that will soon be law, here’s what you need to know about this controversial bill.
What is Bill 30, the Health Statutes Amendment Act?
Bill 30 creates space for more privately operated public health services and changes the way doctors can bill and work with the government. Late into the debate, Health Minister Tyler Shandro added a last-minute amendment to create a “sunshine list” that will require doctors to disclose their compensation from the government.
The bill alters or amends nine existing pieces of legislation. With its passing this week, most amendments will come into force upon receiving Royal Assent, while others will come into force upon proclamation.
What are the biggest changes?
University of Calgary associate professor Lorian Hardcastle specializes in health law and policy. She says that while the bill makes changes to various pieces of legislation, there are four key changes that will have the most impact on Alberta’s health-care system.
First, there will be changes to the Health Quality Council.
“It changes the Health Quality Council from this independent arm’s length body into really an arm of government,” Hardcastle said. “And so the Minister of Health can issue directives to the Quality Council, the Minister of Health now appoints the board of the Quality Council and the Quality Council reports directly to the Minister now.”
Hardcastle said this could make the council less independent and willing to challenge the government. Along similar lines, the second big change brought in by Bill 30 is to increase public membership on the boards of professional councils for groups like nurses and doctors to 50 per cent.
Hardcastle said that while more public involvement can be a good thing, a lack of transparency in how those public appointments are made could lead to more government influence on these tribunals.
“it could be a good thing if the people who are appointed as members of the public to these tribunals represent diverse voices or represent different experiences with the health-care system,” she said. “But the concern is that what they’re going to do is really undermine the self-regulatory nature of these of these college councils, and they’re just going to appoint people who are politically aligned with the government.”
Doctors can focus on providing care instead of focusing on administration.Alberta Health Minister Tyler Shandro
The third major change will allow for-profit corporations to bill the government directly for health services. Hardcastle says this will open the door for these corporations to hire doctors and set up private clinics, rather than have doctors simply operate within the public system.
“For-profit corporations with shareholders can come in and they can open up family doctors offices, and then bill the government and then they then pay the doctors who work there, they can come in and open up private surgical facilities, bill the government and hire doctors to work there,” she said.
The fourth major change, according to Hardcastle, is how Bill 30 will facilitate a shift of surgeries to private clinics rather than the public system.
The government first announced plans to use more privately funded facilities to lower wait times in December, and aims to have 30 per cent of all surgeries in Alberta performed at private facilities by 2023.
But critics point out that shifting surgeries to private clinics could prompt quality concerns and drive up costs. Hardcastle pointed to long-term care as a case study of the disadvantages of private operation compared to public — studies show death rates from the COVID-19 pandemic have been significantly higher in privately run long-term care facilities compared to public ones.
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She said without added funding to health care or recruiting new doctors, allowing these private clinics to open and hire doctors likely won’t bring wait times down as the government claims, they will just “move people around.”
“The government says that these private facilities will help clear public waitlists because they’re opening additional beds and surgical suites,” she said. “The problem with that is that in order to increase capacity and reduce the waitlist. It’s not only a question of beds and surgical suites, it’s also a question of who’s going to work there.”
What are the government and opposition saying about it?
On Wednesday, Premier Jason Kenney defended the bill, saying it will make things easier for doctors, and that it will cut surgical wait times.
He reiterated that the government is not switching to private-payer health care.
“I repeat, publicly funded, publicly insured access to charter funded facilities,” he said.
The opposition NDP called the bill a “power grab” for the UCP.
“They are not, indeed, about providing transparency and openness and opportunity for the average Albertan to participate,” NDP health critic David Shepherd said earlier this month. “They are about grasping more power for themselves and partisan appointments.”
Is this really more like American health care?
Sort of. In one aspect, creating opportunities for private corporations to set up clinics is a shift toward a system more like that in the U.S.
But Hardcastle said there are still some key differences. Most notably, the public system will still ultimately pay for services received in private clinics.
“The thing that this legislation doesn’t do that will still make us stand apart from a true American-style system is that the public system is still going to be paying for the surgeries that you get in private facilities,” Hardcastle said.
The UCP has not ruled out exploring private payments like the U.S., whether that comes from insurers or out of pocket.
The thing that this legislation doesn’t do that will still make us stand apart from a true American-style system is that the public system is still going to be paying for the surgeries that you get in private facilities.University of Calgary associate professor Lorian Hardcastle
The Fair Deal Panel earlier this year concluded that the existing Canada Health Act, which prevents provinces from pursuing privately funded health care, is no longer beneficial for Alberta. Hardcastle said that if the province were to move away from the Act, that could open the door for American-style payment systems.
“I don’t think it’s wrong to say that the step to private delivery makes us more American style, but to truly be a full fledged American health-care system, we would need to take that next step,” Hardcastle said. “And there’s some evidence that that next step is under consideration, but this bill doesn’t do it.”