ESMAIL and MOIR: Smith government’s plan will improve health care in Alberta

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The Smith government recently tabled legislation that will allow Albertans to purchase some surgeries and allow surgeons to work in both the public and private health-care sectors. These changes, if done correctly in forthcoming regulations, will improve health care in the province.

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In response, defenders of the status quo are parroting their tired arguments. Some claim the Alberta government wants to implement an unprecedented two-tier model for health care — a public system and a separate private system. Others say this is the “Americanization” of health care in Alberta, perhaps suggesting it’s the end of universal health care in the province.

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Joining the world

But while the legislation is certainly new in Canada, Alberta would actually join the rest of the developed world by allowing patients to purchase surgical care, and join the vast majority of countries by allowing physicians to work in both the public and private health-care systems.

For example, in universal health-care countries such as Switzerland, Germany, Sweden and Australia, patients can choose between public and private settings for medical care, often accessing the same doctors in either system. And in all these countries, patients enjoy far greater access to health care. Back in Alberta, due to a strict adherence to a failed status quo, Albertans suffer some of the worst access to health care in the developed world, despite Albertans spending world-leading amounts of money on health care.

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Fundamentally, Alberta’s health-care system is failing in part because of a lack of competition to the government-provided system. A private alternative would improve the performance of the public system in two important ways: by expanding access to services and by encouraging higher performance in the public system through competition. When the government prevents private providers from delivering timelier and more patient-focused care, there’s little pressure or incentive to do so anywhere else in the system.

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And when physicians are allowed to work in both public and private settings, the volume of care expands over and above what’s currently provided in the often-restricted government system. This shortens wait times as some patients leave the public queues for a private alternative, freeing up resources for those who stay in the public system.

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Don’t be misled by arguments that allowing physicians to spend some of their time in the private system will somehow starve or harm the public system. Currently in Alberta, there are physicians with limited access to operating rooms and nurses who are leaving the public system who might want to return to work in a private clinic.

Everyone benefits

Finally, some critics appear most concerned that some patients may receive care more rapidly than others based on their ability to pay. But the experiences of other developed countries with parallel private and public health-care systems illustrate clearly that while some patients receive treatment faster, the wait times experienced by all patients are shorter than our own. It’s not surprising Canada has some of the longest wait times in the developed world given we’re the only country that prohibits privately-funded health care.

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While the Smith government’s new legislation would represent a meaningful shift away from the failed status quo, it’s not a venture into uncharted territory. These reforms would move Alberta’s policies closer to those of the developed world’s top-performing universal health-care systems. If there’s any flaw in the plan, it’s the limitation to non-emergency surgery, denying Albertans the benefits of being able to purchase primary and urgent care. But it’s a good first step.

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

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