Alberta was one of the first provinces to reorganize its health-care system into regional health authorities (RHAs). Announced with great fanfare by the newly minted government of Ralph Klein about 14 years ago, regionalization was supposed to rationalize the system as well as make it more responsive to the needs of local communities.
Last month, however, the Stelmach government scrapped Alberta’s nine RHAs and turned over administration of the province’s health-care system to one small but powerful superboard led by Ken Hughes, a former MP and insurance company executive.
Apparently, regionalization had caused more problems for the government than it had solved. Not only that, it had lost control of one of the biggest regions — Calgary.
In Alberta, regionalization was born amidst furious debt and deficit elimination strategies that tagged health-care costs as one of the main culprits for rising government expenditures.
When prominent businessman Bud McCaig was named the first chairman of the Calgary regional authority in 1994, he promised to bring an end to the turf wars between hospitals governed by local boards but dependent on the provincial government for funding. “That has been one of the unproductive things that diminishes everyone’s efforts in the overall goal here,” said McCaig, who was also a key fundraiser for the Alberta Conservatives.
Shortly thereafter, three Calgary hospitals were closed. The local health authority took responsibility for the decision, but it was clear that the Klein government had orchestrated it.
This confusion over roles and responsibilities would continue to dog the system for years to come. Who exactly should Calgarians hold responsible for the fact that there weren’t enough doctors or hospitals beds? Was it the provincial health minister or the highly paid executives of the Calgary Health Region? When the CHR decided a new hospital was needed, why did it have to go cap in hand to the provincial government and then wait years for a decision? Why was it that some regions wouldn’t accept patients from other regions? Who was responsible for the fact that health-care standards varied dramatically from region to region?
Unlike other health authorities, the CHR seemed hell-bent on introducing as much privatization as it could get away with, particularly when McCaig, and later Jim Dinning, were top dogs. Was this at the behest of the Klein government, which was also keen on privatization? Or had the CHR become a captive of local physicians eager to exploit those who could afford to pay out of pocket for their health care?
It was difficult to know, because the RHAs were never very transparent. In Calgary, we were left guessing about many important policies and decisions. For example, the CHR was keen on contracts for surgical services outside public hospitals, but the bidding process was secretive. Many health-care professionals refused to speak openly about problems for fear of retribution. The CHR held board meetings in public, but the public couldn’t make presentations or even ask questions.
“In the end, the RHAs never connected or resonated with the public,” Wendy Armstrong, an Edmonton-based health policy analyst and longtime advocate for patients and consumers, tells Fast Forward. “They spent lots of money on self-promotion but they were still seen as handmaidens of the provincial government.”
However, local, co-ordinated governance of health care also allowed for new and better ways of doing things. Steven Lewis, an adjunct professor at the University of Calgary’s School of Medicine, tells Fast Forward the government moved too fast and should have fine-tuned the regionalization plan rather than scrap it. “Many of Alberta’s health regions were innovative and creative,” he says. “Alberta had become a leader in areas such as health information and primary care because of steps taken by regional health authorities.”
Lewis wonders how one board can now adequately administer a complex system that stretches from one end of the province to the other. “The solution to the problems seems to be a complete oversimplification,” he said.
The appointment of Hughes, yet another businessman, to head this board leaves one wondering if this government will ever figure out that businessmen don’t know much about the complexities of health care. It’s simply not the same as running a business and never will be.
It was likely politics that did in the RHAs. During the recent provincial election campaign, Jack Davis, CEO of the CHR, publicly challenged Premier Ed Stelmach to provide more funding for his region. Davis called a media conference to announce that Calgary emergency rooms had just experienced their worst weekend ever. Over 90 patients who needed to be admitted were still being treated in hallways because there were no beds for them, he said. Stelmach promised to look into it but refused to commit to more money.
It was likely that desperate, and defiant, plea that sealed the fate of health care regionalization. After all, this is Alberta, where the provincial government doesn’t take kindly to anyone who challenges its authority. The real boss has spoken loud and clear.
