The Alberta government is changing the funding for acute care in the province.
Acute Care in the province is currently funded under a "global" system, where the health authority, previously Alberta Health Services (AHS), would receive a single grant from Alberta Health to provide all health care services in the province.
According to a news release on April 7, that funding has increased by $3.4 billion since 2018.
"The current global budgeting model has no incentives to increase volume, no accountability and no cost predictability for taxpayers," said Premier Danielle Smith. "By switching to an activity-based funding model, our health care system will have built-in incentives to increase volume with high quality, cost predictability for taxpayers and accountability for all providers. This approach will increase transparency, lower wait times and attract more surgeons – helping deliver better health care for all Albertans, when and where they need it.”
The province is proposing a move away from global funding to patient-focused funding (PFF), which would pay hospitals and other health centres for the services they provide.
The release notes that PFF will be based on the number and type of patients, treatments, and complexity of care. Smith noted during the press conference that every facility will be paid the same amount for the same procedure, what will vary is the number of patients treated.
"Exploring innovative ways to allocate funding within our health care system will ensure that Albertans receive the care they need, when they need it most," said Health Minister Adriana LaGrange. "I am excited to see how this new approach will enhance the delivery of health care in Alberta.”
According to a video that Smith presented at the press conference, PFF has been successfully implemented in Australia and several European jurisdictions with a resulting significant drop in wait times.
"It is clear that we need a new approach to manage the costs of delivering health care while ensuring Albertans receive the care they expect and deserve," said Dr. Chris Eagle, interim president and CEO of Acute Care Alberta. "Patient-focused funding will bring greater accountability to how health care dollars are being spent while also providing an incentive for quality care.”
The release notes that in 2023-24 nearly 304,600 surgeries were completed and 310,000 are expected to be completed in 2024-25.
"The old top-down approach offers no incentives," said Smith. "(PFF) turns common surgeries into a product with clear, fixed pricing, where facilities compete. Australia is the gold standard."
Smith noted that when facilities start getting rewarded, efficiencies tend to be found.
"No patient will pay out of pocket," said Smith.
Independent think-tank MEI based in Calgary applauds the change.
“For too long, the way hospitals were funded in Alberta incentivized treating fewer patients, contributing to our long wait times,” said Krystle Wittevrongel, director of research at the MEI. “International experience has shown that, with the proper funding models in place, health systems become more efficient to the benefit of patients.”
With the new funding model essentially paying per surgery, funds will follow the patient.
Not everyone is on board with the change.
The Health Sciences Association of Alberta (HSAA) is warning that the PFF model will create a "profit-driven marketplace" for surgical procedures and ultimately risk patient care.
“Surgeries aren’t just performed by surgeons,” said HSAA President Mike Parker. “It takes a multi-disciplinary team of health care professionals looking after Albertans at every stage of their health care journey. Yet today, there was no commitment from the government to retain or recruit the staff necessary to make a real difference in surgical wait times.”
The HSAA notes that the new funding model will incentivize private companies to focus on low-complexity surgical procedures to maximize their profits while the public facilities are left to handle the high-complexity cases while competing for resources and staff.
“Once these for-profit companies successfully corner the market, prices will go up and the cost to taxpayers will go through the roof,” said Parker. “Meanwhile, the number and quality of major surgeries performed in the public system will go down, as hospitals lose staff and become forced to rent public suites back to specialists within these same corporations.”
The HSAA is concerned that the new model will focus too heavily on speed and volume instead of focusing on safety and quality of care.
“This model turns patients into statistics rather than people deserving of thoughtful, compassionate treatment,” said Parker. “This approach only increases the risk of complications and infections, all while turning public dollars to private profits.”
According to a study by the Parkland Institute noted in the HSAA release, fewer surgeries are being performed in public hospitals when compared to pre-pandemic levels and wit times are worsening.
The fact that the new model isn't being rolled out in rural areas confirms to HSAA that the new model is about the money; rural areas don't have the market for for-profit centres.
“That should tell Albertans everything they need to know,” said Parker. “This isn’t about wait times. It’s about turning health services for Albertans into a product with a price tag.”
