Commentary
In every federal election, health care is among the top five concerns of voters. Currently, even with the trade war and cost of living dominating the news, health care still is considered the top issue for 34 percent of people, according to a recent survey. Despite it being a leading federal issue, the administration of health care is a provincial responsibility—and it’s going poorly.
Systemic reform is needed, but is it possible for any province to get it right?
Every province in Canada is grappling with overwhelmed health-care systems and growing waiting times for emergency treatment and specialized procedures. It doesn’t matter if the provincial government is NDP or UCP, the issues are the same. While provinces are tasked with managing the systems, the federal Health Act sets out the rules. It puts premiers in a difficult position. While they get the flack for shortcomings in the system, they are bound through legislation outside of their jurisdiction.
Alberta Premier Danielle Smith has taken an aggressive approach to reforming the system in her province. She dismantled Alberta Health Services (AHS), the province’s centralized bureaucracy managing every aspect of public care, and split it into four smaller entities. AHS itself remained the prime administrator of Alberta’s 106 government-owned hospitals. Since then, the premier has been in a pitched battle with current and former AHS executives as she tries to make changes. Smith fired the entire board of AHS in late 2022 when she became premier. In January 2025, she fired every member of the new board. The former AHS CEO is now suing the Alberta government for wrongful dismissal, and the situation within AHS has devolved into a debacle.
One of the biggest sticking points in health-care reform has been efforts to break up the health-care provision monopoly by having private providers offering services within the publicly funded system. The top universal systems in developed nations all allow a larger presence of private provision and a conservative mantra in Canada has been to try and emulate those nations. The injection of competition can make systems more efficient and responsive to needs. Canada’s current system offers few incentives for providers to excel.
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The problem appears to be occurring when provincial governments have tried to bring private operators into the system. Instead of opening a wider field of competitive providers, crony capitalism may be dominating the day and in Alberta, it has become a disaster.
When Jason Kenney was Alberta’s premier, he tried to have laboratory services outsourced to a private company. It seemed to make sense. Labs could be managed in private settings and take pressure from acute care centres, which were overloaded. The company began operating in January 2023 and it led to waiting times for lab services ballooning. By March 2023, the company gave the government notice of being insolvent. The government paid $31.5 million in cash and took on approximately $66 million in assumed liabilities from the company. It was a disaster.
Details continue to emerge as a procurement debacle for other private services has broken out in Alberta. The RCMP, auditor general, and the government have launched investigations into AHS contracting due to allegations from former AHS CEO Athana Mentzelopoulos. The controversy is about allegations that the Alberta Health Ministry was pressuring AHS to embrace certain contractors for private surgical services. The provincial government denies wrongdoing, and nothing has been proven through any inquiry or court yet.
Whether or not there is merit to the allegations, trust among Albertans is falling as the government on the issue of outsourcing the provision of medical services. Unfortunately, a resolution is likely months if not years away.
The Alberta government has good ideas, but it needs to also ensure successful execution lest it—instead of leading the nation with innovative health-care reforms— become an example of what not to do.
In the coming federal election campaign, Canadians will likely be treated to broad statements on improving health care but not much in the way of specific reforms. Attempts to change the private/public provision dynamic have been failing, and politicians won’t be eager to enter that political minefield. An opportunity has been lost on the federal front.
Despite constant increases in expenditures, outcomes in health care continue to decline due to overwhelmed services. Let’s hope Alberta’s government can get it together on this file and build a successful parallel system of provision. Canada needs an example to inspire health-care reform rather than spending more to keep the current system on life support.
Views expressed in this article are opinions of the author and do not necessarily reflect the views of The Epoch Times.
