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Alberta

Alberta takes big step towards shorter wait times and higher quality health care

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4 minute read

From the Fraser Institute

By Nadeem Esmail

On Monday, the Smith government announced that beginning next year it will change the way it funds surgeries in Alberta. This is a big step towards unlocking the ability of Alberta’s health-care system to provide more, better and faster services for the same or possibly fewer dollars.

To understand the significance of this change, you must understand the consequences of the current (and outdated) approach.

Currently, the Alberta government pays a lump sum of money to hospitals each year. Consequently, hospitals perceive patients as a drain on their budgets. From the hospital’s perspective, there’s little financial incentive to serve more patients, operate more efficiently and provide superior quality services.

Consider what would happen if your local grocery store received a giant bag of money each year to feed people. The number of items would quickly decline to whatever was most convenient for the store to provide. (Have a favourite cereal? Too bad.) Store hours would become less convenient for customers, alongside a general decline in overall service. This type of grocery store, like an Alberta hospital, is actually financially better off (that is, it saves money) if you go elsewhere.

The Smith government plans to flip this entire system on its head, to the benefit of patients and taxpayers. Instead of handing out bags of money each year to providers, the new system—known as “activity-based funding”—will pay health-care providers for each patient they treat, based on the patient’s particular condition and important factors that may add complexity or cost to their care.

This turns patients from a drain on budgets into a source of additional revenue. The result, as has been demonstrated in other universal health-care systems worldwide, is more services delivered using existing health-care infrastructure, lower wait times, improved quality of care, improved access to medical technologies, and less waste.

In other words, Albertans will receive far better value from their health-care system, which is currently among the most expensive in the world. And relief can’t come soon enough—for example, last year in Alberta the median wait time for orthopedic surgeries including hip and knee replacements was 66.8 weeks.

The naysayers argue this approach will undermine the province’s universal system and hurt patients. But by allowing a spectrum of providers to compete for the delivery of quality care, Alberta will follow the lead of other more successful universal health-care systems in countries such as Australia, Germany, the Netherlands and Switzerland and create greater accountability for hospitals and other health-care providers. Taxpayers will get a much better picture of what they’re paying for and how much they pay.

Again, Alberta is not exploring an untested policy. Almost every other developed country with universal health care uses some form of “activity-based funding” for hospital and surgical care. And remember, we already spend more on health care than our counterparts in nearly all of these countries yet endure longer wait times and poorer access to services generally, in part because of how we pay for surgical care.

While the devil is always in the details, and while it’s still possible for the Alberta government to get this wrong, Monday’s announcement is a big step in the right direction. A funding model that puts patients first will get Albertans more of the high-quality health care they already pay for in a timelier fashion. And provide to other provinces an example of bold health-care reform.

Nadeem Esmail

Senior Fellow, Fraser Institute

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Alberta

Net Zero goal is a fundamental flaw in the Ottawa-Alberta MOU

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From the Fraser Institute 

By Jason Clemens and Elmira Aliakbari

The challenge of GHG emissions in 2050 is not in the industrial world but rather in the developing world, where there is still significant basic energy consumption using timber and biomass.

The new Memorandum of Understanding (MOU) between the federal and Alberta governments lays the groundwork for substantial energy projects and infrastructure development over the next two-and-a-half decades. It is by all accounts a step forward, though, there’s debate about how large and meaningful that step actually is. There is, however, a fundamental flaw in the foundation of the agreement: it’s commitment to net zero in Canada by 2050.

The first point of agreement in the MOU on the first page of text states: “Canada and Alberta remain committed to achieving net zero greenhouse gas emissions by 2050.” In practice, it’s incredibly difficult to offset emissions with tree planting or other projects that reduce “net” emissions, so the effect of committing to “net zero” by 2050 means that both governments agree that Canada should produce very close to zero actual greenhouse gas (GHG) emissions. Consider the massive changes in energy production, home heating, transportation and agriculture that would be needed to achieve this goal.

So, what’s wrong with Canada’s net zero 2050 and the larger United Nations’ global goal for the same?

Let’s first understand the global context of GHG reductions based on a recent study by internationally-recognized scholar Vaclav Smil. Two key insights from the study. First, despite trillions being spent plus international agreements and regulatory measures starting back in 1997 with the original Kyoto agreement, global fossil fuel consumption between then and 2023 increased by 55 per cent.

Second, fossil fuels as a share of total global energy declined from 86 per cent in 1997 to 82 per cent in 2022, again, despite trillions of dollars in spending plus regulatory requirements to force a transition away from fossil fuels to zero emission energies. The idea that globally we can achieve zero emissions over the next two-and-a-half decades is pure fantasy. Even if there is an historic technological breakthrough, it will take decades to actually transition to a new energy source(s).

Let’s now understand the Canada-specific context. A recent study examined all the measures introduced over the last decade as part of the national plan to reduce emissions to achieve net zero by 2050. The study concluded that significant economic costs would be imposed on Canadians by these measures: inflation-adjusted GDP would be 7 per cent lower, income per worker would be more than $8,000 lower and approximately 250,000 jobs would be lost. Moreover, these costs would not get Canada to net zero. The study concluded that only 70 per cent of the net zero emissions goal would be achieved despite these significant costs, which means even greater costs would be imposed on Canadians to fully achieve net zero.

It’s important to return to a global picture to fully understand why net zero makes no sense for Canada within a worldwide context. Using projections from the International Energy Agency (IEA) in its latest World Energy Outlook, the current expectation is that in 2050, advanced countries including Canada and the other G7 countries will represent less than 25 per cent of global emissions. The developing world, which includes China, India, the entirety of Africa and much of South America, is estimated to represent at least 70 per cent of global emissions in 2050.

Simply put, the challenge of GHG emissions in 2050 is not in the industrial world but rather in the developing world, where there is still significant basic energy consumption using timber and biomass. A globally-coordinated effort, which is really what the U.N. should be doing rather than fantasizing about net zero, would see industrial countries like Canada that are capable of increasing their energy production exporting more to these developing countries so that high-emitting energy sources are replaced by lower-emitting energy sources. This would actually reduce global GHGs while simultaneously stimulating economic growth.

Consider a recent study that calculated the implications of doubling natural gas production in Canada and exporting it to China to replace coal-fired power. The conclusion was that there would be a massive reduction in global GHGs equivalent to almost 90 per cent of Canada’s total annual emissions. In these types of substitution arrangements, the GHGs would increase in energy-producing countries like Canada but global GHGs would be reduced, which is the ultimate goal of not only the U.N. but also the Carney and Smith governments as per the MOU.

Finally, the agreement ignores a basic law of economics. The first lesson in the very first class of any economics program is that resources are limited. At any given point in time, we only have so much labour, raw materials, time, etc. In other words, when we choose to do one project, the real cost is foregoing the other projects that could have been undertaken. Economics is mostly about trying to understand how to maximize the use of limited resources.

The MOU requires massive, literally hundreds of billions of dollars to be used to create nuclear power, other zero-emitting power sources and transmission systems all in the name of being able to produce low or even zero-emitting oil and gas while also moving to towards net zero.

These resources cannot be used for other purposes and it’s impossible to imagine what alternative companies or industries would have been invested in. What we do know is that workers, entrepreneurs, businessowners and investors are not making these decisions. Rather, politicians and bureaucrats in Ottawa and Edmonton are making these decisions but they won’t pay any price if they’re wrong. Canadians pay the price. Just consider the financial fiasco unfolding now with Ottawa, Ontario and Quebec’s subsidies (i.e. corporate welfare) for electric vehicle batteries.

Understanding the fundamentally flawed commitment to Canadian net zero rather than understanding a larger global context of GHG emissions lays at the heart of the recent MOU and unfortunately for Canadians will continue to guide flawed and expensive policies. Until we get the net zero policies right, we’re going to continue to spend enormous resources on projects with limited returns, costing all Canadians.

Jason Clemens

Executive Vice President, Fraser Institute

Elmira Aliakbari

Director, Natural Resource Studies, Fraser Institute
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Alberta

Alberta can’t fix its deficits with oil money: Lennie Kaplan

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This article supplied by Troy Media.

Troy MediaBy Lennie Kaplan

Alberta is banking on oil to erase rising deficits, but the province’s budget can’t hold without major fiscal changes

Alberta is heading for a fiscal cliff, and no amount of oil revenue will save it this time.

The province is facing ballooning deficits, rising debt and an addiction to resource revenues that rise and fall with global markets. As Budget 2026 consultations begin, the government is gambling on oil prices to balance the books again. That gamble is failing. Alberta is already staring down multibillion-dollar shortfalls.

I estimate the province will run deficits of $7.7 billion in 2025-26, $8.8 billion in 2026-27 and $7.5 billion in 2027-28. If nothing changes, debt will climb from $85.2 billion to $112.3 billion in just three years. That is an increase of more than $27 billion, and it is entirely avoidable.

These numbers come from my latest fiscal analysis, completed at the end of October. I used conservative assumptions: oil prices at US$62 to US$67 per barrel over the next three years. Expenses are expected to keep growing faster than inflation and population. I also requested Alberta’s five-year internal fiscal projections through access to information but Treasury Board and Finance refused to release them. Those forecasts exist, but Albertans have not been allowed to see them.

Alberta has been running structural deficits for years, even during boom times. That is because it spends more than it brings in, counting on oil royalties to fill the gap. No other province leans this hard on non-renewable resource revenue. It is volatile. It is risky. And it is getting worse.

That is what makes Premier Danielle Smith’s recent Financial Post column so striking. She effectively admitted that any path to a balanced budget depends on doubling Alberta’s oil production by 2035. That is not a plan. It is a fantasy. It relies on global markets, pipeline expansions and long-term forecasts that rarely hold. It puts taxpayers on the hook for a commodity cycle the province does not control.

I have long supported Alberta’s oil and gas industry. But I will call out any government that leans on inflated projections to justify bad fiscal choices.

Just three years ago, Alberta needed oil at US$70 to balance the budget. Now it needs US$74 in 2025-26, US$76.35 in 2026-27 and US$77.50 in 2027-28. That bar keeps rising. A single US$1 drop in the oil price will soon cost Alberta $750 million a year. By the end of the decade, that figure could reach $1 billion. That is not a cushion. It is a cliff edge.

Even if the government had pulled in $13 billion per year in oil revenue over the last four years, it still would have run deficits. The real problem is spending. Since 2021, operating spending, excluding COVID-19 relief, has jumped by $15.5 billion, or 31 per cent. That is nearly eight per cent per year. For comparison, during the last four years under premiers Ed Stelmach and Alison Redford, spending went up 6.9 per cent annually.

This is not a revenue problem. It is a spending problem, papered over with oil booms. Pretending Alberta can keep expanding health care, education and social services on the back of unpredictable oil money is reckless. Do we really want our schools and hospitals held hostage to oil prices and OPEC?

The solution was laid out decades ago. Oil royalties should be saved off the top, not dumped into general revenue. That is what Premier Peter Lougheed understood when he created the Alberta Heritage Savings Trust Fund in 1976. It is what Premier Ralph Klein did when he cut spending and paid down debt in the 1990s. Alberta used to treat oil as a bonus. Now it treats it as a crutch.

With debt climbing and deficits baked in, Alberta is out of time. I have previously laid out detailed solutions. But here is where the government should start.

First, transparency. Albertans deserve a full three-year fiscal update by the end of November. That includes real numbers on revenue, expenses, debt and deficits. The government must also reinstate the legal requirement for a mid-year economic and fiscal report. No more hiding the ball.

Second, a real plan. Not projections based on hope, but a balanced three-year budget that can survive oil prices dropping below forecast. That plan should be part of Budget 2026 consultations.

Third, long-term discipline. Alberta needs a fiscal sustainability framework, backed by a public long-term report released before year-end.

Because if this government will not take responsibility, the next oil shock will.

Lennie Kaplan is a former senior manager in the fiscal and economic policy division of Alberta’s Ministry of Treasury Board and Finance, where, among other duties, he examined best practices in fiscal frameworks, program reviews and savings strategies for non-renewable resource revenues. In 2012, he won a Corporate Values Award in TB&F for his work on Alberta’s fiscal framework review. In 2019, Mr. Kaplan served as executive director to the MacKinnon Panel on Alberta’s finances—a government-appointed panel tasked with reviewing Alberta’s spending and recommending reforms.

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