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Alberta

Province introducing “Patient-Focused Funding Model” to fund acute care in Alberta

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Alberta’s government is introducing a new acute care funding model, increasing the accountability, efficiency and volume of high-quality surgical delivery.

Currently, the health care system is primarily funded by a single grant made to Alberta Health Services to deliver health care across the province. This grant has grown by $3.4 billion since 2018-19, and although Alberta performed about 20,000 more surgeries this past year than at that time, this is not good enough. Albertans deserve surgical wait times that don’t just marginally improve but meet the medically recommended wait times for every single patient.

With Acute Care Alberta now fully operational, Alberta’s government is implementing reforms to acute care funding through a patient-focused funding (PFF) model, also known as activity-based funding, which pays hospitals based on the services they provide.

“The current global budgeting model has no incentives to increase volume, no accountability and no cost predictability for taxpayers. 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.”

Danielle Smith, Premier

Activity-based funding is based on the number and type of patients treated and the complexity of their care, incentivizing efficiency and ensuring that funding is tied to the actual care provided to patients. This funding model improves transparency, ensuring care is delivered at the right time and place as multiple organizations begin providing health services across the province.

“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. I am excited to see how this new approach will enhance the delivery of health care in Alberta.”

Adriana LaGrange, Minister of Health

Patient-focused, or activity-based, funding has been successfully implemented in Australia and many European nations, including Sweden and Norway, to address wait times and access to health care services, and is currently used in both British Columbia and Ontario in various ways.

“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. Patient-focused funding will bring greater accountability to how health care dollars are being spent while also providing an incentive for quality care.”

Dr. Chris Eagle, interim president and CEO, Acute Care Alberta

This transition is part of Acute Care Alberta’s mandate to oversee and arrange for the delivery of acute care services such as surgeries, a role that was historically performed by AHS. With Alberta’s government funding more surgeries than ever, setting a record with 304,595 surgeries completed in 2023-24 and with 310,000 surgeries expected to have been completed in 2024-25, it is crucial that funding models evolve to keep pace with the growing demand and complexity of services.

“With AHS transitioning to a hospital-based services provider, it’s time we are bold and begin to explore how to make our health care system more efficient and manage the cost of care on a per patient basis. The transition to a PFF model will align funding with patient care needs, based on actual service demand and patient needs, reflecting the communities they serve.”

Andre Tremblay, interim president and CEO, AHS

“Covenant Health welcomes a patient-focused approach to acute care funding that drives efficiency, accountability and performance while delivering the highest quality of care and services for all Albertans. As a trusted acute care provider, this model better aligns funding with outcomes and supports our unwavering commitment to patients.”

Patrick Dumelie, CEO, Covenant Health

“Patient-focused hospital financing ties funding to activity. Hospitals are paid for the services they deliver. Efficiency may improve and surgical wait times may decrease. Further, hospital managers may be more accountable towards hospital spending patterns. These features ensure that patients receive quality care of the highest value.”

Dr. Glen Sumner, clinical associate professor, University of Calgary

Leadership at Alberta Health and Acute Care Alberta will review relevant research and the experience of other jurisdictions, engage stakeholders and define and customize patient-focused funding in the Alberta context. This working group will also identify and run a pilot to determine where and how this approach can best be applied and implemented this fiscal year.

Final recommendations will be provided to the minister of health later this year, with implementation of patient-focused funding for select procedures across the system in 2026.

Alberta

Alberta Next Panel calls for less Ottawa—and it could pay off

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From the Fraser Institute

By Tegan Hill

Last Friday, less than a week before Christmas, the Smith government quietly released the final report from its Alberta Next Panel, which assessed Alberta’s role in Canada. Among other things, the panel recommends that the federal government transfer some of its tax revenue to provincial governments so they can assume more control over the delivery of provincial services. Based on Canada’s experience in the 1990s, this plan could deliver real benefits for Albertans and all Canadians.

Federations such as Canada typically work best when governments stick to their constitutional lanes. Indeed, one of the benefits of being a federalist country is that different levels of government assume responsibility for programs they’re best suited to deliver. For example, it’s logical that the federal government handle national defence, while provincial governments are typically best positioned to understand and address the unique health-care and education needs of their citizens.

But there’s currently a mismatch between the share of taxes the provinces collect and the cost of delivering provincial responsibilities (e.g. health care, education, childcare, and social services). As such, Ottawa uses transfers—including the Canada Health Transfer (CHT)—to financially support the provinces in their areas of responsibility. But these funds come with conditions.

Consider health care. To receive CHT payments from Ottawa, provinces must abide by the Canada Health Act, which effectively prevents the provinces from experimenting with new ways of delivering and financing health care—including policies that are successful in other universal health-care countries. Given Canada’s health-care system is one of the developed world’s most expensive universal systems, yet Canadians face some of the longest wait times for physicians and worst access to medical technology (e.g. MRIs) and hospital beds, these restrictions limit badly needed innovation and hurt patients.

To give the provinces more flexibility, the Alberta Next Panel suggests the federal government shift tax points (and transfer GST) to the provinces to better align provincial revenues with provincial responsibilities while eliminating “strings” attached to such federal transfers. In other words, Ottawa would transfer a portion of its tax revenues from the federal income tax and federal sales tax to the provincial government so they have funds to experiment with what works best for their citizens, without conditions on how that money can be used.

According to the Alberta Next Panel poll, at least in Alberta, a majority of citizens support this type of provincial autonomy in delivering provincial programs—and again, it’s paid off before.

In the 1990s, amid a fiscal crisis (greater in scale, but not dissimilar to the one Ottawa faces today), the federal government reduced welfare and social assistance transfers to the provinces while simultaneously removing most of the “strings” attached to these dollars. These reforms allowed the provinces to introduce work incentives, for example, which would have previously triggered a reduction in federal transfers. The change to federal transfers sparked a wave of reforms as the provinces experimented with new ways to improve their welfare programs, and ultimately led to significant innovation that reduced welfare dependency from a high of 3.1 million in 1994 to a low of 1.6 million in 2008, while also reducing government spending on social assistance.

The Smith government’s Alberta Next Panel wants the federal government to transfer some of its tax revenues to the provinces and reduce restrictions on provincial program delivery. As Canada’s experience in the 1990s shows, this could spur real innovation that ultimately improves services for Albertans and all Canadians.

Tegan Hill

Director, Alberta Policy, Fraser Institute
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Alberta

Ottawa-Alberta agreement may produce oligopoly in the oilsands

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From the Fraser Institute

By Jason Clemens and Elmira Aliakbari

The federal and Alberta governments recently jointly released the details of a memorandum of understanding (MOU), which lays the groundwork for potentially significant energy infrastructure including an oil pipeline from Alberta to the west coast that would provide access to Asia and other international markets. While an improvement on the status quo, the MOU’s ambiguity risks creating an oligopoly.

An oligopoly is basically a monopoly but with multiple firms instead of a single firm. It’s a market with limited competition where a few firms dominate the entire market, and it’s something economists and policymakers worry about because it results in higher prices, less innovation, lower investment and/or less quality. Indeed, the federal government has an entire agency charged with worrying about limits to competition.

There are a number of aspects of the MOU where it’s not sufficiently clear what Ottawa and Alberta are agreeing to, so it’s easy to envision a situation where a few large firms come to dominate the oilsands.

Consider the clear connection in the MOU between the development and progress of Pathways, which is a large-scale carbon capture project, and the development of a bitumen pipeline to the west coast. The MOU explicitly links increased production of both oil and gas (“while simultaneously reaching carbon neutrality”) with projects such as Pathways. Currently, Pathways involves five of Canada’s largest oilsands producers: Canadian Natural, Cenovus, ConocoPhillips Canada, Imperial and Suncor.

What’s not clear is whether only these firms, or perhaps companies linked with Pathways in the future, will have access to the new pipeline. Similarly, only the firms with access to the new west coast pipeline would have access to the new proposed deep-water port, allowing access to Asian markets and likely higher prices for exports. Ottawa went so far as to open the door to “appropriate adjustment(s)” to the oil tanker ban (C-48), which prevents oil tankers from docking at Canadian ports on the west coast.

One of the many challenges with an oligopoly is that it prevents new entrants and entrepreneurs from challenging the existing firms with new technologies, new approaches and new techniques. This entrepreneurial process, rooted in innovation, is at the core of our economic growth and progress over time. The MOU, though not designed to do this, could prevent such startups from challenging the existing big players because they could face a litany of restrictive anti-development regulations introduced during the Trudeau era that have not been reformed or changed since the new Carney government took office.

And this is not to criticize or blame the companies involved in Pathways. They’re acting in the interests of their customers, staff, investors and local communities by finding a way to expand their production and sales. The fault lies with governments that were not sufficiently clear in the MOU on issues such as access to the new pipeline.

And it’s also worth noting that all of this is predicated on an assumption that Alberta can achieve the many conditions included in the MOU, some of which are fairly difficult. Indeed, the nature of the MOU’s conditions has already led some to suggest that it’s window dressing for the federal government to avoid outright denying a west coast pipeline and instead shift the blame for failure to the Smith government.

Assuming Alberta can clear the MOU’s various hurdles and achieve the development of a west coast pipeline, it will certainly benefit the province and the country more broadly to diversify the export markets for one of our most important export products. However, the agreement is far from ideal and could impose much larger-than-needed costs on the economy if it leads to an oligopoly. At the very least we should be aware of these risks as we progress.

Jason Clemens

Executive Vice President, Fraser Institute
Elmira Aliakbari

Elmira Aliakbari

Director, Natural Resource Studies, Fraser Institute
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