Alberta
Province freezes funds for doctors and launches process to work out a new funding formula
New physician funding framework announce
Alberta will maintain physician funding at $5.4 billion, the highest level ever, and implement its final offer to the Alberta Medical Association (AMA) to avoid $2 billion in cost overruns.
Existing terms will remain in place until March 31, 2020. A new funding framework will then be introduced, in a multi-year process that will require consultation with the AMA at all stages. The new framework will make changes proposed during negotiations to prevent cost overruns, align benefit programs and administrative fees with those of comparable provinces, and improve services for patients.
The eleven consultation proposals will also be implemented on March 31. This includes phasing in changes to complex modifiers, reducing the rate physicians can charge for this billing code to $9 from $18, for a period of one year before the code is removed in 2021-22. In summer 2020, at the direction of the Minister of Health, the Government of Alberta will also introduce a new alternative relationship plan (ARP) with built-in transition benefits to encourage physicians to move from fee-for-service to a three-year contract.
“Our province is facing cost overruns of $2 billion in the next three years due solely to physician compensation. If left unaddressed, these costs would impede efforts to reduce surgical wait times, improve mental health and addiction services, and expand the number of continuing care beds. Despite repeated efforts, the AMA failed to put forward alternatives that would hold the line on physician compensation. The new framework announced today will prevent cost overruns, allow our province to improve services for patients, and still ensure that Alberta’s doctors are amongst the highest paid physicians in all of Canada.”
Background
- The new funding framework will maintain government’s current level of spending on physicians at $5.4 billion.
- The new funding framework avoids anticipated cost overruns of $2 billion over the next three years.
- Alberta has been spending more on physician salaries than other provinces, yet most of its health outcomes are below national averages.
- A doctor in Alberta earns approximately $90,000 more than a doctor in Ontario and physicians’ fees have almost tripled since 2002.
Elements of the new funding framework
- Changes to Alberta’s complex modifier billing system. The rate physicians are able to charge for complex modifiers will be reduced to $9 from $18 for a period of one year before this billing code is removed in 2021-22. Once the new framework is fully phased in, physicians will be able to bill an additional fee after spending 25 minutes with a complex patient case. Alberta remains the only province in Canada that allows for a top-up payment for complex visits.
- Removal of the comprehensive annual care plan from the list of insured services. Currently, physicians can also bill for a similar consultation called a comprehensive annual visit. No other province in Canada compensates physicians twice for annual care consultation.
- Implementation of a new daily cap, modelled after a cap in place in British Columbia, of 65 patients per day. Large patient loads can contribute to physician burnout and may compromise patient safety and quality of care.
- Removing physician overhead subsidies from all hospital-based services. Physicians who work in AHS facilities should not be billing for overhead costs that their community physician colleagues face, such as leases, hiring staff and purchasing equipment.
- Ending of clinical payments, or stipends, by AHS to physicians. This change ends duplication of payments to contracted physicians.
Timeline
- In September 2019, government provided notice to the AMA that it intended to begin negotiations on the AMA Agreement. The notification provided time for the AMA to prepare its proposals.
- In November 2019, negotiations began with the AMA to reach a new agreement; government began consultations on 11 proposed changes to the schedule of medical benefits (SOMB, or “insured services”).
- In January 2020, negotiations and consultations proceeded with no agreement reached. Mediation, on both the negotiation and consultation proposals, began January 31 and continued into February.
- The parties were not able to reach an agreement during mediation.
- Government will implement its final offer from the negotiating table, including the 11 consultation proposals, on March 31.
Alberta
Here’s why city hall should save ‘blanket rezoning’ in Calgary
From the Fraser Institute
By Tegan Hill and Austin Thompson
According to Calgarians for Thoughtful Growth (CFTG)—an organization advocating against “blanket rezoning”— housing would be more affordable if the mayor and council restricted what homes can be built in Calgary and where. But that gets the economics backwards.
Blanket rezoning—a 2024 policy that allowed homebuilders to construct duplexes, townhomes and fourplexes in most neighbourhoods—allowed more homebuilding, giving Calgarians more choice, and put downward pressure on prices. Mayor Farkas and several councillors campaigned on repealing blanket rezoning and on December 15 council will debate a motion that could start that process. As Calgarians debate the city’s housing rules, residents should understand the trade-offs involved.
When CFTG claims that blanket rezoning does “nothing” for affordability, it ignores a large body of economic research showing the opposite.
New homes are only built when they can be sold to willing homebuyers for a profit. Restrictions that limit the range of styles and locations for new homes, or that lock denser housing behind a long, costly and uncertain municipal approval process, inevitably eliminate many of these opportunities. That means fewer new homes are built, which worsens housing scarcity and pushes up prices. This intuitive story is backed up by study after study. An analysis by Canada’s federal housing agency put it simply: “higher residential land use regulation seems to be associated with lower housing affordability.”
CFTG also claims that blanket rezoning merely encourages “speculation” (i.e. buying to sell in the short-term for profit) by investors. Any profitable housing market may invite some speculative activity. But homebuilders and investors can only survive financially if they make homes that families are willing to buy or rent. The many Calgary families who bought or rented a new home enabled by blanket rezoning did so because they felt it was their best available option given its price, amenities and location—not because they were pawns in some speculative game. Calgarians benefit when they are free to choose the type of home and neighbourhood that best suits their family, rather than being constrained by the political whims of city hall.
And CFTG’s claim that blanket rezoning harms municipal finances also warrants scrutiny. More specifically, CFTG suggests that developers do not pay for infrastructure upgrades in established neighbourhoods, but this is simply incorrect. The City of Calgary charges an “Established Area Levy” to cover the cost of water and wastewater upgrades spurred by redevelopment projects—raising $16.5 million in 2024 alone. Builders in the downtown area must pay the “Centre City Levy,” which funds several local services (and generated $2.5 million in 2024).
It’s true that municipal fees on homes in new communities are generally higher, but that reflects the reality that new communities require far more new pipes, roads and facilities than established neighbourhoods.
Redeveloping established areas of the city means more residents can make use of streets, transit and other city services already in place, which is often the most cost-effective way for a city to grow. The City of Calgary’s own analysis finds that redevelopment in established neighbourhoods saves billions of taxpayer dollars on capital and operating costs for city services compared to an alternative scenario where homebuilding is concentrated in new suburban communities.
An honest debate about blanket rezoning ought to acknowledge the advantages this system has in promoting housing choice, housing affordability and the sustainability of municipal finances.
Clearly, many Calgarians felt blanket rezoning was undesirable when they voted for mayoral and council candidates who promised to change Calgary’s zoning rules. However, Calgarians also voted for a mayor who promised that more homes would be built faster, and at affordable prices—something that will be harder to achieve if city hall imposes tighter restrictions on where and what types of homes can be built. This unavoidable tension should be at the heart of the debate.
CFTG is promoting a comforting fairy tale where Calgary can tighten restrictions on homebuilding without limiting supply or driving up prices. In reality, no zoning regime delivers everything at once—greater neighbourhood control inevitably comes at the expense of housing choice and affordability. Calgarians—including the mayor and council—need a clear understanding of the trade-offs.
Alberta
The case for expanding Canada’s energy exports
From the Canadian Energy Centre
For Canada, the path to a stronger economy — and stronger global influence — runs through energy.
That’s the view of David Detomasi, a professor at the Smith School of Business at Queen’s University.
Detomasi, author of Profits and Power: Navigating the Politics and Geopolitics of Oil, argues that there is a moral case for developing Canada’s energy, both for Canadians and the world.
CEC: What does being an energy superpower mean to you?
DD: It means Canada is strong enough to affect the system as a whole by its choices.
There is something really valuable about Canada’s — and Alberta’s — way of producing carbon energy that goes beyond just the monetary rewards.
CEC: You talk about the moral case for developing Canada’s energy. What do you mean?
DD: I think the default assumption in public rhetoric is that the environmental movement is the only voice speaking for the moral betterment of the world. That needs to be challenged.
That public rhetoric is that the act of cultivating a powerful, effective economic engine is somehow wrong or bad, and that efforts to create wealth are somehow morally tainted.
I think that’s dead wrong. Economic growth is morally good, and we should foster it.
Economic growth generates money, and you can’t do anything you want to do in social expenditures without that engine.
Economic growth is critical to doing all the other things we want to do as Canadians, like having a publicly funded health care system or providing transfer payments to less well-off provinces.
Over the last 10 years, many people in Canada came to equate moral leadership with getting off of oil and gas as quickly as possible. I think that is a mistake, and far too narrow.
Instead, I think moral leadership means you play that game, you play it well, and you do it in our interest, in the Canadian way.
We need a solid base of economic prosperity in this country first, and then we can help others.
CEC: Why is it important to expand Canada’s energy trade?
DD: Canada is, and has always been, a trading nation, because we’ve got a lot of geography and not that many people.
If we don’t trade what we have with the outside world, we aren’t going to be able to develop economically, because we don’t have the internal size and capacity.
Historically, most of that trade has been with the United States. Geography and history mean it will always be our primary trade partner.
But the United States clearly can be an unreliable partner. Free and open trade matters more to Canada than it does to the U.S. Indeed, a big chunk of the American people is skeptical of participating in a global trading system.
As the United States perhaps withdraws from the international trading and investment system, there’s room for Canada to reinforce it in places where we can use our resource advantages to build new, stronger relationships.
One of these is Europe, which still imports a lot of gas. We can also build positive relationships with the enormous emerging markets of China and India, both of whom want and will need enormous supplies of energy for many decades.
I would like to be able to offer partners the alternative option of buying Canadian energy so that they are less reliant on, say, Iranian or Russian energy.
Canada can also maybe eventually help the two billion people in the world currently without energy access.
CEC: What benefits could Canadians gain by becoming an energy superpower?
DD: The first and primary responsibility of our federal government is to look after Canada. At the end of the day, the goal is to improve Canada’s welfare and enhance its sovereignty.
More carbon energy development helps Canada. We have massive debt, an investment crisis and productivity problems that we’ve been talking about forever. Economic and job growth are weak.
Solving these will require profitable and productive industries. We don’t have so many economic strengths in this country that we can voluntarily ignore or constrain one of our biggest industries.
The economic benefits pay for things that make you stronger as a country.
They make you more resilient on the social welfare front and make increasing defence expenditures, which we sorely need, more affordable. It allows us to manage the debt that we’re running up, and supports deals for Canada’s Indigenous peoples.
CEC: Are there specific projects that you advocate for to make Canada an energy superpower?
DD: Canada’s energy needs egress, and getting it out to places other than the United States. That means more transport and port facilities to Canada’s coasts.
We also need domestic energy transport networks. People don’t know this, but a big chunk of Ontario’s oil supply runs through Michigan, posing a latent security risk to Ontario’s energy security.
We need to change the perception that pipelines are evil. There’s a spiderweb of them across the globe, and more are being built.
Building pipelines here, with Canadian technology and know-how, builds our competitiveness and enhances our sovereignty.
Economic growth enhances sovereignty and provides the resources to do other things. We should applaud and encourage it, and the carbon energy sector can lead the way.
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