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Alberta

Province freezes funds for doctors and launches process to work out a new funding formula

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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.”

Tyler Shandro, Minister of Health

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.

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Alberta

Alberta Next Panel calls to reform how Canada works

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From the Fraser Institute

By Tegan Hill

The Alberta Next Panel, tasked with advising the Smith government on how the province can better protect its interests and defend its economy, has officially released its report. Two of its key recommendations—to hold a referendum on Alberta leaving the Canada Pension Plan, and to create a commission to review programs like equalization—could lead to meaningful changes to Canada’s system of fiscal federalism (i.e. the financial relationship between Ottawa and the provinces).

The panel stemmed from a growing sense of unfairness in Alberta. From 2007 to 2022, Albertans’ net contribution to federal finances (total federal taxes paid by Albertans minus federal money spent or transferred to Albertans) was $244.6 billion—more than five times the net contribution from British Columbians or Ontarians (the only other two net contributors). This money from Albertans helps keep taxes lower and fund government services in other provinces. Yet Ottawa continues to impose federal regulations, which disproportionately and negatively impact Alberta’s energy industry.

Albertans were growing tired of this unbalanced relationship. According to a poll by the Angus Reid Institute, nearly half of Albertans believe they get a “raw deal”—that is, they give more than they get—being part of Canada. The Alberta Next Panel survey found that 59 per cent of Albertans believe the federal transfer and equalization system is unfair to Alberta. And a ThinkHQ survey found that more than seven in 10 Albertans feel that federal policies over the past several years hurt their quality of life.

As part of an effort to increase provincial autonomy, amid these frustrations, the panel recommends the Alberta government hold a referendum on leaving the Canada Pension Plan (CPP) and establishing its own provincial pension plan.

Albertans typically have higher average incomes and a younger population than the rest of the country, which means they could pay a lower contribution rate under a provincial pension plan while receiving the same level of benefits as the CPP. (These demographic and economic factors are also why Albertans currently make such a large net contribution to the CPP).

The savings from paying a lower contribution rate could result in materially higher income during retirement for Albertans if they’re invested in a private account. One report found that if a typical Albertan invested the savings from paying a lower contribution rate to a provincial pension plan, they could benefit from $189,773 (pre-tax) in additional retirement income.

Clearly, Albertans could see a financial benefit from leaving the CPP, but there are many factors to consider. The government plans to present a detailed report including how the funds would be managed, contribution rates, and implementation plan prior to a referendum.

Then there’s equalization—a program fraught with flaws. The goal of equalization is to ensure provinces can provide reasonably comparable public services at reasonably comparable tax rates. Ottawa collects taxes from Canadians across the country and then redistributes that money to “have not” provinces. In 2026/27, equalization payments is expected to total $27.2 billion with all provinces except Alberta, British Columbia and Saskatchewan receiving payments.

Reasonable people can disagree on whether or not they support the principle of the program, but again, it has major flaws that just don’t make sense. Consider the fixed growth rate rule, which mandates that total equalization payments grow each year even when the income differences between recipient and non-recipient provinces narrows. That means Albertans continue paying for a growing program, even when such growth isn’t required to meet the program’s stated objective. The panel recommends that Alberta take a leading role in working with other provinces and the federal government to reform equalization and set up a new Canada Fiscal Commission to review fiscal federalism more broadly.

The Alberta Next Panel is calling for changes to fiscal federalism. Reforms to equalization are clearly needed—and it’s worth exploring the potential of an Alberta pension plan. Indeed, both of these changes could deliver benefits.

Tegan Hill

Director, Alberta Policy, Fraser Institute
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Alberta

Alberta’s huge oil sands reserves dwarf U.S. shale

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From the Canadian Energy Centre

By Will Gibson

Oil sands could maintain current production rates for more than 140 years

Investor interest in Canadian oil producers, primarily in the Alberta oil sands, has picked up, and not only because of expanded export capacity from the Trans Mountain pipeline.

Enverus Intelligence Research says the real draw — and a major factor behind oil sands equities outperforming U.S. peers by about 40 per cent since January 2024 — is the resource Trans Mountain helps unlock.

Alberta’s oil sands contain 167 billion barrels of reserves, nearly four times the volume in the United States.

Today’s oil sands operators hold more than twice the available high-quality resources compared to U.S. shale producers, Enverus reports.

“It’s a huge number — 167 billion barrels — when Alberta only produces about three million barrels a day right now,” said Mike Verney, executive vice-president at McDaniel & Associates, which earlier this year updated the province’s oil and gas reserves on behalf of the Alberta Energy Regulator.

Already fourth in the world, the assessment found Alberta’s oil reserves increased by seven billion barrels.

Verney said the rise in reserves despite record production is in part a result of improved processes and technology.

“Oil sands companies can produce for decades at the same economic threshold as they do today. That’s a great place to be,” said Michael Berger, a senior analyst with Enverus.

BMO Capital Markets estimates that Alberta’s oil sands reserves could maintain current production rates for more than 140 years.

The long-term picture looks different south of the border.

The U.S. Energy Information Administration projects that American production will peak before 2030 and enter a long period of decline.

Having a lasting stable source of supply is important as world oil demand is expected to remain strong for decades to come.

This is particularly true in Asia, the target market for oil exports off Canada’s West Coast.

The International Energy Agency (IEA) projects oil demand in the Asia-Pacific region will go from 35 million barrels per day in 2024 to 41 million barrels per day in 2050.

The growing appeal of Alberta oil in Asian markets shows up not only in expanded Trans Mountain shipments, but also in Canadian crude being “re-exported” from U.S. Gulf Coast terminals.

According to RBN Energy, Asian buyers – primarily in China – are now the main non-U.S. buyers from Trans Mountain, while India dominates  purchases of re-exports from the U.S. Gulf Coast. .

BMO said the oil sands offers advantages both in steady supply and lower overall environmental impacts.

“Not only is the resulting stability ideally suited to backfill anticipated declines in world oil supply, but the long-term physical footprint may also be meaningfully lower given large-scale concentrated emissions, high water recycling rates and low well declines,” BMO analysts said.

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