Soon after Dr Duckett was hired he received a phone call from Mr Hughes, the AHS Board chair, and Mr Sieben, the AHS Audit Committee chair. They told him that they’d “…just become aware of the need to do a significant financial correction, dimensions still unclear but certainly north of $1B.” No doubt this was unsettling news for Dr Duckett, however, it turned out to be devastating news for Albertans. Why? Because the AHS and the government missed an ideal opportunity to rethink their approach to healthcare. Instead of leaping to the simplistic solution—cut costs—they could have asked themselves: What does a high performing healthcare system look like? What should the government and the AHS do to make Alberta’s healthcare system, in the words of Premier Stelmach, one of the best in Canada?
These are not easy questions, however, we’re not starting from scratch. There are plenty of examples of high performing healthcare systems available, both internationally and here in Canada. A good place for the government and the AHS to start would have been the Canada Health Consumer Index (CHCI) 2008 report. The report assessed the quality of healthcare performance of each of the 10 provinces using straightforward benchmarking and evaluation methodologies. The result is a comparison of performance across five categories: (1) patient rights/information, (2) primary care (access to a family doctor, homecare and elderly care), (3) wait times for specialists, cancer radiation therapy and diagnostics, (4) patient outcomes (infant mortality rates, cancer 5 year survival rates, heart attack mortality rates) and (5) range of services (access to new drugs, vaccinations, cataract operations).
The Dec 2008 report placed Ontario, BC and Nova Scotia in the top three spots and landed Alberta squarely in the middle of the pack. Although Alberta ranked slightly above average in most of the categories its final score suffered as a result of wait times. The CHCI pointed out that Alberta spent more per capita on healthcare than any other province but its middling score was “…indicative of an inefficient system that wastes money.”.
So the government had a choice. It could default to its usual practice and slash the healthcare budget or it could pause to consider whether there was a better solution. Unfortunately the government went with Plan A—slash the budget, without an adequate analysis of the outcome. The results of this ill conceived decision have been documented in the 2009 and 2010 CHCI reports.
The Dec 2009 report ranked Alberta in 4th position, behind Ontario, BC and New Brunswick. Once again Alberta showed strong performance in patient outcomes, but this was offset by wait times which were the longest in the country. Of particular concern was access to cancer radiation therapy.
By Dec 2010, Alberta had fallen to 7th position, tied with Nova Scotia, and just ahead of PEI and Newfoundland. The top performers were Ontario, BC and New Brunswick. The only factor preventing Alberta from falling to the bottom of the list was, once again, its strong performance on patient outcomes. Thereby confirming the anecdotal evidence that once you make it to the front of the line (assuming you don’t die first) you will get excellent care.
So where does that leave us today? Well, Dr Duckett is gone and the search for his successor is underway. The government and the AHS have been bruised by the public backlash over their pathetic performance over the last 18 months and are being given a second chance to fix the problem. The 2008, 2009 and 2010 CHCI reports state that Ontario and BC have had the best performing healthcare systems in all of Canada for three straight years. If the Alberta government is sincere about finding a solution to the healthcare crisis it would be well advised to examine the best practices that have been developed next door and across the street. Let’s hope they do so.