Sweeping changes to come for Alberta's health-care system in 2024

Premier Danielle Smith is set to take scalpel and bone saw to Alberta's $17-billion health delivery system in 2024, while simultaneously scrambling to keep and find more family doctors.

One goal can't wait on the other, Smith said in a recent year-end interview.

"We won't be able to solve the front-line problems without doing a massive reorganization," said Smith.

"Our nurses are getting burnt out after two years and leaving our system. Paramedics last about five years on average. Doctors have reduced their private practice and not enough are going into primary care.

"That's a management problem, decisions that either don't get made or get pushed off, or bad decisions get made. And that has a huge impact on morale."

Smith's United Conservative Party government is expected in the spring sitting to begin passing laws to make good on her plan to dismantle Alberta Health Services, the centralized body that oversees health delivery on everything from acute care to community care.

AHS is to be replaced by four agencies, while being reduced to the role of service provider in acute care.

The model has raised concerns that the four areas — primary care, acute care, continuing care, and mental health and addiction — could fail to be integrated and put care at risk.

In the meantime, Smith said work continues to find more family doctors while keeping the ones the province has from closing up shop.

Alberta, like other provinces, is facing an acute shortage of family physicians, a problem that has a disastrous knock-on effect through the health system as more patients without primary care seek aid in crowded emergency departments.

Just before Christmas, Smith announced $200 million over two years to help primary care physicians keep their practices open.

In the meantime, the province and the Alberta Medical Association are hammering out a new pay model to reflect growing cohorts of patients, inflation, higher business operating costs and more comprehensive care. The care takes into account the face-to-face time with patients as well as the time before and after patients are seen.

Policy agenda

It's an ambitious agenda of policies announced by Smith this year. She is also: steering a debate over leaving the Canada Pension Plan; arguing with Ottawa over energy boundaries; rolling out a new blueprint on green electricity projects; and implementing a promised tax cut.

As well, Smith has promised the six-month moratorium on large green electricity projects will end this spring as her government explores new rules to ensure these projects can be cleaned up after they are done.

And she has promised a renewed fight with Ottawa over what Alberta deems unconstitutional intrusions into its wellspring oil and gas economy.

Smith made it personal in early December, accusing Environment Minister Steven Guilbeault of "treachery" for his green agenda.

Smith, in the interview, defended her language and said, while she has a working relationship with other federal ministers, Guilbeault is beyond the pale and their relationship beyond repair.

"He does pro forma consultation just to tick off a box and doesn't listen, doesn't change direction, doesn't work in any of the feedback that he gets," said Smith.

"For us to have a constructive relationship on environment issues, I do think he needs to be removed as environment minister."

Affordability issues

Smith said she will also focus on affordability issues in the new year. Some of the provincial tax cut on gas at the pumps will return, another challenge for Albertans still facing high auto insurance rates and high electricity prices.

To alleviate some of that pain, Smith, on the first day of her election campaign, promised no future corporate and personal tax hikes without a referendum.

She also promised her UCP would make changes to tax rules to deliver about $760 more a year for everyone making over $60,000, at an estimated cost of $1 billion to the treasury.

The tax hike bill went through as promised, but the tax cut has not materialized.

Smith said the financial headwinds of oil and gas prices have put that pledge on a collision course with another to keep budgets balanced.

Smith's election promise did not include an oil-price caveat.

Asked if she made too hasty a commitment, Smith said the cut is to be rolled out in stages, with the schedule being announced in the Feb. 29 budget.

"It's gonna happen," she said.

One ongoing policy issue on hold is Smith's proposal to have Alberta quit the Canada Pension Plan. It's tied to a government-commissioned report that says Alberta is owed a windfall — 53 per cent of the entire CPP — if it splits off to run its own plan.

The CPP investment board and economists say the true figure would be far less. The federal government has tasked its chief actuary to come up with a calculation. Smith has put public consultations over a CPP exit on hold until that number is produced.

However, a public engagement panel says about half of Albertans it has heard from are happy staying with the federal plan.

Is that enough to stop pursuing the exit proposal? Smith is asked.

"I think it's too soon," she said.

She reiterated Albertans will have the final say, with her government passing a law mandating a referendum before leaving the CPP.

"[Albertans] know that we're overpaying. They know they can have higher benefits. They know they could have lower contributions. They know that we could repatriate those investment dollars.

"[If] they still say no, well, then that's going to be on Albertans. That's their choice."