EDMONTON – Albertaâ€™s oil wealth and stagnant political culture has stunted the provinceâ€™s ability to achieve more efficiency and innovation in its health care system, Stephen Duckett told an Edmonton audience Wednesday.
The controversial former CEO of Alberta Health Services was back in the provincial capital to deliver a lecture, speaking to about 120 people at the University of Alberta on the provinceâ€™s struggles to rein in health costs.
â€œA consequence of the lack of political dynamic in the province is there is no need for innovation,â€� he said. â€œThere is no tussle for power. If there is never a change of government … you end up with (inertia), basically.â€�
Duckett started his presentation by remarking that Alberta in the 1990s had a health system with low average costs and a population with a high life expectancy. He said the trend then reversed over the next 20 years, to the point where the province currently sports one of the countryâ€™s most expensive health systems producing below-average results.
He said Alberta tends to pay more for everything, including the compensation it gives to doctors and nurses, as well as administrative costs. Alberta also has a large number of hospitals and is continuing to build them, even though they are the most costly way of delivering care, Duckett said.
â€œThe province loves hospitals. You might think that hospitals is the only form of health care,â€� he said, adding that Alberta is behind the times in focusing more on primary care and home care.
He said one of the main causes of Albertaâ€™s rising health tab has been the massive revenue brought in through natural resources. While a blessing in some respects, Duckett said such wealth also has meant the government has faced little pressure to say â€œnoâ€� to anything.
Another factor has been a political climate that has seen the Progressive Conservatives in power for 43 years, he said.
Duckett said this dominant-party dynamic has given rise to political interference in the health system, the stifling of public advocacy, and a culture where decisions are based on relationships between political power brokers rather than sound policy.
â€œIn Alberta, political dynamics trump the economic drivers,â€� he said.
As an example, he referred to a decision in 2010 to reform the contracts AHS gave to private eye clinics to do cataract surgeries. He said the idea was to do more surgeries at the clinics offering the best prices, but the facilities that were shut out complained enough to prompt the health minister at the time, Gene Zwozdesky, to reverse course.
Similarly, he said AHS came under enormous pressure to give more work and higher fees to a struggling Calgary clinic performing orthopedic surgeries. As well, the health authority was frequently told to treat Calgary and Edmonton equally when providing new facilities or funding, even if there was no need in one city, he said.
â€œItâ€™s hard to see how these decisions were made on the basis of efficiency improvement.â€�
Duckett said he will be in Toronto next week to deliver a similar lecture, which also forms the basis of a new book that is being published.
After his presentation, Duckett was asked his thoughts on whether AHS should again be given a board of directors. Premier-designate Jim Prentice has said he plans to reinstate a board after the last one was fired in June 2013.