Every province in Canada is struggling with its health-care system.
With the pursuit of private care options off the table for now, Premier Smith has set her sights on reforming the health-care bureaucracy that operates as Alberta Health Services (AHS).
In breaking up the AHS bureaucracy, Smith is reversing a trend of centralizing the provincial health authorities since the 1990s. In 1994, Alberta had over 200 health boards that Premier Ralph Klein merged into 17 regional boards. In 2004, the 17 boards were reduced to nine. In 2008, Premier Ed Stelmach merged all the boards into one “superboard” for the entire province. Now, Smith is splitting AHS into four different organizations with different mandates.
Premier Smith is setting the stage for substantive health-care reforms and she has been carefully removing the gatekeepers and leaders within the bureaucracy. In breaking AHS into four parts, she will be able to clean house further as restructuring begins.
Critics of Smith’s actions claim the costs and inefficiencies will compound under a decentralized bureaucracy as duplication of roles and confusion over authority may set in. These could be valid concerns, but few would claim the existing AHS board had been operating effectively before Smith’s intervention.
Health service management will now be divided by function with primary care, acute care, continuing care, and mental health/addiction care all having separate divisions. While all those functions fall under the realm of health care, they all have different needs and require differing specialists. They could operate more efficiently as they may be managed by specialists in those fields rather than generalists under a superboard.
These new bureaucracies also have overlapping needs and could find themselves competing for health-care resources when they should be working cooperatively. There will surely be some instability as these new management systems establish themselves.
Premier Danielle Smith is playing a long game. She wants to apply broad and substantive reforms to Alberta’s health system but realizes she needs to neutralize her opposition first. The AHS bureaucracy was huge and effective at resisting changes from the health ministry. Now that AHS will be divided, Smith will be able to tinker with reforms in care provision and addiction treatment without battling the bureaucratic behemoth of the AHS superboard.
Smith’s plans could have a national impact. Other provinces will be watching Alberta’s health-care reforms closely. Smith is taking a political gamble that will pay off in spades if health-care reforms are effective in reducing costs and waiting times. Premiers will be emboldened to pursue reforms if Smith succeeds. It will be political suicide if the reforms fail, though, and consideration of health-care reform across the country will be put aside.
It’s hard to tell yet which reforms Danielle Smith will be prioritizing and how far she is willing to go. As she patiently deconstructs the structure managing the administration of the system, it’s clear she is looking farther down the road as she plays political chess.
Smith has big plans and the reforms will be substantial. It’s just a matter of when she feels the stage has been safely set to implement substantive health policy changes.
