Alberta’s risk-taking approach to medicare

I would like to thank the BC Medical Journal for inviting me to participate in the journal’s special centenary issue. My congratulations to members of the British Columbia Medical Association for a century of dedicated service to the people of your province. In BC, in my home province of Alberta, and across Canada, physicians have rightfully earned a reputation as being the best in the world, and all Canadians are proud of the legacy the nation’s physicians write each day.

I suspect that I was asked to contribute this article because of Alberta’s reputation for innovation and risk-taking when it comes to management of the health system. Like all provinces, Alberta is proud of the Canadian health system and is working hard to ensure it serves people as well in the new century as it did in the previous one. However, we can’t let our pride in the health system blind us to the fact that the system needs change. Cherishing the health system does not mean that we should take it as it was shaped four decades ago and cast it in bronze, never to be adjusted to the changing times.

In the 21st century, medicine and health care are poised for developments that will shake the world. Right now, the medical pathfinders of the new century are perhaps just finishing junior high, or studying for their med school exams. If the Canadian health system is to take full advantage of the medical advances that are certain to come, it must be flexible, responsive, and subject to continuing public scrutiny.

In Alberta, we’re always looking at ways to make the system better—to help it serve people better. We believe that the foundation of the system—the five principles of the Canada Health Act—are designed to facilitate change, not block it. We believe that adequate funding is essential, of course, and that’s why we’ve been adding more and more money to the system every year since 1996. But as physicians know, money is not the only answer. All the money in the world won’t make a lasting difference unless we embrace change.

And Canadians are ready to embrace change. Whether it’s new processes to provide primary care or new ways to encourage physicians to practise in remote areas, Canadians have said they want to try new ways of doing things if they hold some promise of success. In the new century, I therefore expect we’ll see more and more health services delivered outside the traditional hospital setting. We might even see the concept of what a “hospital” is reshaped by technology and human ingenuity. We’ll see the wisdom of physicians’ advice on how to live healthy lives reflected more than ever in people’s lifestyles and habits. We’ll see people accepting more responsibility for learning about healthy lifestyles and healthy attitudes—keys to good health care.

The role of governments in providing health care will certainly change as well. I think this change has already begun. Most provinces have removed themselves from direct delivery of health-system services, moving instead to a structure that relies on regional boards and authorities to plan and manage services. In Alberta, our 17 regional authorities and two provincial boards have made great inroads into laying deep roots in the communities they serve.

In Edmonton, for example, the Capital Regional Health Authority has for the last few years operated a Seniors Healthline, a toll-free phone service where anyone in the region can call for free health assistance and referrals for seniors. This might seem like a small step, but it’s a great example of what can happen when health managers are plugged into the communities they serve. I think we can watch for more and more progress and innovation in this area in the coming years.

Such innovation doesn’t mean that governments won’t have a job to do in the health system of the 21st century. At both the provincial and federal levels, governments need to work more closely than ever with key health providers such as physicians and nurses. They need to listen to what citizens are saying, and be able to recognize and collate real citizen input from among the frequent clutter of editorial handwringing and special interest lobbying.

Above all, governments need to work together. It does no Canadian any good when politicians wrap themselves in the Canada Health Act to oppose change, or when they speak about the need for change but then cut down any and all ideas that come forward. Physicians have shown Canadians that medicine is an evolving field and that those who turn their back on change risk being left behind. In Alberta, we’re going to do all we can to ensure that the health system we all value remains strong, responsive, and contemporary. We owe that much to the people of the 21st century.

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Mr Klein is the premier of Alberta.