Alberta fails to fix fragmented health care

Auditor says throwing more money at the problem is not a solution

Alberta’s $21-billion health system has too long operated as an “orchestra without a conductor,” the province’s auditor general said Thursday in a new report that calls for aggressive action to implement overdue reforms.

Merwan Saher’s latest investigation says the province must accelerate efforts to achieve a fully integrated care model used in jurisdictions with the most successful health systems.

The report notes integrated care has been Alberta government policy since the 1990s, but the initiative has remained largely unfulfilled. Instead, excessive fragmentation of responsibilities, poor co-ordination at the primary care level and inadequate sharing of patient information have held the system back from offering more comprehensive care.

“Improvements in the healthcare system are not only necessary and overdue, but improvement is entirely achievable,” Saher told reporters. “You are paying for the best, so why would you not demand the best?”

As the report describes, much of the care Albertans currently receive is episodic, in which patients typically see a doctor or visit the hospital to get a single issue resolved.

However, no one takes responsibility for managing their care over the long term. The system doesn’t focus enough on quality outcomes, and is instead built around funding parameters, union negotiations, the needs of the bureaucracy and political whim, Saher said.

In contrast, an integrated system would give patients regular access to a team of different health professionals, all of whom work from the same care plan and have access to the patient’s health data. Ideally, the team would co-ordinate each patient’s important tests, prescriptions and appointments, and monitor their progress over time.

Saher said the idea for the report came from a realization the province has repeatedly struggled to address many of his office’s past audits. To date, 41 recommendations related to the health system have yet to be resolved, 19 of which have been outstanding for more than three years.

As such, he said the new report deliberately avoids making more recommendations, and instead focuses on identifying the root causes holding back progress — in particular the lack of integration.

The report says pumping more money into what is already Canada’s most expensive health system isn’t the answer, but several other things need to change:

Increasing stability at the top levels of Alberta Health Services so that senior executives stay in place long term.

Addressing “parallel management” of the health system in which AHS and the health department seem to have overlapping roles. The department should look at reducing its role so that operational management is left to AHS, Saher said.

Linking funding and physician compensation models to results. Currently, funding is more tied to the volume of services performed rather than quality.

Depoliticizing health as much as possible so that elected officials “respect operational boundaries” and avoid using health care to score short-term political points. For ministers, this means resisting the urge to intervene in managerial matters, while opposition MLAs should stop using question period to try to shame the minister or demand she take action on a local health issue.

Boosting integration of primary care doctors with the rest of the health system. Saher noted such physicians control a huge amount of the health system’s resources through the fees they charge, tests they order and prescriptions they write, yet they tend to operate independently, with little connection to AHS. Many will need to change how they practice.

Improving information technology platforms so that all health providers, and patients themselves, have easy access to patient records.

Encouraging Albertans to get more actively involved in their own health care and demand better service.

Health Minister Sarah Hoffman said her government has been making progress toward integration, but also warned that changes can’t cause chaos in the system.

“I feel like we’re moving at pretty good pace,” she said. “There are areas that absolutely need to be changed for us to have a sustainable system and as well a stable one, and I think we’re doing that at a rate that protects Albertans.”

The NDP government has already taken steps to address some of the issues highlighted in Saher’s report. A new governance model and funding process for Primary Care Networks are in the works, better co-ordination between AHS and family doctors is being discussed, a new physician compensation model is being piloted, and money has been allocated for a new clinical information system.

However, Saher described those efforts as “piecemeal initiatives,” saying he hasn’t seen evidence they’re part of a larger action plan to achieve integration by a certain date.

The Wildrose and Liberal praised the auditor’s report.

Improvements in the health-care system are not only necessary and overdue, but ... entirely achievable.