How will Alberta's $85-million health care reorganization work?

The new $85-million provincial health system reorganization was partially rolled out Tuesday with the proposed Health Statutes Amendment Act (HSAA) legislation, revealing one key player with multiple roles, and promising “critical improvements to transparency and accountability.”

THREE HATS FOR LAGRANGE

Under the “four pillars” of the UCP government's “refocused” health ministry, the three main health sectors outside of mental health and addiction — acute care, primary care, and continuing care — could each have a “sector minister.”

However, come the fall, all three health roles will be inhabited by Alberta Health Minister Adriana Lagrange, who reports to Premier Danielle Smith. The province's chief medical officer of health reports to the health minister as well.

Wearing all the hats, Lagrange may decide which types of health services are to be delivered in her health services sectors, determine the organizations' structures, and the management functions of the Provincial Health Agencies (PHA).

The three health PHAS will deliver health services or arrange for the delivery of health services, evaluate and adjust health service delivery to meet the needs of Albertans across the province, and implement plans to address system priorities, as set by Lagrange as health minister.

The PHAS will be established by Lagrange through a ministerial order and in consultation with herself as health minister.

As sector minister for the three pillars, Lagrange also has the authority to make appointments among a PHA'S governing members, designating a chair or vicechair.

As both health minister and acting as a minister for each sector, she can require the PHA or Regional Health Authority (RHA) to prepare plans, including health and operational plans, and review the PHA'S or RHA'S policies relating to their internal decision-making and delegation processes.

MENTAL HEALTH AND ADDICTION

Mental Health and Addiction Minister Dan Williams will be in charge of that sector of Alberta health.

Recovery Alberta, the mental health and addiction provincial health agency that will begin operating in the summer of 2024, will run under Williams' oversight and report to Lagrange.

Lagrange sees the newly-formed Canadian Centre of Recovery Excellence (CORE) as “a public agency that would support the Government of Alberta, including mental health and addiction, and Recovery Alberta in advancing the Alberta recovery model,” said a Tuesday government news release.

ADDITIONAL SECTORS NOT ROLLED OUT

The whole four-pillar “sector minister” strategy doesn't preclude the creation of additional sectors.

The HSAA legislation, the UCP government promises, will ensure Albertans have “a system that works for them by prioritizing their need to find a primary care provider, receive urgent care without long waits, have access to the best continuing care options and obtain excellent mental health and addiction treatment.”

It has yet to be determined where in the organization chart of Lagrange's three sectors that public health will reside.

A NEW PLACE FOR AHS

Lagrange will also be in charge of the reduced Alberta Health Services (AHS), which will be tucked under the acute care category, in charge of hospitals.

The place AHS holds in the system came under fire during the Tuesday news conference. Lagrange said AHS oversees 28 per cent of the contracts in continuing care, it dabbles in primary care, it holds contracts with others, and that it has no clear accountability structure.

The plan for the new “four pillars” first came to light at the time of the premier's firing of the AHS board.

On Nov. 8, 2023, Alberta's government linked a “refocused healthcare system” with ensuring patients receive “the care they need, when and where they need it.”

The HSAA introduces the concept of health services delivery organizations (HSDOS), which can be designated by the appropriate sector minister (the health minister in all cases except mental health and addiction) and is accountable to her.

An HSDO can be a person, but not a professional corporation as defined in the Health Professions Act or a physician practice.

“Alberta Health Services (AHS), for example, could be designated as an HSDO in the future, once it is transitioned from an RHA,” the government release said.

“Provisions have been added to wind up the affairs of AHS, over time, and ensure that AHS can continue to operate as a regional health authority in the interim period, before it transitions to an acute care service delivery organization later this year.

“AHS will remain a key provider of health services, and in fall 2024 will transition to focusing on the provision of acute care services.”