Nurses’ top concern is always the safety and good care of our patients, clients or residents. Appropriate resources and conditions of work are necessary to ensure this quality care and UNA has a long history of advocacy aimed at improving nursing workplaces and Alberta’s health care delivery. We welcome the opportunity to bring our front line perspective to the discussion of proposed changes to health care legislation and, more broadly, the future of health care in Alberta.
Overview
In the document A Foundation for Alberta’s Health System, the Minister’s Advisory Committee on Health (MACH) argues that “Alberta needs clarity of purpose and direction for the health system.” The solution proposed in this document is the development of a legislative framework that would not have an immediate impact on health care delivery in the province but rather “set the tone and direction of regulations, policies and best practices” in the future. In fact the document specifically advises the reader not to focus on policy and practice but on the overarching “principles and intent” of the proposed legislation.
The document then goes on to describe a number of concrete goals for the proposed legislative framework. These include establishing an independent entity charged both with “informing” decisions about what services would be adopted as part of health care delivery in Alberta and “assessing” whether these services would or would not be publicly funded; defining consistent terminology across future legislation (an example offered in the document of a term needing definition is “publicly funded services”) and consolidating much of Alberta’s health legislation into the new proposed Alberta Health Act.
The MACH report argues that the five acts which address publicly funded health services are priorities for consolidation: Health Care Insurance Act; Hospitals Act; Nursing Homes Act; Health Care Protection Act; and Health Insurance Premium Act.
Based on past and current trends in the organization, management and funding of health care in the province, UNA is concerned about the direction of the government’s plan for health care delivery and payment in Alberta. In regard to the foundational principles referred to in the document, our foremost concern is that the principles and intent articulated do not fully represent the values Albertans hold on health care. Core beliefs about the importance of “public service” oriented care organizations and values in the delivery of health care are missing from the document and the conversations that have emerged since its release.
Furthermore UNA holds that a focus on principles and intent without adequate discussion of the policies and practices that could follow from these principles significantly hinders the opportunity for Albertans to engage in open and democratic debate on the future of health care in our province.
The choices we make today about our health care system will impact each and every one of us. Any decisions we make should occur only after extensive and thorough democratic discussion.
Conclusion
The MACH report suggests that embedding principles in a broad legislative framework will provide the necessary direction to policy makers, health governing bodies and regulators as well as provide adequate protection for the citizens of Alberta. UNA holds that there is a need for far more clarity in how the province intends to interpret and apply the proposed principles before Albertans can seriously consider the recommendations of the MACH Report.
A focus on principles and intent without adequate discussion of the policies and practices that could follow from these principles significantly hinders the opportunity for Albertans to engage in open and democratic debate on the future of health care in our province. Albertans should be informed of the specific policies and practices that would follow from the proposed principles and must understand what this could mean for the care of their families.
The MACH report speaks of ongoing citizen engagement in the development of legislation, regulation and policy. Yet the workshops conducted to seek input on the MACH report were not initially open to the public. Open and democratic debate has further been hindered by the fact that to date no draft of legislation has been made available. UNA holds that citizens cannot be expected to provide meaningful feedback without open consultation and access to drafts of legislation.
The MACH report proposes a new “arms-length” entity be established to inform decisions about services, practices and policies in Alberta’s health system and assess whether these technologies and services should be publicly insured. UNA holds that policy development and analysis is central to effective government and should not be left to an “arms-length” entity. Governments should be answerable directly to the public for their policy and decisions; any other process compromises transparency and accountability.
UNA agrees that Albertans deserve a more flexible and responsive health care system, one in which access to health care services would not be limited by setting or provider. However UNA advocates for expanding and enhancing public services to include, for example, care for the frail and chronically ill and comprehensive pharmaceutical coverage.
Governments often question the sustainability of our health care system. UNA suggests that this is a short-sighted perspective: health care costs are not usually optional. They will be paid, either as public services funded by our taxes through our government or directly by citizens from their pockets or from expensive private insurance. With the exception of the United States, Canada already has one of the highest rates of private expenditures on health care among OECD countries; do we want to further increase our private expenditures when research has consistently shown that privately funded health care incurs greater administrative and managerial costs and provides poorer safety outcomes?
Collective public payment for services has proven to be better at controlling costs, fairer for citizens and far better at ensuring universal access. The question is not whether we can afford such a system. If we are concerned about the overall health and well-being of Albertans, we simply cannot afford not to expand our public health care services. |
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UNA Recommendations 1. Explicitly articulate the principles of public administration, universality, comprehensiveness portability and accessibility as foundational principles of a new Alberta Health Act.
2. Ensure that a draft of proposed legislation is made available for public consultation prior to consolidation of any existing legislation.
3. Inform Albertans of the specific policies and practices that would follow from the principles in the Alberta Health Act. Engage Albertans in discussion of the actual services, and conditions for services that will be provided by the health system that would result from a new Alberta Health Act.
4. Articulate in legislation the composition, processes and powers associated with the proposed new arms-length entity and ensure that it is the government that remains directly accountable to Albertans for decisions surrounding health care policy, structures and process.
5. Enhance the sustainability of our health system. Public services are best at controlling health care costs and maintaining sustainability. Government should be expanding public services to control costs, heighten safety and quality and to ensure equality. We must address the issues in the funding, capacity, and stability of our health system. Albertans need - and expect - our public system to grow and improve to meet our health care need |
