ALBERTA PROPOSALS

Albertans should pay more for health in blended private-public system: report
JOHN COTTER, Canadian Press

EDMONTON (CP) - Albertans should pay more for health services in a scaled-down public system that includes more private-sector providers, says a report that could affect the future of medicare across Canada. The report released Tuesday calls for the creation of an expert panel to decide what medical procedures the province should cover. It also recommends higher health-care premiums for Albertans, who along with British Columbians, are the only Canadians who pay any premiums at all.

"Medicare was never designed to cover the full range of health services, treatments, drugs and technology available today or envisioned for the future," says the report by Don Mazankowski, a former deputy prime minister.  "If we want to make sure there is access to the best treatments available, we are going to have to make some choices about what services are covered and what services are not." Mazankowski said such measures must be taken to prevent health-care costs from spiralling out of control.

The report also calls for the creation of a blended private-public health system where people could get both insured and non-insured health services in a private facility. "Alberta's health system is not sustainable unless we are prepared to make major changes in how we fund and deliver health services," he said. People could pay for such services directly or through private health insurance. Such a blended system already exists in Alberta for eye surgery clinics.

Premier Ralph Klein commissioned the report last year to look for ways to cut ballooning health-care costs, which are eating up a growing part of provincial budgets across the country. Alberta has earmarked $6.4 billion for health this year - about one-third of its total budget. In other provinces such as Ontario and British Columbia, the number is closer to 40%, according to figures released by the Canadian Institute for Health Information.

While the report focuses on Alberta, other governments will be closely watching its findings and how the federal government responds to them.  Federal Health Minister Allan Rock welcomed the Mazankowski report and said he will weigh its findings along with similar input he has received from Saskatchewan, Quebec and other provinces. Rock said before he gives a full response he wants more information from Alberta about the recommendations for delisting services and the expansion of private health care. "There are some parts that need clarification. I'm not sure what that means," he said.

Rock also tried to reassure Canadians that the Alberta report will not dominate the federal government's review of medicare. "Medicare is a national asset. It belongs not to Mr. Klein or Mr. Rock. It belongs to Canadians," he said in a telephone interview. "That is why we have a national royal commission." The federal review, headed by former Saskatchewan premier Roy Romanow, is scheduled to hand in its report in November.

The Mazankowski report also calls for Albertans to use health-care "debit" cards to pay for medical services. The cards would help the government track how individuals use the system.

It also recommends that people should be guaranteed to receive some medical services within 90 days.

Over the past three months Klein has spoken openly about challenging Ottawa over the Canada Health Act to achieve reform. On Tuesday he was more conciliatory but suggested if there is going to be any friction with Ottawa, it will be about delisting services. "Health care was never meant to be all things for all people for all causes for all times," Klein said.

Both Klein and Mazankowski were defensive about the issue of delisting, insisting that the special panel, not the report or the government itself, will recommend specific measures. "This is the kind of thing as we start to accept recommendations relative to procedures that should be insured or not be insured that could represent challenges to the interpretation to the Canada Health Act," Klein said.

After gauging reaction to the report, Klein will announce how his government will respond on Jan. 23 - the day before premiers and territorial leaders hold their annual meeting in Vancouver. Klein will then present the report to his colleagues at the two-day meeting to seek support for his reform plan.

Medicare advocacy groups such as the Tommy Douglas Institute called the report an assault on public health care. Former B.C. premier Dave Barrett, the institute's chairman, said Canadians should be wary of delisting medical services in favour of private health care. "What's scary in this report is the talk about delisting some services. Are they looking for things that they can quietly drop from the list and push into the hand of private providers?," Barrett said.

Kevin Taft, Alberta Liberal health critic, said the province's health system needs stability, not radical change. Taft scoffed at the suggestion that the private sector can do a better job of providing services. "In study after study, for-profit medicine has been shown to benefit only a select few at the expense of the majority," he said. "The Mazankowski plan will take medicare apart, when what it really needs is to be put back together." Only 18 months ago protesters held daily demonstrations outside the legislature against Bill 11, legislation that paved the way for giving private operators a greater part in Alberta's health-care system. Despite the noisy protests, the bill became law.

Alberta Health Minister Gary Mar said the province can't afford to wait for the Romanow report. "This report won't sit on a shelf," he said. "We'll give these recommendations careful consideration and then we will act."

Highlights of the recommendations in the report of the Premier's Advisory Council on Health for Alberta, released Tuesday:

- Health premiums to rise by 33% to cover 20% of the cost of insured services. Currently health premiums are $800 per family per year.

- Expand the use of contracting out public health services to private providers.

- Issue Albertans medical debit cards to track how individuals use the health-care system.

- Establish medical savings accounts that would pay people a bonus for staying healthy and not using the health-care system.

- Change the way doctors are paid by moving away from fee for services to a system where doctors would receive a salary for providing a set range of health services.