Alberta’s health reforms adopt best practices from world-leading universal systems

Crucially, the government must ensure that practising in the public system remains competitively attractive. Or, in the alternative, the government could simply regulate physicians to complete public service hours before they can care for privately paid patients. Learning from others  Here’s where Alberta can learn from others without having to forge its own path, as the overwhelming majority of developed countries have long permitted doctors to work in both public and private settings. These countries commonly employ both restrictive and supportive regulatory approaches—with many nations using a blend. On the restrictive side, some countries such as Austria and Italy limit the number of private services that can be provided, while countries such as Ireland and Australia only allow more senior doctors to work in both settings. Countries such as France limit the share of income that doctors can earn privately, while countries such as Ireland limit the share of private patients that doctors can see so that seeing more patients privately requires seeing proportionately more in the public system. Meanwhile, countries such as Norway, Portugal, and Spain make public practice more attractive through higher payments and/or more attractive exclusive work arrangements. Finally, a number of countries, including the U.K., Ireland, France, Germany, Switzerland, and Australia, allow health-care providers to provide some privately funded care in public facilities. This makes working in the public system more attractive and encourages public hospitals to provide better service through the demand for more patient-focused environments for private patients. Back in Alberta, the government may have already committed to an over-regulated approach that limits some of the advantages of reform. The government has announced it may restrict private practice to evenings and weekends or to particular sites, may further restrict the medical specialities permitted to provide private care beyond disallowing private options for life-threatening conditions and emergency procedures, and require surgeons who choose to work in both systems to perform a mandated number or ratio of public surgeries. Compared to other countries that allow doctors to work in both the public and private systems, these regulations would place Alberta firmly among the more restrictive regulators. In other words, contrary to the rhetoric of reform opponents, Alberta’s measures are actually quite timid compared to the policies of many other universal health-care countries. While these changes are an improvement on the status quo, limiting the scope for innovative private medical entrepreneurs will limit the gains to the health-care system and is a departure from what’s happening in better-performing universal health-care countries. Indeed, Australia, Germany, and Switzerland all meaningfully outperform Canada in measures of access to health care and wait times, while spending a similar amount or less than we do. These countries all allow physicians to see patients privately within public hospitals and with fewer restrictions on the services they can provide than the Alberta government plans to allow, at least initially. Hopefully, the government reconsiders and looks more closely at the benefits of private competition and patient choice before it unveils the new rules in the new year. Clearly, the Alberta government is about to implement a meaningful reform and a clear improvement on the status quo. But it can go further based on the experiences of other, more successful countries. In doing so, it will likely deliver better results.