‘We’re going to walk before we run’: Alberta Health Minister Adriana LaGrange on the province’s historic health-care reforms

Alberta Minister of Primary and Preventive Health Services Adriana LaGrange discusses her government’s historic legislation introducing a dual private-public health model for physicians. She explains the structural problems plaguing Alberta’s health-care system, how the new model could allow doctors to switch between public and private practice, and the guardrails being proposed to protect universal access. She also addresses concerns about privatization by pointing to successful European models, arguing that innovation and flexibility are essential to reducing wait times and transforming Alberta into a health-care leader. You can listen to this episode on Amazon, Apple, and Spotify. Program Transcript This is an automated transcript. Please check against delivery. SEAN SPEER: Minister, thanks so much for joining us. ADRIANA LAGRANGE: My pleasure, my pleasure. SEAN SPEER: We’re speaking on November 25, the day after you’ve tabled significant legislation before the Alberta Parliament that, among other things, will establish a new dual practice model for Alberta physicians. Before we get into the model and what it may mean for Albertan’s healthcare Services, let’s talk a bit about what went into this decision. Minister, what caused you and your colleagues to decide that something structural needed to be done to improve healthcare outcomes for Albertans? ADRIANA LAGRANGE: Well, Sean, it actually started two years ago when I was appointed as the Minister of Health in June of 2023. And we started digging into why the system was not working. Why are so many surgeries out of clinically approved times? Why are people not getting into emergency rooms in a timely fashion? Why are we not able to attract and retain quality professionals? And so as we dug deeper, as you know, we started refining. I started refocusing the healthcare system in November of 2023. We really had a monopoly that had been created Alberta Health Services. And while I think there were a lot of really great, and there are incredibly great people that are working in Alberta Health Services. It had just become too large, too unwieldy. The accountability factor was missing, the planning was problematic. And I came from education, four years in education, and prior to that it was a school board trustee for 11 and a half years. And while education had issues, it had very good structure. What I was finding within Alberta Health Services, it lacked the structure and I could go into detail, but it would take much too long to do that. So we really looked at, we had already done engagement on continuing care, on primary care, the modernizing Alberta’s primary care system. And we were well on the way on recovery, mental health and addictions and recovery. And so we separated Alberta health services into four pillars. It has taken the better part of two years. We are nearing completion on that. And as we dug deeper and as we engage with everyday Albertans and with physicians and nurses and frontline managers, et cetera, the whole system, we heard over and over and over and over again, why is it that we have to leave our province and go to other provinces, other countries to get surgeries done? Why is it that Europe has a very good universal health care system that also enables the private sector and nonprofits to be able to provide services? And so we started looking deeper at what are the top performing jurisdictions around the world doing and how can we replicate that here in Alberta? And so that has led us to yesterday’s bill, bill which in fact will, I believe, transform health care and the ability to have our healthcare professionals provide the best care to Albertans. Right now, roughly about when I first started, roughly about 40 to 45% of surgeries were being done in clinically approved times. Now we’re nearing 70% in clinically approved times. Because of all of the improvements we’ve made, we’ve been able to attract more physicians. We’ve gone from roughly 10,600 to over 12,700, 769 more coming all the time. But how do we now allow them to also expand access? We are adding 50,000 more surgeries to the record number of surgeries we did last year, which was 318,000. But we know people are waiting outside of clinically approved times. And one way to help that move forward is to allow for this dual practice, which is allowed in other countries and also allowed in Canada within Quebec and New Brunswick. SEAN SPEER: Talk a bit more about what the dual practice model entails. How, in broad terms, Minister, will it work? ADRIANA LAGRANGE: Right now you are either an opted in physician or an opted out physician. And so an opted in physician adheres to the Alberta health insurance care plan. And so you are funded fully by the government. If you are opted out, you are funded fully privately and you can charge what you want in that realm. We have approximately 14 physicians right now that are opted out in the province. But it takes between a year to 18 months to go from an opted in to an opted out. Now, the way that we are structuring it and we’re going to put guardrails in place to make sure that we are protecting the public system. But the way it will work is you can be a participating physician, which would be your opted in. You can be a non participating physician, which would be your opted out. But you can also be a flexibly participating physician, which means you can toggle between the opted in and opted out, public and private. And that can be done on a case by case basis. You would have to inform the patient that there is an option and you would have to be fully transparent as a physician, as a surgeon to say that these are the costs, etc. But you would be able to have that option. Of course, as I said earlier, we’re going to make sure that we have guardrails in place to ensure the public system is strong and well supported. And in fact this would augment the public system or not detract from it. SEAN SPEER: Yes. ADRIANA LAGRANGE: And you cannot opt out if you are doing emergency surgery, if it’s cancer surgery or if you are a family physician. Because right now our priority in family physician that realm is to make sure that every Albertan is attached to a primary care provider. SEAN SPEER: Do you want to talk minister, about some of those other guardrails that in part anticipate potential criticisms that the potential expansion of private services would come at the expense of the public model? ADRIANA LAGRANGE: Well, in fact we haven’t seen that in other countries that do have, you know, whether you talk about Germany, Netherlands, Switzerland, Sweden, many other countries, Australia, New Zealand, where they have dual practice, in fact, it has not detracted. They’ve provided better service, quicker access to surgeries. You know, right now a hip surgery I’m hearing could be up to 18 months, sometimes longer. And yet in those countries they can do it within weeks to months, shorter months, number of months. What the other guardrails that we’re looking at is really we will have a consultation with the college physicians and surgeons with the Alberta Medical association. But some of them could be around. You have to have worked in our system, in our public system. You have to provide amount of hours in our public system or days in our public system and then perhaps be able to do the private surgeries on weekends or evenings. But we will look to what makes sense. We can also we have the authority within the legislation to, if we recognize that we have a shortage of a particular discipline that we make sure that they are not able to opt out or to become flexibly participating physicians until such time as we have the numbers that we need need within the public system. So there’s lots of levers we can pull to ensure that we are, in fact, safeguarding the public system. But really it’s about allowing, you know, more flexibility for those surgeons. I was hearing frustration from surgeons that, you know, an orthopedic surgeon that only had one day a month allocated to them to do surgeries because of the dollar constraints that we have within our province. SEAN SPEER: Yes. ADRIANA LAGRANGE: And so his frustration was, well, I can’t get in to do more surgeries, but if he had access to do more surgeries, he’s got a long wait list. More surgeries could be done. If he can do some of those in the private system, then it just takes one more person off of the queue that can then rise a little quicker within the public system. And I know everyone that I know knows someone who has left the province or left the country to get a needed surgery because the wait times here in Alberta are way too long. And I dare say right across the country, just as our system, we just need to modernize it. We need to look at Europe and what they’re doing and pattern ourselves a bit more after what they’re doing. SEAN SPEER: Indeed. A penultimate question, Minister, we started off talking about how you came to this decision relying on evidence and analysis of what was happening in Alberta and other parts of the country, as well as drawing on best practices from Europe and elsewhere. You’ve talked about being pragmatic with respect to possibly implementing different types of guardrails to ensure that the principle of universality is protected. But the elephant in the room is that this is likely to provoke a reaction, particularly from those who. For whom our public health care system isn’t merely about healthcare delivery. It’s almost a kind of part of their identity or quasi religion or something. What’s your message to Albertans on why they should give this idea a chance? ADRIANA LAGRANGE: Well, first and foremost, the status quo is not working. It is not working. We’re getting worse health care results and we’re spending more and more dollars. So, you know, let’s be realistic. Let’s take an honest look at what actually is going on. As I said earlier, I do not know any person that doesn’t know someone who’s left the province or left the country to get a much needed surgery that they could have had here had we had the ability to accommodate them. When I also look at. There is. There is an ability for people that are on WCB or in the federal system to. To get a different level of care than Albertans. You know, everyday Albertans can get. So there is anomalies that already exist. I think we have to take an honest look at them and say, okay, how are we going to make this system better when you have so many people that are willing to bring in innovation? I’ve heard from doctors and others that would like to see innovation come to the province, but because of some of the, what would I say, the reluctance to look at innovation, to look at the ability to modernize things, that they’re hesitant. Until we do something that says, yes, we want you to come, we want to enable better care for Albertans. And so I think it really means taking a hard, honest look. If you don’t like the system because it’s not working now, yes, doing more of the same isn’t going to fix it. Let’s do something different. Will we get it 100% right? Maybe not. And maybe we will have to be nimble and tweak it. We’ve given ourselves the levers to do that. We’re going to be thoughtful as we move forward. We’re going to walk before we run and make sure that we bring in the right pieces and deal with the right issues at the right time. But to sit back and say we’re just going to hope it gets better, that’s not going to make a difference. The only reason we have 2,000 more physicians in the province than we did two years ago is because we worked together with the College of Physicians and Surgeons to streamline the process. It was only Alberta Health Services that could actually sponsor an international medical graduate before. Now we have clinics that can sponsor individual positions. We have municipalities. We have actually put in accelerator programs for those that are coming from countries that we know comply with the same educational needs that we have. We’ve looked at nurse practitioners. We have them now working to full scope. Some of them are actually taking on patients now because we thought, you know, they’re able to do the vast majority of what a physician can do, minus some surgeries, et cetera, but they can also help expand primary care. Let’s look at team based care. How do we enable team based care? Because we are very complex human beings and a primary care home is about, well, maybe today I need a primary care provider, but maybe tomorrow I need to see a surgeon, maybe the next day I need to see a mental health therapist. We have to work together for the betterment of the patient. So if we put the patient at the center of the care, we will make sure that we are actually providing the service in a timely Fashion for them. SEAN SPEER: Minister, I know you don’t have much time left because you’re in high demand the day after tabling this, I think, historic legislation in the Alberta legislature. But as we wrap up, why don’t you paint a picture for our audience and listeners, particularly those in Alberta, but not limited to Alberta, if this legislation and these reforms are successful, what does it mean for the province’s healthcare system and for Albertans access to healthcare 2 years, 5 years, 10 years from now? ADRIANA LAGRANGE: I believe what it will mean is that every Albertan who’s out there waiting for a surgery will have it in clinically approved times. As I said earlier, you know, we’re reaching about 70% of clinically approved times. That has to be 100%. Everyone deserves to have timely access. Which also means then if you have your surgery done quickly, you can get back to work quickly and, you know, quicker, you can, you know, have a better quality of life. You don’t have to. I know individuals that because they’re waiting so long, they become dependent on drugs and, you know, and, and so that creates a whole other issue we have to look at how do we prevent illness. I also believe it will attract innovation. It will attract people to invest in Alberta. And if we, in fact, can have all of our surgeries and all of our services provided in clin approved times, then there’s excess capacity. Maybe we become the center where people come from other provinces to have their surgeries done rather than having people leave our province. I believe there is an opportunity to look at, you know, beyond surgeries, what other services, something that I’m very. I’m a rehab practitioner by profession, so I really believe in early intervention and prevention. And so as the minister of primary and preventative health Services, I’m looking at how do we empower people to look after their health care and stay healthy. And, you know, there is an ability here, you know, we have such expertise in Alberta. I’ll just share with your listeners that with your viewers that I had eye cancer in 2012. And we have the ex, you know, one of the premium health oncologists, eye oncologist in all of Canada, I would almost say North America and probably globally. And we deal with all the eye cancer, not just for Alberta, but all of Northwest Territories, all of Saskatchewan, part of Manitoba and part of British Columbia, because we have that expertise here. Otherwise we would have to go. And at that time, had that, that program not been available in Alberta to deal with my eye cancer, I would have had to go to Toronto or Philadelphia and so how do we bring more of that expertise, more of those clinical trials, more research? How do we have Alberta become the beacon of health care for all of Canada and I dare say globally? So that’s my vision, that we can be that beacon. But we do have to push the boundaries at times. We do have to change things. And we have to be willing to take an honest, open look at what the reality is on the ground right now. Otherwise, we can’t fix the issues that currently exist. SEAN SPEER: It’s a compelling vision. Alberta Health Minister LaGrange, thank you so much for joining us. ADRIANA LAGRANGE: My pleasure.