The perceived stereotypical divide between the Yee-Haw province and Ye Olde Canada grew wider last week when Alberta Premier Ralph Klein plunked down a series of health-care proposals that collectively hit the country like a splash of cold water. Dubbed the Third Way, the bulk of the province's health-care "policy framework" is laudable stuff, though mostly not revolutionary. The first proposal, for instance, is to put patients' interests first. But mixed among the ideas, planners included an out-of-the-box proposal that would allow private clinics to offer certain services currently available only under Medicare and--gadzooks!--charge the patients directly for them. Another Canadian-taboo breaker is a proposal to allow Alberta doctors to work simultaneously in and outside the public-health sector; now doctors must choose one or the other. Antonia Maioni, director of the McGill Institute for the Study of Canada, calls the plan a significant departure from the status quo. "It's not turning the system upside down yet," she says, but "there is something going on, and that something is this legitimization of the private sector in health care."
Should Canadians, who consider their public system sacrosanct, panic? Here's a primer on the main issues on the table:
WHAT IS ALBERTA THINKING?
A principal justification for the Third Way is that the current system is unsustainable. "The health system must change to survive," Klein said last week. Alberta, the wealthiest province in the country, says if nothing is done by 2030, the public system will completely consume its provincial budget. National health care, of course, is already under stress from rapidly rising costs, as evidenced by long wait times for some treatments and overcrowded emergency wards. The problem, in many cases, is not a lack of doctors, says Alberta's Health and Wellness Ministry, but a lack of operating funds in hospitals to allow medical staffs to do more of certain procedures per week. In some cases, Health and Wellness officials say, practitioners are working the equivalent of only three or four days a week in their specialty.
WHAT IS ALBERTA'S SOLUTION?
Health and Wellness says it is adding facilities and staff to its system but can't continue to do so at the current rate indefinitely. That's why it wants the private sector to start taking up the slack, though only in three areas: knee and hip replacement and certain kinds of eye surgeries, such as cataract operations. The idea is that that would bring additional funding into the system and more fully employ medical staff. To work in the private sector, medical practitioners will have to submit a "business plan" to the health ministry, says Alberta Health and Wellness spokesman Howard May. "Then we appraise [each request] based on a number of things, the most fundamental of which is the fact that the public system will be protected." The ministry is currently ironing out criteria that would allow doctors to work in both systems. "But it will be done on a case-by-case basis," May says. One main criterion is that a doctor who wants to work in a private clinic would have to provide assurances that his private work there would not compromise his work in the public system, May says.