The Right Way?

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WHAT'S WRONG WITH THE PLAN?
Some say the Third Way is a dead end. One criticism is that it is inequitable because people willing and able to pay for certain treatments get faster access than those who can't afford them. Alberta is making no apologies. "That's a fair comment," says May. "That's exactly what we're looking at doing." A key objective, Alberta officials say, is to allow people living in discomfort to receive medical care faster than they might otherwise get it in the public system. "If we say that the guiding principle is to put the patients first and make sure that the public system is looked after," says Alberta health minister Iris Evans, "then why shouldn't those who want to pay for [quicker access] and are willing to make that investment have that opportunity?"

Allowing doctors to move between the public and private systems creates potential ethical problems, says the University of Alberta's Timothy Caulfield, a Canada research chair in health law and policy. Doctors in the private sphere might be tempted to recommend services that are costlier than is medically necessary, putting their financial gain before the patients' best interest.

Another danger is that a small opportunity for private care would eventually open wider and wider. Tom Noseworthy, director of the University of Calgary's Centre for Health and Policy Studies, says it's naive to think the public system would remain viable in such an environment. "There's a limited physician pool, and if [doctors] get distracted working in the private system, there's no management that can make them work in the public system," he says. There is the danger that the system would provide a bridge for physicians to move to a private system and that they would opt out of the public system once the private market grew large enough.

CAN AlBERTA LESSEN THE RISKS?
If Alberta allows doctors to work in both systems, Caulfield believes, strict regulations are needed to ensure that the public system remains viable. For instance, doctors should not be able to make more money in one system than in the other, to limit doctors' incentive to focus more on private-sector work. Liberal Senator Michael Kirby, who co-authored a 2002 review of Canada's health policy, says that to ensure the viability of the public system, the government will need to establish a "minimum-care guarantee," such as maximum wait times. Forcing governments to pay for all medically necessary services, in either the public system or eventually the private system, would create a powerful incentive for provinces to control costs.

WHAT'S NEXT?
The Alberta government last week started a one-month public-consultation period while it tries to establish exactly how the system is to work. It then plans to draft new legislation that could be ready this spring. During the process it will no doubt be watching for signs from Ottawa as to whether it believes Alberta's plan conforms to the Canada Health Act. If Alberta is found to contravene the act, Ottawa could withhold portions of the Health Transfer it hands over to the province. If it still opts to continue with its program, the future of the Canada Health Act could be in question.