A typical red brick rural hospital in Alberta, this one in the town of Black Diamond (Photo: Wikimedia Commons).

Just a reminder, folks: You can’t cut Alberta Health Services management without cutting front-line health care.

One of Opposition Leader Jason Kenney’s standard talking points is that he’ll never cut front-line health care, only needless, redundant, expensive managers cluttering up the system. And since I’m a good union guy, some readers probably figure I should say much the same thing.

United Conservative Party Leader Jason Kenney (Photo: David J. Climenhaga).

As the United Conservative Party leader put it in a recent press release: “We need to push the resources and decision-making to the greatest extent possible out to where they are used, to the front lines. We need to reduce the massive bureaucracy and administration that has grown in the centre of the system.”

The nicest thing that can be said about what Mr. Kenney’s been saying about health care management in Alberta is that it’s deceptive, certainly intentionally so. A couple of pithy agricultural terms spring to mind.

It’s a poorly guarded secret of health care in Canada that most managers in the system do essential work without which front-line health care, like that provided by the Registered Nurses for whom I do my day job, would suffer.

Yes. Some managers are better than others. But if you cut management in the Canadian health care system too much, the quality and effectiveness of front-line care will get worse.

This is especially true in Alberta, where management ranks at Alberta Health Services are quite lean by Canadian standards, Mr. Kenney’s constant bloviations to the contrary notwithstanding. There is very little to cut.

Keith Gerein, Postmedia’s new Edmonton-based political columnist, explained the facts about this in a way that should be helpful to anyone pondering Mr. Kenney’s call to reallocate funding from AHS’s supposedly massive management to the front lines.

Edmonton-based political columnist Keith Gerein (Photo: Twitter).

Mr. Gerein was the Edmonton Journal’s health care reporter before taking on duties as a commentator, so he actually knows what he’s talking about in this area, which is unusual nowadays in the largely beat-free mainstream media. So he was able to zero in quickly on the sleight of hand used by Mr. Kenney to give the impression AHS is overmanaged and bloated while pushing the false narrative that big cuts are possible in health care without doing any harm.

“The idea that AHS is plagued with an army of needless paper pushers is a dubious argument trotted out for years by the former Wildrose Party,” Mr. Gerein explained.

He noted that the respected Canadian Institute for Health Information, whose data Mr. Kenney cherry picked for a few areas in which Alberta is underperforming other jurisdictions on wait times, in fact shows Alberta’s health care system has the lowest administrative costs in Canada – 3.3 per cent of total spending, compared with a national average of 4.5 per cent.

Moreover, Mr. Gerein said, the Conference Board of Canada reports that the average ratio among public agencies is one manager for every nine workers. The average AHS manager, by contrast, supervises 31 employees.”

In other words, with close to 100,000 employees and province-wide reach to serve a population nearly the size of Norway or Finland, Alberta Health Services is a very big organization. But it is not an organization suffering from inappropriate levels of administration. On the contrary, judging from Canadian norms, its administration may be too small.

If you’re looking for the cost outliers in Alberta’s health care system that make it more expensive per-capita than in other provinces, you won’t find them in the counter-factual narrative peddled by Mr. Kenney.

University of Calgary economist Trevor Tombe (Photo: Twitter).

Alberta’s spending is higher than average “almost exclusively for two reasons,” according to University of Calgary economist Trevor Tombe. Those reasons, Dr. Tombe said yesterday in a Tweet responding to Mr. Kenney’s misleading claims, are “(1) physician compensation, and (2) hospital spending, mostly compensation and number/size of rural hospitals.”

If you want to analyze Dr. Tombe’s second point a bit more, consider that salaries in Alberta are also higher than the Canadian average in every other sector of the economy, and remember that both the old Progressive Conservatives and the NDP have kept tiny rural hospitals open all over the province.

This is not a necessarily bad thing. But as a reader pointed out here yesterday, the rural hospitals built throughout Alberta from the 1970s through the 1990s were put there for economic reasons. “They were intended to be anchors to keep people in small towns at a time when rail lines and elevators were closing,” wrote Simon Renouf. “The hospital building boom in the ’80s and ’90s was not for health reasons but rather part of an economic subsidy for rural Alberta.”

As the commenter pointed out, such spending reflected a legitimate government priority. But it was not necessarily driven by the health care needs of Albertans.

This is something rural Albertans should keep in mind if they’re hell bent on electing an austerity party but assume the austerity will always take place somewhere else.

Moreover, as Mr. Gerein pointed out, the NDP Government led by Premier Rachel Notley has had more success controlling health care costs than past Conservative governments. During the final years of the Tory Dynasty, the government was increasing health care funding by 6 per cent a year. The NDP has kept increases to half that amount.

Mr. Gerein mildly chastised Mr. Kenney for his deception, giving him the journalistic equivalent of a tap on the wrist. Arguably, the UCP leader deserved harsher criticism.

Mr. Kenney has to know his diagnosis is wrong and the treatment he prescribes would make the patient sicker.

But ideological market fundamentalists like Mr. Kenney always play the same game. He doesn’t care if his policies make the work of front-line heath care workers harder or patient outcomes worse. In fact, I’d suggest, that’s a feature, not a bug, of his ideological framework.

As we have seen from generations of neoliberal health care “reformers” in Canada and around the world, the goal is always to create the conditions in which public services are undermined and privatization can be justified, the better to transfer the costs of health care to the people who can least afford it.

If that’s what you want, that’s what you want. But don’t blame health care managers and administrators. They’re not the problem.

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  1. Any good conservative will tell you the route to ‘painless’ cuts is to find efficiencies. How is it possible, after all these years of finding efficiencies, that there are still any inefficiencies left? It should also be pointed out that a hospital bed sitting empty would be an example of waste, but if you are riding in an ambulance you will be very glad that that waste exists.

    David’s point about rural hospitals is extremely valid, and should be pointed out to any rural Albertan grumbling about government waste.

    Another gross inefficiency in the system is the lack of long-term care beds, and it has been around for a long time. In the early 80s I was in Foothills Hospital with a broken leg. An elderly woman, with serious dementia, was in the same ward, even though she did not appear to be receiving any treatment. A nurse told me she had been in a long-term care facility, gotten hurt, and while receiving treatment the LTC facility gave away her bed. As a result, she was occupying an active treatment bed while she waited for a new LTC bed.

    The problem persists. More recently, Health Minister Stephen Mandel took a bit of political flak for using the phrase health care workers use to describe the phenomenon: bed blockers. In the past couple of years, I have had elderly relatives experience being bed blockers; both were living in independent living facilities, developed a health issue, had surgery, then waited in their acute care bed for a spot in a long-term care facility to open up. I do wonder if some bureaucrats look at this inefficiency as a good thing – bed blockers do not require as much treatment as surgical patients, so they reduce the staffing cost.

    The solution to this problem would be to build more LTC facilities. Given how baby boomers are about to overwhelm the old-age industry, this makes even more sense, especially before baby boomers retire, so their taxes can pay for them. Millennials et al will have a very real grievance when they are presented with a glut of people needing LTC facilities that do not exist. Their grievance will be even more acute when they think about how our ‘efficient’ governments gave us ultra low taxes while ignoring the upcoming need. (in 25 years 60 year olds will be 85! Who knew?)

    Meanwhile the Canadian Taxpayers Federation’s position is to stop all projects until the economy improves.

  2. I’ve been reading more about the differences between the NDP work so far and the plans the UCP hope to bring if elected.

    Thanks in large part to you, David I am now terrified of Jason and his gang actually winning as seems likely.

  3. The one and only purpose of Conservatives with regards to Canada’s Healthcare is to kill it with a thousand cuts so it becomes unwieldy and dysfunctional so they can point at it and tell everyone how bad public healthcare is and that private corporations can do it much better. That has always been their plan. It’s working in the USA and it’s well underway in the UK.

  4. You have to wonder if the Conservatives are incompetent bunglers when it comes to health care, as in if its not broken break it, or if there is some method to their madness. They do seem determined to create chaos one way or another. In the case of the previous government it was more obvious – cuts to front line workers. Kenney “guarantees”, not to do that, but of course there are two problems with that. First, many people already doubt his signed promises are worth the cardboard they are written on. Second, it allows for a more devious stealthy approach – undermine the support structure and when chaos ensues try to deflect the blame by saying there are no cuts to front line staff. I’m not sure the more devious approach will work, but the one taken by the previous government certainly did not, so at least Kenney appears clever enough not to repeat that again.

    I think their continued bungling of health care was one thing that irked voters about the PC’s and in part led to their demise. However, I also think whether the chaos is caused by a reduction in front line staff or in support services, is a distinction that will be lost on voters. We spend a lot of money on health care so voters expect it to go smoothly and if it does not, the government will be blamed.

    I do think the Conservative agenda is to try and undermine the public system to try create the conditions and support for more private health care. Unfortunately being next door to the US, too many Canadians are well aware of the shortcomings of that system so there is little desire even among many Conservative leaning voters for a great deal of privatization. Lastly, one also wonders if some businesses that might benefit from more private health care supported Kenney’s leadership campaign with large contributions. We still don’t actually know who his financial backers were. At one time, didn’t he also “guarantee” he was going to tell us that?

    1. As noted in my story, I believe they are quite intentional about this, systematically going about creating conditions in which voters believe tthings are so bad that only the “miracle of the market” can fix them. Of course, decades of propaganda notwithstanding, the only thing miraculous about the market in health care is its ability to transfer wealth from the not-so-wealthy to the obscenely rich. DJC

      1. How come conservatives can’t apply this miracle but without the profit margin? Perhaps it is because they don’t have the necessary skills to run a business outside of a crony capitalist system. Or in the case of Kenney have spent their life at the government trough and never had a real job.

        The NDP, in Alberta anyway, is largely still the party of labour and surprise surprise their leader has real world experience in labour. How come the conservatives can’t attract leaders with real world experience in the free market?

  5. I agree with you that in the aggregate, AHS is not “over-managed”… certainly the data generally refute that accusation. However, I have long felt that it is too big, too risk-averse, and takes too long to make decisions. Senior leadership at the organization are trumpeting its 10-year anniversary, and trying to raise enthusiasm amongst its many employees about this milestone and its future, without much success IMHO. Key decisions that should have been taken long ago have not, and efforts to force uniformity on a vast, sprawling health care system, without regard to genuine demographic and geographic differences between parts of the province, have been uneven: in some areas of endeavour, uniformity is both unnecessary and undesirable, where in others it is desireable in terms of equity of services to the population but has not been achieved.

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