Alberta Premier Danielle Smith claimed yesterday a new “patient-focused funding model” planned for Alberta hospitals “will increase transparency, lower wait times and attract more surgeons – helping deliver better health care for all Albertans, when and where they need it.”
But what will really happen when the United Conservative Party Government puts Ms. Smith’s new acute-care funding model into effect at Alberta hospitals?
Back in 2013, Jonathon Ross, a clinical professor of medicine at the University of Toledo in Ohio, warned Canadians what to expect if they were talked into adopting case-based activity fees instead of global funding to operate hospitals.
This is, of course, exactly what Premier Smith touted yesterday at a news conference to announce, in the words of the government’s press release, “a new acute care funding model, increasing the accountability, efficiency and volume of high-quality surgical delivery.”
“I would advise extreme caution and careful assessment of the implications for cost, quality, access, equity and efficiency before adopting this hospital funding model,” wrote Dr. Ross, terming it “activity based funding” or ABF, in a piece for the Canadian Healthcare Network.
“Depending where you live, this method of funding may be called patient-focused funding, payment by results, volume-based funding, service-base funding, case-mix funding, or prospective payment system,” he explained. “But no matter what you call it, ABF has serious side effects.”
It should be noted that “patient-focused funding” is a tendentious euphemism, intended to leave the impression it will make things better for patients, which it will not.
“One of the dangers is that ABF can be used to ‘game the system,’” Dr. Ross said. “When you pay hospitals according to diagnosis, the incentive is to increase or otherwise modify your diagnosis so your hospital will make more money. And that’s exactly what happened when the United States implemented ABF for U.S. Medicare patients.”
“Here in the States, we have a small army of nurses reviewing every case in hospital to remind us to use special words just the right way so we can get more money for each case,” he observed. “The incentive is to list all of the diagnoses you can possibly list for every patient, as some of these will increase the payment even if it does not change your management one bit.”
In addition, he warned, there will also be pressure to discharge patients too soon.
“If the hospitals game the codes upward, then you need another army of regulators to catch them and code them back down,” he said. “There is now a large hospital bureaucracy whose job it is to up-code the severity of illness of Medicare patients and another large Medicare bureaucracy trying to figure out how to stop the hospitals from gaming the system.”
Nothing has changed since then. Indeed, as Nobel Prize-winning American economist Paul Krugman pointed out in January, this is one of the reasons the U.S. health care system costs Americans so much. “Medicare is supposed to provide older Americans with the health care they need,” Dr. Krugman wrote on his Substack. “Yet instead of focusing solely on how best to achieve that goal, we have an arms race between insurance companies trying to game to system to charge more and deliver less and government officials trying to rein them in.”
Ms. Smith was accompanied to her news conference by Health Minister Adriana LaGrange and Chris Eagle, the interim CEO of Acute Care Alberta, the administrative agency set up specifically to introduce this funding scheme as part of the Smith Government’s effort to destroy Alberta Health Services and make its remnants easier to privatize.
They burned up some time that could have been used more profitably for questions about how this will really work with a slick hard-sell video of the premier pushing the funding model.
Alas, when it was time for reporters’ questions, with one honourable exception, every single journalist who showed up or tuned into the tightly scheduled newser, used their time to ask questions about the federal election campaign, Prime Minister Mark Carney’s gentle joke about Ms. Smith, and U.S. President Donald Trump’s trade war on Canada.
Only the Toronto Star’s Graham Thomson asked a relevant question: Wouldn’t incentives for surgeons to do more surgeries in private facilities drain resources from public hospitals, making them less efficient? Would the government, he wondered, let surgeons from private clinics use public operating rooms?
The premier responded ambiguously, nodding affirmatively and mumbling, “Mmm-hmm.” (Whether this would be permitted under the Canada Health Act was unanswered.)
Later, she added, “I would hope our public hospitals would look at this as a way of getting more revenue.” More surgeons will come here, she also claimed, because they will be able to make more money.
“The Premier is blowing things up even further with a plan to use public money to accelerate health care privatization,” Friends of Medicare director Chris Gallaway said bluntly in a news release later yesterday.
The announcement, he said, “continues to claim that privatizing surgeries will save money, expand surgical capacity and shorten wait times for Albertans.” Yet a series of reports show otherwise. “If the Premier was serious about shortening wait times for Albertans, she would invest in expanding use of operating rooms in our public hospitals,” Mr. Gallaway said.
What this government is serious about, of course, is privatizing as much of our public health care system as quickly as possible.
As Dr. Ross put it a dozen years ago: “Beware of American consultants bearing gifts such as case-based payments for hospitals as a cost-saving idea. Count your blessings, Canadians, and get to work improving the effective system that you have!”
Stephen Harper demonstrates he shouldn’t be running AIMCo
Back on Nov. 20, I wrote that the appointment of Stephen Harper as chair of the governing board of the Alberta Investment Management Corp. meant that we could forget about the notion the provincial pension management Crown corporation has an arm’s length relationship with the political level of government in Alberta.
“Mr. Harper remains an active political figure and far-right ideological advocate in his roles as éminence grise of the Conservative Party of Canada and leader of the Munich-based neoliberal internationale, formally and tendentiously known as International Democrat Union,” I said.
Last night, Mr. Harper introduced federal Conservative Leader Pierre Poilievre at a large pre-election pep rally here in Edmonton. That’s fine. Mr. Harper can appear anywhere he likes, just as long as we all understand that this clearly demonstrates his complete unsuitability as a leader of a supposedly neutral manager of thousands of Albertans’ pensions.
Everyone knows Mr. Harper wasn’t appointed to run AIMCo because of his expertise in Finance or Investment Management. The UCP has already taken what has previously was a position based on competence and capability and turned it into a partisan reward. So perhaps it is better Harper isn’t even making the pretence about that anymore and eagerly welcoming Poilievre to Edmonton.
It is probably not a good sign for the CPC their leader is here now, they are probably worried about losing at least a few seats they were expecting to win not long ago.
As for Smith’s thin skinned response to Carney’s not wanting her to speak in the US media. No, it is not because she is a conservative woman, it is because her poor choices in hanging out with the guy attacking Canada and her own attacks and weak support. However, yet again Smith’s response wins the prize for gas lighting, which if it is any consolation, she is as good at or perhaps better at than any man.
It also probably explains her Orwellian sounding “patient centered” health care. The UCPs ongoing health care restructurings are everything but patient centered.
Unless I’m mistaken, wasn’t it 2 yrs ago that Marlaina promised a large increase of Doctors and nurses within a couple of months?
And another wasted question allotment, because Mark Carney supposedly doesn’t like “strong conservative women “,
LOL>> at least the people at his rally did, but one thing we know about the Cons- they have no sense of humor and can’t take a joke. Seems to me, if the suitcase fits….but then again I don’t think they’d appreciate the ‘Carry On’ gang.
Can anyone substantiate that the ‘warehouse’ in Nisku was large enough to hold 15,000 supporters >>according to Western Standard.???
I mean it’s not like Skippy would embellish crowd sizes ala d’rump, right? And I didn’t see the Premier in any of the photo ops, or was it too late since Skippy is off to ‘steel town’
Hopefully the local reporters have been forewarned by their counterparts in NL about what to expect from Skippy’s media coordinators. (Canadian Journalist.ca) …ironically from Petty Harbour ,NL
Hello DJC and fellow commenters,
This system of itemizing everything and charging for every single item and for every action taken in the care of a patient,which is then billed suggests a couple of things to me. First, the cost of the surgeries will be well understood, and then the government will add 20 or 30% to the cost as pure profit for the for-profit corporations. Presumably for-profit corporations will take over more and more of the work now done by the public health care system.
Second, my prediction is that, by the end of Danielle Smith’s current term as premier, we will be paying for health care, although some of the poorest may receive reduced cost or free health care. The wait times for publicly funded health care will be so long that almost everyone who can find the money will pay for their own.
This will, of course, chase business away from Alberta since business prefers to avoid paying for expensive insurance for health care. The negative effects on the health of Albertans is, of course, clear to us all.
And, yet, I think that the base will continue to vote in the UCP who will likely blame someone for the situation and the base likely will accept it as inevitable. Overall a negative situation for all of us.
I think my most gobsmacking moment was seeing a bill on Twitter, from a new mom who went down the list of charges and she was charged $700 *for the nurse handing over her baby to breastfeed*
That’s the bright future privatization of healthcare holds out.
This sell-off must be stomped on at every level, every time. Universal healthcare is either a right, or it isn’t. Let private healthcare plans cover your herbal medications or your CBD or your tylenol or something.
No doubt about it, Danielle Smith wants to pursue a full on American style healthcare system for Alberta. Who will afford that, other than the very wealthy?
Stephen Harper shouldn’t be handling anyone’s pensions. He was PM when people saw their life savings vanish in the income trust fund mishap, to the tune of $35 billion. If Albertans were smart, they would not let Danielle Smith and Stephen Harper handle our pensions, or even Pierre Poilievre.
Possessive its (remnants).
All the signs in place for school vouchers coming our way soon as well, or perhaps I should say, case-based education. Heavy emphasis on family ‘choice’ in letters received from the minister of education and the new minister of infrastructure. Charter and private schools an ‘integral’ component in their view.
I think we are sleep walking into this one, with no Nate Pike so far to call it out. Parents are tired and busy and just want someone to take the best care of their kids. If the ‘fries with that’ model is the one on offer, they will take it.
The main point of public schooling is not just to provide education, but the added value of having working class kids, professional class kids and wealthy kids all getting to know each other so they won’t demonize each other in adulthood and learn how to work with each other in the future.
Levelling the playing field of education between rich and working class neighbourhoods should be another goal–insuring that all kids get an equal opportunity to learn.
As soon as inner-city schools get de-funded while the wealthy send their kids to private schools then add in charter schools and a democracy that took centuries to build can be destroyed in a single generation.
This is how the USA went from a high literacy rate to barely functional.
Let’s learn from history.
re: Mark Carney’s ‘gentle joke’.
It appears Mark Carney has realized what a political opportunity Danielle Smith is giving him. The only people offended by his joke are the Alberta TBA crowd, who wouldn’t dream of supporting him anyway. Meanwhile the joke gives undecided voters, both in Alberta and the rest of Canada, incentive to vote Liberal just to voice their disgust with our premier.
Best of all, it puts Pierre Poilievre in another squeeze where he has do decide whether to speak in her defense or not.
Sorry my sisters, but when was the last time a man in charge listened to any woman?
…Trump…nope
…Trudeau…nope
…Poilievre…maybe his wife, but not Ms. Barton
When I was at UAH in the early 2000s, we were told that the hospital had to do X number of cardiac surgeries in the next month to meet its quota.
The problem was the number of patients waiting for cardiac surgery was about 1/5 of X.
It was interesting looking at the cardiac surgery slate for the next month.
While it’s a well known fact that the $260 billion oil well cleanup mess will become a $500 billion disaster for our children and grandchildren’s future and these Reformers and their ignorant supporters don’t care I was surprised seeing the recent Poilievre rallies that he is attracting a lot more young people instead the normal 80 to 85% ignorant seniors that we have seen in the past. Have these seniors convinced them that he is the best one for the job? Are they as stupid as these seniors and blind to what he wants to do to they? My senior friends and I can’t stop wondering where our children and grandchildren are going to find the money to survive under these stupid Reformers, don’t you? Add in an $85 billion debt, a deficit cost for 60 schools we are short and $20 billion road workers say we need for road and bridge repair. Then there are the lawsuits they will face.
For a humorous take on the US hospital system and its never ending search for cash, check out any episode of St. Denis Medical on Crave. One episode will suffice.
“getting more revenue.” . . . “make more money.” are principles that are central to the predatory capitalist ideal of profit extraction.
As Mr. Climenhaga continues to remind his readers, it is about “market reform”; which, means an increased privatization of health care services that is ideologically consistent with the long standing ideals of the lobbyist ‘leader’ and the patrons and profit seeking benefactors that advise her. See for example,
https://pressprogress.ca/danielle-smith-has-spent-decades-pushing-to-privatize-albertas-health-system/
Corned-beef hash thanks for publishing that, this is the same Danielle Smith who was fired by Conservatives from her role as School Board Trustee in Calgary for promoting Privatization of education. She is a Reformer through and through and that’s exactly what they are about. Privatization of education and health care, as the former conservative MLAs taught me is all they care about. Their attitude is let the stupid people pay, while we help the rich steal their oil and corporate tax wealth. It’s their plan to replace what they give away like Klein did with all his privatization stupidity.
Isn’t this illegal under the Canada Health Act?
Or is she pulling a Trumpty…stick her toe over the line, hope nobody notices, then stomp across if she’s not stopped there?
Marlain-a-Lago and Lagrange aren’t even trying to hide their intentions. They hold a news conference to announce that they have found a way to game the system but make it appear to help patients. What it really means is that they will use some big words and paid-off consultants to funnel taxpayer dollars into their cronies’ pockets as quickly and efficiently as possible. There will be nothing left of public health care by the time these two are done with it.
Stephen Harper’s endorsement might be a big hit in Alberta where the rubes are easily fooled, but it’s not going to fool the rest of Canada who see PP for what he is: a career politician who has never held a job in the private sector and would sell us out to his hero the Mango Mussolini in seconds flat if he thought that he might personally profit by doing so.
The Monkey, The Pig and the Python.
When Jesse Ventura was Governor of Minnesota, he indicated that when ever you want to find the root of corruption, “follow the money.” Charles Bronson once said to one of his villains in a Death Wish movie, “You’re just the monkey…I want to speak to the organ grinder.”
It appears we are witnessing a full court press on the Feds from Danielle and Co., both on healthcare privatization and a police force she can call her own. It was back in 1998 that David Cork in his book “ The Pig and the Python” examined the ways to profit from aging baby boomers. Heck, even Jack Mintz has been advising the UCP and past Alberta Conservative governments to stop looking at those aging Albertans as mere citizens , but rather as commodities that can be profited from via healthcare privatization!
When the dots are connected here, it all starts to make sense. Marlaina does her full court press in healthcare before any intervention via the Canada Health Act can be organized by the Feds being preoccupied by the election. In the meantime, the UCP insiders sign- up for stock/ ownership options with party “friends with benefits.”
It also happens that Panama is one of the oldest known tax-evasion jurisdictions where Dani is a frequent flyer. Are there any obvious patterns here, if one follows the money trail? Who are the monkeys, the organ grinder and python, you say? Follow the money.
My friend in the US told me of being in an accident and needing emergency surgery. She called the insurance company and was told what hospital to go to. When she got there, she called again to find out if the surgeon was covered. He was. She had the surgery. Two weeks later, she gets a bill for US $60,000. When she called the hospital, she was told her surgeon had to leave suddenly and the surgeon who performed the operation wasn’t covered. Nothing she could do. The surgeon and the hospital split the money and the insurance company didn’t have to pay. That’s private health care.