Dear Members,
The Alberta Medical Association has been asked for comment on potential legislation that would expand private-pay options for Albertans and enable dual practice — allowing physicians to work in both the public and private health care systems at the same time.
As the AMA has consistently emphasized, informed reform must guide any changes to Alberta’s health care system. Reform should be evidence-based, transparent and developed through meaningful engagement with those most affected: physicians who know what happens in practice; patients who deserve equitable access to quality care; and other stakeholders (payers, administrators and health professionals) who all contribute to an integrated health system. Quick fixes or poorly designed policies risk destabilizing the system and creating unintended consequences.
Regarding the current information shared in the media on dual practice, the AMA underscores the following principles:
- Expert-inclusive policy development
Physicians and patients must be actively and meaningfully engaged in policy discussions on this issue. - Equity in access
Access to care should be based primarily on need — not the ability to pay. This proposed fundamental policy shift for Alberta should still be aligned with the foundational principles established in the Canada Health Act and in the Government of Alberta’s own Health Charter. - Essential policy provisions
To make this shift meaningful and to avoid negative impacts to the publicly funded system, the policy framework must include:- Clear conflict-of-interest principles.
- Prioritization of resource allocation to medically necessary services provided through the publicly funded health care system.
- Measures to ensure adequate allocation of the health workforce to the publicly funded system for highly complex and emergent care, including life- and limb-saving interventions.
- Measures to prevent public subsidization of private services.
- Contracting guidelines with robust monitoring and reporting requirements.
- Clarity and risk mitigation
We need clear guidance on how policy and practice will function to manage the system and mitigate unintended consequences. Example: Private diagnostic testing — where the AMA has already raised concerns about unnecessary tests consuming system resources and causing patient anxiety. - Insurance design and delivery
Sustainability of the existing Alberta Health Care Insurance Plan must be evaluated and shared with Albertans, followed by analysis of the need for supplementary insurance plans that may be needed in addition to employer plans. - Transparency of system performance
Metrics must be established to evaluate how reforms affect the performance of the health care system and their impact on health outcomes for Albertans. - Government accountability
Government must be held accountable for supporting continuous monitoring, research and reporting on new policies/programs and provide accurate reporting on the success of a dual system.
Informed reform is not optional — it is essential. Albertans deserve a health care system that is sustainable, equitable and designed with transparency and accountability at its core.
Regards,
Brian Wirzba, MD, FRCPC
President, Alberta Medical Association