By Annamarie A. Fuchs. Creator, Partners in Health | Conversations.

 

“Fundamentally, the answer to our challenges in healthcare relies in engaging and empowering the individual.”

Elizabeth Holmes.

 

Health systems across Canada, while being similarly funded to deliver care based on the tenants of the Canada Health Act, can have vastly different names, organizational structures, designs, and delivery models. In Alberta we are fortunate in that there is one primary integrated health authority that is responsible to ‘deliver’ care. That organization is known as Alberta Health Services or AHS.  However, it’s important to remember that there are other organizations that deliver healthcare services as well.  Covenant Health for example is a 150-year-old faith-based organization and one of the largest in Canada that oversees the delivery of care at 17 hospitals and care centers across 12 communities. Covenant Health works with Alberta Health Services and other community partners to provide acute care services, seniors care, and palliative care.

In 2008 when the announcement was made to eliminate the nine health regions and their boards of directors, the Alberta Cancer Board, and Alberta Addictions and Mental Health, many of us were concerned that our new super board which would be known as AHS might be confused by the public with Alberta Health, the ministry of health or simply AH. Years later, people I speak with continue to struggle to understand who or what is AHS and who or what is AH.

In 2019, as a volunteer board member with IMAGINE: Citizens Collaborating for Health I was given the opportunity to develop a high-level graphic representation of Alberta’s health system. That graphic that can be found at  https://imaginecitizens.ca/wp-content/uploads/2019/11/2019HealthServicesInAlberta1_1_1.pdf  So, let’s take a closer look at Alberta’s health system.

Framework:

In Canada, government powers and responsibilities are shared between federal ministries and provincial ministries of health. Our system is modelled after the British Westminster parliamentary tradition which champions values associated with providing a responsible and accountable government that makes every effort to represent the people. At the provincial government level, we have a legislative assembly led by a governing ‘cabinet’ which is appointed by the premier. Provinces invest funds to meet a wide range of priorities to citizens with a primary focus on education, social services, health care and hospital programs.

Health care in Canada is enshrined in the Canada Health Act. Its primary purpose is to ensure that all eligible residents of Canada have reasonable access to insured health services.[1] The development, implementation, and oversight of health policy is a shared responsibility between the federal government and the provincial government ministries of health. Deliverers of insured health services as defined by the Canada Health Act must report to and receive oversight from provincial ministry leaders who in turn, report to the federal government to ensure that full federal cash contributions are received and allocated appropriately. According to the Canadian Institute for Health Information, total expenditure on healthcare services in Canada is approximately $7,064 per person per year or $265.5 Billion.[2] The Ministry of Health in Alberta (AH) oversees what is the single largest government expenditure and in 2021 the Kenney government plans to increase the healthcare budget by another $900 million or 4% for a total of $23 billion. So, how and where is the money distributed?

Alberta Health (AH) is the Ministry of Health of the Government of Alberta. Ministries are run by both elected officials as well as bureaucrats who are Government of Alberta employees. Elected officials represent and are accountable to Albertans and responsible to ensure the appropriate distribution of funds and to provide strategic oversight. Various boards, committees and sub-committees provide the eyes and ears for Albertans and to enable decision makers to work with other groups to ensure that the right services are available. Alberta Health (AH) also sets policy, provides information to the public, and collects a considerable amount of health system data and patient data. AH is led by the Minister of Health, currently Mr. Tyler Shandro and an Associate Minister of Mental Health and Addictions, Mr. Jason Luan. The Board of Directors of Alberta Health Services (AHS) reports to Alberta Health (AH).

Alberta Health Services (AHS) is the largest single health authority and provider of health care services in the country. They are also Alberta’s largest employer and 5th largest single employer in Canada. AHS is responsible to deliver health services to more than 4 million Albertans and to some residents of B.C., Saskatchewan, and the North West Territories. There are more than 110,000 employees working directly in AHS facilities as well as organizations that deliver lab services, and continuing care among others. In total, there are 106 acute care hospitals across the province and more than 850 facilities that offer acute care, continuing care, mental health care, cancer care, and community / home care. AHS is led by CEO Dr. Verna Yui and a Board of Directors, led by Board Chair David Weyant. The AHS Board of Directors oversees the operations of AHS and again, reports accordingly to Alberta Health (AH).

AHS is organized around a zone-based health delivery structure. There are 5 geographically dispersed zones across Alberta which are known as the North Zone, Edmonton Zone, Central Zone, Calgary Zone, and South Zone. Each of those zones has leadership teams, hospitals and other facilities where services are delivered to Albertans within geographically defined boundaries. The leaders from each of these zones report up to an AHS provincial executive team who again, report to the AHS Board of Directors who report to AH.

Earlier, we touched on the fact that health care services are also delivered by Covenant Health which is one of the largest Catholic or faith-based health care organizations in Canada. Covenant Health works with AHS and other community partners to deliver care. Covenant Health has more than 10,000 employees and nearly 900 physicians. They have nearly 1,000 acute care beds and 1,500 continuing care beds (and palliative care) across 17 hospitals and care centres in 12 communities.

Primary Care Networks (PCNs):

If you have a regular family physician in Alberta, you almost certainly belong to a Primary Care Network (PCN). PCNs were established in 2003 through a master agreement between Alberta’s family physicians, represented by the Alberta Medical Association (AMA), AHS, and AH. PCNS provide the first point of contact for Albertans with the health system. Family Physicians or Primary Care Physicians are central to the delivery of healthcare services. There are currently 41 PCNs across Alberta. Each has an Executive Director who runs the PCN and reports to a Board of Directors. That board is made up largely of physicians who are “members” of the PCN. In most cases, AHS representatives also sit on the PCN Boards of Directors. In Alberta, most family physicians have joined PCNs.

A PCN is not a physician’s clinic. It’s a corporate entity with a network of physicians and other healthcare providers. A PCN can be comprised of anywhere from 2 or 3 to dozens of family physicians and their clinics which are located across a geographic area. Again, when you go to your family physician’s office, you are likely receiving care from a physician who is part of a PCN, but that clinic is ‘not’ the PCN. For example, in Calgary there are 6 Primary Care Networks also encompassing the communities Airdrie, Banff, and Canmore. Within those 6 PCN organizations are dozens of clinics and hundreds of physicians working alongside many other health care professionals to provide you with the care you need.

Independently practicing family physicians agree to ‘join’ a PCN as a means to expand the range of services they can offer. When that happens, Alberta Health allocates funds to the PCN based on the number of patients within each physician’s ‘panel’ of patients. These funds allow the PCN leaders to develop specific programs and hire staff who, in collaboration with your physician, offer a range of healthcare services to Albertans. Those services can include but are not limited to occupational health, pharmacists, physiotherapists, kinesiologists, social workers, nurse practitioners, and more. The range of services available in PCNs varies and is centered around 1) the funding available to that PCN based on the number of patients in their total ‘panels’ and 2) evaluation of the type and range of services needed by the people who live in that particular geographic area.

Continuing Care:

Continuing care is delivered along a range of services from home care to supportive living facilities and long-term care as well as hospice and end of life care. There are AHS run facilities, public / private partnerships, private for profit, not-for profit, and faith-based facilities located across the province.

While most people believe that continuing care is largely designed to support older Albertans, anyone of any age can receive continuing care. The type of continuing care that you or your loved one may require is based on the person’s specific needs and related to the support necessary to safely achieve the various activities of daily living. Individual eligibility is determined by a professional assessment of that person’s needs. The cost of continuing care services can also range based on the type of facility or service and the care you or your loved one requires.

Cancer Care:

Cancer care is delivered across Alberta through AHS run tertiary cancer care (inpatient, specialty, and complex care) centres in Calgary and Edmonton. The North, Central, and South Zones also provide a comprehensive range of services in their outpatient regional cancer centers. There are 17 cancer centres situated across Alberta.

Mental Health:

The design and delivery of Mental Health services in Alberta is expressed through 6 pieces of legislation with oversight from an Associate Minister of Health. Currently, Jason Luan is the Associate Minister of Mental Health and Addictions. Services are largely delivered by AHS and Covenant Health however there are also private Mental Health services and community-based physicians providing a range of supports to Albertans.

Specialists:

Many specialists and sub-specialists practice independently in Alberta while others work alongside PCNs or with AHS and Covenant Health in dozens of specialty care clinics such as stroke clinics, cardiac clinics, asthma, neurology, bariatric clinics, intensive disease, and so on.

Public Health and Community Health:

Public Health and Environmental Health services are delivered by AHS staff in Public Health Units across Alberta. Immunization, counselling, screening, population health, disease control, surveillance, and environmental surveillance are some examples of the services provided in public health clinics. In the past year, public health services have been augmented to meet the demand for screening, surveillance, and immunization associated with COVID-19.

Community Health Centers are also run by AHS. They offer a range of services that may include prenatal, postpartum services, health promotion, disease and injury prevention services, well child services, communicable disease control, and school health services.

Home Care:

Home care is delivered largely in the home, but home care staff will also often go into retirement facilities, hospice, and other locations to augment basic care when it’s requested or required.

Home care provides personal and healthcare services to support people to remain independent in a safe environment for as long as possible. Anyone living in Alberta with a valid healthcare card can receive home care services in their own home as long as the needs can be reasonably, and safety met. Staff provide support for activities of daily living such as personal hygiene, medication management, dressing changes, mobilization, and more. AHS staff and contracted providers provide home care services. Depending on the individual’s needs, services such as nursing, social work, occupational therapy, physiotherapy, health care aides, and others are provided. A case manager is the person who assesses and coordinates the care that may be required.

Conclusion

In this article, we hope that we’ve provided a snapshot about how health care is structured, how oversight occurs, and how the system functions to serve Albertans. This is by no means an exhaustive description of the system, but we hope that it offers a sense about the range of services, organizations, and the network of people who support Albertans. We deliberately focused considerable detail around Primary Care because your family physician is your first point of contact with the system. A family physician’s clinic, particularly when it’s connected to a PCN, can allow you to establish and maintain a long-term relationship with a physician and a team of practitioners who know you and who can coordinate care on your behalf. Today, rapid technological innovations are making consistent and more comprehensive care possible through a vast network of electronic medical records and electronic health records. And, if you join ‘My Health Alberta’ you can view your immunizations, medications, and lab tests. You can also enjoy access to information about health conditions, healthy living, medicines, tests and treatments, symptom checkers, and important phone numbers and other information that will help you to access the health system.

The link to “My Health Alberta” is provided below.

https://account.alberta.ca/login?spEntityID=http%3A%2F%2Fsts.xiduam.ca%2Fadfs%2Fservices%2Ftrust&goto=https%3A%2F%2Faccount.alberta.ca%2Fsso%2FSSORedirect%2FmetaAlias%2Fidp3%3FReqID%3Did-8f1c7c14-e6c8-48f4-a5f0-cc773cf9801d%26index%3Dnull%26acsURL%3D%26spEntityID%3Dhttp%253A%252F%252Fsts.xiduam.ca%252Fadfs%252Fservices%252Ftrust%26binding%3D

If you’d like to contribute to the future of health care delivery in Alberta, reach out to your local (regional) Health Advisory Councils. https://www.albertahealthservices.ca/ac/hac.aspx

You can also join an Advisory Council. https://www.albertahealthservices.ca/ac/Page13631.aspx At the very least you’ll learn a great deal more about the health system in Alberta! At best, you’ll have an opportunity to play a role in helping to develop partnerships between communities and improve the delivery of health services.

Alberta’s health care system isn’t perfect. No system is. But for the past 20 years, tremendous innovations and improvements are allowing Albertans to not only receive consistent and reliable care more often, but to contribute to discussions and decisions about their care.

 

[1] https://www.canada.ca/en/health-canada/services/health-care-system/canada-health-care-system-medicare/canada-health-act.html

[2] https://www.cihi.ca/en/health-spending

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