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You can't slash Alberta Health Services' efficient management without hurting front-line care

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

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 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 (AHS) are quite lean by Canadian standards, 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 Kenney's call to reallocate funding from AHS's supposedly massive management to the front lines.

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 Kenney to give the impression AHS is over-managed 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," Gerein explained.

He noted that the respected Canadian Institute for Health Information, whose data 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, 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 Kenney.

Alberta's spending is higher than average "almost exclusively for two reasons," according to University of Calgary economist Trevor Tombe. Those reasons, Tombe said yesterday in a tweet responding to 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 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 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.

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

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

But ideological market fundamentalists like 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.

David Climenhaga, author of the Alberta Diary blog, is a journalist, author, journalism teacher, poet and trade union communicator who has worked in senior writing and editing positions with the Toronto Globe and Mail and the Calgary Herald. This post also appears on David Climenhaga's blog, AlbertaPolitics.ca.

Photo: Royalbroil/Wikimedia Commons

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