Who’s running health care?

It was a good idea then and it remains so today: managing health care is best done by professional administrators, not by politicians. At the same time, broad health-care policy and its budget are best managed by elected officials, not by bureaucrats.

It was a good idea then and it remains so today: managing health care is best done by professional administrators, not by politicians. At the same time, broad health-care policy and its budget are best managed by elected officials, not by bureaucrats.

That’s the system we have in Alberta. On paper, anyway, though certainly not in practice.

Problems arise — big ones — when either side oversteps the boundaries.

Alberta’s top health administrator — Stephen Duckett, head of the health-care superboard — thinks he is creating policy. And government wants to manage how the actual health dollars are spent.

The result is that nobody knows who’s in charge — not Duckett, the superboard, the politicians, doctors, nurses and support staff in the hospitals, the civil servants managing local health programs . . . and not the taxpayers.

Earlier this year, a freshly-appointed health minister made a public slapdown of Alberta Health Services management, by saying there would be no closing of mental health care beds in Edmonton.

This week, both Health Minister Gene Zwozdesky and Premier Ed Stelmach had to jump on an errant Duckett because he told reporters that overcrowded Tom Baker Cancer Centre in Calgary would not be getting a refit again this year — five years after the clinic’s manager said it needed replacement. This month, the capital expenses budget for health care is to be completed, to be announced early in April.

Construction is to begin any time now on Red Deer’s new cancer clinic, which should be completed by the end of 2012. The project will triple the clinic’s floor space, double its capacity, and be able to handle up to 80 per cent of patients in our region who need radiation therapy.

Right now, many patients wait too long to get into our local clinic or get into line at the major clinics in Calgary or Edmonton.

Obviously, increasing capacity in Red Deer could ease some of the burden at the Baker clinic, but it’s hardly the full cure.

Just the same, the elected officials felt the need to publicly repudiate Duckett. He has no basis telling anyone where the province is going to build hospitals or clinics, they said.

And they’re right. When Duckett makes a public statement to reporters out of school, it plunges the government’s hands into a bucket of political muck.

Stelmach can’t allow a public servant to reveal important budget documents ahead of time. Duckett knows this; he won’t allow the operator of the Baker clinic to talk to reporters about the need for a new clinic. So Stelmach either has to pre-empt his own capital plan process and confirm this painful announcement or publicly deny it. This is no way to run a government.

Just earlier, Duckett said in his blog that it may be time to pay doctors and hospitals on a system based on performance.

All ideas can be debated. Part of this concept is to have health funding follow the patient, instead of being put as block amounts into regions and hospitals.

More patients, more surgeries, more funding.

That might be good for the large centres, with big new hospitals, but it’s not so good for smaller or older centres, which would then have little hope of ever getting an improved clinic.

Zwozdesky felt it important to throw cold water on that idea, too. And he said he’d be meeting Duckett to get him “on the same page” as government.

Duckett is supposed to be an arms-length administrator, free from political interference. But government needs to set the broad agenda and then let the professionals do their job.

Greg Neiman is an Advocate editor.