Other provinces show Sask. health-care merger no 'silver bullet': experts

Saskatchewan is merging its regional health bodies into a province-wide authority. Photo from Getty Images

The Saskatchewan government announced this week it would amalgamate a dozen regional health authorities, becoming the latest province to end its experiment with regionalized health care.

Provincial Health Minister Jim Reiter said Wednesday that Saskatchewan will consolidate the 12 regions into a single provincial health authority this fall on the recommendations of an advisory panel

The move aims to reduce administration and streamline legal, IT and accounting work and could save the province — which has a $5.1-billion annual health budget serving 1.2 million people — as much as $20 million. But the minister said cost savings is not the primary driver behind the announcement.

“This is about better and more effective ways to deliver health care to Saskatchewan,” he told reporters, according to The Canadian Press. 

Saskatchewan follows in the footsteps of several other provinces, including Alberta, Nova Scotia and Prince Edward Island, that have gone the single health authority route in recent years, reversing a push towards regional health bodies during a major overhaul of the health-care system in the 1990s.

Other provinces, such as British Columbia and Manitoba, have not gone as far but have reduced the number of regional health authorities (RHAs).

John Church, a health policy expert at the University of Alberta, said, “Good luck to Saskatchewan.”

Church, who has written about the regionalization of health care and its shortcomings, said there are potential advantages of amalgamation, such as the ability to bulk purchase drugs, deal more effectively with regional rivalries and reap significant savings by having a single formulary for the entire province.

But amalgamation doesn’t address some of the underlying long-term issues in the health-care system like significant wait times for a variety of services. The experience in Alberta — the first province to adopt a so-called superboard in 2008 — shows there is still a service divide between urban and rural areas.

“So no matter how you change the governance structure, unless you make some other changes it’s not going to make a lot of difference,” Church said.

If Saskatchewan wants to avoid Alberta’s mistakes, it should start by putting physician budgets in the control of the new health authority, he added.

“That would then make a more direct link between the people responsible for making decisions about what services are going to be provided and how much money is going to the services.”

Daniel Béland, a professor and Canada Research Chair in Public Policy at the University of Saskatchewan, said, having a single administration will reduce some of the co-ordination of care issues and “it can obviously save money, but it’s not a silver bullet.”

According to a report by the Canadian Institute for Health Information, health expenditures per capita in Canada averaged $6,300 a year in 2016 with some provinces spending significantly more than others, including Newfoundland and Labrador ($7,256) and Alberta ($6,995). 

Although Alberta may have saved money on the administrative side with a single authority, it is still spending more than any other province except N.L. on health care, “which shows that centralization isn’t a magic solution to the health care funding challenges we face,” Béland said. 

There are also questions about how the new health authority in Saskatchewan will work. But it would be wise to learn from Alberta’s mistakes, the experts say.

One of the major problems Alberta faced from the start was a lack of clarity about how much independence its new authority had, so this led to ongoing political conflict with the Alberta government, Church said.

Both Church and Béland mentioned the PR disaster over the “cookie incident,” when Alberta Health Services CEO Stephen Dockett refused to speak with reporters following a meeting, saying he was still eating his cookie. He soon left the organization.  

The Alberta government also fired its health services board over disagreements about whether to honour executive bonuses in 2013. 

“If you appoint the wrong people, people who might not be that effective, or if you design the system in a way that people perceive there’s not enough accountability or it’s overly centralized, then it could hurt you politically,” Béland said.

With files from The Canadian Press