First steps

First steps

The Chaoulli v. Quebec ripple effect could mean the offloading of healthcare costs onto the shoulders of Alberta employers.

By Terri Goveia

Iris Evans’ quest for healthcare reform ideas took her on tour this past summer. Evans, Alberta’s minister of health and wellness in Edmonton, crisscrossed the province, met with health officials from the U.S., New Zealand and Sweden at a Calgary symposium, and trekked to Australia—all in an effort to shape upcoming changes to her province’s health system. One place—Quebec—wasn’t on the itinerary. But perhaps it should have been. A recent Supreme Court decision could make it a major outside influence on Alberta’s healthcare future.

In June, the Court opened the door to private health insurance in Quebec, giving patients there the right to use private coverage for public medical services. While that decision offers the same option to the rest of the country, it has particular resonance in Alberta, “the only [other] province that said this was worth considering,” notes Brian Lindenberg, a principal at Mercer Human Resource Consulting in Calgary. Just one month after Alberta premier Ralph Klein openly praised the Chaoulli v. Quebec decision, Evans unveiled a framework for the province’s path to healthcare reform—dubbed the Third Way. Two elements of the 12-point plan head straight for Chaoulli territory: a Healthcare Assurance Act that promises access and a pledge to explore the role of private insurance.

Taking the “third way” will give Albertans faster care, more treatment options, an electronic health record and a healthier population, promises Evans’ plan. It also targets rising costs: basic health service expenditures rose by 3.9% in 2003/2004, reports the Alberta Health Care Insurance Plan Statistical Supplement. But amidst these varied goals “the government appears to be focused on greater private sector participation in healthcare funding and delivery,” says Lindenberg.

Just how much greater? That remains to be seen, according to David Dear, an Alberta Health and Wellness spokesperson in Edmonton. No details of the Healthcare Assurance Act have been worked out yet, he says. Nor has the government defined the kind of non-emergency health services private supplementary insurance might cover. An actuarial study will report on how viable private coverage might be in the fall. What is clear, he says, is that “Albertans want a healthcare system that offers more choice and better access.”

That alone should put employers on notice, says Lindenberg. Like Dear, he acknowledges that “it’s too early” to tell exactly how the planned changes will affect them. Some elements of the reforms are positive, such as a move to recognize—and reward—employers with successful healthy workplace programs. Others, like a redesign of the province’s pharmacare program, could mean parallel change for employers’ drug formularies.

With the ministry looking to trim its $1 billion a year prescription drug bill, employers may well do the same. This would be a shift, notes Lindenberg, since few Alberta plan sponsors have tried to manage their formularies to date. “Whatever is legally prescribed, that’s the coverage, whereas in other parts of the country they’ve chosen to manage the formulary in the context of cost containment.”

Overall, a bigger benefits bill seems inevitable. The reform plan also lets patients select from an expanded healthcare menu—they’ll be able to ask for an upgraded hospital room, or a deluxe, rather than standard, hip replacement—all for an additional fee. “This will create pressure on employee benefits plans to fund those expenses,” Lindenberg points out. At present, he notes, Alberta plan sponsors are already more generous than their provincial counterparts when it comes to supplemental benefits. “[They] may be paying more because they choose to pay more, just through plan design.”

With the system changes slated for late 2005, and into 2006/2007, plan sponsors will likely make different choices quite soon. Which way will the Third Way push them? Without reform plans details, it’s hard to predict, says Lindenberg. But he will make a call for the overall system: “fundamental change.”

Terri Goveia is a freelance writer living in Toronto. goveia.t@rogers.com