We thought we would provide some of our own analysis on the Alberta Budget for 2017-2018 that was presented a few weeks ago.
Cuts to Acute Care and Ambulance Services while Administration, Ministry Support Services and Physician Compensation & Development increase substantially. The majority of capital spending for the next year goes to Edmonton, Calgary and Grand Prairie while Red Deer gets nothing even after there has been publicity around their challenged facilities.
The government has reported the Health Ministry budget in two parts. Alberta Health and Alberta Health Services (AHS). The Alberta Health budget for 2017-18 relative to the budget for 2016-17 increased by $685 million or 5.1%. When compared to 2015-16, the most recent actual reported expenditures, the current budget is $1.394 billion higher or a 7% increase over the 2 years.
The 2017-18 budget for Alberta Health Services compared to their budget for 2016-17 increased by $353 million or 2.5% while comparing it back to the 2015-16 the increase is $568 million or 4% over the two years.
While the budget document reports numbers for the 2016-17 budget, 2016-17 forecast, 2015-16 forecast and 2015-16 actual expenditures, we feel it is the most useful to compare this year’s 2017-18 budget to the money reported as spent in 2015-16.
There are some categories of spending that are reported both in Alberta Health and Alberta Health Services. We have chosen to combine the two reported into one for the comparison of previous expenditures versus the current budget.
The government has spoken of the priority to increase spending in Population and Public Health and it is budgeted to increase by $142 million (25.7% over 2 years) to $695 million this next year.
Spending which directly affects patients in the category of Acute Care was cut overall by $95 million (2.3%), with the majority, $126 million, cut by AHS. On the other hand, Diagnostics, Therapeutic and Other Patient Services shows an increase of $140 million (6.2%) over the two years.
While it has been noted by system representatives that there will be significant savings in the new agreement with the Alberta Medical Association, at this point the combined budget for Physician Compensation and Development is up to $5.198 billion, a $341 million increase (7%) from the actual 2015-16 level.
While there are lots of numbers for review, we will concentrate on a few that we see as indicators and are a concern.
Inside the Ministry of Health, there is a likely needed increase in Infrastructure Support budgeted up to $122 million from 2015-16 at $50 million. In addition though, Ministry Support Services is now budgeted at $86 million, a $36 million (36.5%) increase from $50 million in 2015-16. Administration also is planned to increase to $39 million (30%) from $30 million in 2015-16.
Looking at the Alberta Health Services portion, one area that has been in the news for some time, and our extended family has experienced problems first hand, is the stretched Ambulance Services. The budget for this year is $471 million, cut $4 million below the $475 million actually spent in 2015-16. That is a real concern in a province with a growing population and publicly reported ambulance service challenges in the past. Of course STARS supplements the government service with significant public financial support, and it has reported it tougher to raise money in the current provincial economy. It is very disappointing and alarming to see the government funding being cut for this critical service.
Alberta Health Services is reducing the Information Technology budget from $563 million spent in 2015-16 by $55 million. On the other hand, the ever present and growing Administration budget is now planned to hit $491 million up $65 million from the actual expenditure in 2015-16.
If we combine the Alberta Health increases in Ministry Support Services, and in Administration as well as the AHS Administration increases, the total now budgeted over the 2015-16 reported expenditure is an increase of 131 million (21.3%). It is very hard to understand such an increase in administrative spending while cutting front line spending in Acute Care and Ambulance services in particular, and in an economy where the general population has to get along with less.
If we look at the capital spending listed in the 2017-18 budget, (no comparatives reported for previous years’ actual expenditures) we see the $100 million (of $400 million over 4 years) previously announced for the development a Clinical Information System. Hopefully this will result in a system that informs and engages patients and not just for system administrators and providers.
In the Health Facilities and Equipment portion of the capital budget, there are extensive investments planned for Calgary and Edmonton and much smaller amounts in most other centres. One that stands out is the Grand Prairie’s Regional Hospital with $126 million this year and a total of $353 over the next 4 years. That clearly should be very welcome for that community and region.
The Red Deer Regional Hospital (4th or 5th busiest in the province) is absent from the list entirely. For the full story on the situation there, follow this link to listen to what that hospital’s brave doctors had to say to their community. One cannot help but wonder if there is a connection between the publicity and the disappearance of funding for Red Deer. The Premier herself recently commented not to expect any announcements in the near future.
From our family’s priorities basis, there is potential that some progress may be made on an information system that will inform and facilitate patient and family engagement. We are excited to learn more about what will be rolled out and hope that it happens more quickly than originally indicated.
With respect to the priorities to learn from near misses and tragedies, and the need to change the culture of the system away from top down command and control, it is evident that there is less transparency and decision making is being further consolidated at the very top. This will continue as long as the “healthy public” allows this to take place, either through lack of knowledge and understanding, or simply being compliant when faced with some intimidation of one form or another. Everyone needs to demand more transparency, become better informed and then work together to require the needed fundamental changes to this province’s health treatment delivery system.