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Government per-capita expenditures in Alberta were almost double those in Texas - Alberta spent $8,607 on average during the 2001-to-2013 period, while Texas spent $4,952. Mr. Prentice acknowledged that Alberta's spending is also out of line relative to other Canadian provinces. Compared to the Canadian average, Alberta spends about $1,300 more per capita on programs and services, and more than half of these costs are from salaries alone, he said. The School of Public Policy at the U of C argues the province could improve the way it forecasts oil revenue. According to author Sarah Dobson, there are "serious problems" with Alberta's forecasts. "In a province so dependent on resource royalties for its revenues, adding the unpredictability of unreliable forecasting methods can only put its fiscal planning at that much greater risk of instability," she writes. Unlike other critics, who in the past worried the province's forecasts were too rosy, Ms. Dobson argues Mr. Prentice might be inflating the government's expected shortfall this time around.

The premier has warned that if West Texas Intermediate crude averages US$65 a barrel this fiscal year, provincial revenue would drop by $6 billion to $7 billion, while a WTI price below US$50 could mean a shortfall of up to $10 billion. That's a big bite out of a $45-billion budget. Ms. Dobson said Alberta is assuming a Canadian dollar exchange rate of 88¢ to the U.S. dollar, which is high compared to most forecasters, who see the Canadian dollar falling further to potentially US75¢ by the end of the year. She estimates the government's high exchange rate view is increasing the shortfall by $2 billion. The exchange rate has a big impact on Alberta revenue because oil is sold in U.S. dollars. The revenue picture could be clearer if the province was more transparent about its royalties revenue, she said. The province doesn't provide key information such as how much production has reached "payout" and is subject to higher royalties, how much bitumen has been upgraded, how much bitumen qualifies for a royalty discount, or information on the productivity of crude oil wells, Ms. Dobson said. Rather than being protective of the ways of the past, Mr. Prentice is leading the shakeup and asking Albertans to do their part. The question is whether the resolve sticks when the oil-price roller-coaster turns in Alberta's favour, and the unbridled optimism that comes with oil booms temps politicians to reopen the taps.

Last week, the Parkland Institute - which is based out of the University of Alberta - released its report Losing Ground: Alberta's Elder Care Crisis. It was an update of another Parkland report from 2013. The report states that as of March 31, 2016, there were 14,768 longterm (LTC) beds in Alberta and 9,936 designated supportive living (DSL) beds, as well as 243 palliative care or hospice beds.

The number of LTC beds in Alberta has been relatively stagnant - Alberta only has 377 more LTC beds than it did in 2010, an increase of only 2.6 per cent. The number of DLS beds, on the other hand, has increased by 4,770 or 92.3 per cent. As well, the number of continuing care beds classified as DLC as opposed to long-term care beds grew from 26 per cent in 2010 to 40 per cent in 2016.

That means nearly half of the continuing care beds available in the province for elderly Albertans do not have a registered nurse on-site and are not subject to minimum staffing requirements. "Losing Ground" also examines who is operating the LTC beds in the province. About 21 per cent are operated by Alberta Health Services (AHS) or a regional health authority. Another 10,808 were run by for-profit corporations and 8,881 were run by non-profits. In the last seven years, Alberta has lost 333 beds in public facilities while private, for-profit facilities have added 3,255 beds.

The issue is that publicly-run LTC facilities generally provide more health care to residents than privately-run or non-profit facilities. On average between 2011 and 2013, registered nurses, licensed practical nurses and health care aids in public facilities provided four hours of direct health care to residents compared to three and 3.1 hours per day in non-profit and private facilities respectively. The report stresses that all facilities are required to provide 4.1 hours of care per day to residents, which means they are all falling short due to a lack of staff.

The report also notes that the NDP government has fallen far short of its election commitment to open 2,000 new long-term care beds by the end of 2019, including 500 new beds in 2015. The growth in the older population, coupled with a stagnant number of new LTC beds and move towards private care, means the availability of beds for Albertans over the age of 85 has nearly been halved since 2001. "This drop has greatly reduced the province's ability to meet the care needs of its most frail seniors," said report author David Campanella, in a release.

Minister's response In an e-mail, Minister of Sarah Hoffman said they know there is a huge demand for longterm care and dementia beds that stems from "years of neglect" on the need for affordable spaces for seniors under the previous government. "As a result, we are building spaces and putting in the beds Albertans need as we committed to do in the election and we are doing it collaboratively with communities and community partners." Hoffman said that last year, the province did a thorough review of all proposed Affordable Supportive Living Initiative (ASLI) projects, and implemented important changes to proposed projects to address the needs of Albertans.

Every new approved ASLI project has since opened with higher numbers of dementia and long-term care beds than originally planned, she said. "With ASLI now ended, we are developing a new capital program for long-term care with criteria to ensure the right level of care and the right methods of delivery are expanded," said Hoffman. She noted they have $365 million earmarked for senior care in the current budget and that will improve access for families across Alberta. Following the report's release, the Canadian Union of Public Employees (CUPE) issued a statement that it is disappointed by the lack of progress being made reforming the province's system of senior care.

CUPE Alberta president Marle Roberts said the union, which represents 2,600 long-term care workers throughout the province, has repeatedly asked the current and previous Alberta governments to shift its focus to publicly-delivered services. "This study confirms what others have indicated before - caregivers in public facilities have more times for patients and deliver better outcomes," said Roberts.

We are disappointed that the number of private beds continue to increase, while the number of public beds has dropped ... We are letting patients down by not offering them the care they need," she added.

A report from the Parkland institute claims there has been a trend away from publicly- run long-term care beds, such as those at the Westlock Continuing Care Centre (seen above). The number of long-term care beds offered by private organizations or non-profit organizations, on the other hand, is on the rise.

Wright, who has diabetes and underwent a triple heart bypass three years ago, was in good health when she and two daughters drove to Vancouver and then Squamish, B.C., in August for a family wedding. On the return trip, the trio stopped for the night at a motel in a small town of fewer than 4,000 people called Vermillion, about 200 kilometres east of Edmonton. There, Wright took ill. She couldn't breathe and was having a difficult time walking, so her daughters rushed her to the local hospital.

When she got back to Garson, she and her husband, Jim, hitched up their trailer and went camping for two weeks. They had a wonderful time, but when they returned, there were two envelopes in the couple's mail box. One was a bill for several hundred dollars for examinations by three different doctors in Alberta. The other was a whopping $6,380 bill from an air ambulance company called STARS (Shock Trauma Air Rescue Society). Quite fittingly, Jean Wright was shocked when she opened the envelope, because she thought the flight was covered, she said in an interview at her Garson home.

Wright and her daughters had heard about the Alberta woman who was visiting family near Timmins when she went into early labour and had to be air-lifted to Sudbury. That woman was billed about $10,000 by Ontario's air ambulance service. After Amy Savill went public with her story, the Alberta and Ontario governments agreed to split the bill for the air ambulance. When Wright received her bill, she called one of her daughters and said the younger woman "almost fainted" when she heard the amount. Wright thought: "If I have to pay this bill, they're going to wait a long time. I don't have that kind of money." She is a retired school bus driver and her husband an Inco pensioner.

Wright visited the constituency office of her MPP, Nickel Belt New democrat France Gelinas, who is also her party's critic for Health and Long-Term Care. Gelinas wrote Health Minister dr. Eric Hoskins on Oct. 8, saying provincial governments should "pay the bill as a hospital emergency service when a patient is forced to take air or ground ambulances to the nearest hospital for the necessary emergency treatment. "Hospital and physician services are supposed to be free to all Canadians," wrote Gelinas. The Ontario Legislature is recessed this week and Gelinas hasn't received a reply from Hoskins, she said Thursday. She intends to speak with Hoskins about it Tuesday when the Legislature resumes sitting.

Wright contacted the Edmonton hospital about the smaller bill for doctors' services she received and was told to discard it. She hasn't contacted STARS, but Gelinas said her constituency staff will stay on the case. Gelinas wants Ontario's health minister to establish a policy in which air ambulance transportation for Ontarians out of province is paid by government if ordered by a physician. If Ontarians travelling outside the province require air ambulance transportation, and know they have to pay for it, many will not get the treatment they need because of that cost, said Gelinas.

"This is wrong," said Gelinas of someone like Wright being billed for transportation to get emergency care. The basic tenet of medicare is that all Canadians have access to good health care "no matter the thickness of their wallets. Gelinas, Nickel Belt federal NdP candidate Claude Gravelle and Sudbury federal NdP hopeful Paul Loewenberg have scheduled a news conference for Friday at 11 a.m. in front of Health Sciences North to talk about how the NdP health plan will improve health-care delivery for people in Northern Ontario.

Jean Wright shows off an invoice for more than $6,000 for an Alberta air ambulance ride on Thursday. Wright required medical care involving an air ambulance while on vacation in Alberta.

Most recently, the government allowed teachers to strike for five weeks before they ultimately surrendered last fall. The wage package they accepted - a 7.25 per cent increase over six years - was essentially the same one the government had been offering throughout most of the negotiations. It remained steadfast that teachers accept the same measly terms to which other public-sector unions had agreed. This brings us to Alberta. Of the many pre-budget signals that Premier Jim Prentice has been sending out, one of the strongest has been to public-sector workers. The rich deals they have struck over the years can't be sustained in the current economy. In fact, Mr. Prentice believes they can't be managed even when the economy improves.

These contracts have always been a pet peeve of provincial governments across the country because of the domino effect they created. Alberta wages for virtually any group - nurses, teachers, doctors, civil servants - have always been the benchmark used by counterpart unions and professional associations elsewhere.

Not only have other provinces been forced to cough up more money than they've wanted to, they've also had to watch many of their top people flee to Canada's version of the United Arab Emirates to earn the kind of living they could never hope for at home. The most recent Statistics Canada numbers from January put Alberta on top for salaries among nurses, teachers and unionized workers generally (which would include the bureaucracy). The latest figures from the Canadian Institute for Health Information also indicate Alberta doctors earn the highest wages in the country.

As Mr. Prentice has pointed out, many of these deals have been achieved only by pillaging oil profits that rightly should have been put aside for future generations. That oil and the riches they produce are not the sole domain of the generation alive today. The Alberta Premier is right: The province has been living beyond its means for years now.

And there is a long-term reckoning on the short-term horizon. The B.C. Premier, meantime, has no doubt Mr. Prentice will use this crisis as an opportunity to get public-sector wages in line with the rest of the country.

"Over the years other [Alberta] premiers have been big spenders on public-sector wage increases and it's been a real problem, especially for B.C., because nurses, doctors, teachers, they all have the chance to go right across that border. "We, on the other hand, have had to go through strikes and our unions have had to swallow a lot of zeroes over the years and yet it's made us more efficient in many areas like health care, where we have the secondleast expensive system in the country per capita and yet we have great health outcomes."

t may sound like bragging, but much of it is true. Now B.C. and the rest of the country will watch as the Alberta government struggles to get control of wage costs that were always too rich for the province's blood.

The current model for paying physicians is “expensive, outdated and doesn’t support the efforts of doctors to provide the best care possible,” said Health Minister Sarah Hoffman at a Feb. 8 policy forum in Edmonton on the health system’s fiscal sustainability.

In 2014, Alberta spent $1060 per capita on physician services — the third highest in the country. More than 80% of payments are through fee-for-service, where doctors bill the government for each medical service provided. Proponents of fee-for-service say it gives doctors the incentive to see as many patients and provide as many services as possible. Hoffman wants some of the doctors on fee-for-service to adopt Alternative Relationship Plans (ARP), which she said are not only less expensive, but also reward doctors for the quality of care they provide.

Under clinical ARPs, doctors are paid for providing a set of services at a facility to a target population. There are several types. The annualized ARP, the most common in Alberta, provides compensation based on a formula that determines the number of full-time equivalents (hours per year or days per year) required to deliver services.

In Ontario, the most common ARP is the capitation model, under which physicians are paid a fixed fee per month for each patient registered with their practices, regardless of services received.

The Alberta Medical Association (AMA), which represents the province’s 8921 licensed physicians, supports the change. President Dr. Carl Nohr told CMAJ that ARPs are part of the move toward modernizing the health care system, which now deals with more chronic illness. They give doctors more flexibility, he said.

“They’ll be able to vary the amount of time they spend with individual patients, define how frequently they see patients — all in the context of what’s good for the patients and not necessarily from the business perspective.”

Neither the AMA nor Hoffman could specify the number of doctors they want to adopt this model. Nohr said compensation under an ARP will remain optional, but “our goal is to make it as attractive as possible and make changes to the model as we go, and hopefully over time see a substantial uptake.”

Alberta’s total health budget is $19.7 billion for 2015–16 — the second highest per capita ($4800) among the provinces. But, Hoffman said, “Given how much money is spent on health care in Alberta, the health outcomes in our province can and should be better.”

Hoffman said health care accounts for 45% of the government’s overall budget, and continues to grow faster than both inflation and the population, which grew 2.17% in 2015. If health care spending continues to rise by an average of 6% annually, it will account for 60% of the province’s budget in 20 years. Hoffman wants to decrease growth in health care spending to 2% annually in the next few years, but stressed this does not mean cutting funding; it means curbing spending growth.

Hoffman doesn’t know how much will be saved by changing the physician compensation system, but said “changing the way we pay doctors will have a ripple effect on the entire health system.”

The government’s contract with t

e AMA expires in 2018, and both parties are discussing redirecting funds and developing alternative compensation models. Nohr said they’re looking into a blend of ARP and fee-for-service among primary-care physicians.

One of the very good things that gives me hope for the future is that the profession and the government have a very good relationship,” Nohr said. “So there’s a collaborative, positive relationship between the Alberta Medical Association and the Ministry of Health and that creates the possibility for productive, useful change.”

Kat Lanteigne, executive director for BloodWatch.org and writer of the play Tainted based on three-years of research about the tainted blood scandal, travelled to Alberta to help spread the message about concerns about private, donor-paid plasma collection. Lanteigne said these types of clinics had started to show up in Ontario in the last few years. "This is a big-pharma push," she said. "If they can build a clinic and get a licence from Health Canada then they can open without the province's permission." She said that the private sale and collection of blood and plasma introduces risk into the system. She also dispelled another myth that plasma is being imported into the country. She said that is not the case, as about 70 per cent of the drugs produced from plasma is what is being imported. When successful in the fight to get Ontario to legislate against private, donor-paid plasma collection at the end of 2014, and because Quebec has a similar law, Lanteigne said they made the mistake of thinking that because the largest provinces in Canada had done this, the rest of the provinces would follow suit.

Instead, as part of one of her first decisions, the new federal Liberal Health Minister approved CPR opening a clinic in Saskatchewan. Lanteigne says the Saskatchewan government, led by Premier Brad Wall, then approved the private, donor-paid plasma collection business to open in Saskatoon, "in between a pawn shop and a pay-day loan company." "This collection facility is a blood broker. They are literally a middle man Ñ a source to get profits. "We're asking the provinces and territories to pass voluntary blood donation acts which adds blood and plasma to their existing human tissue acts ..." Lanteigne explained. There is a lot of information on the BloodWatch.org website about the issue, including an informative timeline. The organization also has a Heart Watch rating system. Alberta currently has three hearts and Lanteigne would like to see that increase to five. "Saskatchewan has broken our hearts," she adds.

Kim Storebo, CUPE Local 46 president who works with Canadian Blood Services (CBS), also spoke at the event. She said CUPE supports a public, voluntary-based blood system in Canada, adding CBS needs to increase the number of its own plasma collection sites. The organization has been slowly closing locations since 2012. "There is no evidence the collection of plasma from paid donors will create self-sufficiency," she said. "Under no circumstances should there be payment of blood plasma donors with cash or cash-in-kind equivalents." The union wants to see blood and plasma collection remain the sole responsibility of Canadian Blood Services and for the organization to expand its plasma collection and its work hours and ensure stable and consistent hours for its employees. As part of the wrap-up of the Alberta tour officials with FOM, BloodWatch.org and CUPE presented an online SumOfUs petition with more than 15,000 signatures to provincial health minister Sarah Hoffman asking for all provincial governments to "implement legislation that ensures no for-profit, donor-paid blood plasma collection clinics are allowed to operate in Canada." Azocar assured those at the meetings that Friends of Medicare would continue to lobby the Alberta government this fall and next spring during the Legislature sittings.

hospitals that often run at more than 100 per cent capacity

the health authority hopes to reduce hospital occupancy rates to 95 per cent at Calgary’s Foothills, Peter Lougheed and Rockyview hospitals, as well as at the University of Alberta, Royal Alexandra, Grey Nuns and Misericordia in Edmonton

The provincial health superboard has launched an “intensified, accelerated effort” to reduce occupancy rates in seven of Alberta’s busiest hospitals by October, including ambitious plans to clear out 50 per cent of the backlog of patients waiting for continuing care beds.

Alberta’s medical system also struggles with higher than average lengths of stay for most hospital patients in Edmonton and Calgary.

Liberal health critic Dr. David Swann said proper solutions are more important than “feel-good targets.”

“Where’s the evidence we can actually get there, both in terms of staffing number and new beds?”

489 Albertans waiting in hospital beds for continuing care spaces as of December 2011

creation of a provincial standard for acute care and capacity management (including standard processes for discharge), integrated continuing care planning across the province and ED (emergency department) patient flow improvements

The health board boss also pointed to additional acute care, continuing care and mental health beds, as well as boosted medical support within the community and in supportive living sites as “immediate, local actions” to help hit the new hospital targets.

Reducing acute care bed occupancy rates at the province’s busiest hospitals to 95 per cent by Oct. 31 was one of the recommendations contained in a Health Quality Council of Alberta report in February

Dr. Chris Sikora, Medical Officer of Health, Edmonton Zone, says about half of all confirmed whooping cough cases in Alberta have occurred in the North Zone, which encompasses everything geographically north of Redwater.

Pertussis is a respiratory disease that predominately affects infants ages six months of age and younger, and can cause severe coughing that lasts for weeks and can lead to pneumonia, convulsions, brain damage and even death.

There were many cries of outrage, but the most powerful came from John Osler, whose family has deep ties to the Progressive Conservatives. His father, Jock Osler, was former prime minister Joe Clark's media boss more than 30 years ago. Osler said the PCs had flat-out broken their promise. The South Campus would not only be a "strip mall" hospital, it wouldn't even be cheaper. All the problems of the Foothills site - including traffic and parking - had been considered and solved, Osler said. On Wednesday, he sat beside the new NDP minister, looking like he'd just won the Foothills Hospital Home Lottery. Osler said Hoffman had called in several stakeholders on Monday. She and officials actually listened - a new experience for him. Dan Holinda, the Alberta executive director for the Canadian Cancer Society, had the same experience. "We've been fighting for this for 10 years, but we had to pound on the doors to get government to listen to us. We had to lobby and write letters and mobilize the community," Holinda said.

These patients aren't just Calgarians. They come from across the south. Then they're shuffled about like pieces in a medical chess game. Edmonton, meanwhile, has long had the superb Cross Cancer Institute, which is close to both the University of Alberta Hospital and the U of A campus itself. That kind of integration is essential for research, teaching and many kinds of secondary medical services that cancer patients need. The PCs promised Calgary the same, recognizing that only the Foothills site can meet all those requirements. Then they promised it again, and again. Just when the project was at last approved, ex-premier Jim Prentice strolled in and canned it, promising instead to build a smaller, cheaper centre at the South Health Campus.

But in this situation the minister (Hoffman) reached out to us. She brought us into a meeting this week. And it's the first time where I've had the experience that the government sat and listened." In one way, this was an easy win for the NDP. All they had to do was reverse a colossal PC mistake that symbolized how the old government had come to take Calgary for granted. But now, the real test for the New Democrats is in the doing. Surprisingly, they're still deciding where the new building will be - on the site of parking lot No. 1, which is directly in front of the Foothills entrance, or at parking lot No. 7, in the angle of 16th Avenue N.W. and 29th Street. The Tom Baker will stay in business for elements of cancer care. Some surgeries could be done in the Foothills itself. The new cancer hospital - as yet unnamed - won't be fully onestop, but somewhat scattered around the Foothills campus.

But it's the best option and it's out of the starting gate. We should hope the New Democrats get this hospital finished quickly, before they feel the slightest urge to mimic the government they replaced. Don Braid's column appears regularly in the Herald. dbraid@calgaryherald.com TIMELINE: TWISTS AND TURNS OF THE CANCER CENTRE December 2005: PC health minister Iris Evans announces Calgary could get $600 million to replace the Tom Baker Centre. March 2006: Premier Ralph Klein's government establishes a $500-million fund for screening and research. April 2007: Experts warn of a looming crisis after the proposed $900-million cancer facility left out of provincial budget. September 2007: Alberta Cancer Board expands operations at old Holy Cross Hospital due to a space shortage at Tom Baker. May 2008: Alberta Cancer Board explores private financing to build a proposed $1.1-billion facility.

April 2009: Budget constraints mean there's no money to replace the aging cancer facilities, says the province. March 2010: Premier Ed Stelmach says a new Calgary cancer centre is a priority after AHS says it's not on the government's capital projects list. March 2013: Premier Alison Redford announces plans to build a $1.3-billion cancer centre on the site of the Foothills Medical Centre. December 2014: In light of low oil prices, Premier Jim Prentice confirms construction of the cancer centre will be delayed. February 2015: The PC government explores different options for the centre, and consider South Health Campus as a new location. March 2015: The government announces the centre will move forward, but it may be located on two sites. July 2015: The NDP government announces the new cancer treatment centre will be built at the Foothills Medical Centre campus. Source: Herald archives

Patients suffering in pain on wait lists for surgery have once again been denied their Charter right to access health care outside of the government's cruel, inefficient, and unaccountable monopoly. In 2005, the Supreme Court of Canada famously declared in Chaoulli vs. Quebec that "access to a waiting list is not access to health care." But last week, the Alberta Court of Appeal refused to apply and follow the Chaoulli precedent, citing a lack of evidence in the case of Darcy Allen vs. Alberta.

until September 2010 - a date later pushed back to June 2011. No longer able to work to support himself and his family, unable to perform ordinary day-to-day tasks, and experiencing pain so severe that not even the strongest drugs were effective, he spent $77,000 of his own money on surgery in Montana. Dr. Allen's surgery immediately and significantly reduced his pain, and started his slow journey back to better health. Apart from paying out of pocket, Dr. Allen's only other option was to suffer two years of extreme pain, waiting for the Alberta government's monopoly system to provide necessary surgery.

Dr. Allen's experience with medical wait times is, unfortunately, not unique. While patients in France, Germany, Japan and dozens of other developed democracies count their medical wait times in days and weeks, the government health monopolies in Canadian provinces subject patients to wait times that are counted in months and years. The international evidence demonstrates that there is simply no need for government to impose a monopoly over health care in order to ensure that health services are available to all members of the public. In Chaoulli, the Supreme Court held that while government has every right to create health-care programs, it does not have the right to create a monopoly that prevents patients from accessing health care outside of that government monopoly.

Last week's Court of Appeal decision, as well as the trial decision under appeal, declared that Dr. Allen had not brought forward enough evidence to support his claim. Curiously, neither decision refers to the extensive evidence put before the court about Alberta's long wait lists, and how wait times hurt patients, even killing them in some cases. While refusing to consider - or even mention - this abundant evidence, the court declared that Darcy Allen should have introduced expert reports and expert witnesses to testify about the fact that wait lists exist, and the fact that wait lists inflict suffering - and sometimes death - on patients. The Alberta government has not disputed either of these two facts. They are the same facts on which the Supreme Court relied in Chaoulli.

Following the court's logic, Darcy Allen should have spent $77,000 out-of-pocket on his medically necessary surgery, and then an additional $200,000 to $400,000 to assert his Charter rights, by paying a panoply of experts to "prove" basic facts that have already been admitted by the Alberta government. So much for access to justice.

To respect Charter rights, governments have only two options: ensure that a monopoly system provides real access to health care (not just access to a waiting list), or allow Canadians the freedom to access health care outside of the government's system. A law that creates a government monopoly over health care, by banning private health insurance, complies with the Charter only if that monopoly does not inflict pain and suffering - and a real risk of death - on waiting patients.

Ignoring the evidence before them about Alberta's long and painful waiting lists, Alberta's courts have refused to deal with the violation of Darcy Allen's Charter rights. Hopefully the Supreme Court of Canada will not refuse to do so. National Post Calgary lawyer John Carpay is president of the Justice Centre for Constitutional Freedoms (Jccf.ca) and acts for Darcy Allen.

"It is also not clear why the brand new South Health Campus in Calgary requires renovation or expansion, or how the crumbling Misericordia Hospital will survive when it alone needs over $100 million in upgrades within the next few years," she said in a news release. Azocar said the PC government opened medical transition beds in hospitals in 2010 to deal with the same issues of overcrowded ERs, but closed them in 2013. "They have already closed 36 surgical beds this year at the Peter Lougheed Hospital, replacing them with the rapid transit beds announced last month.

"Today's beds appear to be very similar to the medical transition beds and the rapid transit beds but with a new name: restorative beds," she said. The group that represents about 25,000 health-care professionals in Alberta, including EMS workers, called Mandel's announcement "more smoke and mirrors than real facts."

"I know Premier Jim Prentice doesn't like to talk about mirrors nowadays, but this announcement of restorative beds and changes to the role paramedics seems to promise much, but deliver little," says Elisabeth Ballermann, president of the Health Sciences Association of Alberta. She added that the announcement leaves more questions than answers. Ballermann said one question is whether the 311 restorative beds are in addition to the 464 new continuing-care spaces announced in October 2014.

She also wondered if the beds will be in public or private, for-profit facilities and if the funding will come from the Alberta Supportive Living Initiative new money or part of the $60 million announced in October.

The bad news is that after years of inattention and chronic underfunding, significant issues still need to be addressed. We need a broad public discussion about our expectations and priorities to ensure we get future continuing care right: These are community decisions that ought not to be left entirely to our health bureaucrats, able though they are. As we enter this discussion, we should focus on the real issues and not waste time on red herrings. For example, recent research by the Health Quality Council of Alberta (HQCA) has confirmed that quality of care is not affected by whether the provider is private, non-profit, faithbased or public, or whether the staffare unionized. There is plenty of evidence that all types of providers are responsible, committed and caring. On the other hand, the report identified five concerns of families and residents: the need for more staff; timely help and supervision for basic needs; cleaner and bettermaintained facilities; access to related services; and quality, varied and nutritious food.

This is a telling list because these concerns are primarily driven by funding and continuing care is falling behind. Current rates of funding are actually below what was received in 2011, after inflation and cost increases are factored in. For the past three years, funding increases for continuing care have been zero, between zero and two per cent, and zero. At the same time, overall healthcare funding has increased at six per cent a year.

Just as schools need teachers, funding for spaces has to come with funding for care. In Alberta, continuing care is funded at 19 per cent below the national average. In comparison, acute health care in Alberta gets 33-percent more than the national average. Under these conditions, the HQCA conclusion that there has been "no significant change" in quality of continuing care is a credit to the commitment of our care providers.

It's not just the quantity of funding that needs to be addressed. Our current patchwork system of funding, program models and regulations needs to be revisited. Changes are needed - not to reduce standards, but to allow the system to be more client-and resident-centred, giving providers the flexibility to innovate and respond to the changing needs of clients and residents, and to reflect changes in the scope of practice of our health-care professionals. We need to ask ourselves whether a 30-yearold model of care is acceptable for our loved ones. The NDP government has taken some initial steps toward getting things back on track, but there is urgency to tackling these issues as quickly as possible. The number of Albertans needing home care, supportive living or long-term care is going to increase significantly. Will we be ready? Continuing care providers want to work with the government and all Albertans to build the best possible system. The Alberta Continuing Care Association looks forward to working with government as it takes its next steps to strengthen care and supports.

Tammy Leach is CEO of the Alberta Continuing Care Association.

Justice Slatter clearly had issues with the majority judgment in Chaoulli. He highlighted that section 7 is a notoriously unsettled and controversial Charter provision, and the “drafters of the Charter never intended it to be applied to the review of social and economic policies” (para 33).

“For the last decade, the Alberta government has been trying to get out of the business of seniors care and pass it off to the private sector,” said Roberts.  “The decision to cap funding for lodges was part of that strategy – let public facilities crumble and push seniors to more and more costly private options.”

But many medical tourists are returning home with potentially catastrophic complications, including anastomotic leakages, where intestinal contents leak through surgical staples into the abdominal cavity, increasing the risk of life-threatening sepsis. "It's almost like your stomach ruptures," says Dr. Shahzeer Karmali, an associate professor of surgery at the University of Alberta and one of the authors of the newly published paper.

Complications can be a nightmare to manage and repair "because we don't really know what they've had done," Karmali says. "There's no real operative report; we don't know exactly what happened elsewhere. It's hard for us to figure out what was done, and how to fix it." One woman in her 20s who underwent surgery in Mexico had to have her "essentially her entire stomach," as well as part of her esophagus, removed, he says. She will need to be fed through a feeding tube for the rest of her life. Despite increased funding in Ontario and other jurisdictions, wait lists average five years across Canada. Only one per cent of eligible patients are offered access to surgery. "Consequently,

many patients turn to medical tourism despite potentially severe complications," the Alberta researchers write in the Canadian Journal of Surgery. Earlier work by the same group estimated a complication rate of 42 to 56 per cent for out-of-country weight loss surgery. In Canada, unplanned readmission to hospital within 30 days of bariatric surgery was 6.3 per cent in 2012-2013, according to the Canadian Institute for Health Information. Karmali says Canadians living with obesity are being shortchanged because of lingering stigma and bias. "The stigma is that these people just eat too much and don't exercise enough and they can fix themselves," he said.

"The reality is, it's a significant problem and when people become severely obese it is very hard to 'fix.'" Surgery not only improves weight and overall life expectancy, it helps reduce the drain on the health-care system and economy. A Senate committee report released this month pegged the cost of obesity at upwards of $7.1 billion a year in health care and lost productivity. The committee made 21 recommendations to combat obesity, from overhauling Canada's food guide to banning food advertising to children. But it was silent on reducing wait times for bariatric surgery. Karmali and colleagues surveyed Alberta general surgeons to estimate the cost of revision surgery, ICU stays and other interventions to treat complications in "BMTs" - bariatric medical tourists.

In all, 25 doctors responded to the survey. Together they treated 59 out-of-country surgery patients in 2012-13. Complications included slipped bands, leaking, abscesses and blood clots. The estimated average cost per medical tourist was just under $10,000 - an "extremely conservative estimate" that doesn't include total hospital stay, blood work, nursing care and other costs. By comparison, the average cost of bariatric surgery performed in Alberta public hospitals was just under $14,000. "Alberta does not seem to save much money by limiting the annual volume of bariatric surgeries," the authors write. Studies suggest bariatric surgery accounts for a growing proportion of Canadian medical tourism, with Mexico one of the most popular destinations. According to Statistics Canada, one in four adults in Canada - more than six million people - are obese. skirkey@postmedia.com