2002 Mazankowski Report on Health Care in Alberta

In 2002, several key reports on the future of health care were released, each of which outlined visions for reforming the Canadian health care system. At the federal level, there was the Report of the Commission on the Future of Health Care in Canada (the “Romanow Report”) and the Report of the Senate Standing Committee on Social Affairs, Science and Technology (the “Kirby Report”). At the provincial level, the Government of Alberta released the 2002 Report of the Premier’s Advisory Council on Health (commonly referred to as the “Mazankowski Report”). This article provides background on the Mazankowski Report, as well as an overview and analysis of its themes and recommendations.

Background on the Mazankowski Report

What is the Mazankowski Report?

Mazankowski Report Themes and Recommendations

What are the key conclusions and recommendations of the Report?

Analysis of the Mazankowski Report

How does the Report fit into the general debate on public health care?

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Background on the Mazankowski Report

What is the Mazankowski Report?

Premier’s Advisory Council on Health

The Mazankowski Report was produced by the Premier’s Advisory Council on Health, established, in August 2000, by former Alberta Premier Ralph Klein. The Council had a mandate to review the Alberta provincial health care system and make recommendations for both short- and long-term reform.

The Council had 12 members, including former politicians, health professionals, and academics. The Council was chaired by Donald Mazankowski, who had served in the federal cabinet of the former Progressive Conservative government helmed by Prime Minister Brian Mulroney. Since retiring from federal politics, and prior to his appointment to the Council, Mazankowski had participated in the health field, serving as chairman of the Institute of Health Economics (an Alberta-based research centre) and chairman of the Canadian Genetic Diseases Network.

For more information on the Council’s members:

The Council published its final report, A Framework for Reform, in January 2002. The report is commonly referred to as the “Mazankowski Report,” reflecting the key role played by Mazankowski in its development. It is important to note, however, that the report’s final recommendations were the result of consultation with all Council members and with different organizations and individuals in Alberta’s health care field.

Council’s Mission and Activities

In preparing its report, the mission of the Council was to “provide strategic advice to the Premier on the preservation and future enhancement of quality health services for Albertans and on continuing sustainability of the publicly funded health system.” Within this context, the Council was asked to:

  • Assess the sustainability of the health system
  • Propose potential approaches and strategies
  • Make recommendations on a preferred vision and propose a strategic framework for health and health services in Alberta, consistent with the principles of the Canada Health Act.

In pursuing this mission, the Council:

  • Met with over 60 different organizations and numerous individuals representing various aspects of Alberta’s health system
  • Reviewed hundreds of reports and studies on health care
  • Reviewed information about health systems in other countries
  • Prepared a series of context papers on such topics as how the Alberta health system operates, how long patients wait for health services, and the views of Albertans on the health care system.

(Source: A Framework for Reform, Report of the Premier’s Advisory Council on Health)

Mazankowski Report and the Debate on Public Health Care

The creation of the Council and the release of its report occurred during a period of intense debate on the future of public health care, at both the national and regional levels. Much of this debate stemmed from concerns about the quality of public health care, including concerns about increasing waiting times for some medical services, as well as the public system’s overall financial sustainability. Tensions were high between different levels of government, with the provinces/territories demanding greater federal funding for public health care. In this context, some politicians, health professionals, and academics began to question the very foundations of Canada’s public health care system, calling for greater participation by private insurance companies and health providers.

In addition to the Mazankowski Report, several other key studies on the future of public health care were released during this period. The most ambitious was the 2002 federal report produced by the Commission on the Future of Health Care in Canada (commonly referred to as the “Romanow Commission,” as it was headed by former Saskatchewan Premier Roy Romanow). The Commission’s final report, entitled Building on Values: The Future of Health Care in Canada, was based on extensive public and expert consultation and comprised of 47 detailed recommendations.

For more information on the Romanow Report on Health Care:

  • Mapleleafweb: 2002 Romanow Commission on the Future of Health Care: Findings and Recommendations

Another key report to be released that year was the 2002 report of the federal Senate Standing Committee on Social Affairs, Science and Technology, commonly referred to as the “Kirby Report” (named after the Committee’s chair at the time, Senator Michael Kirby). All three of these reports, the Mazankowski, Romanow, and Kirby, contained significantly different recommendations and visions for reforming public health care.

For more information on the Kirby Report on Health Care:

Mazankowski Report Themes and Recommendations

What were the conclusions and recommendations of the Report?

The Mazankowski Report outlines a broad range of themes and recommendations on reforming health care in Alberta. The following provides a summary of what the Report offered.

For complete details of the Report’s recommendations:

Key Themes of the Report

The Mazankowski Report identified 10 key themes regarding the Report itself and health care reform in general. These included:

  • Long-Term Reform: The Report is not about quick fixes or reducing costs in the short term. Instead, the objective is to reform the system over a longer term. Moreover, the Report is not about broad general ideas or approaches, but attempts to provide practical ideas and solutions to address the sustainability of the Alberta health care system.
  • Equitable Health Care: A central position of the Report and its recommendations is that Albertans should have fair and equitable access to health services. No one should be denied access to essential health services because they are unable to pay.
  • Promoting Health: The Report posits that the best long-term strategy for sustaining the health system is to encourage people to stay healthy. If Albertans and policy-makers focus simply on treating people when they get sick, the increasing costs of new treatments and technology could bankrupt the system.
  • Rejecting Rationing: The answer doesn’t lie in rationing health care services. People are concerned about access to health care services and rightly so. All Albertans should have access to the very best health care when they need it. And it should be available to everyone on equitable terms.
  • More than Efficiency: There is a need to extract maximum value for every dollar spent on health care. Such measures alone, however, will not be sufficient to match increasing demands and costs in the health care system.
  • New Ways of Paying: The burden of health care on the tax system is growing and will continue to grow with new treatments, new cures, new drugs, and growing demand. As such, there is a need to explore new ways of paying for health care.
  • Re-thinking Medicare: It’s time to think carefully about what medical services should be covered by public health insurance. The system was never designed to cover all aspects of health services, but people have come to expect that it will – and at no cost to individuals.
  • Innovation and Competition: There is a need to innovate. It is time to open the system up, allow health authorities to try new ideas, encourage competition and choice, and see what works and what does not.
  • Patient-orientation: There is a need to develop a patient-oriented system that encourages empowerment, accountability, and continuous quality improvement.
  • Made-in-Alberta Approach: There should not be a mimicking of other health care systems, be it those of the United States, the United Kingdom, or Sweden. Albertans and policy-makers must create their own alternative – one that preserves the best of the current system while also ensuring it can be sustained into the future.

Recommendations of the Report

In addition to the key themes identified above, the Report detailed 10 sets of recommendations for reforming Alberta’s health care system:

  • Staying Healthy: The first recommendation is a commitment towards healthy Albertans. Specific reforms include increased support for children in poverty, providing better public health awareness, reducing tobacco use, and providing incentives for people to stay healthy.
  • Putting "Customers" First: This recommendation involves understanding patients as "customers." Reforms include providing a 90-day guarantee of access to selected health services and providing more choice in the health care services they receive and where they receive them.
  • Reducing Services Covered by the Public Health System: The third recommendation calls for a reduction in the services a person would receive through his/her public health insurance plan. An expert panel would be established to review services currently insured and whether coverage should continue. Once a service was "de-listed," coverage would have to be through the private sector.
  • Invest in New Technology: This recommendation focuses upon the importance of new technology (in particular information technology) in making the health system more efficient and cost-effective. Reforms include the development and implementation of an electronic health record, and a debit-style electronic health card to track and improve health outcomes.
  • Encourage Choice, Competition and Accountability: The fifth recommendation would impose greater choice, competition, and accountability in the health system. Specific reforms include making regional health authorities more accountable and specialized, and blending private health care with public systems.
  • Diversify the Revenue Sources: This recommendation sees governments as the primary financial contributors to health, but also views funding from additional revenue sources as a viable alternative. Suggested reforms include increasing health care premiums and allowing regional health authorities to raise additional revenues.
  • Attracting, Retaining, and Making the Best Use of Health Providers: Suggested reforms include developing a "workforce plan" that defines the roles of various health providers and anticipates future demands on post-secondary education, improving morale, and introducing new approaches for paying physicians.
  • Make Quality the Top Priority for Alberta's Health System: Suggested reforms include the establishment of an "Outcomes Commission" which would measure outcomes, track progress, and report results.
  • Promote Alberta's Health Sector as an Asset to the Province: This crux of this recommendation is to enhance the economic benefits and spinoffs of the health care industry. Suggested reforms include the development of provincial centres of excellence in health research, and the commercialization of new products and services developed through medical research.
  • Establish a Clear Transition Plan: The final recommendation is administrative. Specifically, it calls for continued studies concerning the implementation of the reforms, informing the public when changes occur, and addressing barriers to implementation.

Analysis of the Mazankowski Report

How does the Report fit into the general debate on public health care?

Comparison to Current Health Care System

Does the Mazankowski Report represent a radical shift in health care policy, or does it simply involve making current approaches better? The answer is not that clear. On the one hand, the Report explicitly states that it is committed to the principles of Canada’s contemporary health care policy, in particular, the tenets of the Canada Health Act. Yet, on the other hand, the Report makes some recommendations which, if adopted, would seem to radically alter the health care system.

The Report’s mandate was to make recommendations for reform that were consistent with the Canada Health Act. The Act prohibits user-fees and extra-billing while requiring provincial/territorial health insurance plans to be publicly administered, comprehensive, universal, portable, and accessible. Generally speaking, then, there seems to be a commitment to the basic tenets of Canada’s contemporary health care system.

For more information on the Canada Health Act:

  • Mapleleafweb: The Canada Health Act: Provisions and Administration [insert link when published]

Moreover, the Report explicitly states that Albertans should continue to have fair and equitable access to health services, while regarding governments as the primary funders of health care in the province. Again, these are basic tenets of Canada’s contemporary health care system (although, the Report does not clearly define what it means by such things as “fair” and “equitable,” or governments being the “primary” funders of health care). The Report also highlights several non-controversial reforms, which, if implemented, would not radically alter the current public health care system. These include reducing health costs by promoting the general health of Albertans, searching for ways to maximize health care dollars (without reducing quality of service), and investing in new technologies to increase system efficiencies.

The Report does, however, make several key recommendations that might significantly alter the foundation of the current public health care system. For example, the Report suggests that more competition should be introduced in the system as a means of improving innovation, quality, and patient choice. Moreover, it suggests that increased participation by private medical providers would enhance this competition. Such a reform, however, pushes the boundaries of the traditional Canadian health system, which is, to a large extent, a public-monopoly of government health insurance plans and health providers (at least, in the context of medically necessary and hospital-provided health services).

The Report also makes several recommendations that may, in fact, be construed as violating the Canada Health Act. For example, the Report suggests that health authorities should be allowed to diversify their revenue streams beyond direct government funding. One might perceive this as opening the door to user fees, which are prohibited under the Canada Health Act. The Report also recommends re-thinking what services would be provided under Alberta’s public health insurance plan. Extensive de-listing of medical services could be a violation of the comprehensive requirement of the Canada Health Act.

Market-consumerism and Health Care

It is also important to draw attention to the basic language used by the Report, which provide some indication of what sort of health care system it is advocating. In several places, the Report discusses health care in terms common to market economics and consumerism. For example, it often talks about patients as “customers” of health care, whom should be provided with greater “consumer choice.” Moreover, it often references the health care system in terms of market dynamics, with different health providers “competing” with one another for “customer business.”

This type of language differs significantly from other approaches that view health care more in terms of a publicly provided, citizenship-based good. Under this alternative view, the focus is not on market competition and consumer choice, but on “social cooperation” and “citizen entitlements” to a certain standard of health care. Moreover, this sort of language is more closely associated with health care systems that are funded and administered by public entities (such as governments), than those based on competition between private medical service providers.

The point here is not to condemn or praise the Report for this language of market-consumerism, but simply to raise attention to the fact that there are different means of talking about health care. Moreover, these different languages often involve very different priorities for the health care system. The Mazankowski Report uses the language of market-consumerism, and, as a result, seems to place great emphasis on elements such as consumer choice and market competition in its suggested approach to reforming Alberta’s health care system.

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