Albertans will face a 50-per-cent jump in health premiums over the next two years if the Klein government follows through on sweeping internal proposals to implement last month's Mazankowski report.
Confidential documents obtained by The Journal also indicate the government is considering cost savings worth nearly $50 million. These would be obtained by chopping certain insured medical services and seniors' and widows' benefits.
In addition, the government is contemplating a radical restructuring of the province's ambulance system, according to the documents prepared for Alberta's Department of Health and Wellness.
The proposed changes are consistent with the government's drive to squeeze more money from patients and reform the medical system in the face of what it considers unsustainable cost increases.
The health-care premium hike could be included in next month's budget. A 50-per-cent increase would pump an extra $300 million into government coffers by 2003, say the leaked reports, prepared by government bureaucrats in mid-January for Health Minister Gary Mar.
The reports also propose "cost containment initiatives" that involve stripping Albertans of $34 million in chiropractic and podiatry benefits, cutting $10 million in eyeglass and dental benefits for better-off seniors and widows, and eliminating $5 million in medical equipment supplies such as wheelchairs for 28,000 disabled Albertans.
Yet another confidential report, prepared for Mar, Human Resources and Employment Minister Clint Dunford and Municipal Affairs Minister Guy Boutilier, says paramedic services should be funded by a new provincial superboard. Currently, municipalities pay for and run ambulances.
The report also insists Alberta's labour laws be changed so paramedics and emergency medical technicians are subject to compulsory arbitration during labour disputes. That revelation follows years of occasional labour unrest, including a tense situation last spring in Edmonton when Dunford declared a public emergency to halt local paramedics' three days of intermittent illegal walkouts.
Alberta Health spokesman Michael Shields, who said he has seen copies of the minister's reports obtained by The Journal, insisted they were "draft material" and "an early analysis of these issues." He noted the documents were not signed by Mar.
He also said the numbers cited in the documents could "most definitely" change by the time Mar makes final policy decisions regarding premiums, medical program changes and the ambulance system.
Shields noted an expert advisory panel will be appointed by Mar at the Mazankowski report's behest to consider which services to de-list from Alberta's health insurance plan.
"Areas such as chiropractic and podiatry will be part of the job of the expert advisory panel," he said. "They're charged with the responsibility of reviewing that."
Still, Shields did not deny that the exact proposals outlined in the confidential reports could one day be adopted as government policy.
Seniors Won't Be Spared
If they are, a single Albertan who currently pays $408 a year in health premiums would pay $576 annually starting April 1, and $612 effective April 1, 2003. A family with an $816 yearly bill would shell out $1,152 this April and $1,224 the following April.
Seniors who don't apply for low-income premium exemptions would also be forced to swallow the same increase. This would occur despite a 1996 cabinet decree that premiums "would not be increased for seniors in the future, regardless of any other increases that would apply to the public," the report notes.
The 50-per-cent increase is beyond previous estimates given by Premier Ralph Klein, who mused Albertans could expect hikes of 20 per cent to 40 per cent.
The reports say the drastic increase is needed to offset spiralling health spending, which could "take up half of all program spending by 2008."
Premium revenue would pay 21 per cent of the amount the province spends on insured health services such as doctor and hospital care, up from the current 11 per cent, according to the report.
"The proposed changes will help to ensure the sustainability of the health system while protecting the needs of low-income Albertans," the report says.
Another document acknowledges the proposed $49-million cut to insured services and benefits could provoke "a negative reaction from those affected."
The report suggests the $200 yearly chiropractic benefit and $250 annual podiatry benefit be revoked for all Albertans save widows and seniors. It recommends coverage for back and foot treatments be introduced by Alberta Blue Cross, a not-for-profit supplementary health insurance plan.
That would save $34 million.
"Coverage for (these) services ... are not required under the Canada Health Act and are therefore provided at the discretion of the province," the report takes special pains to point out.
It also says Extended Health Benefits for eyeglasses and dental care be yanked from seniors and widows who don't pass an income test. Those who no longer qualify could purchase coverage "through private insurance," the report says.
That would save $10 million.
It also says the Alberta Aids to Daily Living program should be scaled back from its current 86,000 recipients to 58,000 Albertans who have low incomes or reliance on other programs such as Assured Income for the Severely Handicapped.
Changes would also be made "to reduce the frequency or volumes of some benefits." For example, people would be eligible for beds, lifts and wheelchairs once every five years instead of once every four years.
That would save $5 million.
"The recommendations to discontinue or reduce these benefits/services are in no way a reflection on the government's opinion of the beneficial outcome or value these treatments or services provide," the report says.
Ambulance Services
Another report says the province would have to spend an extra $23 million to assume control of Alberta's $106-million ambulance system. Those inflated costs and a provincial ambulance superboard, the report suggests, would be funded by Alberta Health, user charges and other sources, including cancelled municipal grants.
The maximum charge for an ambulance service would fall to $200. In Edmonton, an ambulance ride to a hospital costs patients $297.
It appears the ambulance recommendations are lifted directly from an MLA review of emergency medical services. That would indicate they are more set in stone than other proposals outlined in the documents.
"The ministers (Mar, Dunford and Boutilier) endorse the (MLA) report and agree that implementing the report's recommendations will improve this important health service," the confidential document says.
HIGHLIGHTS
Health premiums:
- Current $34-per-month premiums for singles would rise to $48 on April 1 this year and to $51 on April 1, 2003
- Current $68-per-month premiums for families would rise to $96 on April 1 this year and $102 on April 1, 2003
Service Reductions:
- Chiropractic and podiatry services coverage cuts of $34 million
- Extended health benefits cuts of $10 million
- Alberta Aids to Daily Living cut of $5 million
OTHER HIGHLIGHTS
- Health premium increases would raise $300 million in additional revenue in 2002/2003
- $275 million of the premium increase will be passed on to regional health authorities
- $25 million will be set aside to offset increased premium costs for municipalities, universities, schools and hospitals
- There will be no changes to qualifications for subsidized premiums
- Cuts due to reductions in health insurance coverage for services not deemed to be medically required under Canada Health Act will carry a total savings of $49 million annually. It will be reallocated to regional health authorities
Changes to ambulance delivery services:
- The province would create an emergency medical services board with ambulance service funded provincially
- "formal partnerships" will be created between regional health authorities and municipalities to govern services
- Maximum charge for ambulance services will be set at $200, down from $297 currently in Edmonton
- The estimated cost for the emergency medical services system would be $129 million per year, an increase of $23 million
- $11 million will be collected from user charges
- Changes to labour legislation so that emergency medical services workers and their employers will be subject to compulsory arbitration
