A Patient or Just Another Number? How UCP Policies Exacerbate the Crises in Health Care

We called EMS at 3:43 pm.

The clock in the ER waiting room now reads 1:17 a.m.

My eldest child is in anaphylaxis. She is lying across my lap, in and out of consciousness, gagging and vomiting between laboured breaths. When she faints for the third time, I enter a new phase of silent panic: I cannot leave her to alert the triage nurse.

Then, another family’s misfortune comes to my rescue. Another EMS crew has brought in a friend of my daughter, and his mother manages to convince the nurse to re-assess my child. He takes her vitals, crouched down in front of the hard plastic chair we have been occupying for hours. There are no empty seats.

The nurse is concerned, but focused on the fact that she is still breathing. Her condition is not life-threatening, he reassures me. “Hopefully we’ll be able to call her back soon and get her seen by the doctor,” he says.

There are around 60 others in the waiting room — infants, toddlers, teens, their parents, a few siblings with nowhere else to go. Everyone is tired. We wait another 90 minutes before her name is called. When we leave three hours later, many of them are still there. 

How we got here

Wait times in Alberta emergency rooms are increasing dramatically, along with those in many other provinces. My experience in the ER is neither unique nor exceptional — and, sadly, not even the worst-case scenario. But as a health policy researcher as well as a parent, during these long hours in the ER fearing that my child might stop breathing, I am thinking about all the ways that our health-care system is connected, about what had brought all those other parents to this room, and about all the wrong turns that brought us here as a province.

Since 2023, drastic changes have been implemented in Alberta’s health-care system — most notably, the dismantling of Alberta Health Services (AHS) and the unravelling of nearly every aspect of integrated health care. This literal disintegration came fast on the heels of multiple, compounding disruptions, including the bewildering in-or-out attempt to privatize all community laboratory services in the province and the redistribution of public resources to for-profit surgical contractors.

It was also initiated in the context of ongoing pressures induced by the pandemic — chronic short-staffing, historically high rates of burnout and turnover, and ever-increasing demand. In the last few weeks alone, the UCP government has announced the implementation of three further policies that together enact a fundamental shift in how health care will be delivered, funded, and accessed.

These are not isolated things. These policies do not merely exist on paper, in the cloud, or in the government’s budget ledgers. They are made real, tangible, and life-changing in ERs across the province.

'Patient-focused' funding: Who really benefits 

On June 1, 2026, the UCP government announced the implementation of its ‘patient-focused’ funding (PFF) model for hospitals. More commonly referred to as activity-based funding (ABF), the model can, under the right conditions and with appropriate guidelines and good intentions, incentivize hospitals to deliver targeted services more efficiently, faster, or in greater volumes. The euphemistically branded PFF purports to have public funds ‘follow the patient.’

Under the ABF model, hospitals will be paid based on the number of each type of service they deliver. This contrasts with the current ‘global’ budget model, under which hospitals receive a fixed amount to cover all of their operating costs (in both senses of the word). In theory, the legislation pertaining to ABF or patient-focused funding, introduced in 2025, would in the future also apply to non-hospital facilities such as chartered surgical facilities (CSFs) — effectively removing the “maximum contract value” that acts as a de facto cap on billing in existing contracts.

So what is the real goal of ABF, and who is meant to benefit from this change?

This is what Premier Smith says:

“The current global budgeting model has no incentives to increase volume, no accountability and no cost predictability for taxpayers. By switching to an activity-based funding model, our health care system will have built-in incentives to increase volume with high quality, cost predictability for taxpayers and accountability for all providers.”

According to a press release from the office of Hospitals and Surgical Health Services Minister Adriana LaGrange, “Patient-focused funding is about making sure resources follow the patient and the care being delivered.”

However, as explained in a systematic review of ABF models co-authored by Dr. Danielle Martin (now MP for Toronto University-Rosedale),

“What are those alleged benefits? Enthusiasts point to evidence that ABF can reduce costs per episode of care or improve efficiency, reduce length of stay, and reduce wait times; they also claim that a culture change, by which patients are seen not as cost centres but as revenue generators, is needed in Canadian health care. To elaborate, by fostering competition for patients between hospitals, ABF theoretically provides hospitals with financial incentives to increase efficiency.” 

Despite the Smith government’s protestations, their version of ABF essentially functions as a voucher system with all the accompanying harms. Moreover, on the floor of the Legislature they have also stated that a more overt voucher scheme is in development.  The model risks inflating costs, as private providers seek to build in a profit margin on top of government funding. Press releases and agency websites blithely wave away suggestions of impacts to care as speed and volume are prioritized over quality — promising that “Hospitals that treat more patients receive more funding, creating an incentive to increase volumes where capacity exists” while somehow “still keeping care safe and high quality.”   

Also unaddressed by the minister or the premier is the prospect of hospitals becoming “postcode lotteries” where a local or regional hospital will only offer a limited range of health-care procedures, either because they are the ones that generate the most revenue or because private providers have acquired more resources to perform those procedures over time. 

Private gains, public losses

Following the introduction of legislation in December 2025 to permit Alberta physicians to bill patients privately while continuing to practice within the public — and publicly-funded — system, the Smith government has tripled down on mechanisms to increase surgical volumes by shifting resources and incentives to for-profit providers. Dual practice equals a two-tier system — it exacerbates inequalities by design.

Taken together, the Alberta Surgical Initiative, ‘patient-focused’ funding, and two-tier dual practice function to realize Premier Smith’s aspiration of a health-care system motivated by ‘competition and fear.’

When self-referral and preferential access for patients paying for diagnostic testing and imaging are added to this mix, the pressures on the health-care system increase further. Those waiting for specialist consultation, cancer treatment, or surgical procedures end up waiting even longer: with test results in hand, patients who pay can then seek treatment before those without the means to do so have even seen the doctor for their conditions. At each stage of their health journey, the public queue gets longer as surgeons, anesthetists, OR nurses, and other staff are pulled between public hospitals and private facilities, or pulled out of the public system entirely.

The most glaring flaw embedded in all of the UCP government’s surgical delivery interventions is that ‘resources’ doesn’t just mean public money, but also OR time and surgical staff — effectively cannibalizing the public system. For the UCP and other proponents of these models, the assumption is that health care is all about the numbers: “Delivering more surgeries, faster,” as the default slogan for the Ministry of Hospital and Surgical Health Services. However, “more surgeries, faster” via a two-tier system means less and slower for all other public health care providers.

What 'patient-focused' looks like in practice 

If we accept the premise that this suite of policy interventions is truly ‘patient focused’, what does the UCP health-care transformation really mean for patients? The headlines on my phone illustrate the consequences of Alberta’s approach to surgical delivery. When 94- year old Audrey McRae (no relation to the author) broke her hip in a fall, she and her family faced roadblocks to timely care at multiple points in her health journey: after being taken by her family to the local hospital, Audrey waited overnight to be transferred by ambulance to the nearest regional hospital. But, as her daughter explained in an interview with CTV,

“We had to get her X-rayed there. And then we couldn’t get an ambulance, so she lay in emergency there overnight because that hospital was at capacity as well.” But the waiting had only just started — McRae didn’t get into emergency surgery until Sunday morning, nearly four days after her fall.

McRae’s family says the ER was being serviced by just one surgeon.

The wait times for emergency hip fracture repair are a key indicator for health systems, and in Alberta, it has been inversely correlated to wait times for elective hip replacement. Hip fractures of this kind frequently lead to reduced mobility and loss of independence for seniors — meaning that, in addition to the agonizing wait for surgery, they may face additional waits for community supports or space in a long-term care facility. The beds these seniors occupy then set off a domino effect across the hospitals: one fewer person can be admitted as an inpatient, which means they remain in the ER (in a room, in a hallway, in a closet), which also means those in the waiting room cannot be seen until a bed opens up. My daughter’s long hours in the waiting room are inextricably connected to Audrey’s delayed surgery. And both are the result of political choices.

That same week, an Edmonton man experiencing an urgent complication following knee surgery was sent to the ER in a taxi, after being advised that there were no ambulances available. In a fortnight dominated by headlines about a bizarre rebranding campaign for EMS and votes by seven municipalities on a provincial ultimatum regarding cuts to integrated ambulance and fire rescue services, this incident was framed, justifiably, as a story about pressures on ambulance services. However, an equally distressing aspect was overlooked: whether the patient received his surgery in a hospital or a CSF, when facing severe and urgent complications, he was directed to a public hospital.

CSFs are neither equipped nor legislated to address post-operative complications. This means that mistakes, easy to make in a high-volume atmosphere such as CSFs, are resolved and paid for with public resources, while those making the errors get to keep their profits. Evidence from the UK showed this pattern, which was exacerbated by ABF: surgical facilities contracted to deliver low-complexity elective procedures got more funding than the nearby NHS hospitals received for fixing the complications.

The province’s goal of increasing elective orthopedic procedures has also come at a cost to cancer patients. Despite increasing volumes of less-complex elective procedures, the median wait times for the top five cancer surgeries in Alberta all increased between 2019 and 2026, while the percentage of patients undergoing surgery within the recommended wait times declined almost across the board. This demonstrates that “more surgeries” doesn’t always equal “faster” — and certainly not “faster” for the majority of patients waiting.

This week, the government announced a new 10-year strategy to improve cancer care for Albertans — but without any additional funding to support the implementation of the recommended measures. The aspirational plan also fails to acknowledge how many of its recommendations, such as increased and earlier access to screening, have been made more difficult by the government’s own two-tier policies.

Upstream cuts, downstream crisis

As I looked around the ER waiting room, I saw yet more evidence of the human cost of these policies and how access to quality care is woven together through every part of the system. More and more, children with respiratory virus complications end up in emergency care, compounded in no small part by the undermining of preventative health programs and the lack of timely access to a family doctor.

Between 2019 and 2024 (the most recent year for which Alberta provides data), childhood coverage rates for nearly every routine vaccination have significantly decreased. Among the general population,  influenza vaccination coverage has seen a drop of 17% since 2021/22. As yet another Chief Medical Officer leaves their role and public health inspectors are being laid off to accommodate Premier Smith’s "restructuring" of the health system, easily preventable illness becomes just another casualty of systemic disorder and fragmentation.

In the long hours of our wait, I saw teens arriving on ambulance stretchers, in the throes of panic attacks, with wrists bandaged, or in other visible expressions of emotional distress. The links between cuts to mental health and disability benefits, early intervention programs, and years-long backlogs of families applying for disability supports for their children mean that access is further constrained.

When challenges that could have been mitigated with early intervention programs reach a crisis point, the ER is often the only option. Recent data from the Canadian Institute for Health Information found that, as access to upstream care is diminished, patients across the country are having to wait until they present with more urgent and more complex conditions to be seen by a health-care professional.  

As health policy scholar Andrew Longhurst asserts, “Emergency room wait times are a canary in the coal mine for health care system performance.” And as patients die tragically and preventably in waiting rooms, the fate of the canary tells us that all of these policies are closing doors at earlier, less expensive, and less urgent points of care, placing unsustainable pressures on hospital ERs.

So, since PFF is all about the numbers, let’s take this opportunity to look closely and critically at the numbers that matter to Albertans like my daughter. Here are some examples taken from her recent interactions with the health-care system:

●    9 months waiting for a specialist consultation following referral
●    8 trips to the ER for anaphylactic reactions
●    7 calls to 911 resulting in EMS dispatch
●    6 concurrent fire crews dispatched due to delayed ambulance response
●    5 episodes in which she was seen within 1 hour of ER arrival
●    4-hour average wait 
●    3 weeks to book a GP appointment
●    2 episodes in which she left the ER without being seen
●    1 moment away from being another tragic headline

False assurances and missing guardrails  

Minister LaGrange assures Albertans that emergency health-care procedures will always be prioritized. This is blatantly false. Taken individually and together, the government’s implementation of the Alberta Surgical Initiative (publicly-funded procedures contracted out to for-profit providers), the ‘dual practice’ system, and the adoption of the ABF/PFF model, all explicitly prioritize a handful of elective surgical procedures over every other aspect of health care utilized by Albertans.

The Alberta government does so through policy, through legislation, through redirection and redistribution of funding, through control of publicly-funded OR spaces, and through implicit and overt pressure on surgeons and anesthetists to commit time in CSFs. It does so in the slogans behind which its own ministers stand to sell these changes: “more surgeries, faster” or “patient choice, better access to care.”

These programs, by their very design, succeed at the expense of the emergency, complex, and unprofitable care delivered throughout the public health system. And the data we have — from here in Alberta, from other provinces foolishly following us into the abyss, and from jurisdictions that have undercut the foundations of their own public systems with similar initiatives — makes it clear: you can either incentivize speed and volume or quality and equity. Not both.

For a government that loudly professes to be prioritizing emergency and necessary care, they have also failed — repeatedly — to ensure that the most basic safeguards are in place. Six months after the tragic death of an Edmonton man who waited hours in the ER to be seen, the recommendations from a review into his death still have not been implemented, and the creation of a new triage liaison physician role to alleviate waiting room pressures and ensure the most critical patients are not overlooked has instead been turned into a political football.

The so-called ‘guardrails’ being attached to the new two-tier surgical practice are so vague as to be meaningless, and any targeted requirements will be set by the Ministry of Hospitals and Surgical Health Services and Acute Care Alberta — political, not medical decision-makers. While Minister LaGrange says that family doctors will be excluded from the dual practice model — except when they have a subspecialty in anesthesia or surgery — these are the very roles that are currently facing severe staffing pressures in Alberta.

Moreover, successive ministers of health — and now Hospital and Surgical Health Services — have resisted calls to invest in evidence-based solutions that would both realize capacity within the existing public system and enhance its ability to deliver quality care. Public health expert Babatope Adebiyi emphasizes this approach in a recent article for the medical journal The Lancet: “Reducing surgical backlogs is legitimate, but solutions should strengthen, not fragment, the public system. Evidence-informed alternatives include expanding operating-room hours, improving perioperative efficiency, and addressing staffing.”

Orthopedic surgical residents at the Royal Alexandra Hospital have seen their contracts expire without renewal due to a dispute over compensation for pre- and post-operative care. The government's "priority’ was for “a cost-neutral solution” — one that wouldn’t add to their budget bottom line, but would be absorbed by the surgeons delivering the care. The resulting lack of available staff supervision forced the cancellation of thousands of surgeries, and 18 months later, we know very little about whether the standoff has been resolved. And yet, the Royal Alexandra will be included as one of the 12 initial sites to implement ABF for those very same orthopedic procedures.

Health systems scholars also point to the most fundamental solutions for reducing ER wait times: alleviating hospital capacity pressures by ensuring sufficient bed space and staffing, improving working conditions for health-care workers to reduce burnout and illness that exacerbate short-staffing, and prioritizing patient flow and coordination of care through the hospital and the wider health-care system. These measures imply the exact opposite of dismantling the health-care system and erecting silos with gatekeepers and roadblocks at every access point.

A deluge of damaging policy

Physicians, health systems scholars, and advocates of quality and truly universal public health care Braden Manns and Danyaal Raza stated in response to this deluge of damaging policy: “Every day, health-care workers across Canada hold a strained system together. Last week, Alberta’s political leadership made their job harder.” Sadly, that statement could be made about any given week since the premier announced her intention to “refocus” Alberta’s health-care system.

In doing so against all evidence of the harms being perpetrated by their interventions in health care, the Smith government does not get to impose even more destruction in the guise of market-based “solutions.”

An old proverb warns that, “for want of a nail, the shoe was lost; for want of a shoe, the horse was lost; for want of a horse, the battle was lost…” While this government is trying to win battles by starting bidding wars over our health care, Albertans like my daughter are left desperately seeking horseshoes.

In the hospital corridor, as my daughter waits on an ambulance gurney to be triaged, I apologize to the paramedics. There are two crews ahead of us, two other kids on gurneys. I feel an incredible burden of guilt for this enforced downtime, when I am all too aware of how many other Albertans are waiting anxiously for an ambulance to arrive; guilt for the fire crews diverted from fighting literal fires due to lengthening ambulance response times; guilt for the chair I will occupy in the crowded room of exhausted parents. Because none of this needed to happen. With a next-day appointment to her family doctor, a timely referral to an allergy specialist, an emergency care system with adequate resources to respond to emergencies, preventative efforts to reduce the need for those calls, or a hospital system with the ability to assess patients quickly and effectively, my daughter wouldn’t be here. She would be at home, at school, planning her future. Instead, she is a number that doesn’t add up, in a system being stripped of its capacity to make patients count.

 

Photo credit: Rebecca Graff-McRae