Part 1: The Alberta Health Care Insurance Act
On July 6, 2020, the government of Alberta introduced Bill 30: Health Statutes Amendment Act, 2020 (the “Bill) in the legislative assembly. Most of the provisions received Royal Assent on July 29, 2020 and are now law. The government has stated that the Bill was designed to ensure the government can meet its health-care commitments to strengthen public health care so all Albertans have access to high quality, sustainable, person-centred health services. Despite these stated goals, the Bill has been heavily criticised both in the media and by the official opposition. It has been called a “gateway to privatization,” and there are concerns that the Bill will compromise patient care in Alberta.
Given the controversy surrounding the Bill, it is important to gain a clear understanding of what exactly it has changed with respect to healthcare in Alberta. This is the first in a series of communiqués designed to provide a deeper understanding of Bill 30.
The Alberta Health Care Insurance Act
The changes to the Alberta Health Care Insurance Act (“AHCIA”) have been described as modernizing the legislation, including making it easier for physicians to enter into alternative relationship plans for compensation (rather than fee-for-service) and enabling government to effectively contract with a range of organizations to operate medical clinics.
The changes did affect the parts of the AHCIA related to billing for physician services that will impact the relationship between government and organizations that operate medical clinics (other than physicians, dentists or their professional corporations). While the Bill further facilitates such arrangements, it did not create this anew as some commentary has suggested. The government already had the authority under the AHCIA to enter into alternative payment arrangements with physicians and the various organizational structures within which they work. This authority has been utilized for many years by previous governments of all parties to enter into agreements with groups of physicians, including those practicing in clinical or academic settings.
One key change as a result of the Bill is the availability of tools to monitor and enforce physician billings when provided within a corporate structure. The AHCIA provides a means, for example, to reassess payments for physician services if a determination is made that past payments were not in keeping with either fee-for-service parameters or the restrictions in place under alternative payment arrangements. However, unless provided for in contract, the AHCIA did not allow such tools to be used vis-à-vis corporations (other than professional corporations). The amendments have opened up such legislative tools to be used in the context of agreements with incorporated clinics without the need for such details to be included as part of a contractual relationship.
Another key change is the widening of who is now explicitly contemplated as being in a position to receive payment of benefits under the AHCIA. The AHCIA previously contemplated physicians and dentists directly receiving such payments for benefits under the publicly-administered insurance scheme established by the AHCIA. Private healthcare clinics could contract with physicians for the provision of services, but the AHCIA did not explicitly contemplate payments for physician services being made to a non-professional corporation. The Bill changed the AHCIA so that other entities may directly submit claims for benefits and receive payments for such.
Notably, additional changes to the AHCIA were introduced when the Bill went to Committee. The final version of the Bill, as passed, includes provisions allowing the government to disclose payments made to practitioners under the AHCIA for publicly-funded healthcare services. While this disclosure will not reveal the actual take-home compensation of many practitioners, because it will not account for overhead, it has the potential to largely disclose the amount of public dollars spent on physician services and to whom that amount is paid. Other provinces, including B.C., New Brunswick and Manitoba, publish similar figures.
For additional background on Bill 30, see our recent article, and stay tuned for the next part in this series, which will discuss physician surgical services and contracts with chartered (non-hospital) surgical facilities.