Government & Medicine

Why can't we all just get along?

Alberta bucks a Canada-wide trend and sets the stage for physicians and government to work with � rather than against � each other

By Hugh W Coulthart

Imagine a place where doctors are treated as knowledgeable partners in designing healthcare reform. Imagine doctor-government negotiations that take common interest as their starting point and consensus as their endgame. Imagine a group of doctors who are actually optimistic about the future of medicine in their province and their relationship with the health ministry and regional authorities. Finally, picture the lone-cowboy province taking the lead in creating this new kind of partnership.

In contrast to the heated battles going on in many provinces, negotiations for Alberta's 2003 agreement, ratified in December, managed to break the adversarial mindset. In an uncommon spirit of collaboration, the stage was set for physicians in Alberta to work with government and regional health authorities in the management of healthcare reform. "It gives us a measure of independence," Alberta Medical Association (AMA) President Dr Brendan J Bunting said of the agreement. "If we get to determine our destiny, we feel better about things."

CONFLICT IN QUEBEC
Elsewhere in the country, the issue of what role physicians play in healthcare design has moved front and centre. Quebec doctors have come out strongly against Bill 38, tabled late last year. They feel the bill would compromise the independence of the profession, eliminate their role as advisors, and politicize the health reform process. The bill's creators want to instate a Commissioner of Health and Welfare charged with monitoring these services and recommending changes. But the government would appoint the post, a fact that makes Quebec physician groups wonder how independent the office would be.

Another concern is the proposed abolition of the Conseil M�dical du Qu�bec, a body of physicians, nurses and pharmacists created in 1993 to advise the minister on the functioning and reform of the healthcare system. Dr Yves Dugr�, president of the F�d�ration des M�decins Sp�cialistes du Qu�bec told the Parliamentary Commission that its abolition is "to dismiss, out of hand, the expertise of physicians and other health professionals."

Despite these problems, the situation in Quebec is more optimistic. For one thing, Health and Welfare Minister Philippe Couillard is by profession a neurosurgeon. And both Dr Dugr� and Dr Patrick Garceau, president of the F�d�ration des M�decins R�sidents du Qu�bec, are confident that Mr Couillard will amend Bill 38.

THE OMA GOES TO BAT
Meanwhile, over the border the Ontario Medical Association (OMA) is battling threats posed by the government's Commitment to the Future of Medicare Act, tabled as Bill 8. The OMA fears that measures intended to improve public access to healthcare will interfere with the delivery of services and those intended to introduce accountability expose physicians to arbitrary liability without due process of law.

INNOVATION IN WILD ROSE COUNTRY
The Alberta agreement broke new ground by incorporating a mechanism for primary healthcare reform and by including the province's nine regional health authorities in the process. Since the agreement contemplates changes that will take time to implement, its term was set at eight years, with financial aspects to be re-opened in the third and fifth years.

Equally innovative is the committee structure set out for management of the agreement. It shifts responsibility for primary care reform to the frontline interface between physicians, the local delivery systems of regional health authorities and patients. The Primary Care Initiative Committee is now soliciting proposals from teams of physicians and their professional colleagues that will help tailor services to the needs of well-defined patient groups.