Health Minister Adriana LaGrange published an op-ed in the Edmonton Journal yesterday, claiming that “AHS is shouldering a burden it was not intended to carry”, because it “has evolved beyond its original acute-care hospital system mandate.” This logic, to Minister LaGrange (and her boss), justifies their plan to shrink AHS and decentralize Alberta’s healthcare system, downloading decisions to “local decision-making”.

Two problems arise here: Firstly, her view of AHS’ origin story is, in the words of the Director of Labour Relations for the United Nurses of Alberta, “[a]bsolute fiction“.

The second is that it invokes a common myth of healthcare reform, that the problems in the system arise from having the wrong amount of centralization (either too much or too little), focusing reform on its administrative structure instead of on correcting deficiencies in the substantive delivery of care.

In fact, the real origin story of AHS was the same kind of administrative shuffle because of failures of a decentralized system: AHS was formed in 2008, announced by then-Health Minister Ron Liepert as “a single, centralized health authority” – or a “health superboard”, as it was described shortly afterward in the Edmonton Journal – which replaced the prior model of nine regional health boards throughout the Province. This followed years of healthcare cuts by Ralph Klein and the closure of three hospitals by the Calgary Regional Health Authority (one of which was leased to a for-profit health group).

Ontario has a similar history of swinging between decentralized and centralized models: In 2004, Liberal Premier Dalton McGuinty announced that administration of healthcare would be downloaded from the Ministry at the Province-wide level to 14 “Local Health Integration Networks”, or “LHINs”.

The LHIN model had issues, including that their governance could be pretty unprofessional from time to time, and a 2015 Auditor General report finding a series of failures of the LHIN system to meet (or even really identify) its objectives.

In 2011, the Chair of one of the LHIN boards (and a retired cardiac surgeon) was quoted as expressing skepticism about replacement of the LHIN system – because replacing an administration system is disruptive to delivery (and that it had taken a decade to replace the old system in the first place), and politicization of healthcare was creating a “stop and go system”.

In 2014, Ontario PC leader Tim Hudak campaigned (unsuccessfully) on further decentralization, wanting to replace the 14 LHINs with 30-40 local health ‘hubs’.

In 2019, the Ford government went in the opposition direction, uploading much of the LHIN system’s mandate to a Provincial agency known as “Ontario Health”.

(Note that, in the same we’re reviewing in this article, both the past centralization moves of Alberta and Ontario have been by conservative governments. This is not really a partisan question.)

In short, while there’s no indication as to what the UCP plans to replace AHS with, there’s no reason to think that a decentralized model will be more capable of curing the deficiencies in healthcare delivery than AHS, particularly given Alberta’s past experience with regional health boards and Ontario’s past experience with LHINs. Shuffling around administrative functions (and probably creating more of them in the process) doesn’t create more hospital beds.