May 5, 1997 Health DSS17 Title: Monday, May 5, 1997 Des.subcom: Health Date: 97/05/05 8:04 a.m. [Mrs. Forsyth in the chair] Designated Supply Subcommittee – Health Forsyth, Heather, Chairman Barrett, Pam Broda, Dave Clegg, Glen Dickson, Gary, QC Doerksen, Victor P. Fritz, Mrs. Yvonne Sapers, Mr. Howard Severtson, Mr. Gary Sloan, Linda Tarchuk, Janis Thurber, Mr. Tom G. THE CHAIRMAN: We have a procedural motion that is required prior to commencement of our meeting, and I'll read it.

Be it resolved that the designated supply subcommittee on Health allocate the four hours allotted to it pursuant to Standing Order 56(7)(

b) as follows: (

a) the minister responsible first addresses the subcommittee for a maximum of 20 minutes; (

b) oppositi on subcommittee members then have one hour for questions and answers; (

c) government subcommittee members then have one hour for questions and answers; (

d) opposition subcommittee members then have one hour for questions and answers; (

e) opposition subcommittee time of 120 minutes total will be split 90-10, with the third party New Democrats receiving a block of 12 minutes to be used in either opposition hour; (

f) government subcommittee members have the remainder, and once those government members have finished their questions, the meeting is concluded. I would invite someone to move this motion. Dave Broda? Is the motion carried then? HON. MEMBERS: Agreed. THE CHAIRMAN: I would remind that in order to conclude prior to the four hours allocated under Standing Orders 56 and 57, unanimous consent will be required. Failure to obtain unanimous consent for adjournment prior to four hours would be inconsistent with the undertaking by the House leaders in their agreement dated April 22 and 29, 1997.

Before we get started, we have a request from the hon. Member for Calgary-Buffalo that he's asked me to bring forward as chair. It's addressed to myself. It says: Pursuant to Standing Order 56(4) I request that the Assistant Deputy Minister of the Hea lth Information and Accountability

section (Mary Gibson) attend the subcommittee meeting scheduled for Monday, May 5, 1997, at 8:00 a.m. Thank you. It's signed by Mr. Dickson. As chair I just received this about 2 minutes before 8 when I came in. Mr. Minister. MR. JONSON: Well, Madam Chairman, certainly we always try to co-operate with having all necessary personnel here from my department, but having just been notified of this particular request, that's impossible this morning. MR. DICKSON: Madam Chairman, I might add that I appreciate that it's short notice.

In fact, the decision I made only yesterday that I'd make the request, and I faxed a copy of the notice to your office yesterday, but I appreciate that you haven't had a chance to see it. I made the request, but I expect that the minister can take back the questions and no doubt will contact this particular individual in any event in terms of providing a response. I just simply thought it would expedite some of the follow-up questions if before the end of our four hours this morning it were possible for that individual to attend. THE CHAIRMAN: Mrs. Fritz. MRS. FRITZ: Thank you, Madam Chairman.

I just had a question for the hon. member. Does the employee know that the request was being made? THE CHAIRMAN: Do I know? MRS. FRITZ: No. The employee. I'm just asking the Member for Calgary-Buffalo, Madam Chairman, not you. MR. DICKSON: Well, no, but as I understand the protocol, it's only the chair that can make the request. It's not up to a member to individually start contacting members of the department. I wanted to respect the protocol, which meant through the chair, to the minister, and that's been done. Thank you. THE CHAIRMAN: Mr. Minister, you have the floor now. Thank you. MR.

JONSON: Thank you, Madam Chairman. First of all, I'd like to introduce to members of the committee two members of Alberta Health staff. Seated on my left is Jack Davis, deputy minister, and on my right, Aslam Bhatti, director of finance and all things dealing with money. I appreciate the opportunity to present and discuss the estimates of the Department of Health for the fiscal year 1997-98 with the committee.

First, just to give a bit of perspective to the estimates that we will be looking at today, I'd like to point out that Alberta Health's system has undergone significant changes over the past four years, changes that involve both reducing out-of-control health spending and restructuring the way we govern, administer, and deliver health services. Now many of the major changes of health restructuring have been completed. Spending reductions are over, and indeed we are seeing significant reinvestment in key areas of the health sector.

I don't want to suggest that the changes of the past four years have been easy or that change will not continue, because changes always get difficult, yet it must continue to some degree to ensure that health reform continues and that our health system continues to evolve to meet the changing health needs of Albertans. The coming year, however, will be one of stability and consolidation.

All of the targeted spending increases and all of the initiatives in the Health business plan are directed at maintaining and improving the quality of health services available to Albertans and the effectiveness and efficiency of the health system as a whole. This year's estimates show an increase of 3.9 percent, or $148 million, over 1996-97 expenditure forecasts. This includes a $144

DSS18 Health May 5, 1997 million increase in operating funding and a $4 million increase in capital and will bring total health spending to $3.957 billion. I should note that the spending increases for 1997-98 are in addition to the $196 million increase in health spending in 1996-97. It is important to stress, however, that while we are providing more resources for the health system, we are not returning to the old ways of spending. The additional funding, both last year and this year, is directed toward specific areas of the health system with clearly identified results to be achieved.

We have acknowl- edged that an increasing and aging population in our province results in some pressure points in the health system, and we have taken action to address those pressure points and areas of concern. The program initiatives and funding we announced last Novem- ber as part of our Action on Health package were significant efforts in ensuring access, quality, and stability in our health system. The funding in this year's estimates carries on and complements those initiatives and focuses our attention on the key elements of health care in Alberta.

For example, Madam Chairman, we are providing an additional $20 million this year for provincewide services, those lifesaving procedures such as organ transplants, cardiac surgery, renal dialysis, and neurosur- gery that are performed primarily in Edmonton and Calgary but for the benefit of all Albertans.

This $20 million is in addition to the $57.8 million we added to provincewide services last year, including the $17 million one- time allocation to purchase new equipment and the $41 million to substantially reduce wa iting lists for these critical procedures, waiting lists which, I should add, develop despite the health system performing more of these procedures than ever before. With last year's funding we expect to have waiting lists within nationally accepted standards by this summer.

The $20 million added this year will enable us to address physician and regional health authority costs for potential volume increases this year in these provincewide services. At the same time we acknowledged last year that our increasing and aging population and their increasing need for health services was putting greater pressure on our frontline health workers. Last November, to address this problem, we provided an additional $21.7 million to regional health authorities directly targeted to hiring additional staff.

This year we are providing another $21.8 million, and together this $43.5 million will enable health authorities to hire up to 1,000 more nurses and other frontline staff. These extra staff will relieve the pressure on frontline workers and enhance the quality of care provided to patients whether in acute care hospitals, long-term care centres, or in their own homes and communities through home care. As a third priority this year an additional $105 million is being provided to regional health authorities.

Combined with the funding for frontline staff this ensures every health authority at least a 4 percent increase this year. Together with the implemen- tation of the new population-based funding system this funding now gives regional health authorities a solid, predictable, and stable funding base. It enables the authorities to deal with local pressure points and local priorities ensuring access to quality health care for all Albertans. The estimates we are looking at today also recognize an inherent inequity that existed in our health system in the area of ambulance services.

Albertans requiring emergent medical care will no longer pay the costs of an ambulance transfer from one eligible facility to another facility that provides a higher level of care. Our government is providing $7 million a year in additional funding to pay for ground ambulance transfers for emergency patients including interhospital transfers for nonpatients. This funding will cover transfers when a medical decision is made that the person requires care that isn't available in the first facility, and ground ambulance is medically required for transport.

Currently, Alberta Health funds health authorities for inter- hospital ground ambulance services for inpatients and home ambulance services for seniors and low-income Albertans with all other ambulance costs being the responsibility of individual Albertans or their insurance companies. This additional funding recognizes the changes in hospital services resu lting from restructuring and will ensure a fairer system of payment by Albertans for ambulance services. 8:14 Another priority area recognized in these estimates, Madam Chairman, is the area of drug therapy.

On a regular basis new drugs with major medical value and benefit for patients are emerging onto the market. Unfortunately many of these new drugs are also very, very expensive. This year we are providing an additional $35 million for emerging high-cost drugs. While there are a number of initiatives under way to keep drug costs down in Alberta and while we recognize the high cost of some of these new drugs, we are also committed to ensuring that Albertans have access to proven leading-edge drug therapies.

We also acknowledge that while sometimes drugs are expensive, immediate and effective treatment with drugs can often result in longer term cost savings for the health syst em by eliminating the need for hospitalization and more intrusive and intensive medical interven- tions. Also linked to our priority of providing Albertans with the most advanced level of care is our commitment this year of $7.5 million to purchase new medical equipment.

At the same time that we are providing additional funding to key areas of the health system, reinvestment which I might add is possible only because of our fiscal responsibility over the last four years, we are also continuing our efforts to reduce administrative spending and focus our resources on health services for Albertans. Administrative costs in the Ministry of Health have been reduced by over $5 million from last year and staff reduced by 245 permanent and nonpermanent employees. We have streamlined the way we do business while focusing on the core responsibilities of government.

Lastly, Madam Chairman, to fu rther ensure stability in the health system, long-term care accommodation rates, already among the lowest in Canada, are being maintained at current levels with no increases this year, and Alberta health care insurance premiums are being maintained at the 1996-97 rates. These premiums will make up about 15 percent of total health expenditure this year. In closing, Madam Chairman, I want to emphasize that the funding increases being requested for 1997-98 are targeted to achieving specific results in the health system.

The funding being provided will ensure that as a government and as a province we meet our continuing commitment to providing a quality and accessible publicly funded health system for all Albertans. Though total health spending is increasing, we remain committed to continuing the process of health system reform, to continuing to find more effective and efficient ways of doing things, and to continuing to improve the quality of care received by Albertans.

Madam Chairman, I believe I have in these opening comments covered most of the major changes, major highlights of the Department of Health's budget for 1997-98, and I now look forward to discussing the elements in further detail. Thank you. THE CHAIRMAN: Thank you, Mr. Minister. Mr. Dickson, you're first.

May 5, 1997 Health DSS19 MR. DICKSON: Thanks, Madam Chairman. Good morning, Mr. Minister. Putting to you an undertaking that had been given several times by your predecessor, and that is that before Alberta implemented a smart card health system, the Department of Health would co-operate with the Information and Privacy Commissioner to ensure that there was a formal, full impact assessment done prior to implementation of the program.

I guess we can quibble over what we mean by smart card, but I think what you and I probably both understand is that it is a means of having personal information consolidated and a vehicle for it readily being accessed by components in the health system. My initial question to you, Mr. Mini ster, is: will you continue the undertaking given by your predecessor, and if not, why not? I'll let you respond to that, Mr. Minister. MR. JONSON: I'm quite willing to do so, Madam Chairman, but I'm just wondering about the procedure here in terms of time allotments.

I wouldn't want to take away from the opposition's time by giving lengthy answers. I can proceed this way; I'm quite comfortable with it. MR. DICKSON: I hadn't wanted to subvert the rules, Madam Chairman. I've got a whole series of sequential questions, and depending on the response to this one, I can hopefully economize a lot of your time, Mr. Minister, for the balance of the morning. THE CHAIRMAN: Mr. Minister, Mr. Dickson has the floor for one hour. At that time we w ill then go to the government members. If he asks a question and you answer in that total of one hour, it's entirely up to you. MR.

JONSON: Madam Chairman, first of all, the smart card as such is not by any means a top or first priority, and in fact there's been no overall decision to go with a smart card system in the specific sense. However, we have two initiatives under way. One is a process of extensive consultation on the development of a parallel piece of legislation to the protection of privacy legisla- tion which would apply specifically to the health system. It's our full intention to table prior to the end of this session draft legislation which would be held over for further examination.

But even before the preparation of that draft legislation, we have been engaged in a consultation process with the overall community on various key issues with respect to protecting health information. Secondly, yes, we are also in a planning process with respect to a modern integrated information network within the health care system. One of the large needs of the future that I think all people looking at health planning agree on is that we need a better, more current database on which to make health care decisions and do health care planning.

So the second initiative is planning for a technology-based modern health information system. MR. DICKSON: Mr. Minister, perhaps I can ask you this – and I don't require responses to the follow-up questions at this time, thanks very much. Will the minister require that in any informa- tion system, personal identifiers will be segregated and scrambled before information is supplied to any other office, department, or agency other than that which acquired the information in the first place?

The other question, I guess, would be whether this government has either entered into an agreement with or solicited any proposal from Smart Health Inc., a wholly owned subsidiary of the Royal Bank of Canada, which has just entered into an agreement with the province of Manitoba and proposes to implement across the country in conjunction with provincial governments a health information management system. The final supplemental question, then, would be whether this government intends to use the personal health information Act of Manitoba as a model for its new Bill in this jurisdiction. MRS.

SLOAN: I actually have a number of categories of questions that I would like to ask the minister this morning, but I'll begin with questions related to the ministry structure. I think it has been well documented and proposed by a variety of stakeholders and the public that the 17 regional health authorities and the structure therein have not been for all intents and purposes efficient, easily managed. I would relate that to the key perfor- mance measures that are utilized by your ministry. I do not see a single measurement that relates to the provision of service in a regional structure.

I wonder why that is, particularly at a time when we have subjected the system to that type of delivery system. Intertwined with that, I would pose the questions related to labour mobility and stability. I do not see any key performance measures that relate to that. We have been through the cyclical cycle of terminating thousands of qualified, well-educated, reliable health care professionals in this province. The majority of them have left the province to work, and now we are in the not at all surprising position of scouring the land for qualified individuals to staff our communities and facilities.

So I would urge the ministry in the construction of subsequent business plans and budgets to intertwine the measures of regional delivery, labour mobility and stability, as an indicator of service. 8:24 MR. SAPERS: Good morning, Mr. Minister, Mr. Davis, and Mr. Bhatti. Thanks for coming out again this morning. It's nice that you've made some opening comments about the reinvestment, but I thought that by now the rhetoric would have stopped about the out-of-control health spending. I can't help but comment on that.

Y ou know and your staff know and the Alberta public know that wasn't the case, and it's been pretty much debunked. I think that as minister you should stop perpetuating that particular myth, particularly when we're talking about your estimates. My first set of questions has to do with program 1, and I'll ask them as a package. I guess I would appreciate a very brief response, and we'll look forward to a more detailed response in writing, as has been the practice.

I note that under line 1.0.10, health plan administration, there's an almost $9 million allocation, which is about $800,000 or so less than last year for health plan administration. I was confused last year and I continue to be confused this year as to why that continues to be separated out, why it's not part of the deputy minister's office, and what exactly is being allocated to justify that separate line item for the $9 million. Does that count in your reduced administration charge, or did you separate it out so that it looks like there's been less spent on administration?

The second question I have about program 1 has to do with the Mental Health Patient Advocate's office. The budget is pretty much status quo. It has increased by a little bit. I'm wondering whether or not you're anticipating changing the status of that office so it can deal with voluntary patients. That's been an ongoing request of that office, the Ombudsman, and of course the opposition. I'm wondering whether this is the year that you're finally going to do the right thing there and include voluntary patients. My next question under program 1 has to do with line 1.0.13,

DSS20 Health May 5, 1997 the Provincial Health Council. A status quo budget, Mr. Minis- ter. I'm surprised about that. It would seem to me that the role of the Provincial Health Council is ever expanding. They've written a couple of excellent papers. Y ou haven't fully responded to the recommendations in their work so far. The throne speech talks about some kind of mental health accountability framework. Dare we call it a health charter? I guess for reasons well known I can understand why the government wouldn't. But it seems to me that the responsibility for that would fall to the Provincial Health Council.

If you could tell us a little bit about how that council is going to do its business, more work with the same budget. Finally, in program 1 the budget reduction for the Public Health Advisory and Appeal Board. Now, it is a small reduction, but it seems to me that with the stated commitment in the business plan, in the throne speech, in presentations that you've made publicly and that the Premier has made publicly, there is this commitment to public health.

Certainly we have a number of environmental concerns that have arisen out of the transfer of responsibilities regarding landfill and the disposal of biomedical waste. I'm wondering how we can afford to spend less money for that body. I'll pause at this point. As I said, I would like some brief response before we continue. MR. JONSON: First of all – I'm going in reverse order, if you don't mind – with respect to both the appeal board that you referred to and the Provincial Health Council, I agree that the functions here are important.

We are committed to providing, in the case of the appeal board, service for appeals. The Provincial Health Council, yes, has done some good work, and they are planning for the upcoming year. Madam Chairman, the point there is that the work or manda te is being fulfilled with the amount of money allocated. In the way we look at things within Health, we are not automatically assuming that because there is a particular issue or issues or work to be done, that has to translate into a budget increase.

I feel that the Provincial Health Council has an adequate budget for the coming year, and the appeal board, as I recall, operated within its budget last year. So we're not automatically tacking on additional money when we think the mandate, the important work can be fulfilled.

With respect to the question about the Mental Health Patient Advocate's office, we have an initiative under way which I think hon. members are aware of, and that is we're looking at and following up on the recommendations of the Provincial Health Council, which did, I think, a very good report on a task that was assigned them by the previous minister. That is to look at an overall more effective and co-ordinated approach to appeals on issues and problems within the health care system in individual cases.

That appeal process, that review, that consultation is currently under way, and we will be coming forth with recom- mendations and actions before too long. With respect to the reference to the health planning administra- tion, if it's acceptable to the committee, I'll ask Mr. Davis to give you the details there. I would like to just say one general thing, and that is that our department is largely an administrative department. There are some direct services that we provide, but the whole thing is administration, if you want to give it that label.

What divisions we establish and who does what is our judgment of how best to fulfill that overall mandate. In terms of the total department's internal funding, we have reduced it significantly. MR. DA VIS: Thank you, Mr. Minister. Since this area falls directly under Mr. Bhatti's responsibility, we might have him comment. I'm sure he'd have the details better than I would. MR. BHATTI: Element 1.0.10, health plan administration, consists of two branches.

One is the claims branch, that processes the claims for physicians and other providers, and the other one is the registration branch, which registers the 2.7 million Alber- tans for health services. Basically, most of the money is in manpower. About $8.5 million of the approximately $9 million is manpower oriented to deal with those issues. We have about 35 million claim items in the claims area and probably about 850,000 telephone calls a year through the registration branch. MR. JONSON: Thank you. MR. DICKSON: Mr. Minister, let's turn our attention to program 2.

About 55 percent of the spending goes to regional health authorities. I've got a couple of questions there. Y ou recall that on April 22 you were asked a question in question period about a population-based funding formula, and you asserted at that time that clearly that was in effect as of April 1, 1997. Y ou also referred – this is at page 98 of Hansard – to a very credible council or committee to monitor the implementa- tion of that formula and to recommend any needed adjustments . . . such as marked growth in particular areas . . . due to our strong economy.

Now, a couple of questions flow from that. 8:34 Firstly, from your comment it appears that even though we have a population-based f unding formula, when population changes, there may be some need to move away from a population-based formula, which to me seems to be a bit of a tautology. Maybe I am misunderstanding what you said on April 22. Perhaps you could make available to us particulars of the formula. It appears that the formula is something more than simply a function of the number of people living in each of the 17 regional health authorities.

I'm wondering whether there is some weighting in terms of age, in terms of income, all of those other variables that we know have a direct impact on the health of a population. My question in sum was: can you provide us with text that identifies very specifically the precise formula that went into effect on April 1, 1997, to apportion funding among and between the regional health authorities? Because on the face of it, when I look at the allocation, it looks to me like there are some weighting factors there, and it's not a straight, flat function of population.

Then my follow-up question would be: when we have as many people as you do working under Mr. Bhatti in the finance and health plan administration, why would you then need another committee to monitor population-based funding? Y ou have regional health authorities who I know on an ongoing basis do plenty of advocacy in terms of what they think their needs are, and they're quick to point out when they think they're not getting the kind of resources they need. Y ou have a very large finance and health plan administration. Why do we need yet another committee, albeit in your words “very credible,” to monitor this?

There may be something there I'm missing, but I'd sure like some clarification from you on that. The final follow-up would be this. We've lost in Alberta I estimate about $160 million with the reduction in the federal transfer payments. Now, given the announcement on April 28 by Ottawa and the increase in the CHST, will that have any impact on the Action on Health program and the undertaking of you, Mr. Minister, and your government to increase funding either in the

May 5, 1997 Health DSS21 current budget year or in 1998-99 or 1999-2000? I know we're dealing with the budget for the current year, but you've clearly referenced the Action on Health plan in your narrative that goes along with the budget. So I'd be interested in a clarification there. Thanks, and I'll turn it over to my colleague. MR. JONSON: Excuse me, if I could interject here for a few seconds on just one item for the assistance of members of the committee. The quite comprehensive report on the funding framework was released in July of last year.

It outlines in some detail the factors that are used in the formula. So I would just draw that to your attention because it does answer, I think, all the questions you have regarding how the formula is structured. MRS. SLOAN: Thank you, Mr. Minister. Just to supplement the questions raised by my colleagues.

In relation to program 2 and the regional delivery, while the ministry claims success with respect to reduction of administrative costs, the ministry's budget in program 2 does not for the opposition or the public's consump- tion give any breakdown as to the administrative and service delivery costs per region. As well, there is no accounting in the ministry's budget tied to that of the accruing deficits that are occurring within the regional struct ure at this point in time. I think both of those figures, statistics, should be available for public consumption.

They should be able to judge for themselves whether or not in fact costs, administratively and for program delivery, have increased or decreased. Without those we're not in a position to be able to do that. I would also like to follow on the questions with respect to the appeals processes that are in program 1. I count there, Mr. Minister, no less than five, I believe, different advisory and appeal mechanisms, some new, some old, for the most part all subjected to decreases in their budget in this fiscal year.

In light of the serious concerns, the increased incidence in reports that have occurred over the last three years, I question why that would be. What degree of, I guess, security and faith can the public place in a process that puts structures in place and then reduces their funding?

I would question those allocations on that basis in hand with the fact that the Provincial Health Council process and report and the recommendations therein, which was marketed across this province by the Premier as the life raft upon which the system would be stabilized, have still not been acted on, in their majority, by this government. Again, I question a status quo budget on that particular budget line 1.0.13.

Is it the govern- ment's intent not to allow that particular body, after all of their work and consultation, to be in a position to implement the recommendations or at least advise the ministry with the recom- mendations? The third topic area that I would like to discuss – and it transcends all of the program areas – is privatization. I again believe for the public's knowledge and consumption it would be worthy to note what the overall costs of privatization of health care delivery services have in fact tallied up to, not only in the last budget year but since it was incepted in 1993.

Certainly we see and hear discussions both in the House and publicly that this government is proposing further privatization. We know that is occurring at a variety of levels. It's occurring within the ministry itself. It's occurring regionally and to some degree at a provincial level. But while all of that discussion is occurring, the ministry fails to provide either in terms of budget figures or performance measures the hard factual data, Mr. Minister, that we as the opposition and the public as the consumers of health care need to know.

Is private health care more efficient, whether that private health care is in the way of having laundry privately cleaned or laboratory services privately delivered? There are many specula- tions out there. I'm simply asking, with all due respect this morning, that those figures be provided to the public by the ministry in order that the public and the regions to some degree can judge whether or not it is efficient use of taxpayers' dollars to contract out health care services at any level in the service plans. Thank you. MR. SAPERS: Mr. Minister, I'm still actually in program 1.

I'm looking at the capital investment: 1.0.5, health information and accountability division, a capital request for in excess of $5 million. I assume that's hardware and software. What I would like to know is: how much of that is software development, if any, if it's being contracted out or outsourced, or whatever the current government phrase is, for the software development, and is this the total amount of capital investment required to accom- modate not just the year 2000 changeover but also the health information system, whether you call it a smart card or whatever it's eventually going to be called?

If the answer to that is no, I'd like to know what additional funding will be required over what time frame. 8:44 Finally on that line element, Mr. Minister, does any of that include hardware and software that'll be given to practitioners or provided in some way to practitioners? As you know, one of the big concerns for medical doctors, for example, is that they will be expected to assume a tremendous cost burden once the govern- ment decides what kind of health information system it wants.

Doctors have told me they're not interested in assuming that burden, either the hardware, the software, or the personnel costs required for the initial inputting or the maintenance of any kind of new database. Still under capital investment but the next line, 1.0.8, health workforce and administrative services. I see that there is no money being requested this year. Why is that? Was the $35 million all spent, and are there no leftover investment needs under that line item? Perhaps I should stop there, b ecause the rest of my questions have to do with program 2. MR. JONSON: Perhaps I could respond to those.

With respect to the question on hardware and the health information system, the $5 million is not the total by any means. We're making a major effort in this particular area, and in looking over the course of the business plan, we're going to be committing more funds to getting that done. None of the money, however, is, as I understand it, for practitioners. It is for developing the overall system in the province. Perhaps I could ask Jack to just give you a quick overview of what is happening and what's in the budget. MR. DA VIS: Thank you.

In a moment I'll ask Aslam to speak to the $5 million, because it falls within a fairly narrow account- ing

interpretation. In terms of the overall system, we're just now in the process of trying to select a suitable health information technology provider to work with us in developing the system and do a full costing analysis. We have a rather large stakeholder committee headed up by Dr. Tom Noseworthy that has representation from the regional health authorities, from the two medical schools as well as from the Alberta Medical Association and the College of Physicians and Surgeons to look exactly at how this system can be scoped out, how it can be made to work, and what the reasonable

DSS22 Health May 5, 1997 costs and reasonable ways are to finance or pay for the system over time. This is going to be a bit of a process. It's a major undertaking, and we do need to be careful as we move forward. We've allocated some money in the budget this year for system design and for a few things that we think are important early initiatives that the system get under way collectively. Unfortu- nately one of them happens to be the year 2000, which is kind of a catch-up and remedial problem and doesn't really move us forward but does need to get done.

We are looking at some other initial areas in the area of telehealth and the pharmacy area. This is a long-term commitment that will need to be carefully managed. In terms of software development within the department, there are always projects that are under way, enhancements or new projects being developed. They have always been undertaken by private-sector companies with the specialty in that particular area. This department and most departments have not done their own software development for years.

Again our major focus this year in the department in terms of software development will be around the year 2000 compliance. We do have a pilot project under way on registry/stakeholder type of activity which will allow providers other than just Alberta Health to put people into the registry system. Aslam, maybe I could turn it over to you in terms of this $5 million and exactly what that means, and I believe as well the $35,000 in 1.0.8. MR. BHATTI: On the first one, going from $488,000 to $5.1 million, basically there is a change in acc ounting policy as to when to recognize the cost of software development.

Previously what we used to do is that if we spent, say, $40,000 developing software, we would expense it in the year that we used the money. The Auditor General has come back and said that anything over $25,000 that enhances the life of a system should be amortized. Basically, we took our operating moneys and put them into capital. So it's really not an addition of more money; it's just changing between an operating vote and a capital vote. MR. SAPERS: So I should be able to find corresponding de- creases in some operating lines, Aslam? MR.

BHATTI: Certainly, and I can walk you through that in the written answer that we give you. MR. SAPERS: That'd be great. MR. BHATTI: That's exactly what's happened there. In terms of 1.0.8, that's $35,000, not $35 million. We had set up a telephone system for STD and TB services, so it was a one- time purchase of equipment, which we did last year. MR. SAPERS: I do have one supplementary, though, arising out of Mr. Davis' answer. I take it, then, that most of that $5 million is in fact system development money. That would be the short- form answer.

I don't want to oversimplify it, but my question about that is: have you included in that estimate at this point, at the ground floor of this development, a global risk assessment of the privacy and security aspects of creating such a massive data set and system? Is that risk assessment under way, and will you be publishing the results of th e risk assessment for some public input? MR. DA VIS: Well, we are currently in the process of selecting a quality assurance group that'll work with us. We do take the complexity and the many issues around this very, very seriously.

That's why we have this large stakeholder committee that was actually appointed by the minister and does make recommenda- tions to the minister on how to proceed with these issues. A request for proposal, which you may have seen a copy of, highlights security as a vital component of the new system. The stakeholder group has been selected, I think purposely, from a group of people that will have those types of concerns. We have a number of physicians. Dr. Tom Noseworthy heads up the committee. We have Dr. Mo Watanabe on the committee, the two deans, the Alberta Medical Association, Dr.

Dosseter from the Health Ethics Network. I think everybody that I've talked to in the system recognizes that this is vital to moving forward from a patient care, research, and administrative perspective but that it can't move forward unless those bases are covered. So that's kind of the long answer, to say that we're looking at these issues and that there will be, as the minister's indicated, extensive reporting on what we're doing, but we're not going to move real fast. There's not something happening every week here because the homework is being done and being done very carefully on this one. MR.

JONSON: Perhaps, Madam Chairman, just very quickly I could cover a series of questions from the previous questioner. The administrative component and the overall expenditure and budget of the regions is tabled in the Legislature through the RHA's financial statement, so this information is available, Madam Chairman, also the deficits and surpluses, of which there are a number. THE CHAIRMAN: Gary, go ahead. MR. DICKSON: Actually, just following up on the last round of questions, I'd specifically ask Mr.

Davis, through the minister and through the chair – I listened carefully to your description of the stakeholders developing the new information management system. As closely as I listened, I couldn't hear anybody identified as being the advocate or the person whose sole interest was protect- ing the privacy of Alberta patients. Everybody else on the committee has a vested and direct interest in the use and applica- tion of information, so I'm just wondering who on that task force is the advocate for the protection of personal privacy. 8:54 A further question, Mr.

Minister, would be: why was it that in the so-called consultation on information management systems for the province, you invited submissions in late December, the cutoff was the end of January 1997, and at least three or four days before the end of the period for submissions your colleague Dr. Oberg was speaking publicly about what the government had decided they would and would not do. So you might share with us what happened to the public consultation process and the extent to which the government intended to modify its plans based on what it heard.

The other point relative to th is whole business of health information. Why, Mr. Minister, would you not ensure that the Information and Privacy Commissioner, who is in fact independ- ent of government, or his delegate would be an integral part of the group that you've put together of stakeholders looking at the management of health information? THE CHAIRMAN: Do you want an answer, Gary? MR. DICKSON: If I can get an answer now, I'd be delighted, Madam Chairman.

May 5, 1997 Health DSS23 MR. JONSON: Well, I'd just comment very quickly. As far as the Information and Privacy Commissioner, certainly we will work with him, but it is not, as I understand his mandate, appropriate that he become an integral part of a policy develop- ment process in government. But in terms of being consulted on key issues and questions which may or may not in the future impact on his role, certainly we are committed to doing that.

It is not – well, I'm just repeating myself, but it has not been the case that we pull the commissioner into a policy development process, because he has to maintain his neutrality and only be able to comment and to critique as necessary. The other item, with respect to the consultation. The consulta- tion was done and is ongoing, really, through the committee. It is very valuable, I think, and its messages are being taken seriously.

In terms of what an individual member of the Legisla- ture may propose as his view is his right and his, I guess, role to do so, but it is not government position in terms of the overall context. My deputy would like to just comment on one further point. MR. DA VIS: On the issue of having somebody at the committee level representing the privacy concerns, the committee recognized the difficulty of coming up with a single individual that could represent all of those concerns but in the end asked Dr. Dosseter from the Health Ethics Network to represent, as best he could, the concerns of the average Albertan.

This committee, I should stress, is working to advise the minister of the technology and health system issues in terms of the legislation. The committee has input into that, but the legislation, as the minister indicated, will be tabled, hopefully in this session, and then sent back up for another round of further detailed public consultation. This committee is not controlling the process around the legislation. They're separate. MR. DICKSON: I guess just a supplementary question coming out of the response. The individual you mentioned I understand has a background, certainly, in medicine and ethics.

What back- ground does that individual have in data protection and what is actually a fairly sophisticated area in terms of protecting and promoting privacy of individual Albertans? MR. DA VIS: Well, if you're referring to him not having a background in the technical elements around protecting data in the system, I would agree.

That is something that we'll be challeng- ing our strategic partner with and also something that our quality assurance consultant will be looking at in terms of what's in place worldwide to deal with the protection issues, which are absolutely a fundamental piece of moving forward with this kind of an issue. MR. JONSON: Madam Chairman, there's one overall point here that we, at least, certainly appreciate. That is that there are two parallel activities here. I think to provide integrity within what we're doing, we need to keep them somewhat separate. That is (

a) to develop the health information protection of privacy legislation and controls, and the development of the overall information system. Certainly the two have to mesh. We are very sincere about wanting to make sure that we have very forward-looking health information legislation and regulations in place. We also want to have the best possible data system for health care planning. MR. DICKSON: I would just say to the minister, Madam Chairman, coming out of those responses, that typically in information management the devil truly is in the detail.

If in fact this task force is looking at the system that's going to be adopted, why wouldn't we build in privacy concerns? This is not, Mr. Minister, on the basis of what I hear, simply a policy group. My understanding is that there's a mandate to look at a system to be able to manage government health information. If in fact it's a question of selecting a system rather than just an abstract policy discussion, then why wouldn't you build in that kind of privacy advocacy, that privacy promotion, right at the front end rather than waiting until after the matter with legislation?

The legislation is general and broad, and the detail is going to be done by way of regulation anyway. THE CHAIRMAN: If I may interject just for a second. Gary, at the beginning when you started talking, you said that you didn't need an answer today. MR. DICKSON: Right. THE CHAIRMAN: So are you requiring answers now, or are you still waiting? We seem to be getting into a bit of debate here. So I need some clarification, as the chair of this committee, whether you want the answers later on, as you earlier indicated, or if you now want them now. MR. DICKSON: No.

I just wanted to take advantage of the fact, Madam Chairman. If the minister and the deputy volunteered some key information, I wanted to follow up now while they were here, but generally I think we're operating on the basis that we expect the answers to come in due course. THE CHAIRMAN: The minister can respond to answers if he needs to clarify something in regards to questions. Are you finished, Gary? MR. DICKSON: Y es, I am. THE CHAIRMAN: Okay. Linda. MRS. SLOAN: Thank you, Madam Chairman.

I would like to just continue on the vein of accountabi lity and perhaps ask the minister to turn to the key performance measures. Then I would like to relate them back to your programs. When I reviewed the program performance measures for the Ministry of Health on page 248, what I came up with was a compilation of subjective opinion measurement and some very I guess creative contrast between – I'll use the example of breast screening rates.

I found it very interesting that the department as a measure would put out their rates of screening on breast cancer, not as a measurement provide the incidence of breast cancer in this province so that in any, I guess, logical fashion we can relate our performance to the actual incidence. Obviously, as well, breast screening is not the only way of attacking this disease. So it seemed to me, using that as one example, the measurements were very, very narrow. 9:04 I also wanted to draw attention to the first, second, and fifth as well as the second-last measurements.

All of those, in my mind, are subjective opinion measurements. I would put this question to the minister. Why would you as a minister, as a department choose to define and measure your performance on the basis of subjective opinions rather than looking at comparable performance measures utilized by not only other provinces but other countries: infant mortality, morbidity, infection rates, readmission rates?

DSS24 Health May 5, 1997 Even if you wanted to add them to all the subjective ones you have now, why would you not use and make those a published statistic upon which the public can base their opinions as to the performance? I guess I would say, Madam Chairman, that the minister has chosen to selectively answer it. He hasn't answered any of my questions yet this morning, but if he's not prepared to answer them this morning, I would request a response in writing. MR. JONSON: Well, Madam Chairman, I was sensitive to the discussion you just had from the chair. THE CHAIRMAN: I just want to interject.

The minister did clearly state at the beginning that he wanted you to have the time of one hour so that you could ask your questions. I don't think he's ignoring the answers; he's giving you your time allotted, which was one hour. MRS. SLOAN: Thank you. The other category of questions that I would like to raise to the minister is with respect to the health foundations.

This is one of the number one growing industries within the health sector in this province, and we see now almost every region in a variety of forms creating private foundations whose sole purpose is to raise additional money to provide health services to regions. In the most recent Auditor General's report the Auditor General made the recommendation that the Department of Health, regional health authorities, and health facility foundations needed to work towards an effective reporting relationship between the founda- tions and health authorities.

He also made the very critical recommendation that the foundations not only need to be in the legislation but perhaps need to be outlined in legislation at more length. I do not see any accounting within the ministry budget of the revenue accrued by health foundations in the province. I think that would be a very useful measurement as the ministry chooses to reduce or to increase health spending.

I think the public, we as the opposition would like to know how much additional money is being funneled to the system to support critical services and the critical purchase of equipment that is coming through the efforts of these foundations. Perhaps it may have been an oversight on my part, but is there any reference to those foundations in this budget in the measurements? If there is not, if my conclusions and review were correct, I would strongly say that the ministry should for the purposes of accountability include those in subse- quent budgets. Thank you. MR. SAPERS: Mr.

Minister, this is maybe going to be a bit of a barrage, because I have a series of questions under program 2. I guess I'll try to get the questions on the table. Maybe during your next hour you could answer some of them since you don't want to take up opposition time. I appreciate that. AN HON. MEMBER: It's our hour. MR. SAPERS: Oh, I hear that we don't have unanimous consent, Mr. Minister, to do that. Under practitioner services, firstly, in program 2, a general question for all of 2.1.

It seems to me that over the three years that the health system has been in some turmoil since the cutbacks began, we in the Legislature have been faced with supplementary estimates in each of those years for practitioner services, whether it be Blue Cross or physician services or what have you. I notice this year we're pretty much looking at status quo if you compare it to the net expense forecast to the end of '97, not compared to the actual '97 budget.

I'd like to know what changes you've made in your department in terms of budget forecasting that give you some certainty this year that the numbers are right, since they've been wrong each and every year for the last three. I say that truly with respect and admiration for the senior staff in your department who have been faced with an almost impossible task of doing the projections given the political mandate they had to survive under. So I'm not being critical at all of Mr.

Bhatti and the people that work so hard to keep the numbers on the right track, but I would like to know what changes you've made and on what basis we can be certain of these numbers. Under provincial programs I notice in 2.2.7, out-of-province hospital services, that the amount of money budgeted is the same this year over what we expect this year's net expense to be. Certainly there has been a lot of media attention to a number of high-profile cases, increasing pressure on people to go out of province because they can't access services that they need here. The issue in my mind is again one of forecasting.

I guess I would like some detail as to how those dollars have been spent. How much of that has been spent as a result of people going through the appeal process? How much of that money has been spent through the normal course of events, if I can put it that way? How much of the money that was in last year's budget remains allocated but not yet spent; in other words, people that may have been approved but are on a waiting list for an organ or something of that nature? Also under provincial programs 2.2.1 1 deals with workforce adjustment programs. No estimates requested, no money requested this year.

Is all the work done in workforce adjust- ment? I was just reading about some more layoffs at the Glenrose. I've been getting updates from some of the other regions telling me about staff dislocation, programs still being shut down as a result of last year's budget cut. We all know that that ball keeps rolling. I'm wondering why your government has backed away from funding workforce adjustment programs. Y ou know, Mr. Minister, that there are many people who have been displaced in this process at all levels of the system.

As the health workforce rebalancing process continues, there's going to be even more displacement. Why would you take that support away from those health care workers now? Under 2.3, which deals specifically with the regional and provincial health authorities, first a general question. Where in this budget is the funding for the boundaries review process, which you confirmed is ongoing? Who exactly is doing that process? What will the cost be of that process? When do you expect it to report? Could you please provide us with terms of reference for this process?

I'm also wondering whether or not you're anticipating expenses related to the election of two-thirds of the regional health authority members and when we can expect to see the breakdown of the projected expense for that. 9:14 Also, under the provincial health authorities, questions have been raised about the population-based funding model.

While it has been articulated in a paper that was released last summer, I'm wondering whether or not you've taken the time to adjust that model based on the criticisms it's received: its inequity to rural Alberta, the difficulties with adjusting for in-and-out migration, the difficulty of costing out the same services because of different overhead charges from one region to another, and also the more general criticisms levied at that model because it failed to properly account for population growth and change in demographics, particularly the aging population and a population that has a

May 5, 1997 Health DSS25 particular bulge, if you'll excuse the expression, of women who are at the peak of their utilization in terms of their age. While the model exists, it's been criticized, and are you responding to that criticism? My last set of questions for the moment – actually, it's my second last – has to do with the Provincial Mental Health Advisory Board under 2.3.19. There's quite a considerable expense related to that board. I understand now that your government has changed its policy, Mr.

Minister, that you're no longer committed to a dollar for dollar return to the community for mental health programs. It used to be that every time a dollar was saved on the institutional side of mental health, your govern- ment had made the commitment that same dollar would be spent in the community. My understanding is that that's no longer the commitment of government or the mandate of the Provincial Mental Health Advisory Board. I'd like some clarification as to why that change of policy, and I would love to be corrected if I've got that wrong.

Also, could you update us on the divestment readiness of the 17 authorities? Which ones are ready to go? THE CHAIRMAN: Hon. member, I'm sorry; I have to interrupt. Y our time is up, your one hour. MR. SAPERS: Y ou interrupted several times with procedural suggestions, Madam Chairman. My calculation is that I have a minute and 42 seconds left, so if I can continue, I'll take advan- tage of my time. THE CHAIRMAN: Do we have agreement? SOME HON. MEMBERS: No. MR.

SAPERS: The past practice has always been that procedural discussions get subtracted from the time allowed for questioning, and I calculated your interventions at a minute and 42 seconds. THE CHAIRMAN: I will let you fi nish this question, and then we're going on to this one. Make it brief, please. MR. SAPERS: Okay. Thanks. The Provincial Mental Health Advisory Board I think we were discussing. I'd like to know which regions are prepared, which aren't, and how you are responding to those regions which say that they need a considerable amount of new dollars before they're ready to take over those services.

I will end my questions there. Thank you for your co-opera- tion, Madam Chairman. THE CHAIRMAN: It's now time for the government members to ask. I have Victor Doerksen first. MR. DOERKSEN: Thank you, Madam Chairman. I will give the minister liberty to answer whichever questions he wishes, and if he doesn't wish to answer any, that's fine. He will then get back to me in writing. The first question that comes to mind is capital investment. The capital investment plans for the individual RHAs are not reflected in the Health estimates but I think are located in Public Works, Supply and Services. MR.

JONSON: That's correct. MR. DOERKSEN: Okay. The first question I have is: the dollars that are itemized for capital projects under Public Works, Supply and Services, do those numbers reflect the announcements that were just made for the Capital region, or are these now for the next year? [Mrs. Fritz in the chair] MR. JONSON: Madam Chairman, the announcements made last week with respect to the Capita l health authority projects are within the amount budgeted this year within Public Works, Supply and Services.

In other words, this does not represent any increase in what I believe is a $108 million annual allocation to Health capital projects. The other comment that I would make is that any given capital project, particularly a major one, usually takes up to three years to complete, sometimes longer when you consider the planning process. Let's say that it's a project estimated at $10 million. There might be $4 million, $4 million, and $2 million in three years of a budget with respect to that. That's where those projects are. MR. DOERKSEN: Okay.

The reason that I'm asking that question is that I am leading in to some follow-up questions that have to do with the David Thompson region master plan. I have seen their master plan, and they're of course anxious for the minister to approve that plan. Included in their plan is some upgrading which would be required to the third floor of the Red Deer regional hospital for their palliative care unit as well as to allow for an expansion of the number of beds for the psych unit. I know you're well aware of their particular situation.

Then following that, I think a third priority would be some plans with respect to the Richard Parsons auxiliary hospital. I'm just at this point merely putting in a plug for them. They've worked hard. I think the plan is good. They are seeking your approval on it. I didn't see them in the budget, which was why I was asking. At some point maybe you could elaborate on the process of how one goes about getting their capital plans approved and their master plans approved. Madam Chairman, I have a lot more questions, but I'll defer to my colleagues, and if my time comes up again, I'll move on to my other ones. [Mrs.

Forsyth in the chair] THE CHAIRMAN: Thank you. We have one hour, so I'm sure it will. Gary. MR. SEVERTSON: Thank you, Madam Chairman. My question to the minister is on page 242, reference 2.1. It follows a little bit the same as Edmonton-Glenora's question on physician services. The $767 million expended, is that the total expenditure of the AMA agreement, or are other things included in that? I share the same concern that last year it went up by $15 million over budget. What assurance do we have that it will stay at this level? This year you got $767 million.

That's what you ex- pended last year, but you'd budgeted $752 m illion. So it's actually two questions in one. Does that reflect the Alberta Medical Association agreement, the total expenditure there? MR. JONSON: Well, that particular budget line dealing with physician services has a number of components to it. By far the overwhelmingly largest

section is the AMA agreement, which is represented by $736 million approximately. Also, we have

DSS26 Health May 5, 1997 salaried physician programs. I guess the best example might be the pathologists that work within your major hospitals. They represent about $9.8 million in terms of expenditure there. Y ou've got an out-of-province medical reciprocal agreement; we're paying doctors under that program. That's another $1 1 million. There's the out-of-country medical and hospital costs, $3 million. Supplementary medical and hospital assistance: we'll have to explain that specifically. So we've got a number of components in that total.

It's accurately reported, and it does go to physicians, but the portion that is the AMA agreement is $736.7 million of that. Then there were those other items that I listed. 9:24 MR. SEVERTSON: Thank you. Supplementary question. A tripartite process has been esta blished with the regional health authorities and the AMA and Alberta Health. What is its purpose, and what do you expect to achieve in that tripartite process? MR. JONSON: Madam Chairman, the tripartite process is linked to the physician agreement of two years ago.

It was comprised of the AMA, the RHAs, and the government, and its purpose was to look at new models, you might say, of physician payment, of service delivery, which would maintain or enhance the quality of care but also result in efficiencies, in cost reductions. It's taken quite awhile to get to this point, but we are at the point where we're moving to implement I think it is six pilot projects with new models of paying physicians, different clinic and delivery arrangements.

So we hope that some efficiencies will come out of those examples being successful and then what we learn being able to be applied across the system. MR. SEVERTSON: I have one more, Madam Chairman. THE CHAIRMAN: Y es, go for it. MR. SEVERTSON: Recently, well, it made the news quite a bit, reference to the AMA requiring an additional $50 million increase in their agreement. Is this accounted for anywhere in the budget, or would it have to be next year's budget? MR. JONSON: The reference to the $50 million – certainly there's no additional $50 million in the budget.

This is perhaps part of the opening of negotiations which are slated to begin around June of this year for the next round of negotiations. What is in the budget – and this is something that is different in budget number two as opposed to budget number one, is that there is an additional $20 million in these estimates, $10 m illion or less of which we anticipate being needed to pay for physician services that result from the significant amount of money that we've put into provincewide services on November 24, 1996.

By putting that into the regional health authorities and that generating more services, more procedures, that of course in turn has a draw on the physician pool. So there is an additional $20 million here. We anticipate $10 million for physician services and a further $10 million for provincewide services. MR. SEVERTSON: Where does that show up in the budget, Mr. Minister? MR. JONSON: Let's see. The best page would . . . MR. SEVERTSON: If you haven't got it handy, I'd . . . MR. JONSON: We'll find it here. It would be in program 2, as I recall, 2.3.23. THE CHAIRMAN: Item 2.3.23? We have Dave Broda next, please.

MR. BRODA: Okay. To the minister. There's been a commit- ment made to communicate more with the public, to educate the public about the health system, yet in the budget under 1.0.3 public communications is down by 1 1.6 percent from last year. Doesn't that seem kind of contradictory? MR. JONSON: Y es, I think it might if you just looked at it on the surface.

As I've said throughout and I'll probably say again, Madam Chairman, in response to questions, I think that the government overall has tried to get away from the assumption that if you're doing something that requires adding some more money into the budget, there are ways of doing things more effectively and efficiently and still meeting your goals without adding to the budget. Sometimes you can reduce. In this particular case one of the real efforts that we'll be making is to sort out and not duplicate information and communication expenditures between Alberta Health and the regional health authorities.

I think we've been successful to some degree in that, although we've got a lot more work to do. With respect to our own public communica- tions work, yes, the expenditure is down, but that does not mean we are not making every effort to make sure our messages get out there both in co-operation with regional health authorities as well as directly from us in those things that are appropriate. MR. BRODA: Okay. A further question, if I may. Will the department have the capacity to do required policy work when the budget for the policy branch will have been reduced by about 58.6 percent? MR.

JONSON: Basically, Madam Chairman, my answer would be the same as for the previous question. That is a very signifi- cant percentage reduction, and perhaps if it's acceptable, I could ask Mr. Davis to reply. THE CHAIRMAN: Jack, you'll have to put your microphone a little closer when you're talking, please. MR. DA VIS: Okay. I think this reflects more on the internal reorganization of the department. We used to have a division in the department that did all the policy work, and now we have it distributed throughout the depart ment, depending on the area of responsibility.

So the policy work for health information and accountability would come out of that division now rather than being done in a separate area. I think in a lot of ways we've enhanced our capacity to do the strategic policy work we need to, and we have it done by the people that are actually working in that particular area. MR. BRODA: Okay. Madam Chairman, a supplementary question. What functions are included in the health policy division? MR. DA VIS: In addition to hea lth policy, the health policy division also looks after the pharmaceutical area.

They look after issues management, they look after the federal/provincial relations area, which is a fairly active one as well, and they do the legislative planning and legislative work.

May 5, 1997 Health DSS27 MR. BRODA: Thank you, Madam Chairman. THE CHAIRMAN: Janis. MRS. TARCHUK: Thank you, Madam Chairman. My question to the minister has to do with 2.3.20. I'm just wondering what is included in the program funding lines there that isn't included in 2.2.10? MR. JONSON: Y ou said 2.2 . . . MRS. TARCHUK: Dedicated program funding, 2.3.20. I'm just wondering about the differences between that allocation and 2.2.10. MR.

JONSON: Well, we can get the details to you, but the whole area of dedicated program funding – we have a number of commitments vis-à-vis the federal government and other relation- ships. One of the major areas, as I understand, of dedicated program funding is the whole area of human tissue and blood services and the commitment that we have through the federal government and the Red Cross in that particular area. That would be one example. I can get the other specific items and provide them to you. MRS. TARCHUK: Great. Thank you. Is it okay if I continue with a separate question, not quite related? MR.

JONSON: Y es. MRS. TARCHUK: Okay; 2.2.1 1, the workforce adjustment programs. I'm just wondering why there are no funds allocated to that program for the '97-98 year? 9:34 MR. JONSON: Basically, Madam Chairman, this question has come up before, and that is that in terms of this funding, which is specific to Alberta Health, we have used, allocated, dealt with the different factors here as far as Alberta Health is concerned. Now, Mr. Davis might be able elaborate further, but we have done our reorganization here. MRS.

TARCHUK: Then I guess just one supplementary question: what will be done in the future to address workforce adjustment issues? MR. JONSON: Madam Chairman, as I indicated, as far as Alberta Health is concerned, at this point in time we did not foresee the need to commit additional dollars as far as our own internal operations are concerned, but if there are further changes, certainly we will have to recognize that and propose or reallocate expenditure within the budget.

What I'm saying is that we certainly recognize that there needs to be that type of program, that type of expenditure if we are in fact making more changes. MRS. TARCHUK: Thank you. THE CHAIRMAN: Mr. Thurber. MR. THURBER: Thank you, Madam Chairman. Some of this, Mr. Minister, has been dealt with kind of peripherally by the opposition, but I want to talk specifically about subprogram 1.0.5. We're back into health information and accountability. I think it's a very important area, and it needs further outlining by yourself, if you could, please.

My first question: I would like to know exactly what functions are included in that particular budget in health information and accountability. I don't think that's been made quite clear here yet this morning. I have another couple of questions on that same thing. MR. JONSON: Madam Chairman, I think previously this morning we concentrated mainly on the planned information systems and the anticipated operating and planning of that, but also under the budget line we've got our whole area of library or, I guess you could call them, research services that we maintain right now.

Secondly, there are information services provided to and in conjunction with physicians and the overall development of our accountability framework for the health care system. Those activities come under that as well. MR. THURBER: Thank you. Could you clarify for me and this committee actually how much of this budget relates directly to health information? MR.

JONSON: As I indicated, I think, Madam Chairman, in the question with respect to the $5 million which was primarily involving an accounting change – I think that question was previously answered, but in this particular budget line there's approximately $18 million budgeted for this overall effort in health information and maintaining current programs as well. MR. THURBER: One final, if I might, Madam Chairman. Does that approximately $18 million cover the costs that are going to be incurred by the regional health authorities as well, or is that strictly an internal thing? MR.

JONSON: That doesn't include the funding that we anticipate with respect to the regional health authorities. The amount budgeted for the RHA-related information systems is $20 million. MR. THURBER: Just one final. THE CHAIRMAN: Go ahead. MR. THURBER: Just a quick one. Now, is that included in the RHA budgets as opposed to including them in your own budgets from the department? MR. JONSON: The money that I just talked about, the $20 million to the RHAs, is another example under that dedicated program funding line that I referred to earlier. MR. THURBER: Thank you. THE CHAIRMAN: Mrs. Fritz. MRS.

FRITZ: Thank you, Madam Chairman. Thank you, Mr. Minister, as well. Some of these questions have already been answered, but in your opening remarks you mentioned that a thousand front-line workers would be hired in the field of medicine, and I often hear that being referred to as RNs. I wondered if you could comment on that. Do you anticipate that's registered nurses? MR. JONSON: Madam Chairman, certainly not entirely. We have the LPNs, licensed practical nurses. We have institutional aides. In some cases regional health authorities, I'm sure, will see perhaps in the maintenance support to the system their

DSS28 Health May 5, 1997 primary needs. So we're talking here about staffing at the front of the system, whether it is in terms of maintaining facilities or – I think in most cases it would be people who are in direct contact with patients. We never indicated it was confined only to RNs. MRS. FRITZ: Okay. Thank you, Mr. Minister. Also, I'm interested in “health access – are services available when people need them?” on page 195. I've read them in three different documents now over the past week: the business plan update and then the post-election update and also the estimates book that's here before us.

I think they lead us as a government into areas that we see are of importance to you. I know I have to thank you, too, in commenting on the number of initiatives that I have seen come forward from your ministry in regards to health promotion, prevention, wellness, all of that area. I wonder if you'd comment on 5 where it says, “length of stay in emergency after hospital admission.” That's one area where I didn't notice a percentage of target dates. Perhaps it's an unfair question at this time, but I am wondering: what is the average length of stay now? MR.

JONSON: Well, that would depend on what condition we're dealing with here. I would undertake, Madam Chairman, to respond in detail with respect to the different categories of patients and what our targets are there. I'm just glancing over some of our statistics here. Perhaps the best way to respond is in detail. We'll get that to you. MRS. FRITZ: Thank you. I'd appreciate that. Then as I go down, as well, number 10, “provincial rate of injury deaths including suicid e,” I noticed it was going to 13. The 45, I think, in one of the books I had read was back in 1994 or so or '93.

Do you have any current stats for '95-96 as to what the rate is now? MR. JONSON: I'm just looking at the material here. Our current rate, as I understand it, is 45 per 100,000. Our target is to go to 13 per 100,000, which is quite an ambitious target. MRS. FRITZ: It is. MR. JONSON: Nevertheless, it's a very tragic area of modern life. So that's what we're aiming at there. MRS. FRITZ: Okay. Thank you. I saw that. It's just that I felt the rate actually is higher than 45 per 100,000. I'd be interested in that information as well.

Then on a level with the childhood immunization coverage, I noticed in the budget somewhere that I think the immunization for – I can't remember if it was a million dollars or whatever, but it's increased in cost. I also noticed that the immunization rate is relatively the same. I wondered what that cost was for – I didn't know if it was for the red measles that has happened recently – and if that came through the ministry or through the RHAs to immunize even the teens. I think it is in grade 9 or so now that they're giving the booster immunization. I wondered if that was what that was for. MR.

JONSON: Madam Chairman, I think that's essentially correct. At least in terms of the single largest component of that increased expenditure, it would be the overall measles initiative. MRS. FRITZ: It was. Okay. Thank you. Then on 12, “number of deaths due to cervical cancer.” I applaud you, noticing that that number, the target, is zero. It is certainly a death that is preventable through Pap smears and especially with women over the age of 15. My question is how you plan to reach that target. That may be unfair.

I'd appreciate some information on that, simply because I've noticed – as I say, I do applaud the initiatives you've shown, especially in the area of health for children, youth, and women. In this area I won- dered if you would be developing a task force to do that or if it's something through each RHA or . . . 9:44 MR. JONSON: Well, I think, Madam Chairman, in this area of cervical cancer we're not anticipating a task force, because the medical community, the people in the health system, have overall consensus on what needs to be done.

The key to it of course is early screening, and our plan, our intention, is that we meet a standard in terms of screening which, as I remember it, is that there should be a Pap test, or Pap smear, procedure undertaken every three years after a woman is 15 years of age. That seems to be the standard in terms of one of the most effective measures in dealing with this problem. MRS. FRITZ: Thank you. This is a bit of a different question from this area of the budget.

When I was door knocking, as many of us did during the election, I certainly heard from seniors at the door that we were no longer subsidizing their health care at the rate we had been, and it was creating a hardship for the seniors. My question is: what are the premium revenues that are collected from seniors versus non- seniors? That, too, might be an unfair question at this time, but I'm hoping you do have an answer to that. Also, I was looking for how many seniors are exempt from paying premiums and how many had actually received a subsidy. MR. JONSON: Well, we can provide you with that detail breakdown.

I think there is an overall figure, though, for – is it half a million people that have some degree of premium subsidy? We can get you the breakdown in terms of seniors versus other categories in the population, but by far the largest component of that $500,000, I think about $250,000, is seniors, subject to more details, Madam Chairman. MRS. FRITZ: Okay. Thank you. Then one last question, Mr. Minister: how many nonseniors are subsidized? MR. JONSON: Well, that's a fair question, but it'll be in the breakdown of the subsidies that are provided. MRS. FRITZ: Okay. Thank you, Madam Chairman. THE CHAIRMAN: Mr. Clegg.

MR. CLEGG: Thank you, Madam Chairman. My question certainly isn't going to be to try to get more resource people or more programs. I'm a great believer in an effective and efficient system of health care in this province, and having more programs and more resource people doesn't always help health care. I say that as a general statement. I'm always happy when we spend less money, not more money. I guess that's the Scotch coming out in me, but I don't think spending money always leads to more services. I think, like I said earlier, it's the effectiveness of our programs, and that's what really is important.

I'm always happy

May 5, 1997 Health DSS29 to see that the administration cost has gone down 5 and a half million dollars over the last year. Could you, Mr. Minister, tell me how much it has gone down, say, in the last two or three years in total? MR. JONSON: Well, Mr. Deputy, would you comment on that? Y ou've been leading it significantly. MR. DA VIS: The question was: just the dollar value of the reduction? MR. CLEGG: Y es. What I'm always interested in, Mr. Minister, is dollars. That's what our society is based on. MR. DA VIS: The total reduction over the last couple of years was in the $12 million range. MR. CLEGG: Okay.

That sounds great to me. In the last year how many of these were the result of outsourc- ing, and what is the difference between the management and the nonmanagement? MR. DA VIS: We would likely need to get you more detail, but there are roughly 60 positions that were involved in outsourcing, primarily the movement of the operation of some of our computer systems over to ISMA in Alberta. About 10 percent of our total reductions have been management and the balance nonmanage- ment.

I would like to point out that as we moved through this process, we worked extremely hard with each individual employee that was impacted to see if we could place them in other locations in government or work through arrangements with them that were best suited to their individual needs. MR. CLEGG: That leads to my final supplementary question. What provisions have been made for salary and wage adjustments? I always like to be fair to our employees. For departmental staff and certainly for the RHAs, has there been some adjustment in the budget to reflect some increase in salaries? MR.

JONSON: Perhaps I could interject here. With respect to the regional health authorities, there are two or three points to be made. One is that all of the regional health authorities received, if you looked at their budget bottom lines, a 4 percent increase. Y es, 2 percent was targeted towards the hiring of additional staff, but we also have a 2 percent guaranteed increase overall for all RHAs. I think it would be fair to say that the salary component, or the payroll component, of RHAs would be somewhere in the range of 60 to 70 percent of their overall operations. So there is money with respect to that.

The other thing is that, for a number of the regional health authorities, through the application of the formula their increases were over the base 4 percent. So there is money that has been put in the system for RHAs to meet in- creased costs, which might very well be in that area of remunera- tion. As far as the department itself is concerned, we are certainly, in our budget projections here, planning for our commitments that we have right now. In terms of negotiations that may be upcom- ing, that will have to be part of an overall government approach. I don't know if there are any more specifics there. MR.

CLEGG: That leads me to one question. I think we're all familiar with increments. I have two da ughters working in the health system, so I'm very fa miliar with that. One of my daughters is a nurse. We also know that when you get incre- ments, they are automatic. We've got a lot of people in our health care system that in fact aren't on that system, and they fall behind because they don't belong to the specific union that has the automatic increments. Is there any adjustment there?

It really bothers me that because someb ody has this increment system in place, then they do automatically, unless they're at the top of the level. Some people work there and are very good workers, but they don't have that system in place, so they don't really get any increase. That really bothers me. Is there any thought put into that, Mr. Minister? MR. JONSON: I note the question and the point being made, Madam Chairman.

What is planned for, certainly by the RHAs and in the context of the department itself and the civil service ourselves, is that where you have your collective agreements, we plan to, on the basis of the costs that we're going to experience in terms of payroll – but certainly the point that you made is well taken. There are certainly differences in the way people are paid under these arrangements, and one is to have increments in some cases, not all. MR. CLEGG: Thank you, Madam Chairman. 9:54 MR. DOERKSEN: I'm going to ask some questions related to transfer payments.

Now, when I ask these questions in the House, of course the Opposition House Leader doesn't like it when we ask questions about federal transfer payments. But I noticed that when his colleague did this morning, there was no objection, so I think I'll be safe in this committee this morning. I want to point out that on page 250 – because this isn't always talked about a lot either, I don't think – if I read the numbers correctly from the '95-96 actual figures, the Canada health and social transfer contributed $712 million to Alberta.

In '97-98 the estimate will be $472 million, which is a decrease of $240 million from the federal government. That's not to say I disagree that that didn't have to happen. I think we are advocates of the federal government getting their books in order too, so I want to make that statement. But during that same time period, the contribution from the general revenue fund increased by over $500 million. So this is money that came from Alberta and I think is a reflection of the fiscal policies of our government. Being able to do that I think is something that Albertans need to be proud of.

It's not something that's well understood, I don't think, in terms of the impact we had to absorb from the loss of transfer payments, and to pick up that shortfall, plus add to it, is significant. With that little bit of a lead-in, the question I have on the transfer payments – and again there have been several announce- ments during this federal election.

We're making some presump- tions in terms of perhaps what the outcome of the election might be, so I know that some of these questions may be speculative in nature but, at the same time, I think need to be considered because they will have impacts in terms of our funding. The first one has to do with the transfer, the announcement that they're going to cancel out part of the transfer that we are expecting. The question would be: how much money would that be with respect to Health? The question that follows from that then is: would that mean an au tomatic increase to the Health budget if that were to happen?

The second question relating to some of the announcements again has to do with this national pharmacare proposal which has been talked about. I think it's going to have significant cost implications. I'm not sure what time frame we might be looking at in terms of implementation, whether we even had any discus-

DSS30 Health May 5, 1997 sions about that, what the Alberta position might be or whether we've developed a position on that pharmacare program. So those are my two questions with respect to the federal transfers, if the minister has any comments at this time. MR. JONSON: Madam Chairman, first of all, with respect to the pharmacare proposal, this is a general statement, general proposal that seems to be now being made by the federal government in the course of the election campaign.

It originated most certainly from the Canadian health forum, this overall discussion and consultation exercise that was done by the federal government and led to their final conference report in I think it was February of this year. So all we have right now, Madam Chairman, is that report and its recommendations and a statement or statements from the federal level indicating that they are going to propose or take some action in this area.

The statements I have made are that we can see some merit in certain features of a pharmacare program, but we can only say that we want to see what the proposal is, what the details will be, particularly with respect to financing. We should not be raising people's expectation about coverage in this area unless there is, you know, adequate funding available, particularly from the federal government since they are proposing it. So we have many questions here, just as I'm sure the general public does. Perhaps at the upcoming ministers' meeting we will learn more about what they might be proposing.

The second thing, with respect to the transfer payments. It was kind of interesting, Madam Chairman. Earlier in the discussion today one of the members of the opposition Liberals indicated that there had been an announced increase in the transfer payments. We welcome the statement, but the statement is really that the planned decrease will not take place, which is a little different. In any case, the money from the government of Canada is not directly affecting our overall budget in Alberta Health.

There will have to be a decision made by the provincial government in terms of how this lack of reduction, if you will, will be utilized in the context of overall government policy with respect to these transfer payments. It doesn't directly mean that we'll be factoring that cessation of the reduction into our budget. The budget is here, put before the Assembly for its approval, and once we actually know the details of this announcement about the hold on reduc- tions and transfer payments, then it'll be a decision for govern- ment and Treasury to deal with. THE CHAIRMAN: Go ahead. MR. DOERKSEN: Okay.

Thank you, Mr. Minister. This is a new question to do with our drug budget. Something that's been pointed out to me on several occasions – and I guess this is more of a policy issue than it is a budget issue, but it does have budget implications. I hope I describe it correctly, not being a pharma- cist by background. I hope I get this correctly. The specific situation would be a home parenteral – is that how you pronounce that? – program, which is really outpatient delivery of medication. There would be some units given to the patient at home for prescribed therapy.

If they were to have that drug therapy administered in the hospital, the cost of the drug is covered. By having the therapy done at home, there's no cost to the hospital system – in one sense I guess you could say we're saving the hospital system money – yet now we are asking the patient to pay for the drug therapy. It's a difficult issue, I know, but it is a situation that's been raised with me on several occasions, and I think it needs to be looked into. I guess the most difficult

part is that some of these particular treatments happen to also be among the most expensive treatments. I'm wondering if we're doing any thinking along that line to address that particular seeming inequity. I wonder if the minister would have any comments about that. MR. JONSON: Madam Chairman, the member identifies, yes, certainly a problem area and from an ideal point of view certainly a deficiency in the continuum of drug coverage.

We are looking at that as one of the issues, one of the areas in terms of the overall picture in long-term care that we would like to be able to address in subsequent years in some way. There is, of course, Blue Cross coverage available, but even there, particularly with seniors, they see that co-payment as something that is discrimina- tory, in hospital versus in continuing care. So I acknowledge it as an issue, one that we need to work on. The only other comment I would make, though, is that we will have to work our way through this carefully and, I hope, fairly.

But for the person who may not have been in hospital but has extremely high, let's say, blood pressure medicine or something of that nature, at what point do you stop with, say, the full coverage, of saying we were able to do that? It's one that needs an overall look, but I ac- knowledge it is an issue certain ly, something we'd like to work on. 10:04 THE CHAIRMAN: Are you done? MR. DOERKSEN: I had some more, but I'll let . . . THE CHAIRMAN: Okay. We'll have Mr. Thurber. MR. THURBER: Thanks, Madam Chairman. I just have one follow-up question, Mr. Minister, on the health information thing.

I've had a lot of concerns expressed to me during the election and before that, in fact for the last seven or eight years, where people would like to know what it's costing the health care system when they go and see a doctor. Now, in your deliberations on the health information part of it, is there a thrust toward trying to get that information out to the patient, to the consumer in this case as it were, so that when they leave a doctor's office – and I think it might be more difficult in hospitals – they would in fact know what the taxpayers of this province have paid on their behalf for that visit?

I'm just wondering if that's part of your deliberations, to try and come up with a system that would better inform the consumer as to what it does cost when they go to the doctor. MR. JONSON: Madam Chairman, this system that we are developing would certainly facilitate that, I think, and make it more easily done.

As to whether we would put in some regula- tion, though, requiring the issuing of statements to people using the doctor's office, or whether we would go back to something that was tried in this province at one time, and that is the issuing of an annual statement to all Albertans on their utilization of the health care system and how much it had cost, is something we would need to make a decision on as government. The informa- tion system we're talking about is the vehicle for doing that efficiently, but that's a decision we will have to make. MR.

THURBER: My concern and the concerns that have been expressed to me are that hopefully that would be part of the discussions at some point in time so that it can be on the table as part of the agenda. MR. JONSON: Noted. THE CHAIRMAN: Are you done, Halvar?

May 5, 1997 Health DSS31 MR. JONSON: Y es. THE CHAIRMAN: Gary. MR. SEVERTSON: Thank you, Madam Chairman. I've got a couple of questions I would like to ask, somewhere on the same line as I did last time. On line 2.2.10, dedicated program funding of $17.8 million: is it the same as the physician services? Does that include other programs? What kinds of programs? There's more than one dedicated program, I would take it. And what would they entail, the different programs? MR. JONSON: Madam Chairman, there are a number of different programs under 2.2.10. I'll just quickly run through them.

There's support that we provide to federal nursing stations, which we do have in the northern part of the province. We have a capital debt repayment program and a capital upgrade program for nondistrict nursing homes. The funds for that come out of here. We provide funding to AIDS agencies and the HIV screening program. We have our health promotion programs in a number of areas. We have a dental outreach and cleft – it should be lip, not hip – palate program, and a number of different initiatives in the area of aboriginal health.

So they're listed there, and I could provide you with information in terms of exactly how much money is in each category. Roughly that money is broken down to: nondistrict nursing home capital upgrades, 4 and a half million, and the rest of the allocations are in that 1.5 m illion dollar range. MR. SEVERTSON: My supplementary to that question, Madam Chairman. THE CHAIRMAN: Go ahead. MR. SEVERTSON: There's a reduction of $3.5 million, which is a fair amount of reduction when you consider the total amount of spending. Percentage-wise it's pretty high. What's the rationale for that type of reduction on that? MR.

JONSON: Well, the primary reason for that line going down relates to the overall nondistrict nursing home capital upgrade program. This particular program and the construction and so on related to it has basically concluded, and our obligations in terms of paying for that capital plus servicing – we had an agreement with respect to servicing debt. That draw, should we say, on our budget is coming down. It's an initiative that essentially is done. We're still paying the bills for it. MR.

SEVERTSON: Madam Chairman, could I ask on a com- pletely different line on that, or do I have to stay with the same main question? THE CHAIRMAN: No. We still have time left, so you can ask it. MR. SEVERTSON: Okay, Madam Chairman. To the minister. Earlier in the first hour of discussion there was some mention that the regional health authorities weren't acc ountable and it wasn't lined out. I think you started to explain how the regional health authorities do account for their spending and it is in reference to administration and other lines. How do they report their adminis- tration for the general public?

Could you expand on that? MR. JONSON: The regional health authorities are required to file with us, first of all in the sequence of the process, their overall business plans. Then at the end of their fiscal year they're required to file their financial report with the breakdown of expenditures in various categories. As I've said, those finalized reports are tabled with the Legislature.

Because, of course, there also have to be audit statements done, they are subject to the scrutiny of the Auditor General, whether the Auditor General does it directly through contract through his office, which some of the RHAs use, or whether the RHA engages its own auditor. So there is a whole process which is reported on there in terms of where they are spending their money. We in Alberta Health have periodically summarized for more easy reading the trends in terms of expenditures, and it's in our annual report. As Mr. Bhatti has just indicated to me, on page F39 of our annual report you'd find that right now.

MR. SEVERTSON: Thank you. MR. DOERKSEN: I just have a question or two relating to the population-based funding formula that's coming out. I want to say from the outset that I'm positive on the funding formula; I think it's a good move. But there are some questions that arise out of it. Y ou will recall, because you were the minister at the time, how we approached the funding for education, which was on a per student basis. It essentially accommodated system growth so that if your population increased, there was an automatic increase to your budget.

I don't know if the population-based funding is based on the same model or whether it's just a pot divvied up by whatever the population of the region happens to be. One of the reasons, of course, I ask that question is that we are expecting some significant growth in the central Alberta region with the plant expansions there. The question arises out of that. Secondly, also what I thought was a good move in the Educa- tion formula was the administration cap per school boards, that they had to come within it.

I wonder if there has been any thought given to doing the same thing with respect to the regional health authority. MR. JONSON: Madam Chairman, with respect to the admin cap, I have certainly given some thought to it, but to this point in time there's been no decision to establish a hard cap, although we've certainly been working with th e regional health authorities and other entities in the health care system. I think it's been a theme, and that is to try and make sure that administrative costs are kept as low as possible. We've had, I think, some success or some response in that regard.

Madam Chairman, some of the earlier questioners perhaps have not been able to avail themselves of the report that was put out in July. But yes, the whole idea of a population-based funding formula – albeit right now it would only be adjusted annually. Some people would like it adjusted every month if the population is going up; those whose population is going down would like it every three years. Y es, it does respond to the total numbers of the population, also to the changing demographics. For instance, if you have an aging population, that additional factor – it's in the formula for the older population.

It would come into it as well. So it does respond annually to the changing nature of a region's population. 10:14 THE CHAIRMAN: All right, it's now the opposition's turn. Gary, your gang has one hour.

DSS32 Health May 5, 1997 MR. DICKSON: Thanks very much, Madam Chairman. I want to turn to the issue of mental health, Mr. Minister, and perhaps I might start by asking you this. I remember when the Alberta Mental Health Board existed. The concern at that time was that we were spending $145 million for mental health facilities and $97 million of that was going into tertiary fac ilities, specifically the big psychiatric centres.

Now, what's not apparent from the budget we have in front of us is the extent to which you've been able to do what the provincial Mental Health Board had deter- mined was absolutely essential, which was just transferring dollars out of the big institutions into the community. I wonder if you could particularize for me the extent to which you've been successful in starting to redress that imbalance?

The related question would be: as a percentage, I know that back in 1994-1995 we were looking at 69 percent of the dollars going into either psychiatric hos pitals or psychiatric units in general hospitals, with just a tiny portion of the overall pie going into funded agencies, care centres, and so on. I'd like some particulars in terms of the extent to which we've been able to redress that imbalance, Mr. Minister. Now, the other thing I want to turn to is in program 2, and it's related.

Y ou'll appreciate now that Calgary, with the closure of the Holy and then the Bow Valley centre, no longer has psychiat- ric beds in the downtown portion of the city. I'm curious, Mr. Minister. The last comprehensive community needs assessment done in terms of acute care psychiatric services had been done in 1994, but I know from just representing a good chunk of the downtown area that what was described in that community needs assessment hasn't changed. In fact, from my perspective, it's been exacerbated with an increased number of people in the inner- city area.

The recommendation in that community needs assess- ment was they talked about the need for acute care psychiatric facilities in beds proximate to where the biggest concentration of that population is. So I'd like some particulars from you, Mr. Minister, in terms of how you plan to address this need. If somehow this situation's been ameliorated and the need is demonstrably smaller than it was in 1994, I'd like you to share those particulars. I suspect it isn't, in which case I come back and ask how we're going to meet that need now that we don't have a hospital downtown. [Mrs.

Fritz in the chair] I should tell you I had a chance to tour the 8th and 8th clinic. There is a mental health worker there but certainly no psychia- trist, and there's certainly no facility or prospect of having beds for the most seriously ill in terms of the mental health population. I think what I'd also like to do, and this still relates to program 2, Madam Chairman – a number of specific concerns. The government has now accepted that the role of a midwife is an appropriate role in the Alberta health care delivery system. My question is about funding for midwifery.

I don't see it in the budget, and perhaps, Mr. Minister, you'd be good enough to indicate where in the budget we have in front of us for 1997-1998 there is funding available to deal with that particular program which has only recently been sanctioned in this province. [Mrs. Forsyth in the chair] Mr. Minister, in terms of region 10, the Capital health author- ity, there had been a report done on October 18, 1996, by the medical staff. It is entitled Report of the Critical Assessment Committee Region Ten Medical Staff.

Now, presumably this was one of the stimuli or part of the input that resulted in the Novem- ber announcement of additional funding, but from everything I hear from region 10, it seems there is a whole series of concerns that have been raised that have not yet been addressed. I'm wondering if you can in fact respond to those recommendations from the critical assessment committee in late 1996 that are still outstanding and have not yet been addressed.

The other question I was going to ask is: you talked earlier about you're in the process of developing benchmarks for waiting lists and what would be acceptable and what is not. Perhaps you could clarify the Premier's council on quality care that had been created with much fanfare some years back. Perhaps you can clarify for me the current role and immediately prospective role for the Premier's council on quality care. Is that the agency that's going to determine what is an appropriate waiting list in this jurisdiction? Or is in fact that council moribund? I don't know, Mr.

Minister, and I need some clarification from you on that. Now, I'm hopeful to get updated numbers in terms of medical specialists working in Edmonton and Calgary. One of my problems, Mr. Minister, is when I hear you talk about the number of specialists in Alberta. What I find confusing is that it appears to me – and I'll use an example. Dr. David Jenkinson, who is an outspoken advocate in terms of inner-city health care needs and certainly would be well known to your department, now practises in the U.S., but he still shows up on the rolls of the College of Physicians and Surgeons.

He still shows as being a specialist in the province of Alberta, but of course he hasn't practised here for some time. So when you indicate the number of specialists available in the province, I wonder if we can distinguish between those who are actively engaged in the practice of their specialty and those who have long since left the province. I know that's a particular concern in Calgary. Just before I turn it over to my colleague, a specific concern that had been raised by a constituent.

I wanted to ask you, sir: I understand that for patients who are dependent on transfusions, it's fairly common that they get an iron overload situation, and there's an injection that has the effect of dealing with the excess iron in their system. It's my understanding that the difficulty is that this isn't funded in the province, so what we end up doing – again, this may be an example if something happens more often. This often leads to the onset of diabetes and heart disease, all of which end up being more costly than the initial iron removal treatment.

So I'd be interested in some particulars in terms of why we don't fund that. I understand in Ontario that's totally funded by the province, presumably because it's a good preventa- tive health measure. With that, I'll give my colleague a chance to ask some ques- tions, Mr. Minister. 10:24 MRS. SLOAN: Thank you, Madam Chairman. Mr. Minister, for the purpose of clarifying my previous statements and then subsequent questions that were raised with respect to the regional health authorities' accountability, I would draw the committee's attention to recommendation 16 in the Auditor General's report.

Specifically what that recommendation outlined was that the Department of Health must establish a “reporting framework” that provides the necessary information, in relationship to management and operating staff, public, MLAs, and board members, to measure the “accountability, governance and operating” criteria for regional health authorities. The Auditor General outlined that that information is not available in a complete or integrated form and that the vision for accountability in the system has not been made clear.

It follows through with four other points in relation- ship to “performance information” being needed, that “two-way

May 5, 1997 Health DSS33 communication” must occur, that “the information reported should be useful,” and that “external reporting should be aligned with internal reporting.” Those are a portion of what I was referring to in my earlier comments, and I wanted to ensure that my questions were recorded in that context. It may in fact be that the annual report provides some measure of that. I'm not sure if it does, and I would be most interested in having the opportunity to hear further from the minister on not just what is going to be undertaken this year but in subsequent years to ensure that occurs.

I would like to raise a specifi c question in relationship to program 2. In 2.2.3 I note that the ministry allocated a significant increase in funding for the purchase of v accines and sera. I'm wondering if the minister can indicate to me whether or not that money incorporates dollars for the purchase of syringes, needles and for the manpower to administer those vaccines. It is a rather urgent question, Madam Chairman. The reason I ask it is that my understanding is the regional workforce has been given a mandate that they must complete this vaccination program by early spring of '98.

I think it's a very prudent piece of information that is needed, as to whether the ministry is assuming costs for syringes, needles, and manpower or if that's being left for the regions to incorporate somehow in their budgets. MR. JONSON: Madam Chairman, in terms of what I understand is referenced to the measles vaccination program, Alberta Health is paying for the drug or for the serum, not for the basic operating supplies. This is done through the regional health authorities, as it has been done for years through hospital boards and public health units. MRS.

SLOAN: If I could just make a supplementary rebuttal, I think this is a very beautiful example of how our process of reporting, budgeting, and planning is somewhat unraveling in this province. It's well known that we've had an increased incidence of measles and, obviously, for the benefit of all people in the province we have to undertake a v accination program. For the ministry to only purchase vaccines when a significant amount of money is then required for the purchase of equipment to adminis- ter and the manpower is, I believe, a significant oversight or, perhaps, a purposeful oversight.

It seems to me that it stresses the system, particularly a system, a community service delivery system, that is already stressed and trying to meet the demands that have been placed upon it. When I contrast that with the supplementary estimates where you have taken it upon yourself to make additional allocations for physicians' services because of increased demand and increased need, why, Mr.

Minister, do those same principles not apply when it comes to the administration of vaccines to schoolchildren in this province and the provision of funds to pay for registered nurses or other equipment required to administer that? I would certainly not only hope for some degree of answer to my question, but I would also seriously request some degree of action with respect to that.

My understanding is that we have a significant amount of management overtime being allocated to deliver those vaccines as well as caseloads having to be neglected, while nurses are mandated to have those vaccines administered by a deadline that the Ministry of Health sets. If I could switch, then, to the workforce rebalancing initiative, not referenced specifically within the budget in the performance measures. I guess I raise some questions again with respect to accountability. Obviously, public stakeholders have been aware of this initiative, that it is undergoing consultations.

Some degree of consultations have occurred. Specifically in relationship to the budget, I found it of interest that in program 1, 1.0.15, the health disciplines and advisory appeal services warranted an allocation in this year's budget. My understanding of what was proposed in the health disciplines legislation was that that advisory and appeal mechanism would be put in place upon the passage of that legislation. I find it curious, Mr. Minister, that we're allocating funding already for that purpose and the legislation itself has not been debated in the Legislature.

I don't know if there's any reasonable rationale for that, but it is a significant amount of money and it seems to me we're to some degree putting the cart before the horse on that. I would also like to relate th is initiative to the workforce adjustment budget line and the previous questions raised with respect to that, the response by the minister saying that restructur- ing is complete.

It is of interest to me that that statement would be made when, in fact, one of the principles that seems to underpin the health disciplines legislation is a move in this province towards an increased utilization of unlicensed and unregulated staff. In hand with that, if that is the intent, I would anticipate that we will see a significant reduction, that being layoffs of other classifications of providers. It is curious to me, Mr. Minister, that in the face of that occurring, the ministry no longer sees fit to provide workforce adjustment funding.

Another initiative which relates, is in fact very intertwined, is the LPN regulations and the continued suggestion that that is going forward. There's widespread understanding that that is going to be utilized in a widespread fashion across the regions, to utilize LPNs as primary staffing for the delivery of nursing care. So again, relating that to the health disciplines process, the workforce adjustment, it doesn't appear that there is any funding. There is, as well, another related topic: the lab restructuring which continues in the broader sector to be discussed.

Calgary is raised as one example where there is proposed to be more restructuring of that sector. Again, I relate that to the workforce adjustment and why we would not deem it prudent or justifiable to provide adjustment moneys in those instances. Thank you. 10:34 THE CHAIRMAN: Gary. MR. DICKSON: Madam Chairman, thanks very much. Just turning back to program 2 again.

I want to talk for a moment or ask some questions in terms of a hospital closure, but before I do that, certainly a lot of notoriety is being attracted to the changes at the former Grace hospital and the prospect that there will now be a for-profit corporation operating on one of the floors of the hospital. Y ou, Mr. Minister, have been quoted as saying that you wanted to do some kind of review or inquiry to determine whether it would have an adverse impact on waiting lists in other parts of the region.

I'm wondering whether in fact you've completed that study, what conclusions you've come to as a consequence your investigation, what criteria you or your department identified as being the matrix through which you were going to filter the information and come to a determination of whether this was something that was prejudicial to the needs of Calgarians or not. I'd be most interested in that.

Speaking of hospital closures, the advisory group that had been set up to deal with the disposition of the Holy Cross site – which must be about 10 months ago now – I understand has done some shortlisting of those people that had come forward in response to the advertisement you had published probably in November, December of 1996. What's the status of that process, Mr. Minister? Since you will have the last word after you get the report from the Calgary group, tell us please what criteria you're

DSS34 Health May 5, 1997 going to be using in determining what will be an appropriate disposition of the Holy Cross site. I think my same question would apply in terms of Bow Valley. My question there would be: since it appears that the CRHA is, from all reports, determined to demolish the building as quickly as possible, what steps have you or your department taken, Mr. Minister, to determine that there can be no future use of any part of that facility? I'm thinking specifically of buildings F, D, and G, all of which have been newly renovated since 1972.

What consideration has been given to keeping one of those three more modern towers for some other health-related purpose, whether it's geriatric care or some other service which has a particular need downtown. The related question would be that I know when the province of Manitoba closed hospitals in Winnipeg, they had a very sophisticated program to study the short-term and near-term impacts on the health of people living in a particular region. My understanding is that it was the Manitoba Centre for Health Policy and Evaluation.

They have what's called a populist data base, and it apparently allows them to track the impact on public access and quality of care as well as the general health and population as a consequence of closing 20 percent of the acute care hospital beds in Winnipeg. I'd like to think, Mr. Minister, that we're at least as smart as the people in the province of Manitoba. I'd like to know what sorts of measuring tools you're going to apply to determine that impact of hospital closure, particularly in Calgary where it's been of particular concern. I think those are the key questions I have at this time.

The other thing I'd ask you to provide me with is: the 8th and 8th clinic in Calgary has the capacity to monitor an enormous number of variables. They have a software system at work in the 8th and 8th clinic which allows a very sophisticated kind of tracking. I'd like assurances from you, Mr.

Minister, that Calgarians and all Albertans will have the benefit of seeing that kind of statistical information that's going to be presented in a way so that all Albertans can judge not just the decision made by the Calgary regional health authority but the kinds of impacts and conse- quences that flow from making Calgary the only city on the continent that doesn't have 24-hour emergency service downtown. Those are my questions at this point, Mr. Minister. Thank you. MR.

SAPERS: Still on program 2, the question I have relates to the amount of money your department, both pre-election and now in this budget, has reallocated to the regional health authorities. First of all, I would like to know whether or not you've done the analysis to show how this money, once adjusted for inflation and population change, compares to the actual, in adjusted dollars, per capita expense over the whole time line of the restructuring in health care, going back to '93 and then projecting out to the end of this business plan. I'd like to be able to make an apples to apples kind of comparison.

There's certainly a lot of cloudiness in the minds of the public about where we really stand on health care spending through the regional authorities based on those announcements. Also, there has been some misinformation circulated about the people to be hired to fill the thousand full-time equivalent positions. From time to time they've been referred to as a thousand full-time nurses, other times a thousand full-time equivalents, and other times up to a thousand people will be hired, some of whom will be nurses. I'd like the definite word on that.

What do these thousand positions truly represent, and how do you perceive that they will be allocated across the regions? What mechanisms do you have in place to ensure that these dollars go into the creation of new full-time positions? Are you setting actual targets for the regions and saying that the analysis done by Alberta Health indicates that this region or some other region is short this or some other number of registered nurses, LPNs, et cetera? If you produce that kind of matrix, we'd certainly like to see it. On the same lines, Mr.

Minister, I'm curious as to what penalties, financial or otherwise, there will be when a regional health authority or another provincial board is unable to deliver on its mandate or uses the money in a way that wasn't intended. Of course, going along with the notion of there being some kind of consequence or penalty, there would have to be some kind of detailed monitoring.

So I'm curious to know what specific monitoring you've set up on this allocation of apparently new dollars and what the consequenc e will be if your monitoring determines the money has been used in a way contrary to the purpose set out by government policy. 10:44 Several years ago I had an opportunity to query your predeces- sor about the number of registered nurses that was projected to be the adequate number of registered nurses to meet the health care needs of Albertans in community and hospital settings. We never got a complete answer to that question.

We're considerably farther down the road in terms of both health care restructuring and setting up an evaluative framework that I've heard you talk about over your tenure as Health minister. So I'm wondering: can you help me understand how we now know how many physicians we need, particularly in nonurban centres; and going along with the number of physicians, could you let me know whether or not it's your departmen