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The Health Services Preferential Access Inquiry – Final Report

On August 21, 2013, the Health Services Preferential Access Inquiry presented its final report to the Speaker of the Legislative Assembly of Alberta. 

The Final Report of the Inquiry can be accessed below:

Executive Summary

Introduction – Origins of this inquiry

The Canadian health care system is premised in part on the ideal of equitable access to necessary physician and hospital services without regard to one’s ability to pay for those services. Equitable access involves ensuring that patients who have the same medical conditions have the same opportunity to access the same services.

Still, there exists a pervasive belief that Canada has a two-tiered health care system, where advantage is secured, not necessarily through wealth, but through connections or status. In short, some believe that others get faster access to health care for reasons other than medical need. This perception is likely widespread, but evidence showing the existence of a two-tiered system is largely anecdotal. Nonetheless, this perception corrodes faith in the claim that Canadian health care is premised on equitable access.

The Alberta government established the inquiry under the Health Quality Council of Alberta Act in February 2012. The inquiry’s terms of reference ordered it to consider the following:
1) Whether improper preferential access to publicly funded health services is occurring; and
2) If there is evidence of improper preferential access to publicly funded health services occurring, make recommendations to prevent improper access in the future.

Several events precipitated the call for this inquiry. In June 2011 Alberta media reported claims by the former Chief Executive Officer of Alberta Health Services (AHS), Dr. Stephen Duckett, that some of his predecessors had designated “go-to guys” who would manipulate wait lists for medical procedures. The media also referred to a 2009 document distributed to senior AHS executives claiming that it was “not uncommon for executive members or other leaders of health care organizations to receive requests to provide preferential or expedited care for ‘prominent’ individuals or the family and acquaintances of ‘prominent’ people.”

The media also cited claims by Dr. Raj Sherman, MLA for EdmontonMeadowlark and an emergency room physician, that it was common for rich and well-connected Albertans to jump wait lists for medical care. He was quoted as saying that he personally received requests from hospital executives for certain patients to get preferential treatment.

The allegations of these individuals and the claim that it was not uncommon for senior executives to receive requests for expedited care proved to be unfounded. However, the inquiry’s terms of reference called on it to explore any preferential access that may be occurring within the health care system. The inquiry did in fact learn of incidents of improper preferential access and also identified several systemic issues that could foster an environment conducive to such improper access.

This inquiry was able to examine only one small corner of Alberta’s complex health care system. Even for this limited review, Commission counsel interviewed more than 150 individuals. The inquiry received hundreds of emails, letters and telephone calls from the public. In total, 68 witnesses testified and the inquiry received 172 exhibits. Ten parties presented written submissions at the end of the hearings. Still, the inquiry’s findings must not be taken as findings about the system as a whole.

While this inquiry uncovered instances of improper preferential access, it did not find specific evidence that anyone had been medically harmed as a result. It would be almost impossible in any event to show that giving one person improper preferential access directly harmed another – that is, short of actually seeing a patient bumped to make way for someone with the right connections.

The more significant question is whether improper preferential access causes harm to the principles underlying publicly funded health care in Alberta.