Alberta’s fairness watchdog is calling for more transparency from the committee that decides what out-of-country medical care will be covered by the government.
Following a five-month investigation, Alberta Ombudsman Gord Button said Tuesday that Alberta’s Out-of-Country Health Services program suffers from systemic problems, with the dominant issue being a lack of clarity about how its committee arrives at decisions.
“There’s not enough information provided for anybody to make a determination as to the fairness and reasonableness of those decisions,” he said.
The province pays for out-of-country care if its Out-of-Country Health Services committee deems that it’s not available in Alberta. The committee is comprised of four doctors appointed by the health minister and a team leader from the provincial health department.
The province also has a six-person panel that hears appeals of the committee’s decisions. The appeal panel, appointed by the minister, consists of four doctors, one ethicist and a member of the public.
In a special report released Tuesday, Button is making 52 recommendations that call for better communication, more accountability and improved training for the review bodies.
He also recommends funding applications be made by doctors and dentists, not the patients themselves, which is the current practice. These medical professionals are in the best position to provide the required information and the change would bring Alberta in line with other provinces, he said.
Button also re-issued a previous recommendation that the review panel re-hear four cases whereby Albertans were denied funding for treatment “because of issues of administrative unfairness.”
“I believe these citizens deserve a fair decision and an explanation,” Button said. “Administrative errors were made by the appeal panel and these Albertans should not be the ones to suffer.”
Button is asking for a response within 45 days from the appeal panel and Health and Wellness Minister Ron Liepert.
Alberta Health and Wellness just received the report and hasn’t had a chance to review it yet, said spokesperson John Tuckwell.
“The minister has made it very clear he’s confident in the expertise of the committee. They are independent and operate [at] arm’s length from government,” he said.
Button agreed the minister must stay out of the committee’s decision-making but said he is ultimately responsible for ensuring the committee has good governance.
Alberta Liberal critic Harry Chase wasn’t hopeful the report will prompt significant action.
“How many times has Auditor General Fred Dunn pointed out similar situations where he’s made recommendations that the government’s failed to follow up on?” he said.
A full list of Button’s recommendations is included in the report Prescription for Fairness, which is posted under “what’s new” at www.ombudsman.ab.ca.
