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The Differential Impact of Health Care Privatization on Women in Alberta

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The Differential Impact of Health Care Privatization on Women in Alberta THE DIFFERENTIAL IMPACT OF HEALTH CARE PRIVATIZATION ON WOMEN IN ALBERTA C. M. Scott T. Horne W. E. Thurston PRAIRIE WOMEN’S HEALTH CENTRE OF EXCELLENCE RESEARCHP POLICYP COMMUNITY Administrative Centre: Regina Site: Saskatoon Site: Prairie Women’s Health Prairie Women’s Health Prairie Women’s Health Centre of Excellence Centre of Excellence Centre of Excellence The University of Winnipeg University of Regina Extension University of Saskatchewan 515 Portage Avenue Regina, SK S4S 0A2 Saskatoon, SK S7N 5E5 Winnipeg, MB R3B 2E9 Telephone: (306) 585-5727 Telephone: (306) 966-8658 Telephone: (204) 786-9048 Fax: (306) 585-5825 Fax: (306) 966-7920 Fax: (204) 774-4134 E-mail: [email protected] E-mail: [email protected] E-mail: [email protected] WEBSITE: www.pwhce.ca The research and publication of this study were funded by the Women’s Health Bureau of Health Canada, the Women’s Health Research Group at the University of Calgary, and the Prairie Women’s Health Centre of Excellence (PWHCE). The PWHCE is financially supported by the Centre of Excellence for Women’s Health Program, Women’s Health Bureau, Health Canada. The views expressed herein do not necessarily represent the views of the PWHCE or the official policy of Health Canada. THE DIFFERENTIAL IMPACT OF HEALTH CARE PRIVATIZATION ON WOMEN IN ALBERTA C.M. Scott, T. Horne and W.E. Thurston ©2000 C.M. Scott, T. Horne, W.E. Thurston, and the Prairie Women’s Health Centre of Excellence ISBN 0-9684540-7-0 ORDERING INFORMATION The full text of this report will be available on the PWHCE website at www.pwhce.ca in the summer of 2000. Additional print copies are available by mailing a cheque or money order for $10.00 in Canadian funds to: Prairie Women’s Health Centre of Excellence Room 2C11A - The University of Winnipeg 515 Portage Avenue Winnipeg, MB R3B 2E9 THE DIFFERENTIAL IMPACT OF HEALTH CARE PRIVATIZATION ON WOMEN IN ALBERTA Contents Acknowledgements ...................... i 6. The Delegated Administration Act and The Government Organization Act ...........24 Executive Summary ......................ii 7. A Better Way (I)......................25 8. A Better Way (II) .....................26 PART 1: INTRODUCTION 9. Action on Health .....................28 Gender-Based Analysis in Alberta ............2 The Evolution of Alberta Health and Social Policy 10. The Health Statutes Amendment Act ......30 in the Canadian Context...................6 11. Health Summit ‘99 ...................30 Public Participation......................11 12. Health Information Systems: The Health Information Act ......................31 PART 2: PRIVATIZATION OF HEALTH CARE 13. Bill 11: The Health Care Protection Act ....32 IN ALBERTA 1989-2000 14. Community-based Care and Home Care . 37 The Current Vision for the Health of Albertans . 15 The Provincial Platform: Key Policy Initiatives . 16 1. The Rainbow Report ...................16 PART 3. CONCLUSIONS.................40 2. Partners in Health .....................18 3. Starting Points ........................19 Appendices ...........................41 4. Health Goals for Alberta ................21 5. The Regional Health Authorities Act .......21 References............................43 Acknowledgements We would like to express our thanks to Phil O’Hara Cathie Scott, MSc and Erin Rutherford for the commitment, energy and Graduate Student, Community Health Sciences insight that they brought to this project. University of Calgary 3330 Hospital Drive NW We would also like to thank the Centres of Excellence Calgary, Alberta T2N 4N1 for Women’s Health Program (Women’s Health Director, CST Consulting Bureau, Health Canada); the Prairie Women’s Health 2907 - 13th Avenue NW Centre of Excellence; the Women’s Health Research Calgary, Alberta T2N 1M1 Group, University of Calgary; and the National P: (403) 284-9718 Coordinating Group on Women and Health Care F: (403) 289-2619 Reform for providing encouragement and financial E: [email protected] support. Tammy Horne, PhD WellQuest Consulting Ltd. 11511 - 125th Street Edmonton, Alberta T5M 0N3 P: (780) 451-6145 F: (780) 451-5280 E: [email protected] Wilfreda E. Thurston, PhD Associate Professor, Community Health Sciences University of Calgary - 3330 Hospital Drive NW Calgary, Alberta T2N 4N1 P: (403) 220-6940 F: (403) 270-7307 E: [email protected] i THE DIFFERENTIAL IMPACT OF HEALTH CARE PRIVATIZATION ON WOMEN IN ALBERTA Executive Summary BACKGROUND wan scans in 1999. The recent commissioning of this report by the Prairie Centre, and a similar The Prairie Women’s Health Centre of Excel- examination of Newfoundland under the auspices lence is a member of the National Coordinating of the National Network on Environments and Group on Health Care Reform and Women. The Women’s Health, completes the coverage of pro- Coordinating group is comprised of representa- vincial jurisdictions in the scans. tives from the five Centres of Excellence for Women’s Health, the Canadian Women’s Health The National Coordinating Group hopes to foster Network, and the Women’s Health Bureau of collaboration and encourage other health resear- Health Canada. It has developed a framework for chers and women’s health organizations to take investigating the impacts of health reforms on up the challenge of monitoring the impacts of women to guide researchers’ efforts to monitor health reforms on women and women’s respon- the effects of health reforms on women—as pa- ses to health reforms. tients and service recipients, as paid and unpaid health care providers, and as participants in OVERVIEW health policy discussions. The purpose of this paper is to explore the extent As part of this national project, the Centres con- to which health care privatization is taking place ducted provincial and regional scans of policies in Alberta and to determine the impact of health and research related to privatization in health care privatization on women. To do this, we used reform and its impacts on women. The Prairie a gendered lens to examine a number of key pro- Centre conducted the Manitoba and Saskatche- ii THE DIFFERENTIAL IMPACT OF HEALTH CARE PRIVATIZATION ON WOMEN IN ALBERTA vincial health policy documents. The review was The shift to more privatization in health has been conducted between February and April 2000. It accompanied by resistance to acknowledging the was beyond the scope of this project to directly detrimental impacts of privatization, particularly examine the impacts of health care privatization; on women. Women are providing more services no new data were collected. While this report is at home, in the not-for-profit organizations, and not intended to provide a complete review of all with less support. Women working in services in policy related to health care privatization, it prov- Alberta know that, as elsewhere, the gendered ides an overview of policies and initiatives that impacts of restructuring are not evenly distrib- exemplify of the Alberta government’s policy uted among women, and that young women, im- platform. migrant women, women of colour and working class women have been hardest hit. Restructuring This report traces the development of health pol- has been linked to the intensification and icy initiatives from 1989 to the present, feminization of poverty for young and elderly demonstrating that there has been consistent sup- women in particular. port for increasing the role of the private market in Alberta’s health care system. Privatization The government’s commitment to privatization takes several forms - shifting service delivery out of the health system has also been accompanied of public institutions such as hospitals to private by a trend toward increasingly limited and con- clinics, shifting costs of services from govern- trolled public participation in the planning pro- ment to individuals, shifting caregiving work cesses. Legislative and public opposition to the from public sector health workers to unpaid care- current privatization policy agenda has done little givers and adopting the management strategies of to alter the course or the pace of change. Given private sector business. the government’s apparent lack of responsiveness to public input, it is not surprising that there ap- There has been a perception among many people pears to be a great deal of skepticism among Al- in Alberta that health care restructuring was initi- bertans regarding their ability to influence the ated and continues without having an overall plan policy process. This was illustrated again in place. While there may have been a lack of recently during public discourse around Bill 11, clarity regarding specific strategies for change in which permits increased private sector involve- the health system, there has been a consistent ment in the health system. As well, Albertans commitment to increasing the involvement of the must now deal with 17 regional health authorities private sector in health care financing (e.g., out when it comes to organizing around health poli- of pocket costs) and delivery (e.g., services deliv- cies that affect them at the local level, rather than ered through for-profit clinics, work for family being able to deal with a central provincial struc- caregivers, particularly women). This commit- ture. ment has not wavered, despite the equally consis- tent expression of public concern regarding the potential negative impact of health care privatiza- tion. iii PART 1 INTRODUCTION The purpose of this paper is to explore the extent systems of oppression (e.g., racism, ablism, to which health care privatization is taking place
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