"The Ministry has developed a robust set of assessment criteria ... Balanced decision making processes for assessing the proposed agreements have been developed to ensure objective and unbiased rationales."

Edmonton -- Eighteen contracts with surgical facilities in Alberta have been approved by Health and Wellness Minister Gary Mar. The Minister also released a list of reasons for approving the contracts, covering specific ophthalmology, dermatology, plastic surgery and pregnancy termination procedures, along with three independent studies of the contract assessment process and criteria.

"Patients will continue to have uninterrupted access to insured services such as cataract surgery, and we now have strong new rules in place to make sure those services are regulated by government," said Mar. "Albertans will now know what agreements have been made, how much they cost and what is being provided."

The Minister also announced that he is extending existing contracts for oral surgery for one month to allow health authorities and all service providers, including oral surgeons, more time to conclude contract discussions. A Directive from the Deputy Minister will be issued to extend these contracts to ensure that patients continue to have access to existing services.

The approved contracts amount to a total of $9.0 million, about 0.16 per cent or less than two-tenths of one per cent of Alberta's current health budget. The contracts are the first to be covered by new patient protection rules proclaimed in the Health Care Protection Act.

No new services are included in the approved contracts and no overnight stays are involved.

Criteria for contract approval as stated in the Health Care Protection Act and its accompanying regulations include compliance with the Canada Health Act. Health authorities must also ensure that no conflict of interest exists in the contracting process. Health authorities must also show that any contract will ensure patient access, safety and satisfaction; deliver a demonstrable public benefit; and keep expenditures within the authority's budget.

Facilities must also be accredited by the College of Physicians and Surgeons of Alberta to perform the specific service contracted and to ensure that all professional medical and patient safety standards are met.

As final control checks, the assessment criteria were subjected to independent third-party scrutiny by the Vancouver office of the international business consulting firm of Watson Wyatt Worldwide. Consultant Dr. John F. Stockton of Vancouver carried out an independent third-party review of the contract proposals and the resulting recommendations and the Office of the Auditor General further reviewed the contract approval process. The outside reviews are expected to cost about $41,000.

The Minister's rationale for approval, including a list of approved contracts, and the independent third-party reviews are attached. Individual health authorities should be contacted for details of specific contracts.

Two contracts will be up for renewal in the Spring of 2002 and will come under the Health Care Protection Act upon expiry.

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David Bray - Communications, Alberta Health and Wellness - (780) 427-7164

For toll-free access from anywhere in Alberta, dial 310-0000.

Edmonton, September 29, 2000

Third Party Reviews of Assessment

Watson Wyatt Worldwide (Vancouver office) reviewed the assessment criteria. One recommendation, to exclude health authority board members and staff from decisions in a conflict of interest situation, did not require action. Existing bylaws on conflict of interest are clear.

The assessment criteria incorporate 11 other recommendations. Four were editing changes:

• A new paragraph introduces the five components of quality standards.
• More explicit wording specifies there can be no preferential access.
• It is stated explicitly that all Canadian patients are treated in accordance with the Canada Health Act principles of accessibility and portability.
• Measuring and monitoring performance were combined into a single criterion.

In addition, contracts must:

• Include legal liability in determining adverse impact on the publicly funded health system.
• Include facility commissioning and operating costs in cost effectiveness comparisons.
• Meet expanded relevant standards of patient care.
• Have plans to co-ordinate pre-, post-, and emergency care with health authorities as required.
• Have no adverse impact on the ability of the public health workforce to deliver services.
• Identify any other factors that may have an adverse impact on the public health system.
• Clearly define health authority roles and responsibilities.

The Auditor General of Alberta reviewed the assessment process. He supports the principles, and acknowledges the Minister's due diligence, the department's proposal and contract guidelines, and that a plan is in place to evaluate the process at the end of the project.

The Auditor General offered eight suggestions for future improvement. None of the recommendations required action during the current approval process. Alberta Health and Wellness has agreed to take future action on all recommendations:

• Establish principles to guide the decisions of those participating in the process.
• Consider the level of due diligence required of the Minister and health authorities.
• Require compliance with proposal and contract guidelines.
• Incorporate a process for continuous improvement.
• Develop consistent performance measures for particular surgical services.
• Use qualitative and quantitative terms to describe assessment criteria.
• Describe how the results of third-party reviews will be incorporated.
• The individual responsibilities of each assessment team member will be defined.

Dr. John F. Stockton of Vancouver conducted an independent assessment of all contract proposals. The consultant was guided by criteria previously reviewed by the Auditor General of Alberta, and the Vancouver office of Watson Wyatt Worldwide.

The Stockton report agreed the proposals provide an acceptable level of compliance with the legislated requirements of the Health Care Protection Act. Based on this compliance, the Stockton report confirms the department's rationale for approving the contracts.