Alberta's "paying for choice and access" health reform plan draws hot controversy.

Hot controversy greeted Alberta's proposed health care reform presented by Premier Ralph Klein and Health and Wellness Minister Iris Evans. Actually, only one item in the program was subject to dispute--the issue of "paying for choice and access."

If implemented the choice and access provision would enable physicians and facility providers to work within and outside the public system. It would also allow patients to avoid waiting lists by paying for services outside the public program.

The government promises close monitoring of these private arrangements to assure that the public system would not be adversely affected by the alternative access services.

Even though leaders of the Canadian and Alberta Medical Associations have shown interest in allowing alternative, private-pay services, they have not endorsed the Alberta proposals and will wait until they learn more details. They are concerned about the type of regulations that might be imposed by the provincial government on doctors practicing in the private pay area.

Not all physicians were holding back. "It frightens me," said Dr. Brent Piepgrass, vice-president of medical services with Peace Country Health, according to a report in the Daily Herald-Tribune in Grande Prairie. He believes it will damage an already fragile system.

Prime Minister Stephen Harper declined to make any comment saying he wants to make sure any changes respect the Canada Health Act.

He is anxious to avoid a confrontation with Ralph Klein. Harper's tenuous conservative government is backed by 26 members from Alberta, many of whom have loyalties to both Harper and Klein.

Most of Canada's premiers and provincial health ministers have questioned the Alberta approach and find it will violate the Canada Health Act.

Unions representing health care workers, Alberta Union of Provincial Employees and CUPE Alberta have attacked the government and called on federal Health Minister Tony Clement to take a strong stand against the plan.

The Health Policy Framework paper makes a number of proposals which are less controversial. These include

* A greater role for patients in maintaining and improving health care:

* Promoting flexibility in scope of practice of health professionals, enabling nurses, pharmacists and others to play a larger role;

* alternative compensation structures that provide incentives for quality of care, efficiency and inter-professional collaboration;

* Strengthening inter-regional collaboration, establishment of shared service networks throughout the province;

* Reshaping the role of hospitals, enabling more day surgery, ambulatory and community treatment; * Creating long-term sustainability and flexible funding options;

* Expanding system capacity, increasing the supply of health care professionals;

* marketing of intellectual property and innovations developed in Alberta.

As more details are announced, the proposals will be subjected to a public consultative process.

www.health.gov.ab.ca/healthrenewal