Health Position Statement

2025 - Volume 2

Health care is a fundamental aspect of safe and healthy rural communities. Accessing quality health care in rural Alberta presents challenges for municipalities and their residents. The RMA believes that rural Albertans deserve a voice in determining how health care services are funded and provided in their communities.

What is the RMA’s position on the importance of having a municipal perspective on health?

The presence of hospitals, primary care facilities, and emergency services in rural communities provides not only health benefits, but broader community benefits. These include attracting new residents, stimulating economic growth, and providing opportunities to educate the new generation of health professionals.
Provincial decisions on investment in rural health facilities and capacity must not be based solely on per capita usage or cost rates, but must recognize the unique challenges of accessing healthcare in sparsely-populated rural areas, and the economic development risks of inadequate or unavailable healthcare services.
In many rural areas, municipalities have played a direct financial role in attracting health professionals. As the provision of health care is a provincial responsibility, municipalities should not be forced to dedicate limited budgets toward health care recruitment and retention.

What financial considerations do rural municipalities have with respect to health?

Any changes to the funding of health services in Alberta must take into consideration the importance of full-service hospitals and accessibility to health services and their impact on the viability of rural communities. This includes the reconfiguration of the services provided by rural hospitals.
Any service changes should account for potential effects on rural communities struggling to recruit and retain health care professionals and maintain health facilities.
Municipalities in rural Alberta are often burdened with the costs to provide peripheral aspects of health care, including the costs to attract and retain medical professionals, transportation to and from health care facilities, and costs associated with responding to emergencies on Crown land.
Alberta’s health funding mechanisms must evolve to support flexible health care delivery in rural Alberta. All health care providers, not only physicians, should have the ability to independently operate within their sphere of qualifications in rural municipalities.
Primary care facilities play an important role in rural health care provision, including the services provided by nurse practitioners.
The use of virtual health initiatives requires access to reliable and affordable highspeed internet in rural and remote communities. This access must be addressed before virtual health initiatives replace or supplement in-person services.
Health care delivery in rural Alberta has unique characteristics, including the high volume of on-call services and the important role of part-time nurses. Retaining these flexible positions supports access to adequate health care in rural areas.

What collaborative relationships are essential to rural municipalities in health?

The current transition of the healthcare system into four pillars has not been properly analyzed through a rural lens. RMA is calling on the Government of Alberta to address this by clarifying how changes to hospital operations, strategic and operational decision-making will include rural voices. RMA is also calling on the Government of Alberta to include a rural Generalist Physician on the Health System Integration Council.
Effective emergency dispatch systems must optimize efficiency and encompass all rural first responders, including ambulance and fire services.
The Government of Alberta launched the Rural Health Action Plan in Fall 2024, which is intended to help guide actions, address challenges, and improve outcomes in rural and remote health care. This action plan aims to ensure that all Albertans have access to high-quality health care when and where they need it.
Rural municipalities must continue to collaborate with relevant professional associations to recruit health care professionals to rural Alberta and provide joint advocacy (e.g. Rural Health Professions Action Plan [RhPAP], Nurse Practitioners Association of Alberta [NPAA], and College of Physicians and Surgeons of Alberta [CPSA]).
Hospice associations provide valuable end of life care in rural communities. The Government of Alberta must work with hospice stakeholders to develop a sustainable community hospice funding model.

How does the work of the RMA support the sustainability of the health sector?

The RMA champions the rural municipal perspective on health services through regular participation in several province-wide boards and committees such as the Rural Health Professions Action Plan (RhPAP) Board of Directors and the Cancer Strategic Clinical Network Core Committee.
The RMA is involved in the Alberta Emergency Medical Services Standing Committee (AEMSSC), which is intended to inform the Minister of Health of ongoing evaluations of different EMS systems in the province and provide recommendations.
The RMA President co-chaired the Alberta Emergency Medical Services Provincial Advisory Committee (AEPAC), which was established to address the growing demand of Emergency Medical Services (EMS) throughout the province. A report was created with 53 recommendations to improve access to health services across Alberta. It is essential that these recommendations are promptly and thoughtfully implemented.

What current health related issues are impacting rural Alberta?

Alberta Health Restructuring

In November 2023, the Government of Alberta and Alberta Health announced a massive restructuring of the health care system in Alberta. The intent of this redesign is to create a four-pillar system consisting of acute care, continuing care, primary care, and mental health and addictions organizations.
Any restructuring of the health care system must be done with careful consideration of the effects it will have on rural municipalities and access to care in rural communities.
The Government of Alberta is creating twelve Regional Advisory Councils and an Indigenous Advisory Council to bring forward local priorities and give input on ways to improve the health care system. It is essential that these councils have adequate rural and municipal representation.
The redesign must account for the continued challenges of recruitment and retention of frontline staff in order to be successful.
The approach of this redesign may lead to an increase of privatized health care services, which may create service delivery risks, especially in rural areas.
The redesign has proposed multiple levels of accountability, including ministers, managerial positions, councils, and boards. Although enhanced accountability within the health care system will be a welcomed change, having multiple forms of oversight can make it difficult for prompt decisions to be made, which can affect the efficiency of the health care system.
Bill 55, the Health Statutes Amendment Act, was introduced to continue the Government of Alberta’s work in restructuring Alberta’s healthcare system. It amends 58 pieces of legislation, including the Emergency Statutes Amendment Act, Health Facilities Act, Municipal Government Act, and Provincial Health Agencies Act. Bill 55 further consolidates control over public health under the direct authority of the provincial government and increases the risk of rural health services being reduced or eliminated in some areas as service level decisions could conceivably become more linked to profit generation under the change.
It is unclear whether rural health care operators and leaders were engaged regarding the effects of this transition. A rural lens must be applied on any health care decisions made on changes through Bill 55.
Local and community input into health care in Alberta is crucial to ensuring effective accountability.
The reporting of key provincial health information must be used in a way that ensures the effectiveness of individual hospitals and the health care system in general.

Medical Professional Recruitment and Retention

The Rural Health Action Plan 2024-2027 recognizes that there are difficulties with recruitment and retention in rural areas and acknowledges that a robust approach must be taken to consider service delivery models and the different types of providers that communities need access to.
Grants such as the Physician Recruitment and Retention Fund must have clear eligibility requirements, have reasonable application periods, and provide sustainable funding.
Alberta’s current medical professional compensation model should be reviewed to ensure it supports the independent or collaborative provision of primary care services in rural Alberta from a range of medical professionals, such as licensed practical nurses.
Recruitment of medical professionals should accommodate flexible positions, as these support access to adequate health care in rural areas.
The Government of Alberta should expand the current number of eligible seats in programs such as the Combined Laboratory and X-Ray Technicians Program at NAIT and encourage post-secondaries to provide rural-specific training to students.
Mental health practitioners who start a practice within rural and remote areas should be considered in the Canada Student Loan Forgiveness Program as a way to incentivize location of such practices in rural Alberta.

Accessible Transportation

For many rural residents with limited mobility, access to transportation is important not only to their health in times of need, but also to ensure they can continue to participate meaningfully in their community.
Due to low population densities and large service areas, rural municipalities often collaborate with neighbouring municipalities and non-profit or service organizations to develop accessible transportation services that meet local needs.

Seniors

Increased operational support of seniors’ lodges and other programming is required at the provincial level to keep pace with the rising costs of providing quality care for seniors in rural and small municipalities.
Aging in place and living independently are important strategies for providing seniors with an opportunity to age with dignity. Funding for home care, assisted living, and accessible transportation for seniors are all key components to supporting rural Alberta’s aging population.

Air Ambulance Services

In Fall 2023, the Government of Alberta conducted an air ambulance landing site review. The review focused on performance, cost-benefit analysis for future upgrading, value for money, sustainability, and operational policy and protocols for airplane and helicopter landing sites.
Nearly two years after the review commenced, it has not been released. RMA is seeking the review outcomes and next steps from the Government of Alberta.
Air ambulance service is critical to supporting access to medical services for those in rural areas. Any changes to the agreements between Alberta Health and air ambulance service providers must maintain base locations and service levels.
Consultation with affected municipalities is essential for the success of air ambulance landing sites in Alberta.
All areas of the province require equitable air ambulance service.
If upgrades are required for airports being used for air ambulance services, financial support should be provided to ensure safety and continuity of service.

Emergency Medical Services

Rural emergency medical services and ambulance service levels must reflect regional needs, particularly in light of the centralization of emergency dispatch services.
The Government of Alberta must ensure that any changes to ambulance service linked to the broader health system restructuring maintain or improve rural ambulance access and take place based on engagement with rural stakeholders.
When appropriate, non-ambulance transportation vehicles should be used for clinically stable patients to allow ambulances to be reserved for emergencies. Further, ambulances based in rural areas should be required to return to their home community directly and not be diverted for calls outside of their region.
As municipal first responders often respond to significant natural disasters or other traumatic events, it is critical that the Government of Alberta ensure that quality and equitable clinical counselling and mental health support services are available for first responders throughout the province.
Rural municipalities often respond to emergencies on Crown land due to being the closest emergency responder available. The Government of Alberta must create a mechanism to compensate municipalities for Crown land emergency responses.

Rural Hospitals

Using narrow criteria such as intake rates does not reflect the value of hospitals to rural communities. Hospitals must be viewed as having health, quality of life, and economic benefits for rural communities.
Any decisions to close or change service levels in rural hospitals must be accompanied by community consultations and improve the overall quality of rural health care.
Hospitals with low intake rates should be used to provide specialized services such as day surgeries. This would relieve stress on highly used urban hospitals and reduce wait times for procedures.
Rural hospitals should be utilized in innovative ways, including providing specialized care for children and offering day surgeries.