Recommendation No. 9 Governance and accountability of Academic Health Centres We recommend that Executive Council assign responsibility for implementation of our prior year recommendations that:
• those who manage and fund academic health activities acknowledge the full scope and magnitude of those activities and the consequences for the accountability of academic health centres
• the entity or entities responsible for academic health, and their mandates, roles, and accountabilities be clearly
defined and, on this basis, the appropriate organization and governance structure be established
Recommendations repeated I addressed these recommendations to the Ministry of Learning in my 1998-1999 Annual Report (1999—Nos. 18 and 19) and to the universities of Alberta and Calgary in last year’s Annual Report (2000—No. 39). In both years the government accepted the recommendations. I am repeating them again because we have evidence of only limited progress in addressing the major risks in academic health.
Academic health is a partnership
Academic health centres are partnerships of medical faculties, health authorities, and academic physicians. They educate health professionals, conduct health sciences research, and provide specialized clinical services. The Council of Academic Health Centres of Alberta (the Council) consists of the two vice-presidents (academic) and the two deans of medicine at the universities of Alberta and Calgary and the CEOs of the Capital Health Authority and Calgary Health Region and the Alberta Cancer Board. The ministries of Health and Wellness, Innovation and Science, and Learning provide the bulk of funding. These ministries together with the members of the Council represent the major stakeholders
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in academic health.
Academic health faces serious risks
In our 1998-1999 report we stressed the serious risks faced by the academic health centres:
• lack of understanding among stakeholders of the scope of academic health and lack of transparency of funding
• lack of information on the financial status of the centres
• inequities in physician remuneration
• dependence on external funding of activities that generate administrative infrastructure costs
We estimated the total 1997-1998 cost of academic health at
$350 million, 70% of which was ultimately funded in various ways by the Province. Accountability for the use of this substantial amount of public funds is seriously lacking.
Some issues have progressed The faculties are piloting alternative plans for compensation of faculty members in cooperation with ministries. These plans have the potential to mitigate physician remuneration risks.
We were informed that the Council made proposals concerning governance and structure to the universities. The universities have not yet responded.
No one has assumed leadership
Further progress requires stakeholders to agree on who is
accountable for what. They are aware that the issues are complex and urgent. But no one has assumed leadership. The Council is merely an advisory body. Last year I agreed that the universities were the most appropriate bodies with the requisite authority.
However, the universities say it is the ministries’ responsibility because they decide the funding mechanisms.
Accordingly, in the interest of resolving the impasse, I am addressing this recommendation to all stakeholders through Executive Council.
Ministry financial statements
My auditor’s report on the Ministry financial statements contained a reservation of opinion
I audited the financial statements of the Ministry of Executive Council for the year ended March 31, 2001. My auditor’s report contained a reservation of opinion because capital assets costing less than $15,000 are expensed and are not recognized as assets in the Ministry financial statements.
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Gaming
Overview
The mission of the Ministry of Gaming is “to maintain the integrity of gaming and liquor activities in Alberta and collect revenues for the Province.” The organizations in the Ministry of Gaming reporting entity include the Alberta Gaming and Liquor Commission (AGLC or “the Commission”), the Department of Gaming, and the Lottery Fund. The Minister of Gaming is also responsible for the administration of the Racing Corporation Act.
Gaming has grown by nearly 60% in 5 years
The gaming industry in Alberta generates significant revenues. Of the total proceeds from legalized gaming (wagers less prizes) of
$1.5 billion in 2000-2001, approximately $1.0 billion was deposited into the Alberta Lottery Fund, approximately $335 million was paid as compensation to gaming operators, and approximately
$170 million passed directly to charities under the “Charitable Gaming Model.” Analysis of gaming’s growth of almost 60% in the past five years indicates there has been a shift from gaming activities such as bingo and horse racing to activities such as video lottery terminals (VLTs) and slot machines. Liquor and related revenue, net of cost of goods sold, contributed an additional
$468 million to the Province’s general revenues in 2000-2001.
The Ministry faces a number of challenges
The Ministry faces a number of challenges. From a policy perspective, the Ministry works to balance the interests of the government, private sector businesses, charitable organizations, and the public in decisions about the gaming and liquor industries. From a regulatory perspective, the Ministry must monitor compliance with liquor, gaming and tobacco laws and agreements. From an operational perspective, the Ministry operates the large-scale systems that control liquor distribution and electronic gaming activities in the Province.
Scope of work
Our work focused on compensation to gaming operators
In 2000-2001, our Office examined the systems used by the AGLC to set the compensation rates for VLT and casino operators. We also reviewed the systems used by the Commission to manage contracts for the operation of electronic racing terminals.
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