Background
The Prairie Women's Health Centre of Excellence is a member of the National Coordinating Group on Health Care Reform and Women. The Coordinating group is comprised of representatives from the five Centres of Excellence for Women's Health, the Canadian Women's Health Network, and the Bureau of Women's Health and Gender Analysis of Health Canada. It has developed a framework for investigating the impacts of health reforms on women to guide researchers' efforts to monitor the effects of health reforms on women--as patients and service recipients, as paid and unpaid health care providers, and as participants in health policy discussions.

As part of this national project, the Centres conducted provincial and regional scans of policies and research related to privatization in health reform and its impacts on women. The Prairie Centre conducted the Manitoba and Saskatchewan scans in 1999. The recent commissioning of this report by the Prairie Centre, and a similar examination of Newfoundland under the auspices of the National Network on Environments and Women's Health, completes the coverage of provincial jurisdictions in the scans.

The National Coordinating Group hopes to foster collaboration and encourage other health researchers and women's health organizations to take up the challenge of monitoring the impacts of health reforms on women and women's responses to health reforms.

Overview
The purpose of this paper is to explore the extent to which health care privatization is taking place in Alberta and to determine the impact of health care privatization on women. To do this, we used a gendered lens to examine a number of key provincial health policy documents. The review was conducted between February and April 2000. It was beyond the scope of this project to directly examine the impacts of health care privatization; no new data were collected. While this report is not intended to provide a complete review of all policy related to health care privatization, it provides an overview of policies and initiatives that exemplify of the Alberta government's policy platform.

This report traces the development of health policy initiatives from 1989 to the present, demonstrating that there has been consistent support for increasing the role of the private market in Alberta's health care system. Privatization takes several forms - shifting service delivery out of public institutions such as hospitals to private clinics, shifting costs of services from government to individuals, shifting caregiving work from public sector health workers to unpaid caregivers and adopting the management strategies of private sector business.

There has been a perception among many people in Alberta that health care restructuring was initiated and continues without having an overall plan in place. While there may have been a lack of clarity regarding specific strategies for change in the health system, there has been a consistent commitment to increasing the involvement of the private sector in health care financing (e.g., out of pocket costs) and delivery (e.g., services delivered through for-profit clinics, work for family caregivers, particularly women). This commitment has not wavered, despite the equally consistent expression of public concern regarding the potential negative impact of health care privatization.

The shift to more privatization in health has been accompanied by resistance to acknowledging the detrimental impacts of privatization, particularly on women. Women are providing more services at home, in the not-for-profit organizations, and with less support. Women working in services in Alberta know that, as elsewhere, the gendered impacts of restructuring are not evenly distributed among women, and that young women, immigrant women, women of colour and working class women have been hardest hit. Restructuring has been linked to the intensification and feminization of poverty for young and elderly women in particular.

The government's commitment to privatization of the health system has also been accompanied by a trend toward increasingly limited and controlled public participation in the planning processes. Legislative and public opposition to the current privatization policy agenda has done little to alter the course or the pace of change. Given the government's apparent lack of responsiveness to public input, it is not surprising that there appears to be a great deal of skepticism among Albertans regarding their ability to influence the policy process. This was illustrated again recently during public discourse around Bill 11, which permits increased private sector involvement in the health system. As well, Albertans must now deal with 17 regional health authorities when it comes to organizing around health policies that affect them at the local level, rather than being able to deal with a central provincial structure.

Conclusion
The current Conservative government holds 64 of 83 seats in the provincial legislature, with the opposition Liberals and New Democrats holding 16 seats and one seat respectively. Through participation in public forums and town hall meetings focussed on health care restructuring, Albertans have added their voices to those of their elected officials; however, legislative and public opposition to the current privatization policy agenda has done little to alter the course or the pace of change. Despite the level of public discourse regarding the current legislation, there has been little public discussion of the gendered impacts of the move toward privatization.

We have demonstrated that there has been a long-standing commitment in Alberta to increasing the role of the private sector in health care. While we recognize that the private sector is currently and will continue to be an integral part of the health system, we advise caution. In this report, we conducted gender-based analysis of key health policy events that took place in Alberta between 1989 and 2000. This analysis highlights the serious implications that increased health care privatization will have for women (such as lower wages, less secure jobs, out-of-pocket costs, informal caregiving obligations). Before current legislation is passed, and before any further legislation is introduced, the implications for all citizens, most particularly for women, must be comprehensively and systematically examined using strategies for meaningful public participation in decision-making.

If we are to preserve the environment on a sustainable basis, achieve gender equality, take into account the legitimate claims to identity of certain minorities within existing democratic states, and foster the development of cultural options beyond commodification, we require an activist democratic state. (Broadbent, 1999, p. 92)