EDMONTON - Stroke victim Ian Young says medicare founder Tommy Douglas would be "horrified" to see what's happening to health care in Alberta as the province struggles to control spending.

Young says costs are being shifted onto patients and he fears that means some Albertans may avoid seeking treatment they need.

"There's going to be more people not getting the care they deserve for financial reasons," said Young, 45, who won an award of courage from the Glenrose Rehabilitation Hospital in Edmonton.

"Some people are going to go without or start self-medicating."

All provinces are struggling to control health-care costs, but the situation in Alberta has become critical in recent months.

A source told The Canadian Press that the Health Ministry is facing a deficit of up to $1.3 billion. Premier Ed Stelmach confirmed in a year-end interview that the department is bleeding red ink.

"Part of the billion is the accumulated deficits of the regional health authorities," said the premier. "Some of it is due to our labour agreements, some of it is due to growth in programs ... new therapies, new drugs."

The province may end up putting a lid on health spending increases over the next few years, he suggested.

"We'd look perhaps at a fixed percentage over a number of years so that health can plan better," he said. "They're always the large elephant in the room -- about 40 per cent of our budget."

Health Minister Ron Liepert recently released a strategy for the next dozen years that is aimed at curbing spiralling health-care costs.

That plan includes changing the role of rural hospitals and pushing a larger portion of drug costs onto patients, especially those who can afford to pay, including well-off seniors.

Liepert isn't mincing words. He says seniors have come to expect too much from a health-care system that now costs the province $13 billion a year.

"I don't see why there should be an entitlement mentality that when you turn a certain age you're entitled to something," the minister said in an interview.

But Carol Wodak, who has become a voice for seniors in Alberta, resents that they are being blamed.

"I don't know that we've taken health care for granted, but we certainly understand that's one of the reasons we pay taxes," she said in an interview.

"So if there's an entitlement, it's certainly something we've paid for."

Liepert has moved quickly since becoming health minister in March to retool how health is handled in the province. He replaced nine regional health authorities with a new superboard. More recently, he trimmed $30 million from the prescription drug program by tripling some premiums and bringing in a $7,500-deductible for high-income earners.

Long-term care is also being overhauled to reduce costs by trying to keep seniors in their homes longer.

The most significant changes are yet to come, but are outlined in a document that was quietly released on the Health Department's website in mid-December.

The 44-page report by the U.S. consulting firm McKinsey and Co., says under-utilized rural hospitals need to change how they operate to take pressure off crowded urban facilities in Edmonton and Calgary.

"There are some hospitals in rural Alberta that probably are not serving their communities the way that they potentially could," said Liepert. "But it has nothing to do with closing them."

The report, which was used to draft the government's health-care strategy for the coming decade, also calls for new labour agreements with nurses to reduce overtime costs.

"It just seems like every area we deal with, when we take a look at it ... quite frankly you could do it another way that makes it more efficient."'

But Wodak worries that many people don't really understand what's happening because they haven't been able to "decode" the minister's public statements on changes to health care.

"One day they'll apply for something they need and discover they have to buy it themselves," she said.

"As soon as folks with family members in nursing homes find out they're going to have to start paying for drugs and medical supplies, I think they're going to be some upset."

Albertans have been upset in the past over proposed health reforms. Protests drew thousands of people when Ralph Klein was premier and promoted more private health-care delivery.

But Liepert believes people are now more open to change, given the economic meltdown that is sweeping the globe and forcing governments to cut costs or sink into debt.

"It's probably easier to get people's attention than it was six months ago," he said. "Because clearly when you're coming out projecting surpluses of $8 billion, people say `What's the problem? Just spend more.'

"We've got ample proof and evidence that if you spend more, and don't spend it right, it doesn't solve the basic issues."