Healthy Cuts?

The provincial government is asking the regional health authorities to cut spending by 3% next year. This in spite of a virtual freeze in the prior year, continuing upward pressures from both inflation and an aging population and a continued 6% annual increase in federal contributions to health care.

This is one of a series of difficult choices being made to improve the province’s fiscal position. But it is not quite as courageous as it looks. We are told that health leaders are asked to look for savings in non-essential services but after the pressures of recent years it would be surprising if there was much non-essential expense left to save. It is certain that these cuts will adversely affect health care; the question is how to minimize the damage.

In fact the opportunities for big savings require initiatives that can only be taken at a ministerial level:

  1. We have nine regional health authorities. The smallest of these is less than 10% the size of the largest (Capital Health) and most of them are about one quarter the size of the Cape Breton Health Authority. We could save money and manage better with two or three less.
  2. Give the DHA’s more scope to effect the cuts with the least damage to patient care. Allow reductions in both unionized and non-unionized positions. Allow the closure of lightly used emergency rooms at night, and repurpose some as primary care clinics. More generally allow regional authorities to experiment with different ideas to see which ones work.
  3. The current structure has physicians and surgeons paid and managed independently from the other health care professionals. This contributes considerable inefficiency to the system. It is rather like having a hockey team in which the right wingers get their direction from the owner but the rest of the players are directed by the coach—not a recipe for great teamwork. A unified management structure would have doctors and other health professionals, as well as administration, all report through to a single executive. This should be tried first in non-teaching hospitals. It would allow for more brisk and comprehensive decision making by regional health leaders.
  4. The current system insists on a personal visit to a physician to receive the outcome of routine tests. Otherwise the physician can’t get paid. This is expensive and often a nuisance for patients. A system that allows a modest payment to physicians for calls and emails should save the system money.
  5. There are already private providers offering health care services outside the public system—for example MRI’s in Clayton Park, day surgery in Dartmouth. Allowing a broader range of such services would take pressure off the public system and shorten waiting lines within it.

Some of the savings have to be found at the regional level. The Minister is wise to not engage in those details.

But the Minister controls some of the best opportunities to save money without hurting patient care and must act on them. And she must give the health authorities broad scope for managing their part of the problem.

So far the Minister has set a goal without evidence that she is willing to own any of the choices that the goal requires. To show real courage she should accept accountability for coming up with half of the 3% cuts through initiatives that only she can take.

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