Helping Health Care?

The health care system in Nova Scotia has been under great financial pressure for the last two years. After many years of budget increases in the 5% – 7% range, the increase last year was 2.7% and this year’s budget provides for 2.8%. These are about the same as the wage settlements recently provided, so there is no room left in the budgets for adding capacity.

Meanwhile our population is aging. New treatments and technologies put constant upward pressure on the cost of delivering health care. As governments come to grips with these challenges, it is clear that the system will never be able to meet all the demands for care. The question is how to deliver the most and the best care within the available funds.

Government should be exploring every possible avenue for improving outcomes. It frequently seems to be doing the opposite.

Government has initiated a good effort to consolidate services among the district health authorities, with an impressive goal to achieve annual savings of $42-$55 million by the fifth year. Let’s hope the implementation is more successful than the pledged reduction in the civil service.

But even if successful, this program ignores the larger opportunity available by reducing the number of those authorities. For example, the combined budget of the Cumberland, Colchester, and Pictou authorities is only about three quarters of the one in Cape Breton. Combining the three small authorities could both reduce overhead and allow for more efficient deployment of health care professionals. Government has shown no inclination to move in that direction.

Senior health care leaders have identified opportunities for savings by outsourcing non-medical functions such as cafeterias and laundry. The savings could be used to hire more healthcare providers. But that has been vetoed by the government.

Most recently, proposed new legislation is designed to prevent insured services from being offered outside the public system. This is based on two highly questionable assumptions:

  1. That patients within the system are somehow disadvantaged if someone uses their own money to pay for treatment outside the system. Suppose someone is waiting for a knee or hip replacement, which could easily take two years or more according to the most recent data.  If that patient goes to Boston to get the surgery at his or her own expense, it shortens the wait time for everyone in the system. Why should it be legal to make that choice in Boston but not in Bedford or Bridgewater, which would be cheaper and better for the patient, and would keep the economic value of the activity in Nova Scotia?
  2. That the public system will run short of resources if doctors are allowed to operate outside of it. But they always have the option of doing exactly that by moving, perhaps to Boston where they can treat people tired of the long waits in Nova Scotia. More to the point, it is the tight limits on funding that restrict the number of physicians and surgeons available, not health care professionals leaving the system. For example, cosmetic plastic surgery treatments are uninsured so some practitioners also operate outside the public system. But it is not running short of plastic surgeons.

Any effort to bring the province’s books into balance requires restraint on health care, which is 45% of total spending. It is by far the biggest expense and the biggest source of pressure for more. With wait times higher than they should be and emergency rooms frequently overburdened, or inoperative, it has required considerable political courage for the government to squeeze health care spending.

It is odd then that so much of government’s attention seems to be devoted to putting an ideological straightjacket on a system that urgently needs creativity and experimentation. It is even more ironic that the principal thrust of its new proposals is to make it harder for patients to obtain care.

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