There Is Not Enough Money

To pay for all the health care services that Nova Scotians expect or want would cost much more than we can afford. It is time to deal with that reality.

This year’s health budget of $4.1 billion is 41% of the total. Over the last four years, it has been growing at 2.4% per year—while all other spending grew at 1.4% per year. Even at those modest growth rates, health care will eventually become half of our spending.

It would be wrong to blame the federal government. Health care transfers to Nova Scotia from Ottawa have been growing at a much higher 4.2% over the same period, and are scheduled to grow at 5.3% next year.

Meanwhile, calls for ever-greater spending come from all directions. Opposition parties keep pointing out shortcomings in mental health care.

The Nova Scotia Nurses’ Union has released a report saying that long-term care is in crisis. There are 6,900 patients in our 90 facilities, many of which are old. Long-term care will cost $567 million this year.

There is a waiting list of 1,600 more patients, some of whom are occupying acute care beds. Demand will increase with the rapidly growing population of seniors. The NSNU wants lots more nurses and new facilities.

The Centennial building at the Victoria General is a mess, and the services provided there need to be relocated.

What kind of help can be expected from Ottawa? The Liberal platform calls for about $10 billion per year of infrastructure spending. Based on population, Nova Scotia’s annual share would be $260 million.

Of course, there will be lots of demand, including highway twinning, commuting options, and other health and education facilities. Nevertheless, this could make a valuable contribution to the cost of replacing the Centennial facility.

The only provision in the platform specific to health is for home care. Nova Scotia’s per capita share of the platform amount would be $11 million next year, growing to $26 million over four years. If the share is based on our population of seniors, it would be a little more.

This year’s cost of home care is $241 million, so the 5%-10% increase from federal money would be useful—but certainly not transformative.

The Liberal platform promises a “new Health Accord with provinces and territories, including a long-term agreement on funding.” But there is nothing in its financial projections to indicate more money being available.

Likewise, the platform commits to “…join with provincial and territorial governments to buy drugs in bulk” and “…make high-quality mental health services more available to Canadians who need them, including our veterans and first responders” but there is no financial provision backing up either promise.

The federal Liberals are already seriously challenged to meet their budget promises, even in the fourth year. The economy is soft and oil prices are low. They will not realize what they projected from increased taxes on high income earners—in fact, those changes may further hurt the economy by driving highly creative and capable people to move south.

So it seems very unlikely that Minister Morneau will go beyond their already overextended promises. Nova Scotia’s health ministry can hope for help with infrastructure and home care, and not much else. How should we go forward?

(1) A good starting point would be for all three political parties to acknowledge the limitations on the public purse, thereby ceasing to make it difficult for people to spend their own money in Nova Scotia on services that are also part of the public system.

Those people are not jumping the queue—they are leaving it, making things faster for those still in it. Today’s availability of private MRI services has done no damage to the public system.

(2) It costs about $15,000 per year to support a senior with home care, compared with $82,000 for long-term care. Of course, the latter group will have greater needs on average, but the minister is right to focus on maximizing the number of people who can be supported with home care.

(3) Relocate some of the high volume/low risk services such as ophthalmology, small plastic surgeries, and some orthopedic surgeries such as routine hip and knee procedures.

Standalone facilities in places like Dartmouth Crossing or Bayers Lake would make them much more accessible for patients and most staff, not to mention the free parking. They could also be put in place less expensively and much more quickly than a replacement for the Centennial building.

(4) To increase revenue, we need to aggressively grow our economy.

(a) With the low Canadian dollar, we should allow standalone health care facilities to serve out-of-province and out-of-country patients. That need not inconvenience publicly funded patients, who would always have to be served within prescribed standards before any other work could be considered.

A medical tourism business could mean higher volumes and therefore lower costs per procedure. And it could be an important economic driver that would take advantage of an area where we have established expertise.

(b) Burning coal from Donkin instead of shipping it in from Columbia is a good idea. It will not result in any more greenhouse gases, and will provide much-needed jobs in Cape Breton.

(c) It has been more than a year since the Doelle-Lahey report concluded that, with an overhauled regulatory framework, “aquaculture that integrates economic prosperity, social well-being and environmental sustainability… is low impact and high value.” Yet we still do not have regulations that would permit new fish farms, nor a date by which they can be expected.

Nova Scotia is going to be hard pressed to provide satisfactory access to public health care. It is time to use every tool at our disposal.

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