Health Care—It’s Complicated

“Nobody knew health care could be so complicated.”

So said Donald Trump on February 27th. Trying to choose the stupidest thing he has ever said is a daunting task, but this one is a strong contender.

Anyone who has given serious thought to health care will know that it is immensely complex. The large and unwieldy system needs to continuously adapt to changing demographics in the population it serves, and frequent developments in standards and methods of care.

Our own politicians know this. They also know that health care is a top issue for many voters. So, in the heat of an election campaign, they feel obliged to make simple and clear promises that might turn out later to be unwise or misunderstood.

In the 2013 election, the Liberals promised to “ensure a doctor for every Nova Scotian.” At the time, Nova Scotia had more doctors per capita than any other province. We still do although, like others, we are short of family physicians.

The number of people in every province that don’t have a regular doctor ranges from 8% to 25%. This happens, in part, because many of us have not felt the need for one. A commitment that everyone would have a doctor was not a good idea.

The start of the 2017 campaign has produced a new set of lightly researched promises.

Just before the campaign started, the government rushed out an announcement that a new outpatient facility would be built at Bayers Lake.

The Liberals have not been able to satisfactorily explain how the choice was made, nor why the site was chosen in spite of being the least attractive for bus service. The city denies that it was asked for availability or pricing for the possible sites it owns.

The government could have helped itself by reminding people of the intention to also establish a new outpatient facility on the peninsula.

For his part, Progressive Conservative Leader Jamie Baillie said on Monday that he would build a new Victoria General hospital. More than a year ago, the Health Authority commenced implementation of a plan to disperse the functions currently at the VG to a number of locations, including Dartmouth General Hospital, the Infirmary site, Hants Community Hospital, Scotia Surgery, the Dickson Cancer Centre, and a planned hospice. The Dartmouth expansion, estimated at $132-$138 million, is well underway.

On CTV Tuesday, Baillie said that the current multiple site replacement process might be the right option, but would like to review decisions that are not too far advanced, such as the choice of Bayers Lake for the outpatient centre. Which is fine, but that’s not the way he described it on Monday, or continues to say in his new health care ad.

Baillie also criticized the Health Authority for being inefficient, although he has provided no data to support the contention.

This can be a no-win topic for any government. If expenses grow rapidly, critics will say that the system is inefficient. If they grow slowly, critics will say health care is under-funded.

Health Care spending in the 2017-2018 budget goes up by 2.5%, compared to 3.7% for all departments. Over four years, the increase in health is 5.6% versus 11.7 % in all departments. Is that inefficient?

The 2017-2018 budget noted that Home Care underspent its budget in the prior year. It is seeing 16% more patients than four years ago, and is close to eliminating its waiting list. It has also contributed to a 52% waiting list reduction for long term care. That sounds like a significant improvement in efficiency.

NDP leader Gary Burrill commits to spending $120 million over four years for more clinics, doctors, nurse practitioners and other health professionals. He also wants to restore $8 million in cuts to nursing home operators.
He is not from the so-called “conservative progressive” wing of the NDP. He is unconcerned about running deficits and his team is well stocked with union activists. A rerun of the public-sector wage settlements given out by the Dexter government would put the province’s finances in distress for a decade.

The parties do not appear to differ on the big questions. Nobody is seriously questioning the health region amalgamation, nor the multiple site replacement of services currently at the Victoria General, nor the delivery of primary care via collaborative teams of health care professionals.

Voters will see many announcements on health care during the campaign, some resembling a bidding contest on who will spend the most to recruit doctors or fix emergency departments.

They should view those announcements skeptically. Politicians try to deliver a simple and appealing message. On a topic as complex as health care, they will often gloss over details that make a big difference.


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