Todd Whitcombe
As I See It
Back in 2006, the B.C. Liberals launched the "Conversation on Health Care" program.
It was a $10 million dollar initiative designed to engage the public in a conversation about the health care system and what we should do to fix it. Complete with a web-site, public forums, and a "final" report, it was intended to be a step forward in the whole health-care debate.
"No one is suggesting that we don't have improvements to make," said Premier Campbell, "I think including people in this and looking at the long term is one of the critical components of sustaining health care."
We were told that the government needs the public's input on how the government can curb and prioritize spending on health care.
What ever happened to the Conversation on Health Care? We were promised copies of the final report, and yet I haven't seen one. Did we not get to a final report?
Were all of the dire statistics and predictions just so much smoke and mirrors?
At the time, the government was predicting that health care costs were going to sky-rocket. That they were going to soon be consuming more than half of the provincial budget.
According to then Finance Minister Carole Taylor, by 2017, health would take up 72.3 per cent of the provincial budget, leaving only enough money for education and nothing else.
Is that what happened? Are we on track for 72.3 per cent of our budget being spent on health by 2017?
I would suggest that the answer is "no" and further, that it was never ever "yes." Consider the following numbers:
Fiscal Year 2000 - Budget: $21.5 billion, Health: $8.3 billion, percentage: 38.5.
Fiscal Year 2006 - Budget: $35.4 billion - Health: $11.9 billion, percentage: 33.7.
Fiscal Year 2010 - Budget: $40.6 billion, Health: $15 billion, percentage: 36.9 .
Admittedly, the numbers are rounded off and are the budgeted figures - not the actual amounts spent nor the revenue gained. Recall that in 2006, for example, the government had a healthy surplus. That means that health represented an even smaller percentage of our provincial revenues.
In any case, even the most cursory glance at the numbers for the past decade and beyond demonstrates that health has maintained its status quo and represents something like 38 per cent of provincial spending.
It is hard to imagine where the number 72.3 per cent came from.
Maybe it was the same people that kept telling us that the deficit for the past year was going to be $465 million, maximum.
It would seem to be a reasonable assumption, though, that moving forward health will likely remain at around 40 per cent of the provincial budget. Furthermore, 40 per cent is normal and acceptable.
So, fast forward to this past week, when Health Services Minister Kevin Falcon announced that the government is going to move to a "patient-focused funding model" for the 23 largest hospitals in the province. And yes, the University Hospital of Northern British Columbia qualifies for the list.
The question should be asked - exactly what problem is this meant to fix? "Patient-focused funding is part of our broader innovation and change agenda to improve patient care while managing growing health-care costs and preserving our public health-care system for our kids and grandkids," said Falcon.
"Growing health-care costs," is that what we are fixing? As a percentage of the provincial budget, costs aren't "growing."
In absolute terms, sure, we are spending more money on health. But absolute terms for funding don't mean a whole lot. It is more about what is affordable and 38 per cent of the budget is affordable.
That said, the other stated objective of the new system is to improve wait times and limit hospital stays. And to better manage the system.
Well, there is a lot that can be said for managing the system better. I have no doubt every one of us has stories to tell about hospitals throughout the province. But will this new system make things better?
Not if you believe research out of Great Britain where such a model has lead to "code upgrading" which is a practice where simple procedures are moved to a more expensive category for the purpose of funding.
Nor if you think people recovering from major operations should be allowed to stay in a hospital until it is clear that they can go home. Nor if you think that enabling half of the spinal surgeries to be shifted from inpatient cases to day procedures is not necessarily a good idea.
I am all for innovation in health care. Some of the innovations that were suggested during the Conversation on Health Care have been implemented for the betterment of the system.
But I am sure that "patient-focused funding" was never one of them.
