 The
headlines about British Columbia's healthcare system
over the past few weeks have been nothing short alarming:
massive budget overruns, a health authority chief fired,
another health chief quitting in protest, reports of
patients sleeping in closets and nurses' lounges.
Is it as bad as it sounds? Is BC's
healthcare system really headed for a financial crash
— a jump from the current 41.6% share of the province's
budget to a whopping 71.3% portion by 2017-18 —
as provincial finance minister Carole Taylor has insisted?
DATA
TRACKING
Not everyone agrees with her predictions. "It's nonsense,"
says David Schreck, former NDP MLA in North Vancouver-Lonsdale
and an active political blogger. But Ms Taylor has the
cold, hard numbers to back her up, right?
Not so, according to BC political
consultant and journalist Will McMartin. Mr McMartin's
diligently researched accounts of what he calls "Carole
Taylor's false alarm," published in the independent
newspaper The Tyee, reveal a surprising and crucial
detail about the projected rise in healthcare spending:
that 71.3% figure is a proportion of the government's
overall spending, which has been decreasing steadily
as welfare costs have decreased. That doesn't remotely
amount to proof that healthcare costs are spiralling
out of control, reports Mr McMartin. In fact, he goes
on to cite figures from the province's official record
books that show that if you measure health spending
as a proportion of gross domestic product (a close approximation
in terms of methodology to the "dollars spent per capita"
model used by the Canadian Institute for Health Information),
BC's healthcare spending growth in recent years and
projected several years into the future is well within
the normal range established over the past few decades.
BC spent an average of 6.6% of its GDP on health over
the last 20 or so years; in 2005-06, BC spent about
7% of its GDP on health, and Mr McMartin's projections
show that number will fall slightly to 6.9% by 2008-09.
His conclusion, after analysing all that data: "Health
spending has not exploded, nor is it threatening to
do so. There is no looming fiscal crisis."
AN
OLD BIRD
One of the most frequently cited reasons to worry about
the price of healthcare is the aging of the population.
The BC Conversation on Health (a series of provincial
hearings being held by premier Gordon Campbell to determine
citizens' thoughts on the healthcare system's sustainability)
website features a message from Mr Campbell that reads:
"We need the Conversation on Health because British
Columbians can — and must — find ways of making
our health system sustainable for the future. We face
many challenges as our population ages and new technologies
and treatments are introduced."
So, as the thinking goes, more
elderly people equals higher costs — sounds reasonable
enough and it's not a new idea. Yet for Dr Robert Evans,
a health economist at the University of British Columbia
Centre for Health Services and Policy Research, this
is a dangerous old canard. "The song and dance about
the aging population [bankrupting the healthcare system]
has been with us for decades," he says, "but every research
group says it is not true. It's true that the elderly
population will cause a rise in spending, but it is
not big and not fast."
And recent data seems to back up
Dr Evan's claims. A 2005 CIHI report on health spending
addressed the issue of the cost of an aging population:
"the aging-specific effect will not contribute more
than 1.0% annually to total provincial and territorial
government health expenditures between 2002 and 2026."
THE
SKY IN FREE-FALL?
So what's going on here — why is the Campbell government
maintaining that healthcare spending is set to go through
the roof, and has in fact begun to do so already in
several large health authorities, despite a wealth of
evidence that appears to point to the contrary?
"Chicken Little has always been
with us," sighs Dr Evans. "The rhetoric of crisis is
as old as Medicare." He adds that the sky is "absolutely
not falling."
But if there is no serious health
spending crisis in BC, why the recent flap over the
alleged lack of money for the Vancouver Coastal Health
Authority (VCHA) and the Fraser Health Authority budgets?
After all, the province fired Trevor Johnstone, the
chair of the VCHA, for making cut-backs to try to make
up a $40 million deficit. And two days later, Keith
Purchase, head of the Fraser Health Authority, resigned
in protest and said the promised 7.1% increase in funding
from the government will not suffice to cover the region's
costs.
Couldn't these incidents be taken
as evidence of a larger problem? Mr Schreck doesn't
think so. "You can't take one year, that is inconsistent
with the last few decades, and say this is a trend,"
he says. Dr Evans agrees: "It's neither an anomaly nor
a sign of out of control costs — just part of the
normal back-and-forth between governments and providers.
Healthcare in BC, as in the rest of Canada and the industrialized
world, is in a constant state of tension between demands
for expansion by consumers and efforts at containment
by payers."
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