"Who will start a frank debate on health care?"

[Guest Ian Wong]

Here's an interesting article in today's Globe and Mail. It's an opinion piece relating the need to stop the endless blame-game between the provinces and the federal government, and to take a long hard look at how our health care system is going to survive the future. The most stunning quotation within this article comes from Newfoundland's budget over the last 9 years, where total government expenses only rose 2 percent, while the health care budget skyrocketed up 70 percent. This is obviously not a sustainable trajectory, and the author makes the argument that we need to find money somehow, whether that be directly through privatized healthcare, or indirectly through increased taxation.

 

Ian

 

www.theglobeandmail.com/servlet/ArticleNews/TPStory/LAC/20040401/COSIMP01/TPHealth/

 

Who will start a frank debate on health care?

 

By JEFFREY SIMPSON

Thursday, April 1, 2004 - Page A17

 

A small and a large province just illustrated yet again how health care is eating budgets alive.

 

In Newfoundland and Labrador, the government produced a chart in its budget showing that since 1995-96, overall government operating expenses had grown by about 2 per cent, while the health budget soared about 70 per cent.

 

Think about it. The health-care budget grew 35 times faster than the combined budgets for everything.

 

That's the expenditure side. How about health care relative to government revenues? Hear Finance Minister Loyola Sullivan: "Spiralling health costs . . . are growing at more than double the rate of growth in government revenues."

 

Now you tell me: If health care has grown 35 times faster than all other spending and twice as fast as revenues, can it be sustained? Obviously, the question is rhetorical.

 

Switch to neighbouring Quebec, the country's second-largest province. There, Finance Minister Yves Séguin announced an increase in program spending of 2.9 per cent. The health budget, which accounts for 42.6 per cent of all provincial spending, will rise by 5.1 per cent.

 

Do the math. If health is rising much faster than overall spending, other areas must suffer. And they will. Education will rise by 2.7 per cent. All other spending will grow by only 0.5 per cent. This year's increase in the health budget will represent three-quarters of the total increase in government program spending.

 

Details vary from province to province, but the pattern is the same. Provinces are implementing delivery reforms. They are grouping doctors, nurses and other health-care practitioners into clinics. They are adopting new technologies. Some are proceeding with electronic patient records. They are reorganizing administration by region.

 

They are following the prescriptions of health-care reformers to make the system more patient-friendly and less costly. So when people claim that the pressure on health budgets could be lessened by administrative reforms, they should take a look around. It's happening.

 

Yet health-care budgets are soaring, crowding out spending on all other areas of government activity. Only in Alberta, where the recent budget announced an 8.4-per-cent increase for health care, can a government simultaneously drive up health-care spending and push up spending elsewhere.

 

What to do? The first thing we should all do is close our ears to wild rhetoric that the system is being "starved" for funds. Since the last federal budget, MPs from every opposition party (check Hansard) have screamed that the Liberals are "starving" or shortchanging health-care.

 

A few facts, please. Ottawa is now transferring $36.5-billion of new money over five years for health care. Read carefully: That's new money.

 

Canada now spends more of its national income on health care than every country with a largely public system except Germany. Health care's share of GNP stands at 10 per cent.

 

Share of GNP share can be misleading. It conflates public and private spending. Economies grow and contract, influencing health care's share of the total.

 

So check another indicator, this one from the World Health Organization. It measures per capita spending of public money. It shows that only two countries with largely public systems (Germany and Norway) spend more per capita than Canada. Sweden, that bastion of social democracy, spends about $200 (U.S.) less per capita than Canada. France spends about $50 less; Australia about $225 less.

 

Slice the numbers as you wish. Compare Canada's spending with that of other countries. Compare health-care spending to growth in government revenues, or inflation plus population growth, or spending on other programs. We have an unsustainably expensive system.

 

What would make it sustainable? More reforms to administration would help, but only a bit. More best practices, technology, reorganization and so on. These changes -- many of which are now being implemented -- will not make the system sustainable at current levels of taxation while maintaining other programs.

 

More money for health-care has got to come from the same source: Canadians' pockets, either by allowing Canadians to buy more health-care services -- that is, more private money into the system, as is done in all other countries with public systems -- or by higher taxes.

 

There isn't a politician in the country willing to state this stark and obvious truth. They're too busy blaming each other for not plowing even more money into an already costly system.

 

Some day, somehow, a frank, open and painful debate will begin about the real health-care financing choices that were completely obscured by the Romanow commission.

 

Newfoundland's and Quebec's budgets, like those all across Canada, show the need for the debate. Who will start it?

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<threadtitle>FYI: fellowship training stress assessment study</threadtitle>

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<username>mydream88</username>

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<title>FYI: fellowship training stress assessment study</title>

<pagetext>Hi all,

I just read an article that may interest you:

 

Parshuram C, Dhanani S, Kirsh J, Cox P. Fellowship training, workload, fatigue and physical stress: a prospective observational study. CMAJ March 2004; 170(6): 965-970.

 

mydream88:)