When the Ball
government announced a cut of 93 positions in the health care system last
week, for savings of $7.6 million, budget watchers expressed sympathy for the
56 employees actually let go but, otherwise, waited for the next shoe to drop.
government announced a cut of 93 positions in the health care system last
week, for savings of $7.6 million, budget watchers expressed sympathy for the
56 employees actually let go but, otherwise, waited for the next shoe to drop.
And with
good reason.
good reason.
Health care
consumes 36% of an $8.5 billion operating account — spending on the day–to–day operation of programs
and services (source: Budget Update). $1.58B of that sum constitutes deficit —
the shortfall between cost and the revenues available to pay for them. The
difference is financed by government’s borrowing program.
consumes 36% of an $8.5 billion operating account — spending on the day–to–day operation of programs
and services (source: Budget Update). $1.58B of that sum constitutes deficit —
the shortfall between cost and the revenues available to pay for them. The
difference is financed by government’s borrowing program.
Health care’s
proportionate share of the deficit this year — alone — amounts to $569 million.
The sum is in addition to the borrowing done by the health Boards directly (several
million) which only shows up on the government’s books in the “Total Debt”.
And a full accounting of health care’s cost should include infrastructure — the amount applied to the capital account. Putting those sources of health care deficit together you would discover a shortfall well in excess of $600 million per year.
But, for the sake of clarity, we’ll just stick with just the operating deficit.
proportionate share of the deficit this year — alone — amounts to $569 million.
The sum is in addition to the borrowing done by the health Boards directly (several
million) which only shows up on the government’s books in the “Total Debt”.
And a full accounting of health care’s cost should include infrastructure — the amount applied to the capital account. Putting those sources of health care deficit together you would discover a shortfall well in excess of $600 million per year.
But, for the sake of clarity, we’ll just stick with just the operating deficit.
It would seem
sensible to assume that other sectors of government can’t absorb overspending
by health care. So what does this mean for the health care system?
sensible to assume that other sectors of government can’t absorb overspending
by health care. So what does this mean for the health care system?
The
government has stated that it plans budget balance in 2022-23 — which few believe — but
the achievement over the next six budgets equates with annual cuts to
health care of around $95M…a figure that is higher when the effect of fast–rising debt servicing and related costs — like the deferral of pension
contributions — are factored in. But, again, let’s keep the arithmetic straightforward.
government has stated that it plans budget balance in 2022-23 — which few believe — but
the achievement over the next six budgets equates with annual cuts to
health care of around $95M…a figure that is higher when the effect of fast–rising debt servicing and related costs — like the deferral of pension
contributions — are factored in. But, again, let’s keep the arithmetic straightforward.
A cut of $7.6
million against the total problem of $569 million or even against $95M in one year — suggests more cuts are inevitable.
When? That’s another story, but I’ll take a
guess at the end of this piece.
million against the total problem of $569 million or even against $95M in one year — suggests more cuts are inevitable.
When? That’s another story, but I’ll take a
guess at the end of this piece.
Still, the
health care conundrum is obvious: what will the system look like if we cut over
half a billion dollars from the budget — even over six years? What can we
expect if we don’t?
health care conundrum is obvious: what will the system look like if we cut over
half a billion dollars from the budget — even over six years? What can we
expect if we don’t?
This post is
not intended to deal with such weighty topics. That will take some time, even
after the Budget is delivered on April 6th. Today’s post is intended to provide readers with a
documented appraisal of the enormity of the challenge — one that is singularly
ours.
not intended to deal with such weighty topics. That will take some time, even
after the Budget is delivered on April 6th. Today’s post is intended to provide readers with a
documented appraisal of the enormity of the challenge — one that is singularly
ours.
The numbers
are important to understand because only they can give some context to any remedy.
are important to understand because only they can give some context to any remedy.
Secondly, it
seems clear that we have to put forward a new “model” of how health care should be
administered. And we have to do it soon. Creating a longer queue for health
services with cuts to personnel won’t work. The inescapable fact — even if
it seems cliché — is that we have to do more for less. We have to both change the
system and cause operating costs to drop.
seems clear that we have to put forward a new “model” of how health care should be
administered. And we have to do it soon. Creating a longer queue for health
services with cuts to personnel won’t work. The inescapable fact — even if
it seems cliché — is that we have to do more for less. We have to both change the
system and cause operating costs to drop.
The post “Dr.
Parfrey’s Refreshing Frankness“ triggered much interest. Possibly it exposed
the nasty truth that we have not been good stewards of this gift of wealth,
education, and technology.
Parfrey’s Refreshing Frankness“ triggered much interest. Possibly it exposed
the nasty truth that we have not been good stewards of this gift of wealth,
education, and technology.
The raison
d’etre of Parfrey’s group “Choosing Wisely NL” needs no further explanation.
They just need to get to work. We need other such groups with similar goals in different areas of heath care. We will have to
co-ordinate those efforts on an urgent basis — without getting mired in
hundreds of studies and slowed by an even larger web of bureaucracy.
d’etre of Parfrey’s group “Choosing Wisely NL” needs no further explanation.
They just need to get to work. We need other such groups with similar goals in different areas of heath care. We will have to
co-ordinate those efforts on an urgent basis — without getting mired in
hundreds of studies and slowed by an even larger web of bureaucracy.
The
announcement by the Health Care Corporation of 176,000 missed specialist
appointments — ‘no shows’ — last year alone, also resounds. That figure is for Eastern Health. Presumably the other Boards have a story that matches that one. Who is minding the shop? Indeed.
announcement by the Health Care Corporation of 176,000 missed specialist
appointments — ‘no shows’ — last year alone, also resounds. That figure is for Eastern Health. Presumably the other Boards have a story that matches that one. Who is minding the shop? Indeed.
Is the
public willing to countenance waste while queues for consultations and
treatment get longer? Is health care such a ‘sacred cow’ that it is above scrutiny?
public willing to countenance waste while queues for consultations and
treatment get longer? Is health care such a ‘sacred cow’ that it is above scrutiny?
It is worth reminding
that other provinces have managed their health care systems better. We invoke the “rural” card — putting
blame on a dispersed population — as if ours is the only rural
jurisdiction in Canada.
that other provinces have managed their health care systems better. We invoke the “rural” card — putting
blame on a dispersed population — as if ours is the only rural
jurisdiction in Canada.
A series of exhibits prepared by the Canadian Institute for Health Information will help provide
a better understanding of this and other issues raised in this piece. All but
the first formed part of a presentation by Dr. Wade Locke to the Chartered
Professional Accountants in February. The remarks contained within the exhibits
(mostly highlighted in red) are solely his work. Outside the exhibits, unless noted, the
editorializing is mine.
a better understanding of this and other issues raised in this piece. All but
the first formed part of a presentation by Dr. Wade Locke to the Chartered
Professional Accountants in February. The remarks contained within the exhibits
(mostly highlighted in red) are solely his work. Outside the exhibits, unless noted, the
editorializing is mine.
Let’s start
here:
here: