My column this morning is on health care. I don’t pretend to be an expert in health care economics but I have studied the data in fair detail and was involved in the preparation of two health care regional strategic plans.
My premise is that doctors and health care practitioners need to lead the effort towards economic sustainability in the health care sector.
We have over 11,000 more workers in health care today in New Brunswick compared to 1999 with no real evidence of better outcomes. We are spending $1.2 billion more this year than in 1999 on health care.
I recently read Dr. Furlong’s book – Medicare Myths – and I think this is a great first step to change the conversation. He argues that over-utilization is the number one problem with the system.
The data backs him up. We have massively enlarged the size of the health care sector in New Brunswick in the past 15 years on a population base that has not increased. Therefore, there must be either a) far more interventions per capita than before or b) significantly less interventions per health care practitioner. My limited research into this says it is the former.
I was involved with the tele-care initiative way back in the mid 1990s which was meant to stem the tide of visits to emergency rooms across the province. While I don’t have much data on this, it would seem that it hasn’t.
So the system reverts to ‘time’ as a substitute for money as the only way to limit use. Hospitals could easily staff up emergency rooms but they use waiting (time) to try and discourage usage. There is ample data on wait times that shows the shorter they are, the more usage there is.
Dr. Furlong wants people to start paying directly for a portion of health care – through the taxation system. He doesn’t get into too much detail in the book but goes to great lengths to say it is no user fees and not a parallel system. In his view, this is the only way to get people to understand the cost implications of their health care decisions and – on the supply side – to get health care practitioners to understand the cost implications of their health care decisions.
Nobody likes talking about ‘cost’ and ‘health care’ in the same sentence. This is Canada after all but it is basic human nature to equate things that are ‘free’ with ‘cheap’. Health care is not cheap – it is rapidly becoming the second largest cost behind housing for the average household – if you were to apportion the public cost and add in employer cost and direct cost.
The best time to have this conversation is now – when we have a fiscal crisis. It was easy for politicians to pour virtually all new money into health care when they could – now they can’t so let’s talk.