I see that New Brunswickers want more doctors and more health care workers. At some point we are going to have to realize that the health care system cannot be fixed by massive new cash and new hires. The system just absorbs all new resources like that weird looking vortex in the original Star Trek series. The number of workers in the health care and social assistance sector is up by over 24% in 10 years. Actually it is up 27% in eight years if you want to be specific.
It seems to me that the ‘fix’ to health care will be elsewhere. I think governments should commit to providing stable, inflation-level increases to the system each year (it’s been close to triple the rate of inflation in recent years) and then look to innovation in service delivery, systems, and even revenue models. It’s no secret that I support some form of nominal user fees for those that can afford it as a moderating force on the system. I don’t think that wil fix the system but it will make us think about health care costs a little more directly.
Health Care & Social Assistance Employment Growth in New Brunswick
|
Year |
Health care and social assistance |
Total Population |
Per 1,000 Population |
|
2000 |
50,500 |
750,517 |
67.3 |
|
2001 |
49,300 |
749,801 |
65.8 |
|
2002 |
49,500 |
749,331 |
66.1 |
|
2003 |
53,300 |
749,389 |
71.1 |
|
2004 |
53,600 |
749,369 |
71.5 |
|
2005 |
56,000 |
747,960 |
74.9 |
|
2006 |
59,100 |
745,674 |
79.3 |
|
2007 |
61,500 |
745,561 |
82.5 |
|
2008 |
60,500 |
747,147 |
81.0 |
|
2009 |
62,800 |
749,468 |
83.8 |
|
10 Yr Growth |
+24.4% |
-0.1% |
+24.5% |
Source: Statistics Canada Labour Force Survey.
Here’s a neat little thought experiment/forecast that will never happen but it is interesting to look at trends. Right now there is one health care worker and social assistance worker for every 10.5 other people in the population. To put it another way, when you attended the Paul Anka concert, more than one person in each row was a health care worker. By 2050 following the same trends there will be one health care worker for every three other people in the province. That gives the term ‘family practice’ a whole new meaning when there is a health care worker per family.
To be fair, I think you have to go back a couple of decades to average things out. There was, after all, some compression in health care spending in the 90s.
Dr Dennis Furlong has suggested that we all get health accounts into which GNB would allocate a certain amount of money; funds would then be withdrawn from the accounts to pay for routine healthcare services. The idea, I guess, is that we would watch the balance go down and adjust our use of the system accordingly. Seems to me, however, that this would be an administrative nightmare that would be hugely expensive. First, there would have to be steps taken to ensure that the charges all went to the right account, then there would have to be a delivery system that gave us access to the account. In addition, we would have to have access to an appeal system in case we felt that charges were wrongly assigned or incorrect. Not to mention what to do about costly or catestrophic illness.
A user fee system would also be administratively costly, especially if there was a fee waiver for low-income persons, students, etc. I’d rather avoid all that but I’m not sure cost containment can be achieved when health care is just a hot issue politically.
I think that is a really good point and applies more broadly. Public sector wages were held down during most of the 1990s as well and then rapidly expanded in the early to mid 2000s. I suspect the trend pattern from the early 1990s is likely to repeat itself for the next 5-10 years.
There can be some small changes before big changes need to occur. If you saw “Sicko” then you saw how british doctors actually get paid more, the healthier their patients get. We have a revolving door system and a virtual doctor monopoly. I remember reading the ‘job ads’ placed by our region of waterloo for doctors, its so bad that they are offering full time pay for part time hours, as well as golf club memberships and on and on. Its a real mess, and I’d agree that money isn’t necessarily the answer to everything, and more GP’s aren’t either. Any time I’ve had a problem the GP has been useless, and didn’t even want to make a decision. If I wanted to see a specialist, he just referred me along. The last time I went to a clinic, a young doctor was there complete with laptop, and she literally googled in my symptoms. It was the one time I’m happy our educational system isn’t as highly subsidized as it used to be!