Tuesday, March 11, 2008

Trimming the Fat in Health Care

Implementing changes to our medical system is never an easy thing! For many, Health care is the "sacred cow" that should not be tinkered with by Politicians. But, when you make administrative changes that are more effective, transparent and create true accountability to tax payers then recognition must be given for making those efforts.

Today my colleague, Mike Murphy, Minister of Health, announced the reduction of Regional Health Authorities (RHAs) from 8 to 2. By reducing the regional health authorities to 2, our Province should be in a position to improve the clinical needs of its citizens and establish shorter wait times within each region. Regional Health Authority A will be located in Bathurst, while RHA B will be housed in Miramichi.

As Murphy points out, 8 RHAs created unhealthy competition and fierce battles between regions over resources. Furthermore, each RHAs duplicitous model of "eight of everything" was a tremendous burden on the tax payer. Eight human resource departments, eight informational technology groups etc., is not responsible government in the RHA model and by reducing the number to two we should realize savings which currently costs New Brunswickers $250 million per year. Heading toward an over $50 million dollar deficit for the year is hardly an effective approach to directing more of our health budget into patient care, which is exactly what New Brunswicker's want and why Murphy's decision which takes effect immediately is the right move.

More to come. I look forward to hearing from you,



NB taxpayer said...

Good points, TJ. And you're right, New Brunswickers have nothing to gain, and everything to lose, by having the status quo maintained within the Canada Health Act, especially with an ever expanding aging population which puts more stress on an already fragmented system. A good first step by you guys would be to not only lobby Ottawa to amend the Canada Health Act [CHA], it could introduce more competitive and effective tendering services within the health care system. This would involve taking the lead from other provinces who contract out specific health services to the private sector.

One interesting dynamic is already taking place in British Columbia, in that, the Gordon Campbell government is now saving $66 million annually in their health care system by outsourcing services such as food preparation, hospital security and laundry.

The upshot of these changes alone would be to save money on health care delivery so that it gives you guys more freedom to spend in other areas of higher priority. At the moment, I think health care eats up about 40% of total spending (and that includes debt repayment charges).

mikel said...

In BC it's the government doing the accounting AND making policy decisions-so you can't exactly trust their numbers. In the short term there are 'sometimes' savings from privatizing, but in New Zealand its now coming out that in the long term the insatiable desire for profit (which in a public corporation is a legal requirement) has meant many privatized services are more expensive AND don't have the value of providing a living wage.

For example about five years ago I believe there was a little scandal about inedible food being served at nursing homes in NB. This was from a contract with an ontario company, which shipped in food that was pretty lousy quality.

That not only kills employment in the province, but obviously nutrition is pretty important in a nursing home-you just end up paying for it elsewhere.

Even in this 'restructuring', any job losses are not only lost to the industry but in all likelihood the province as well since there is simply no other industry for these people to move to (and Alberta is always waiting).

However, over at gypsy's blog he says that an article says there AREN"T going to be job losses. If there aren't job losses then where exactly are the savings coming from?

But often the 'shorter wait times' is the carrot that is held out for people, but how EXACTLY does having fewer health authorities bring about shorter wait times? That makes an assumption that a doctor in Woodstock is sitting on his butt in an empty room while there are lineups in Fredericton. That may be true, but I highly doubt it.

And its not exactly clear why, if thats the case, does structural change need to be necessary. IF a cardiologist in Sackville CAN see a patient from Saint John then surely health authorities are not THAT autonomous. I know my dad's heart doctor is in Saint John even though he's in Fredericton.

When 'trimming the fat' you have to be careful of the 'toronto effect'. Namely, before amalgamation it was said all kinds of savings could result with fewer politicians. Of course as soon as they got in they voted themselves a raise and new office expenses for staff because they were so overworked. In the end, it actually cost MORE.

The river valley health authority currently has openings for about 35 positions, almost none of which are in administration. If that HA is combined with another, that doesn't guarantee administrative savings in personnel if it requires as many people to do the job for the region as it does for the single HA.

The ASSUMPTION is always that some administration is being done that is 'useless'. Whether that assumption is true or not is pretty important. The devil is in the details, and if there are no details its pretty hard to gauge. Just so you know, THAT is why people generally distrust any tampering with the health care system.

T.J. Burke said...

Great points NB Taxpayer. I think you will pleased to know that other cost saving measures may take place. An incremental approach is the prefered method as opposed to a complete overhaul of administrative services in our health care system.