Have we finally wrestled that voracious gobbler of tax dollars - the public health-care system - to a standoff, if not to the ground?
By that I mean the days of the system automatically devouring increasingly large amounts of money every year to feed itself may be drawing to a close, at least in British Columbia. Of course, I don't mean the health-care system will stop being the biggest area of government spending by far (the health-care budget this year is pegged at $16.9 billion, out of a budget of $44.4 billion).
But the rate of growth in spending is slowing down significantly. The annual hike is down to 2.6 per cent this year, compared to just several years ago when it was above five per cent. Now, there are those who think this is bad news. After all, shouldn't we be plowing even more money into the system rather than less? If we don't, won't health-care standards suffer?
The answers are: a) not necessarily and b) no.
The ideological defenders of the public health-care system (who think the answer to everything is to blindly spend gargantuan amounts of more money) think the only measuring stick worth anything is per capita spending. In other words, B.C. should spend more dollars per person than anywhere else, and things will take care of themselves.
But those with experience in the system, who study it and come up with good ideas for change, point to another, and far better, measurement: health outcomes.
And in that regard, B.C. ranks the highest in the country. While we sit second-to-last in per-capita spending (only Quebec ranks lower) we beat most other provinces in all kinds of areas: best cancer survival rates, lowest heart attack rate, longest life expectancy, lowest smoking rate, lowest infant mortality rate, etc.
When it comes to wait times for certain surgeries (an admittedly frustrating situation for many people on those wait lists), they've been mostly going down and not up. The median wait time for a hip joint replacement has declined to 13 weeks from 19 weeks over the last 10 years, while a knee joint replacement has gone from 25 weeks to 18 weeks over the same time period.
None of this is to suggest the health-care system does not need constant upkeeping and reform (crowded emergency rooms, for example, seem to be a chronic problem, and we could always use more nurses). But it is encouraging that blind yearly spending hikes are being replaced by newer, innovative ways of spending that are both efficient and lead to healthier outcomes for the users of the system.
Not being able to count on big increases in funding every year has brought some much-needed discipline to the system, and employing some different models has also helped.
One of the most significant changes that is paying off is the government's relationship with doctors.
In the past, physicians were viewed as costly, self-interested cogs in the system. Now, however, they are viewed as equal partners who have real responsibilities when it comes to running the health-care system.
For example, several joint committees have been established with the Doctors of B.C. (formerly called the B.C. Medical Association) where doctors and the government shape policies that are aimed at improving patient health, rather than protecting the financial interest of either party.
One committee is for general practitioner services (overseeing improvements to the primary care system), another is for specialist services (aimed at improving access for specialist care) and a third is for shared care (focused on better integration of all levels of care).
As well, something called the Divisions of Family Practice has been created. It links family doctor practices and is designed to improve common health-care goals in a particular region (improved maternity coverage, for example).
Committees such as these were unheard of a decade ago. They appear to be improving patient care by focusing on smart, evidence-based decisions rather than on simply demanding more money, either for doctors' pay packets or a health authority's budget.
The Canada Health Accord between the provinces and the federal government died last week. It means Ottawa will be cutting in half its annual transfer of money to pay for health care.
The fact the B.C. government hardly said a peep about the accord's demise is evidence of how much the system has changed in the past few years.
Keith Baldrey is chief political reporter for Global B.C.
