Health reforms are not so drastic B.C.'s medical services have been ailing, so the government has to try a new approach


Victoria Times Colonist


Wednesday, April 24, 2002
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HUNDREDS OF PROTESTERS beat on the doors of the hotel ballroom where Health Services Minister Colin Hansen was to announce the province's restructuring of medical services.

Hospital Employees' Union spokesman Chris Allnutt called the changes drastic, and said "they clearly send a message that (Premier Gordon) Campbell doesn't care about health care...."

Yet, for all the wailing and gnashing of teeth in some quarters, the changes announced Tuesday are, in fact, not that drastic or dramatic.

Three small hospitals will close in the Interior, and the province as a whole will move toward larger regional hospitals. These will offer more and better services and, it is hoped, attract and keep rural doctors by offering better working conditions.

Vancouver Island hospitals won't be greatly affected, except for the closing of the maternity ward at Saanich Peninsula.

Some specialties will be consolidated in one hospital (obstetrical/pediatrics at Victoria General, for example), which makes sense.

About 600 Island jobs will be lost in restructuring, out of an Island health workforce of 16,000. That's just under four per cent, and hardly drastic.

All of this and more has happened, and is happening, across Canada as provinces fight to control health costs, only most started the process several years ago. And it's got nothing to do with political party labels.

Saskatchewan's NDP premier Roy Romanow cut about 50 small hospitals in the 1990s, and met the same gloom-and-doom predictions.

Followup studies showed that mortality actually decreased after the closings. Why? Because although they had to travel farther for care in rural areas, sick people got better care in the larger regional facilities.

Last year, Saskatchewan's Fyke Report recommended that that province's now 70 hospitals be reduced even further to 20. Alberta's current health restructuring is also more radical than what is being proposed here.

THIS RESTRUCTURING is not Armageddon for B.C.'s health system -- quite the opposite. The system is in far more danger of collapse if the government doesn't take action to find efficiencies and reduce unnecessary costs.

Costs in health care in B.C. are rising by about seven per cent a year, well above B.C.'s economic growth of two per cent, and now make up about 40 per cent of the provincial budget.

Something has to give if expenses aren't to spiral out of control, especially since one possible area for cuts -- health-worker salaries -- has been closed.

The government got into huge trouble when it used legislation to restrain the big pay increases demanded by doctors and nurses. Yet higher wages are a major reason for a $1.1-billion increase in a health budget that was supposed to be "frozen."

What's left? Changing how the system is run to find efficiencies, large and small. And whenever there is change there will be some people hurt, and others who think the changes are ill-advised.

Some of the changes may be, unwise, depending on how they are handled.

For example, the government has reneged on its New Era promise of 5,000 new extended-care beds. Instead, it wants more ill and elderly people cared for at home, with better home-support from government.

Fair enough; many seriously ill people and seniors would prefer to be at home, and home care is much cheaper than an acute- or extended-care bed. This is what the previous NDP government attempted with its Closer to Home policy.

But, faced with cost pressures elsewhere, that government failed to fund the necessary home supports to make the program work. The same could happen here: big promises, but no follow-through.

The same may apply to the new regional health centres. The restructuring promises increased transportation so people in outlying areas can reach the centres, but will the government match its promises with adequate funding, or try to skimp?

WHAT THE PROVINCE is attempting here is a systematic approach to managing health-care costs, which is the way to go.

But it won't work if some parts of the system aren't put into place which, given B.C.'s sad history with this type of restructuring, is more likely than not.

Did the government have any choice? Given the exploding costs of health care, no.

It would be faulted far more if it failed to seek efficiencies. Will the restructuring work as planned?

As with so many major initiatives by this government, we won't know until a year or two down the line.

Meanwhile, there will be protests. There will be anger by people who've lost their jobs or their local hospital. There will be mistakes. And there may be more cuts and changes to come if this restructuring doesn't realize the necessary savings.

But -- and this is clear in every province -- changes in health-care delivery to create more efficiency are necessary and desirable.

The province has taken the first step; success will depend on how well it stays the course.

© Copyright 2002 Victoria Times Colonist

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