1-hour travel time to Emergency care for BC citizens. 2-hour travel time to Acute care service. ... 34 severance agreements made between Vancouver Coastal and its non-unionized ...
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Within the next year, federal and provincial elections will be fought in large part over the issue of healthcare and responsibility for it.
And while there is a robust federal debate over healthcare—funding and scope—there has been no debate over provincial health initiatives since the current government’s election.
The most extensive contraction of health service in the province’s history, and the most expensive, has occurred without debate, with a minimum of discussion and a maximum of rancor.
The current government was elected in
2000 on the promise of an open, inclusive, consultative, transparent service that would
not cut health services but would cut costs, providing healthcare more efficiently and less expensively.
During the campaign, both the public and health professionals agreed on the need for change, that the system needed fixing, or at least would benefit from improvements.
If we could have more for less . . . Why not?
In April, 2002 the BC government announced major changes to the infrastructure of the provincial health care system.
One goal was to restore public faith in provincial health care BC.
“We can never again let the system run down to the point where people lose confidence in health care.”
H. McLeod, Vancouver-Costal Health
Authority interim CEO.
Province Newspaper, 24 April, 2002, A4.
The promise of more for less was made with full knowledge of BC’s population trends. Increases in most jurisdictions meant more service would be required in all parts of the province, and especially in its most populated, southern districts.
Courtesy CHSPR: BC Health Atlas, 2002.
The result has been less for more . . . less service at a greater cost during a period of rapid population growth. There is less public confidence and worse relations between the government and the health professionals who provide bedside service.
B.C. hospital service capacities have decreased by between 8 and 12 percent overall.
The closure of hospitals, ER’s, and nursing homes has increased pressure on remaining institutions.
Closures may have increased both systemic costs (Lin, 2001).
The “restructuring” has been a wholesale contraction.
Put another way, in the language of “patient days” service, this is at least 11.4 % of patient days at full capacity.
At 85 % capacity the reduction is approximately 10 percent. This is well below OECD median levels.
Great: Less persons in hospital is more people at home with lessened noscomic illness. . . . if decreased patient days was accompanied by increased homecare services and support. It would be good if it did not also represent persons sent home from hospital who needed to be hospitalized, if all those who needed hospitalization received it.
Communities with hospitals that have been
Ashcroft Castlegar Clearwater
Delta Enderby Ft. St. James
Kaslo Kimberly Mission
Summerland Sanich Victoria
New Westminister Vancouver
VGH Status 2000-2001:
662 patient days per 1000 pop. age adjusted.
= 1.8 bed per 1000 pop. age-adjusted.
= 2.1 beds per 1000 pop. age adjusted
@ 85 percent capacity
587 patient days per 1000 pop. age adjusted.
= 1.6 beds per 1000 pop. age adjusted.
= 1.9 beds per 1000 pop age adjusted @
85 percent capacity.
surgical procedures (hip replacement,
for ex.) have at least doubled.
Communities with ER’s that have
been eliminated or downgraded:
Summerland Port Moody
Demand is relatively inelastic.
93 percent of all hospitalizations are unavoidable (Lin et al. 2002).
They are required if patient life and life quality is to be maintained. Delay may result in longer hospitalization in the end.
All changes occur within the context of this relative inelasticity.
Because demand is relatively inelastic, and service therefore mandated, closure of one institution places pressure on those remaining, and on other parts of the system.
Money saved in one place must be spent in another, or downloaded to the patient. Savings are thus typically illusory.
Impact is greatest on referral centres that receive the most complex cases and serve simultaneously as local and district hospitals. VGH, for example,
serves (a) Vancouver (b) Greater Vancouver
(c) Vancouver Coastal and (c ) the province at large. Fewer hospitals in outlying areas increases pressure
on VGH. Downgrade of services (emergency and acute) at distant hospitals increases pressure at
tertiary and higher level centres.
Similar problems can be seen at other provincial referral centres. For Example:
G. F. Strong: Spinal Cord Injury
traumatic brain injury
Closure of Skeleen Village, a TBA
B.C. standards in this area do not compare favorably with even those in the U.S.:
1-hour travel time to Emergency care for BC citizens.
2-hour travel time to Acute care service.
Changes have increased distance to service in most areas, urban and rural.
The necessity of sending some patients to Alberta or U.S. medical institutions
for urgent treatment is a hidden cost
of the B.C. system contractions.
Stories abound but no analysis of the system cost—or life cost—has been reported.
The B.C. government has approached the business of health care by transforming healthcare into just another business. It isn’t, neither economically nor socially.
“Just in time” manufacturing
modes do not serve in public service.
Health care requires slack and redundancy if emergencies (epidemics, major accidents) are to be handled). Short-term cost-benefit
accountancy is costly, and may result in
“the continued escalation of health care costs is not sustainable,” Ministry web site.
“In BC, we're spending over 42 per cent of the total provincial budget on health care, with $2 billion in new funding added over the past three years.”
B.C. Ministry of Health web site accessed 8 May 2004.
BUT federal monies for provincial health systems have increased, in part as a result of the Romanow Commission and its debates. This has been a boon unacknowledged by B.C.’s government in public or on its website.
The government has blamed rising costs/declining services on patient-related employees:
“We now spend $10.7 billion a year on health care. Of those dollars, almost 70 per cent goes to compensation for health care providers and support workers . . .the continued escalation of health care costs is not sustainable.”
B.C. Ministry of Health web site accessed 8 May 2004.
VCHA financial statements peg the cost of the restructuring in 2002-2003 at $20.2 million for VCHA alone. Similar costs presumably occurred in other Health Authorities.
“Restructuring costs: In the current year, management has recorded an expense of for restructuring costs in the amount of $20.2 million. The restructuring costs consist of severance and related costs that are anticipated to result from the restructuring of the VCHA.”
From: 2002/03 VCH financial statements
The number of employees earning more than $75,000 a year at VCHA alone rose from 2002 to 2003 by about 47 percent. The cost was about $55 million.
From: 2002/03 VCHA financial statements
These are not cooks, dietitians, electricians, laundry workers, lab technicians, floor nurses, etc. They are financial analysts, risk assessment supervisors, managers, PR personnel, etc. The promise of money “going directly to the patient” is unmet.
In addition, there were 34 severance agreements made between Vancouver Coastal and its non-unionized managers in 2002-3 for between 1 and 18 months compensation. An unknown but significant number of managers were on paid stress leave as well.
Promises of openness and consultation have been unmet. The changes, while fundamental, have occurred without public debate, discussion, or citizen discussion. There is, however, a carefully constructed, provincial health services web page on the Internet.
Instead, the government has used paid advertising as its principal medium for discourse. In two separate campaigns the health ministry has spent over $900 million on advertising promoting its “restructuring.” This does not include the cost of “branding” of LHA’s, web page design, etc.
The result is precisely that of a private corporation (Phillip Morris, perhaps) repositioning a product it wants to sell to the public. It appears to be a U.S. model of private health and private business transposed into a Canadian provincial setting.
The U.S. experience in private health care suggests a management overhead of at least 20 % of total cost of service. It is a minimum inevitable with privatization . . . and apparently with the B.C. government’s “business” model.
Timing of changes has been rapid and without thought to human consequences or long-term planning necessities. As one minister said, patient problems are the “sawdust” that accompanies any “renovation.”
Clearly, changes have been rushed and therefore implemented without adequate safeguards.
As SFU’s Charmain Spencer notes:
“To date, consumer input and influence have been noticeably absent from the development of the assisted living mode. Perhaps not surprisingly, the resulting health, safety, and tenancy safeguards . . . have been minimal.”
Spencer, C. 2004.
have doubled or trebled.
Scarcity is typically a
condition we create, an
outcome and not an
Current policies have created scarcity, or increased it.
Book Titles 1990-2004
The Wreck of the William Brown: A True Tale of Overcrowded Lifeboats
and Murder at Sea (Douglas & McIntyre, 2003; McGraw-Hill, 2004).
Scarce Goods: Justice, Fairness, and Organ Transplantation (Praeger Pub: 2001)
Age Speaks for Itself: Silent Voices of the Elderly (Praeger Pub: 2000)
The Limits of Principle: Deciding Who Lives and What Dies (Praeger Pub: 1998)
· Second Chances: Crisis and Renewal in Our Everyday Lives (Turnerbooks: 1998)
·The Message is the Medium: Online Data and Public Information (Praeger Pub: 1996)
· Watersheds Stories of Crises and Renewal in Everyday Life (Lester Pub.: 1994)
·A Place in Time: Care Givers for Their Elderly (Praeger Pub: 1993)
· Mirrored Lives: Aging Children and Elderly Parents(Praeger Pub: 1990)
·The News as Myth: Fact and Context in Journalism (Greenwood Press: 1990)
· Journalism for the 21st Century: Electronic Libraries, Databases
and the News (Praeger Pub: 1991)
·Creating a Cycle Efficient Toronto (Toronto City Cycling Committee) 1992
Six Islands on Two Wheels: A Cycling Guide to Hawaii (Bess Press: 1990).