Government & Medicine

A budget nip and a tuck

Danny Williams' Tories usher in a new era of frugality for Newfoundland's healthcare system. Deficits, and tensions, are running high

By Deana Stokes Sullivan

"A tough budget for tough times" is how Dr Susan King, president of the Newfoundland and Labrador Medical Association (NLMA), describes the new provincial budget, announced on March 30.

People in the province have been waiting with bated breath for Premier Danny Williams' government to set out their first budget since they took office in October 2003, ending more than a decade of Liberal rule. Tensions are running particularly high in the province as the ongoing civil service strike involving 20,000 staff, including healthcare workers, continues to drag on. Finance Minister Loyola Sullivan says that this budget is aimed at reversing the 'living beyond our means' culture that existed under the Liberals. He claims he will be able to reduce the projected 2004 deficit of $602 million by 40%, promising that short-term pain for long-term gain will improve the province's fiscal picture.

CUTTING WHERE IT HURTS
For the health sector at least, that pain promises to be acute. Several projects initiated by the Liberals have been cancelled, including a $75 million redevelopment of the James Paton Memorial Hospital in Gander, which they'd already spent about $56 million on, and a cancer clinic and hospital extension in Grand Falls-Windsor. A new health facility planned for Grand Bank on the province's south coast has also been shelved even though close to $3 million has been lavished on its steel structure, which will now have to come down.

Health Minister Elizabeth Marshall says her government wants to look at all healthcare facilities in the province and develop a long-term strategy for the infrastructure. "It's going to be a year of belt-tightening," she warns, although there is a modest funding increase this year to $1.6 billion (up from $1.5 billion last year) to sweeten the deal. Healthcare accounts for about 32% of the province's total expenditure.

The number of healthcare boards, which currently number 14 and oversee public health, nursing homes and hospitals, will be reduced within the next six months. Ms Marshall says that no decision has been made yet on how many boards will be left, but she says 14 is too many for a province with a population of just over half a million. She admits that the savings will be minimal, but that the primary intention is to provide a better continuum of services.

WHERE THE MONEY'S GOING
"There really needs to be a better integration of community programs and hospital programs," says Ms Marshall. Plans for primary care renewal, which began under the Liberal regime, are also expected to change the face of healthcare.

In 2000, the federal government launched a Primary Health Care Transition Fund to assist provincial and territorial governments with transitional costs as they renew their primary care systems. Newfoundland and Labrador's share was $9.7 million. To date, seven proposals have been accepted and this year the province will spend $4.3 million to support the first phase of implementation of primary care initiatives.

Dr Susan King says the NLMA recognizes the need to balance Newfoundlanders' desire to have their health services nearby and having the resources to fund the latest in technology, treatment and diagnostics, but they hope that these decisions are made based on common sense and logic rather than political will. On the positive side, they're pleased with the budget's allocation for promoting healthier lifestyles, such as $1 million for mental health services, $100,000 to deal with addictions and gambling, $250,000 for healthy children, healthy schools program and $500,000 for school lunch programs.

An additional $8.5 million is also being provided for the province's prescription drug program, which assists low-income earners, including seniors and social assistance recipients. The cost of that program will be just over $100 million this year, with $800,000 earmarked to include a new chemotherapy drug, Gleevac, to the formulary. However, drugs to treat Alzheimer's disease � Aricept, Exelon and Reminyl � which the local Alzheimer's Association has long been lobbying to be included, won't be covered.