Premier Gordon Campbell
discusses the province's 2008 budget at the Vancouver
Board of Trade on February 20
Photo credit: Courtesy of
the Province of British Columbia |
British Columbia's latest Throne
Speech and budget, both presented in mid-February, have
revived that vexing and divisive question that just
won't go away: is the healthcare system sustainable?
In BC, where Gordon Campbell's
Liberal government has time and again hinted at its
desire for an increased role for the private sector
in healthcare delivery, the problem of sustainability
is proving to be one of immense import in considerations
both political and economic. And — as physicians
have become accustomed to by now — when political
and economic pressures accumulate on the healthcare
system, practical considerations about the realities
of medical care tend to fall by the wayside.
"These things, the budget and the
Throne Speech, are kind of general," says British Columbia
Medical Association president Dr Geoff Appleton. "[Health
Minister] George Abbott told us on February 21 he would
be getting back to us with details. The Ministry of
Health, I think, does not know where it's going on a
lot of things here, for sure."
SUSTAINABLE
DEBATE
Some of the confusion stems from Premier Campbell's
promise in his Throne Speech, delivered the week prior
to the budget, to add a new principle of "sustainability"
to the province's Medicare Protection Act.
His government has been warning
for years that healthcare costs are spiralling out of
control. Two of every three dollars of new spending
announced in the February 19 budget are for healthcare
— a total of $3 billion extra for healthcare, for
an increase of 6% — and Finance Minister Carole
Taylor says spending hikes of that magnitude are not
sustainable over the long term.
Sounds scary, but not everyone
buys that all this means we need to amend the Act.
Economist and former NDP MLA David
Schreck points out that the Medicare Protection Act's
preamble already states "the people and government of
British Columbia recognize a responsibility for the
judicious use of medical services in order to maintain
a fiscally sustainable health care system for future
generations."
So what's going on here? Mr Schreck,
echoing Dr Appleton's sentiment, says the language is
vague and the specifics sorely lacking. "It's all smoke
and mirrors," he says. "They're playing silly games
with words, trying to make the public think they're
doing something when they aren't."
PRICKLY
PRIORITIES
Also on the table, to rectify the physician shortage,
is a proposal to change existing legislation to allow
BC to recognize physicians' credentials from other provinces,
even if the doctors are trained outside Canada, and
foreign-trained doctors will be given a new class of
restricted licences to allow them to practise. A new
Health Profession Review Board will ensure health workers
can "fully and appropriately utilize their training
and skills, and not be denied that right by unnecessary
credentialing and licensure restrictions."
But, as with the sustainability
amendment, this suggestion raises more questions than
it answers. Licensing matters are decided exclusively
by the College of Physicians and Surgeons, but Premier
Campbell has taken a tough stance. He told the Vancouver
Sun that "turf wars" with the College won't stop him,
prompting the Sun's editorial page to encourage the
government to pass legislation like the 2006 Ontario
law that compelled the College there to comply. In a
letter to the editor a week later, College registrar
Dr Morris Van Andel defended the College's position
on licensing foreign-trained physicians and blamed the
government for not creating more training spots to speed
the process along.
Dr Appleton is concerned about
suggestions in the Throne Speech on healthcare workers'
scopes of practice. Premier Campbell pledged to allow
nurses to perform suturing, ultrasounds, allergy testing,
local anesthesia, cardiac stress testing, to order lab
work, blood tests and x-rays, and to give medications
for "minor pain" at triage. He also wants to permit
paramedics and midwives to perform more medical procedures
without doctors' supervision, and allow pharmacists
to renew prescriptions and naturopaths to prescribe
some medications.
Again, sounds scary, but details,
as in other announcements, are sketchy at best. What
will midwives be allowed to do? Nurses doing cardiac
stress testing? How long can pharmacists renew scripts
for? "I haven't a clue what that might mean," says a
perplexed Dr Appleton of the ideas.
The government has also decided
to expand its alternative hospital funding experiment
across the province. Interim results for the case-based
funding pilot projects in four Vancouver EDs, made public
last month, have already shown 10% faster access to
care.
TEPID
RESPONSE
Nadeem Esmail, the Fraser Institute's director of Health
System Performance Studies, says the Throne Speech and
budget are a mixed bag for physicians and the healthcare
system. "I don't think [the government] has done enough
to answer criticism, but it is a step in the right direction."
Others haven't been so gracious.
Dr Appleton says the government neglected to address
the shortage of acute-care beds in the province. Some
have criticized the 6% hike in health spending as not
enough money. And mental health was largely left out
of the Throne Speech and budget, save for a vague pledge
to update the province's 10-year plan.
The government's big Throne Speech
win was its new carbon tax, but, wrote Marc Lee, a Canadian
Centre for Policy Alternatives economist, in the Vancouver
Sun, "Masked behind the pages of green, however, is
a status quo that leaves a lot to be desired."
"This budget represents a lost
opportunity for healthcare and BC patients," Hospital
Employees' Union secretary Judy Darcy said. "[The government]
is committed to a vague notion of transformational change
but there are few details about their plans in this
budget."
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