I didn’t see the single provincial health board decision coming. I thought the province would break it up into south, central and north regions much like it did with the young offenders’ facilities.
The information to date is so preliminary that it is hard to determine whether this is a good move or not, but we should assume that a financially-strapped provincial government believes it will save money in the long run. What is dangling in the wind is whether delivery of health care services will be the same, better or worse under this model.
In listening to media reports on the announcement, the major public reactions seem to be lack of community input and that decisions will be made by a remote board not understanding local concerns. Chalk this up to taking the Band-Aid off with a quick rip versus a slow peel.
Had the government held public hearings, every health organization would have presented reasons for maintaining the status quo and predicting doom and gloom if any change was to be implemented, particularly if there were to be jobs eliminated.
And, of course, everyone (and there are many) who had a negative experience in health care would have taken the stage to tell their tale of woe, although those tales would have related to the current system rather than any proposed new governance model. Already detractors are claiming this move is the first step to privatization, trying to instill fear in our hearts. Don’t they know the federal government mandates that all provinces provide public health care?
A governance board sets the policies and goals, negotiates contracts and, likely, sets an annual budget. It does not do daily management of hospitals nor should it impede the operations of doctors’ offices. We can presume that some chief executive officers and administrative positions will be transitioned into managers with new titles, changed responsibilities and possibly lower wages.
I would like to think that a new board will examine issues that, although they seem costly at the front end, may prove to be financially prudent down the road. For example, I have never understood why hospitals discharge most mothers and their infants within hours of birth, especially first-time mothers or single mothers without home support.
After long hours of labour, a mother needs time to recover, may have medical needs resulting from the delivery and requires instructional help with nursing and infant care. I wonder how many of those new mothers and/or infants wind up returning to doctors’ offices and hospitals with more costly health needs that could have been prevented with some post-natal care.
In the last few years, we have been warned that changes to health care are essential, or the system will collapse under its own weight. However, changing a governance model isn’t going to improve health care delivery, although changing public mentality and managing expectations of our systems could preserve it.
We see health care as free, but it is not free. It is tax-funded and nigh on 50 per cent of every tax dollar goes into medicare. When medicare was introduced in 1961-62, we all paid an annual premium. There were rates for families and singles and those with incomes under a certain threshold did not pay.
Other provinces still do have premiums and/or insurance packages for additional services, such as ambulance, therapists, prescriptions, dental, optical, travel, and so on. Many residents of Saskatchewan also have additional coverage packages that are part of their employment contracts, yet we don’t see this as tiered health care.
But if a private clinic offers cataract surgery or an MRI at a cost to the patient, it is viewed as tiered service, a form of privatization and as unfair even though this does shorten the queue and take stress off the public system. It is a parallax view.
There was a time when we had deterrent fees, and once or twice an annual statement arrived advising how much money was spent on us individually or on our families in that year.
Political opposition cried foul and those practices went by the wayside. Then a government came along espousing universality, meaning no one should pay anything and that’s when we all stopped caring about the cost. Just give us everything we want and don’t charge us. We buried our heads in the sand, bought into the free model and then complained about increasing taxes and declining services.
During medicare’s history, new services were added and some were eliminated due to excessive costs. Some hospitals were closed and many facilities fell into disrepair, remaining so to this day. Wait times for surgery were growing and facility operational costs were becoming prohibitive. People started using high-cost emergency departments for hangnails and sniffles instead of booking a doctor’s appointment or going to a medi-clinic.
When pharmacare came into being, patients were being over-medicated because the cost of the dispensing fee was cheap. We abused our system and let it become a political football. Now it is time to pay the piper.
Have no doubt that the proposed model will evolve over the months and years to come. Opponents will sabre rattle about privatization and any change of service delivery. Perhaps the new board will be comprised of members from each of the current regional boards, who will be conduits for local concerns.
The future role of Catholic hospitals, which are owned by the Catholic Health Council, will need to be determined. But if nothing else results from this proposed model, the government has, at the very least, opened the door for a dialogue about medicare and we, at the very least, should open our minds to considering options for the future of our valued health care system.
As a friend likes to tell me, we should pay at least the same amount to see a doctor as we pay a barber for a haircut.