EDITORIALS Leaner times for health care

It looks as if some tough choices lie ahead for the Vancouver Island Health Authority. In 2014 and 2015, the provincial government has warned VIHA to expect funding increases averaging just two per cent. Those are formidable targets. A look back shows why. After the 2008 recession, VIHA’s funding increase was pegged at six per cent annually for three years. The result was a management plan to cut 3,000 MRI scans and 760 non-emergency surgeries. A number of community services were also targeted for reduction or elimination.

If that is where a six per cent increase leads, what will two per cent bring?

Of course, these are difficult days. Resource revenues have still not recovered to pre-recession levels.

Even with tax hikes and a raise in MSP premiums, the provincial government is struggling to make ends meet. In that context, the Ministry of Health has an obligation to demand efficiencies.

The problem is, health authorities have already been there and done that. Over the last decade, B.C.’s hospital sector reduced overhead costs by 25 per cent. And the province’s growing population is being cared for with 30 per cent fewer beds.

As a result, our hospitals have the lowest all-in cost per patient of any province in Canada. They also have the most efficient nursing service. The question must be asked, how much leaner can they get and still provide safe treatment?

There is always some slack in the system. VIHA recently announced that three of its underused laboratories will close at noon each day. The facilities run only a handful of tests most afternoons. But that won’t go far toward closing the gap.

The government believes additional savings can be found by managing hospitals more like a business. The Health Ministry wants regional authorities to behave like private contractors, selling their services to government for a negotiated price — so much for a hip operation, so much for an MRI scan and so on.

The idea is that by creating a marketplace for health services, with government as the purchaser, hospitals will become more cost-conscious. But this is risky business.

First of all, the price sheet isn’t really negotiated. The ministry sets it.

And unlike a real marketplace, where contractors can walk away if there’s no money to be made, health authorities don’t have that option. They are forced by law, as well as professional duty, to treat any patient who comes through their doors.

Second, there is a significant difference between a health-care system built around patient need and one where price is the driving force. Humans aren’t a commodity, and each patient is unique.

What happens if a hip operation runs into complications and the budgeted time for the procedure doubles? Or perhaps an MRI scan turns out to be slightly misaligned.

In a patient-centred system, the surgeon takes whatever time is needed to do the job properly. A second MRI is ordered. But in a cost-driven world, there are different pressures. The operating team hurries to catch up. The radiologist settles for an iffy scan.

It is unlikely this would happen right away. The professional habits of a lifetime endure for a while. But eventually, a new mindset might take over. Get it done on time and price, or else.

There is, as always, another side to this debate. Funds are not unlimited and health budgets do have to be controlled.

It is possible, as the government believes, that hospitals can find ways to meet tough price targets without compromising patient safety.

But the centre of gravity in our health-care system is clearly shifting, from professional caregivers to professional number-crunchers. That is a dangerous trend.