Is Nova Scotia ready for a health-care tsunami?
New model of delivery needed to address rising costs as baby boomers age
The aging of the population is about to create an unprecedented crisis to Nova Scotia’s health-care system.
Demands on the health-care system are nearing a breaking point. The health-care budget for the next fiscal year is $4.6 billion – 42 per cent of the total provincial budget. What will that number look like in 2030, when the number of 65-year-olds or more in the province increases by more than 50 per cent over 2015 numbers? Based on the current model, it’s highly likely that without significant changes, health-care costs in Nova Scotia will increase by more than 50 per cent, as well.
How can Nova Scotia’s taxpayers afford such an escalation in costs without it negatively impacting other public services or without having more taxpayers to pay the bill? Nova Scotia’s population is already older than the rest of the country – and it’s about to get worse.
The model of health-care delivery will have to change if the system is to become sustainable, long term. The promise that every citizen will have their own doctor isn’t practical. The new generation of private family practice doctors aren’t willing to work the long hours of their predecessors, seek more work/life balance and prefer to work in group practices rather than independently. That’s one of the reasons it’s becoming more and more difficult to attract family doctors to rural areas.
What governments should promise is that every citizen will have access to a doctor – but not necessarily the same one each time. This encourages a group-practice model and more daytime and after hour walk-in clinics. The use of strategically located walkins would provide some relief from overcrowded emergency rooms.
Establishing a network of walkin clinics means tough decisions will be needed in terms of how many of Nova Scotia’s 32 hospitals continue to operate. As the auditor general has made clear, Nova Scotia currently has too many hospitals for the size of its population. Tough choices are required. Nine centres in Nova Scotia serve 95 per cent of the population within about a 30-minute commute.
The recent decision by the government of Nova Scotia to close two aging and non-salvageable hospitals in Cape Breton is perhaps a model of future healthcare delivery for the region. In announcing the closure of these two hospitals, the government indicated those facilities would be replaced by collaborative healthcare centres (think walk-in clinics) to provide non-urgent care. The emergency centres at the two remaining hospitals would be significantly improved to replace the ERS at the two closing hospitals (which had been experiencing emergency room closures due to unavailability of physicians). Further, the number of long-term beds would be increased in the community. This is perhaps the way forward for the rest of the region.
As people age, their use of the health-care system increases. Baby boomers will define provincial health care, just as they have defined every other stage of their lives, simply due to the sheer size of this cohort. With baby boomers now quickly crossing over into the 65-year-old group, there will be many consequences. Think about joint replacements, incidents of dementia, the need for more longterm care beds. How will Nova Scotia’s health-care system cope with the inevitable increase in demand?
The number of long-term care beds will have to increase significantly by 2030, perhaps by as much as 50 per cent. Currently, there are 7,855 long-term beds provided by the public and private sectors, and that doesn’t include those in hospitals waiting for long-term beds. The current wait list for long-term care is more than 1,000. Perhaps some hospitals could be converted to long-term care facilities?
Does the province have an estimate of the need for long-term beds over the next 20 years and a strategy to address that need? The Conference Board of Canada estimates capital costs of each new long-term care bed is over $300,000, while annual operating costs are $75,000. There are currently 255,000 long-term beds in Canada, with an additional 200,000 expected to be needed by 2035. Is the health-care system in Nova Scotia prepared for this tsunami?
At a minimum, the population must become open to a new model of health-care delivery that will include fewer, but more enhanced regional hospitals within a reasonable commute; improved access to a family doctor, although not necessarily the same doctor each time; more use of walk-in clinics for urgent but not life-threatening care; the use of more nurse practitioners in the provision of front line health care; and the adoption of preventive health strategies to encourage healthy lifestyles.
The good news? With the passing of the baby boom generation, the pressures on the health-care system will abate, just as it did with the demand for public education and universities when the numbers of students declined following the baby boomers. But that’s still a couple of decades into the future. Don Mills is the former owner of Corporate Research Associates and a recognized expert in data trends in Atlantic Canada. After selling his business recently, he remains passionate about data – and learning the guitar. He can be contacted at dmillshfx@gmail.com or on Twitter at @donmillshfx.