Restraining the growing costs of health care

Politicians look for savings in health system

Under pressure from an aging population and ever more expensive new treatments, tests and drugs, Manitoba’s health care budget could eventually run short of growing room, critics say. Rachael Hiebert

As politicians strive to outbid each other’s remedies for health care staff shortages, we hear less about how they’d tackle the long-term challenges facing the health care system – the system today’s young people will be paying for in the coming decades.

Manitoba’s health care budget has gradually increased from 32 per cent in 1980 to 43.5 per cent by 2005. Recently its growth has slowed, reaching 43.7 per cent by 2010.

Phil Cyrenne, an economics professor at the University of Winnipeg, points out that healthy equalization and federal transfer payments have helped cover recent cost increases. But the federal transfer agreement is due for renegotiation in 2014.

Under pressure from an aging population and ever more expensive new treatments, tests and drugs, the health care budget could eventually run short of growing room. 

“Once it gets over 50 (per cent) then there’s a saying that pretty soon there’ll only be two ministers: one will be the finance, the other will be the health. You won’t need anybody else,” Cyrenne said.

Health Minister Theresa Oswald, along with PC health critic Myrna Driedger, share similar outlooks on ensuring sustainability of publicly funded healthcare.

“There’s a whole lot of ways you can find efficiencies within the system just by looking at innovation,” said Driedger.

“We have to be innovative within the system, and find efficiencies in what we’re doing every day,” said Oswald.

Noralou Roos, a founding director of the Manitoba Centre for Health Policy, described several ways of reducing costs without cutting services. One option is to spend less on high-cost screening, surgery or drugs when their benefits are not supported by research.

“We know that for certain kinds of conditions they can be very useful in terms of diagnosis,” she said of MRIs and CT scans. “But extending it to other areas where we really don’t have good evidence, that’s when it (is) ... increasing expenses without any obvious payback.”

Rising drug costs are another drain she’d like to see remedied.

“If Canada introduced a universal pharmacare system and negotiated across the country, they could bring the prices down no question,” she said.

Improving quality and patient safety would also save dollars, Driedger said. She offered the nursing shortage as an example of unnecessary costs.

“The amount of overtime that is being billed is staggering,” she said.

Exodus of doctors

Driedger suggested the province needs to stop the exodus of doctors, which in turn creates extra costs for recruitment. She said Manitoba falls behind most other Canadian provinces when it comes to retaining doctors.

When renegotiating the health care transfer in 2014, the federal government will be looking for evidence of cost-effective practices, said Driedger. Manitoba needs to prepare by starting to pull that information together, but it won’t be easy, she said.

“We’re so behind in analysis in health care, that we have some of the oldest IT equipment in Canada. Because of that, you can’t gather information and you can’t analyze it,” she said.

If Canada introduced a universal pharmacare system and negotiated across the country, they could bring the prices down no question.

Noralou Roos, founding director, Manitoba Centre for Health Policy

Oswald disagrees. She said the University of Manitoba’s research facility, the Manitoba Centre for Health Policy, is the envy of the nation.

“We have the largest repository of health data of any jurisdiction in Canada.”

She said the data provides evidence of which programs work, which need modification and which need to be scrapped.

“She’s just dead wrong, and by a hundred miles, in saying that we don’t gather evidence,” Oswald said. “There is a huge body of evidence and data that we will be able to provide to the federal government.”

Oswald emphasized the need for accessible primary care so situations don’t become acute. She said planned primary care networks would free up doctors’ time by giving people easier access to other health professionals.

And she said the province already saves money on drug purchases by collaborating with other provinces.

With new technology, she added, hospital stays can be reduced. For example, a new gamma knife to perform laser brain surgery has cut hospital recovery time from 30 days to less than one.

Roos, Oswald and Driedger all mentioned the potential to relieve pressure on the health care system by working to prevent chronic disease.

But Cyrenne thinks the main cost issue is difficult for politicians and the public to face.

“Most of the real costs for health care are incurred in the last few years of life,” he said.

“People in desperate circumstances will spend all their money on last-ditch treatments for their conditions, ... but I think with a public health care system you need to have some kind of dialogue about what can be treated and what shouldn’t be treated.”

Published in Volume 66, Number 4 of The Uniter (September 22, 2011)

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