Earlier this year, Premier Eby instructed British Columbia's health minister to review the regional health authorities and tackle administrative costs to “focus resources to the front line.” That review is currently underway.
No doubt there's some administrative fat to trim, but solving the myriad problems with B.C.’s health-care system requires more than a hiring freeze and the firing of a few C-suite managers.
Intermittent ER closures, hundreds of thousands of British Columbians without a family doctor, and lengthy wait times totalling almost 30 weeks from GP referral to treatment, all point to deeper systemic problems that urgently require meaningful solutions.
Some will argue these problems are the result of chronic underfunding of health care or perhaps the price we pay for universality. But patients in other developed countries with universal health care know otherwise.
Indeed, in countries such as Switzerland and Germany, patients have universal access to high quality care but receive it in a far timelier fashion. They also have more physicians, hospital beds and medical technologies (e.g. MRI machines) compared to Canada, despite spending roughly the same on health care as we do (as an age-adjusted share of the economy).
If the goal is to truly improve access to health care for British Columbians, Premier Eby should direct the health minister to broaden her horizons and learn from other countries that have a proven track record delivering timely universal access to quality care. Among other things, the health minister would quickly find these countries (and increasingly other Canadian provinces) pay for hospital care differently than B.C.
Today, hospitals in B.C. receive a lump sum of money each year from the provincial government. Consequently, from the hospital’s perspective, there’s little financial incentive to serve more patients (who act as a drain on their budgets), operate more efficiently or provide superior quality services.
In contrast, the better-performing universal health-care systems in Germany and Switzerland flip this system on its head. Instead of handing out bags of money each year to hospitals, they pay their hospitals for each patient treated based on the patient’s particular condition and important factors that may add complexity or cost to their care. Under this model (known as “activity-based funding”), hospitals see patients as a source of revenue rather than a cost to be minimized. The result is more services delivered using existing health-care infrastructure, which lowers wait times and improves quality of care.
Importantly for B.C., there’s no new ground to break here. Many developed countries with universal health care began shifting to activity-based funding in the 1990s. Indeed, the reforms in some countries began so long ago they are now on their second or third generation of activity-based funding, incorporating further innovations to encourage an even greater focus on quality. This vast and lengthy experience with activity-based funding in other universal health-care countries can help inform B.C.’s approach, helping the province get the reforms right from the get-go.
The Eby government’s latest system review may find some incremental administrative savings, that’s not what B.C.’s health-care system needs. It instead requires sensible reform that will bring it in line with better-performing systems abroad, for the benefit of patients and their families.
Mackenzie Moir and Nadeem Esmail are analysts at the Fraser Institute.
