Since the inception of the system that we loosely call the Canadian Health Care System, in 1959 the federal and provincial dialogue has been a succession of squabbles over funding. What was intended as a 50:50 cost sharing has grown far beyond that in scope and complexity.
So here we are, once again, with more federal/provincial discussion with the predictable scenario: national consensus “the system is in crisis” with a federal response of “let’s pour more money on this troubled sector.”
Then in the public discourse in social media, conventional media, and advocacy publication, the public is, once again, treated to the usual arguments: use the money to hire more doctors and nurses, use the money to build more nursing homes, give employees a respectable income that is attractive.
Advocacy groups and unions then line up to express their public positions with such phrases as “too many administrators; use that money for nurses”, “hire more doctors”, “all care staff deserve a raise”, “cut the wait times in Emergency” and the list goes on.
For decades, the infusion of new money after the federal-provincial negotiations has always resulted in serious increases in the flow of federal funds. And, so it should be since it was the federal government that set the legislative framework in 1959 and renewed it in 1982. But the several new funding allocations have never resulted in material improvement to the international status of the health care system in Canada. It is true that from time to time, funds have been directed toward the crisis of that year such as technology, medical school enrollments, senior care. But that has all left Canada with a system that, despite its great qualities, still ranks 9th out of 10 OECD countries!
The USA ranks 10 on those same indicators and when you google the OECD, you find that the comparative indicators deal measure the effectiveness of national health systems on the most important indicators of health service success. The US does not fare well on those indicators and has the most expensive system on a per capita basis with Canada being just marginally better.
In the context of the current transfer of new federal money to the provinces, then, it is not like the performance of Canada’s system, a blend of socialism with some capitalism involved, is a model of success to be preserved as is. The notion, as popularized in public discourse in New Brunswick, that somehow the elements of the system that are “run by government” are somehow better than those elements that are directed by the private sector is simply uninformed opinion.
I recall, for instance, when entering the long-term care system in 2006, having invested 45 years working in the hospital sector, the culture of the sector seemed very negative. In the months prior to being named CEO at York Manor, I have vivid recall of what seemed like daily negative messaging in the press about nursing homes in New Brunswick. The combination of the union messaging and the then nursing home advocacy groups created a public perception that would not be inviting for good employees to join the sector. In New Brunswick at that time, and for decades previously, nursing homes were owned and managed by community non-profit, voluntary boards and tightly regulated by the Department of Social Development. In our quest to inject some new thinking and new ideas into York Manor, now York Care Centre, I had to go to Ontario to attend the Ontario Long Term Care Association where innovation and new ideas were not only evident but electrifying. In the conference that I attended, nearly 80% of the participants were from the facilities owned and operated by the private sector.
So, we brought some of those ideas, and discovered even more in our research in Nova Scotia and elsewhere, to York Manor and completed the transformation to York Care Centre, known now as a Centre of Excellence in Aging Care.
A strong private sector presence in health and long-term care should be no threat to unions, staff, or the public. What the private sector brings to the table is better management, trained management, tighter control on spending, and vastly improved human resources management. That is why, for instance, as far back as the 1960’s, health facilities across the country had to engage the private sector to manage food and cleaning service; the salaries and benefits offered by the socialized system were insufficient to attract and retain persons with experience and training in these areas of specialty.
Offsite clinical services are an area in which there is wonderful opportunity for engagement of the private sector. On a recent visit to the United States, I accompanied a relative to a private radiology facility where, in the space of 30 minutes I observed a waiting room full of people being processed thru their x-rays, ultrasounds, CT scans and mammography exams. The focus on patient relations and efficiency was palpable with the reports being electronically transmitted the same day to the hospital chart.
The issue is not private sector vs. public sector; the real issue is the quality of the regulatory process. Private sector provision of health and long term care services can easily get out of control unless government has a trained, knowledgeable, strong, evidence-based regulatory process that is free from political interference. And therein is the issue in New Brunswick. Those who are negotiating with physicians need to be very knowledgeable and experienced. Those who regulate long-term care need to be experienced and trained in long term care and politicians need to steer clear.
Many of the issues that blow up in public come as no surprise to the informed observer; but to the public and, often, to government, the obvious is ignored thus resulting in nasty situations boiling over. I have seen it repeatedly.
Let’s fix regulation and build a highly-effective health and long-term care system.
Ken McGeorge,BS,DHA,CHE is a retired career health care CEO, part time consultant, and columnist with Brunswick News; he is the author of Health Care Reform in New Brunswick and may be reached at firstname.lastname@example.org or www.kenmcgeorge.com
Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.