By David Shipley
New Brunswick’s top business leaders are worried about the future of health care in the province. In focus group conducted by Bristol for the Telegraph-Journal, six prominent executives discussed some of the major challenges the province is facing. The members of the group were promised anonymity.
While the executives did not question universal access to publicly funded health care, they were concerned about government control and poor management of the system.
“There is finally a debate. People don’t realize that we’re going to end up with two departments: The Department of Finance to collect the money and the Health Department to spend it,” one of the leaders commented.
“Every dollar of increase to heath care is coming from another department.”
The provincial government has budgeted $2.1 billion for health care this year, a 6.6-per-cent increase over the 2006-2007 budget.
Health-care spending in New Brunswick accounts for roughly one-third of the $6.6 billion provincial budget. Increases in the cost of health care have outpaced inflation and even the typical government budget growth of three per cent a year.
Health Minister Mike Murphy has said repeatedly in recent months that a revamped provincial health care plan will aim to rein in spiralling costs. Rising expenditures come at the same time as provincial tax revenues are being pressured by the medical needs of an aging population. Revenues are also stagnating as the number of people living in New Brunswick declines.
The business leaders questioned whether government should be in charge of managing the health care system.
“I don’t know what the taboo is. Where has the government ever managed anything, whether it is the post office or the Soviet Union, and done it well? The health-care system is no different.”
New Brunswick’s ailing health care system, the leaders said, is having an impact on their ability to attract and retain skilled workers.
“I spent $100,000 on a recruiter and hired three people. Within a few months they were all ready to leave because they couldn’t find a doctor,” one leader said. “They were claiming false advertising! No support system in the province!”
The province is now paying for the short-sighted decision in the 1990s to cut its quota of places to train physicians in medical schools, said one leader. As well, the move away from a fee-for-service model to a salary model for physicians was deemed a mistake by a member of the group.
“Fee-for-service doctors with 4,000 patients, now are coming in on a salary and expected to have 850 patients, and some of them only 350,” said one. “So we’re going to need three times as many doctors and, guess what, they want to be paid as much as the person who had 4,000 patients.”
The group called on the province not only to reform how it deals with doctors, but also how it utilizes other health care resources and facilities such as hospitals.
“Look at those hospitals! As businesses we couldn’t pay for this infrastructure and afford to run it only eight hours a day. We would have to run 24 hours a day. The province is not utilizing its infrastructure in a cost-effective way and that is driving the costs up,” said one.
“The private system would run it around the clock: You’d get your appointment at 2 a.m. and be told that’s how we keep the costs down.”
The business leaders urged the province to take stronger steps to control costs.
“How come there is no cost accounting in place where you would know exactly what steps a patient goes through and how much it cost?” asked one.
The provincial government is in the process of developing more detailed medicare billing and transaction tracking as part of its E-health initiative.
“I’d like to see a black-belt in six sigma or lean manufacturing go into a hospital and work out the efficiencies and productivity ratios,” said another leader.
Not all of the concerns were focused on health care delivery or costs. Skyrocketing prescription drug costs were also a concern.
“The cost of drugs is going through the roof for employers as well as employees, double-digit increases. In my son’s class, one-third of the children are on long-term medication. That’s unreal!”
Maryse Courville, senior research consultant with Bristol, said the focus group was made up of leaders from the largest New Brunswick companies.
“We made an effort to get a cross-section of industries as well as regional representation,” she said. “There was a keen interest in taking part in this. They were quite candid and open in expressing their opinion.”
Charles Cirtwill, acting president of the Halifax-based Atlantic Institute for Market Studies, said he isn’t surprised by the ideas voiced by business leaders in the focus group.
“We’ve been hearing this behind the scenes for quite some time,” he said, adding, however, business leaders have been reluctant to voice such opinions publicly.
Cirtwill said the public is becoming increasingly open to the idea of publicly funded, but privately delivered health care. But while the public may back such reforms, provincial governments have been reluctant to proceed because of the strength of public sector health care worker unions.
“I don’t think there’s going to be huge hue and cry if they shift to a privately-delivered model as long as there are no limitations on access to core care.”