Wednesday October 11, 2000
Halifax Chronicle Herald

Dr. Hamm misdiagnoses our health-care ailment

By Brian Lee Crowley

DR. JOHN HAMM’S formidable medical skills don’t seem to extend to a proper diagnosis of the malaise affecting this province’s health-care system. In fact, he’s committing a cardinal sin in medicine: mistaking the symptom for the underlying disease.

The symptom that has attracted the premier’s attention is the poor health of Nova Scotians. Our health indicators are worse than those of many other provinces. That, says Dr. Hamm, means Nova Scotia should get more – up to 15 per cent more – in health-care funding from Ottawa to close the “health gap” with the rest of the country.

Yet the real disease is poor management of the health-care dollars we’re already spending, a fact that comes through clearly when you compare the provinces’ health-care performance more carefully than the premier has done. What caught Dr. Hamm’s attention was a recent study by Dalhousie University’s Population Health Research Unit. According to the study, Nova Scotians have greater health-care needs compared to other provinces in Canada. To cure this disease, the Hamm plan prescribes that healthier provinces like Alberta and Newfoundland receive less of the Canada Health and Social Transfer, the federal program that supports health care, social services and post-secondary education funds. Sicker provinces, like Nova Scotia, would be entitled to a substantially larger share of the CHST.

Yet, as my colleague Peter Fenwick and Dr. David Zitner, head of medical informatics at Dalhousie, argue, the health of Nova Scotians is obviously a function of the quality of health care and other services that are already in place. If Nova Scotians are that much sicker when they spend almost the same amount per capita on health care as Albertans, then there is something drastically wrong with the way dollars are being spent in Nova Scotia. With lower wage rates in Nova Scotia hospitals, the spending should go that much further. The Nova Scotia government clearly needs to concentrate on getting better value for money – the kind of value already being achieved elsewhere – before asking for more.

The Dalhousie study shows Nova Scotia far behind Alberta when it comes to prevalence of sickness and chronic complaints, but it is even farther behind Newfoundland. Even though Newfoundlanders have a shorter life expectancy, they are a much healthier population despite spending much less on health care per capita. If Alberta, with its booming economy, is a bad comparison for Nova Scotia, Newfoundland is not. Newfoundlanders come from the same British stock as Nova Scotians and they have deeper levels of poverty and higher levels of unemployment.

What should be done about Nova Scotia’s high spending and poor results? David Zitner says that three simple innovations called for in a five-year-old report prepared for the federal and provincial ministers of health on using hospitals better would be a good start.

First, every day, each hospital should check to make sure that the treatment patients are getting will actually benefit them, and that they are in the right setting for the care they need. Second, timely access to services either in the hospital or the community must be guaranteed, and information about waiting times made public. Finally, we have to keep careful track of when and why patients’ conditions improve, so that we can actually tell when new policies and procedures make a difference for the better.

The Dalhousie study should be a wake-up call to the provincial Department of Health that despite spending $2,845 per capita on health care each year, the results are nowhere near good enough.

A successful demand for more transfers based on the Dalhousie study would, if successful, mean the transfer of approximately $45 million a year to Nova Scotia, while up to $25 million each would be taken from Newfoundland and the other healthier provinces. Try selling that in St. John’s or Edmonton. And, as Peter Fenwick notes, the premier’s insistence that the federal government accept the Dalhousie report as the basis for transferring funds from other provinces to Nova Scotia is also not even supported by the Dalhousie study itself. Its authors were careful to emphasize that “the models we present are preliminary and are employed for illustrative purposes. They are not sufficiently refined to be used for resource allocation.”

If the federal government were serious about the health of Canadians, it should do the opposite of what the premier is suggesting. Instead of rewarding provinces that produce poor results for their health-care spending, it should provide additional funds for provinces that are able to provide value as they spend our dollars. For too long we have rewarded failure instead of success.