October 16, 2000
St. John’s Evening Telegram

Solving Nova Scotia’s problems, with Nfld’s money

By Peter Fenwick

Nova Scotia Premier John Hamm has a solution to his health-care crisis — take tens of millions of dollars from Newfoundland’s transfer payments and give it to Nova Scotia.

A fine strategy for Nova Scotia, but something that Newfoundland Health Minister Roger Grimes might find a tad unacceptable. Remarkably, however, I have yet to hear a peep out of the Newfoundland government about this reverse transfer proposal.

Hamm has the statistics, he believes, to back up his scheme. He points to a Dalhousie University study that appears to show that Nova Scotians need much more health care than the Canadian average, up to 15 per cent more by his calculations. That same study by the Population Health Research Unit appears to show that Newfoundland needs about 12 per cent less heath-care funding than the national average.

The study, which has been done by highly competent academics, argues that funding for health care should be apportioned by need, and not by population as is currently done with the Canada Health and Social Transfer (CHST). In the study, need is assessed through a variety of indicators, some having to do with life expectancy, the number of seniors in a province and the incidence of chronic conditions such as heart disease and diabetes.

But a large part of the formula is based on a health self-assessment that was done several years ago. The National Population Health Survey asked a number of questions to assess people’s health. The questions ranged from a simple, “How do you rate your health?” to questions about chronic conditions, lack of mobility and whether or not one had heart disease or diabetes.

When asked, only nine per cent of Newfoundlanders rated their health as poor or fair, compared to 17 per cent in Nova Scotia. Less than half of Newfoundlanders reported a long-term health condition, compared to two-thirds of Nova Scotians. Similarly, Nova Scotians reported almost twice as much heart disease as Newfoundlanders.

The other self-assessed indicators were similar. Newfoundlanders say they suffer less from restrictions to their activities, from clinical depression and from high stress than do Nova Scotians. It almost brings back memories of the Happy Province, the slogan that used to be on licence plates in the 1960s. And it may be just as subjective as those licence plate slogans of Joey Smallwood’s.

When the researchers compared this self-reporting to the actual number of days spent in hospital, and the number of visits to a doctor, they found a strong correlation. In other words, if you complain a lot about being sick, you go to the doctor and the hospital more often than those who complain less. Evidently these complaining Nova Scotians chew up health-care services at a much greater rate than do Newfoundlanders.

Ironically, one of the indicators that really put Newfoundlanders at an advantage was their unfortunate tendency to die younger than Nova Scotians. On average, Newfoundlanders live about a year less than Nova Scotians and have a higher mortality rate. Evidently, this is a plus when it comes to conserving precious health-care funding. It is those elderly Nova Scotians who are eating up their health-care budget.

In a reply to the study, and the Nova Scotia premier’s use of the study, my current employer, Brian Lee Crowley of the Atlantic Institute of Market Studies, pointed out that the dismal health of Nova Scotians may be due to poorly spent health-care money. Nova Scotians are just not getting their money’s worth. After all, per capita, Nova Scotia spends more than Newfoundland on health care.

Of course, the same studies that support Hamm’s request for more health-care funding from Ottawa through the CHST could be interpreted entirely differently: If Newfoundlanders die earlier, maybe they should receive additional funds to put in place health-care programs that would extend their lives. And if Newfoundlanders report less heart disease and diabetes, maybe it is because they have not been properly diagnosed as yet.

If diagnostic facilities were better in Newfoundland, maybe more diabetics would be discovered.

There may also be a cultural bias to the questions used in the survey. Newfoundlanders may not report minor losses of mobility and may have a more optimistic view on life, all of which would skew the results of the survey: “No ma’am, I got no problem with my mobility, I gets around fine even with my limp.”

The Dalhousie study was extremely tentative in its findings, arguing the techniques were not sufficiently refined to be used for resource allocation. Unfortunately, when Nova Scotia’s premier used them at a federal-provincial conference to argue for more CHST funding, he overstepped the bounds of the study.

It is, however, a report the Newfoundland health minister should study closely before Hamm wins the day and Nova Scotia diverts tens of millions in health-care funds across the Gulf.