Spending more to be sicker makes no sense.
by Don Cayo



In Manitoba, where Premier Gary Filmon faces an election within a few months, health care doesn’t seem to be a big issue. I was in that province for a few days last week, and if you can believe what you read in the paper and hear in casual conversation, people seem to think their system has weathered a series of spending cuts reasonably well. Better yet, they now see it modestly rebuilding.

But across the border in Saskatchewan, where Premier Ray Romanow faces an election within a few months, people are anything but sanguine about health care. The province’s nurses are poised to strike – again. And the NDP government is still taking heat for its sweeping health care reforms of the early 1990s.

The emphasis of the reforms sounds great – focusing on “wellness” instead of acute care, caring for people in their homes instead of in hospital, and all that sort of thing. But it involved closing 50 rural hospitals, reducing staff, and all of that sort of thing.

As in Atlantic Canada, a passionate debate seems to be fueled more by perception and feeling than by science and fact. But at least a small element of science was injected into it last week, and the reaction to it is instructive to Atlantic Canadian voters and governments alike.

Last Wednesday the major newspaper here published the findings of an Alberta study that looks at recent changes in life expectancy in the three westernmost provinces. It found that people are living ever-longer in British Columbia and Alberta, but in Saskatchewan they’re dying earlier than they did in 1990. And infant mortality is also up during the same period.

To critics of the NDP government, this is seen as proof positive of the failure of the Romanow government. But those in power are spinning it – not surprisingly – a little differently. They mount some credible counter-arguments: that the short term of the study makes it impossible to differentiate between a trend a blip; that the problem is less attributable to health care than to poverty, particularly in the North where the predominantly Aboriginal population lives in some appalling conditions; that spending cuts can’t be responsible for the change because Alberta cut spending even more; and so on, and so on, and so on.

What intrigues me as a visitor watching the unfolding debate from the sidelines is how a little bit of data – and it is a very little bit of data – can trigger so many wildly speculative responses. And what intrigues me as an Atlantic Canadian is that we lack even a little bit of data to hint at how good, or how bad, our provincial health care systems have become in this leaner meaner age.

In other words, the Prairie Provinces don’t know much about the state of their health care systems and the efficacy of the policies their governments have recently adopted. But we really don’t know anything about ours.

In New Brunswick, where the Atlantic region’s only current provincial election campaign is under way, voters are clearly worried about health care. But – unless there has been a major change in the campaign since I left the province on a trip West a week ago – the parties are scarcely discussing the reality, or otherwise, that underlies these concerns. What passes for debate is little more than a slanging match – an “our party will spend more than your party” kind of exchange.

I don’t know what will become of the Prairie study – whether it becomes the basis for further work to start getting a real handle on the outcomes of policy decisions, or whether it remains just a political football to be spun in a different direction by every interest group. I do know that the newly formed Saskatchewan Party – and I have no idea how credible these folks are – has responded to it in what sounds like a sensible way. They’re proposing a value-for-money audit of the province’s health system.

The same kind of approach is urgently need in each of the four Atlantic Provinces. We need to start by knowing precisely how we’re doing. Enough of the colourful, but not always credible, horror stories – let’s look at results. Are we sicker than we used to be, or healthier? Or are we staying about the same?

Then we need to know how our health outcomes in various areas stack up against those in other places of similar background. Are we doing better with some kinds of diseases than others? Can measurable gains to be made through better preventive programs? In what areas are we doing well enough? In what areas do we lag?

And finally, we should know if – or where – in the health care system we’re getting good bang for our buck. And if – or where – we’re not.

The Prairie study may kick-start just such a process out West. I hope it does. And I hope we’re wise enough down here to try to learn something from it.