CALGARY (Staff) — It seems no one talks about health care today without mentioning costs.
Health-care spending consumes about a third of most provincial budgets.
Critics say the system has become bloated and wasteful with too many resources devoted to the treatment of sickness rather than promotion of healthfulness.
Yet behind all the focus on the “sickness” of the health-care system, efforts are under way to reform the 30-year-old publicly funded plan. As it was 35 years ago, the Prairies are the laboratory where many of these changes are being tried.
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With budgets under assault, the new emphasis is on prevention and community or home treatment. Provision of health care is being decentralized.
The problem, according to the Alberta Health business plan, is ineffective spending. “Our current system focuses principally on an institutionally based illness model. Treating illnesses and injuries is … more expensive than preventing them.”
Other provinces, with governments of varying ideologies, concur.
A 1992 Saskatchewan Health report said 60 percent of that province’s health dollars were spent on hospitals and long-term care with another 15 percent paid to doctors.
Governments across the Prairies are attempting to reverse that trend by putting more money into community programs that provide more choices to people who want to stay healthier and out of hospitals.
Critics say extensive reform and heavy-handed cost-cutting means an end to universal health care and the ushering in of a two-tiered system with top-notch medical attention for the wealthy, and less service for the poor.
Defenders of the reforms insist they are needed to save the system.
“I think there’s a lot of misconceptions about what we are really trying to achieve,” said Alberta health minister Shirley McClellan.
“We shouldn’t be surprised if there is some reservations or reluctance until we move more into this change and see it actually functioning and working.”
In Alberta, two-tiered medical care and privitization of medicine haven’t materialized despite the reforms. Private specialty clinics with payment-for-service have existed for years.
Reduction needed in acute-care beds
Like her counterparts in Manitoba and Saskatchewan, McClellan wants to cut costs by reducing the number of acute-care beds. At the same time, responsibility for health care would pass to affected individuals and their communities.
Alberta spends close to $4 billion a year on health care. The plan would reduce spending to about $3.7 billion by 1997.
By expecting communities to take more responsibility for the care of their own people, different processes will emerge.
“There isn’t just one model (of health care). There are basic services that must be provided throughout the province. It’s important that those areas can focus on those needs,” said McClellan.”The question is how do we pay for all the choices?”
It may mean some cuts.
While a province may provide partial funding for things like podiatry, physiotherapy and chiropractors, they may not be deemed medically necessary and a cash-strapped province may cut support.
Alberta recently named 17 regional authorities to replace more than 200 health facility boards. Each will receive a lump sum from the province to manage health care in their communities. The province will establish medical care standards and regulations but will leave the delivery of care to each community, said McClellan.
Saskatchewan on same reform path
Saskatchewan set up 30 health districts in 1993 to be responsible for everything from hospital administration to home care and public health needs.
At the same time, the province removed acute-care funding from more than 50 rural hospitals, turning them into “wellness centres” amidst widespread community protest.
It’s still early for an assessment but government officials feel the decision was a wise one.
“We were removing funding that for all intents and purposes, wasn’t being used anyway,” said Roy Schneider of Saskatchewan Health.
In many cases, people from smaller communities travel to larger centres for acute-care treatments.
A study released last November suggests two-thirds of the patient days in Saskatchewan’s small hospitals could be better served through out-patient services, long-term or home care.
Schneider added that people sometimes are admitted to hospital because the family feels it has no option. They deserve sympathy, but “is that any way to run a health-care system?”
Manitoba reforms community based
Manitoba also is reforming with an eye on community-based care.
Several years ago, it consolidated into eight health regions.
“Ten years from now, the changes will be so radical that we won’t even recognize some systems,” said Reg Toews, Manitoba assistant deputy minister for mental health.
“We’re not just tinkering with a system, rearranging the old program into new programs,” he said.
“We’re really trying to make an essential value change as well. When you get consumers in the room it makes professionals listen in a way they seldom do.”
