Get a grip, start with health care

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Finance Minister Stan Struthers ( )

Budget

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This is the final part of a three-part series on the April 17 Manitoba budget.

The Selinger government is in a fiscal pickle of its own and Mother Nature's making. However you cut it, the latest projections are that the deficit this year will be well over $1 billion, notwithstanding an expected $445 million in federal flood support.

The budget Tuesday will be Finance Minister Stan Struthers' first crack at getting a handle on government spending. The stakes are high and the margin for error narrowing.

Since the NDP took power in 1999, spending has ratcheted up, outpacing revenue growth and far outstripping the consumer price index. You don't have to be a mathematician to know that when spending dwarfs revenues, accumulating deficits are the inevitable result. Take the Health Department, for example. During the last 12 years, health-care spending has gone from 37.9 per cent of total expenditures to 43.4 per cent. Last year, health spending went up 4.57 per cent while the consumer price index rose only one per cent.

Controlling escalating costs while improving service delivery is one of the major challenges facing all governments in Canada, and there are hopeful signs the Selinger government understands this reality and is prepared to do something about it.

Containing health-care costs would be a good place to start, as the Business Council of Manitoba found recently when it hosted a day-long symposium on health-care reform. Business leaders, physicians, nurses, hospital administrators and senior executives from regional health authorities heard presentations and engaged in a constructive conversation about creating the conditions for a higher-quality health system at sustainable rates of cost escalation.

What they heard was an inspiring account of how Kaiser Permanente, an American health maintenance organization with nine million members, 16,000 physicians and 170,000 employees, mostly unionized, routinely deliver the best health outcomes in the United States. Kaiser responds to requests to share its story around the world.

Molly Porter, the woman who presented the results, said she has no advice to give Canada about insurance schemes, referencing the hodgepodge of the American system.

Its integrated service model, though, is impressive and effective. Canadians will have to set aside their instant skepticism and fear of the "Americanization of Canadian health care'' to learn with an open mind.

The integrated model means a more appropriate alignment of responsibilities between specialists, family physicians, nurses and nurse practitioners. It means a steady movement toward team practices where the appropriate service providers meet the needs of the patient. It means the patient ought to be at the centre of the system. It means that ramping up the capacity of our electronic medical systems must become a fundamental part of Manitoba's health-care system.

Kaiser's website has transformed care. Patients can set their own appointments, email their doctor, check their medical records, review their immunizations and see for themselves how they can better prevent illness.

Today, 45 per cent of primary care takes place by email or telephone. Triage nurses direct much of the phone traffic and, along with the patients, determine the most appropriate health-care provider to talk to, email or see in person.

Fast-forward to Manitoba: Emergency room congestion is a growing problem and many professionals agree that up to 50 per cent of those visits are unnecessary and would be better handled through other primary-care options. Expanded home care is part of the solution and so are more effective ways of treating the chronically ill, especially the elderly, who have no need for prolonged hospitalization or the services of a personal-care home.

Struthers has an opportunity to tell Manitobans he understands that, without implementing reforms, delivering health-care services is not only a recipe for fiscal catastrophe but will crowd out other important government programs, particularly education.

The long-term strategy should include completion of our electronic medical records, controlling costs through more appropriate care delivery, enlarging the role physicians play in system reform and encouraging all Manitobans to take more responsibility for their own health and well-being. None of this will be easy, but the alternatives are worse.

Reforming the health-care system is only one of many initiatives the Selinger government will have to implement if we are to get a handle on chronic deficits. Smarter government is seldom a mantra on Broadway. The fiscal noose is tightening and we will not achieve our economic potential if governments fight a losing battle with the bottom line. What Struthers says Tuesday will tell us if he understands this imperative or whether we will continue to pile up the debt, threatening not only our capacity to grow but those very services Manitobans expect their government to deliver.

Jim Carr is president and CEO of the Business Council of Manitoba, a group of CEOs of Manitoba's leading companies.

Republished from the Winnipeg Free Press print edition April 16, 2012 A10