Ottawa’s money will help, not cure what ails health-care system

Hey there, time traveller!
This article was published 16/02/2024 (616 days ago), so information in it may no longer be current.

The problem with grandiose health-care accords between Ottawa and provincial governments — like the one announced this week in Manitoba — is they usually come with no strings attached.

In most cases, the much-lauded agreements include more funding for provinces, but almost no way of tracking how that money is spent, or whether it improves patient care.

The accord announced Thursday between Prime Minister Justin Trudeau and Manitoba Premier Wab Kinew makes some improvements on that, but not much.

As part of the deal, Manitoba must demonstrate that it’s reducing some wait times and hiring front-line workers, including nurses and doctors. But the specifics of those performance indicators are flawed.

They don’t include wait times for surgical procedures such as hip and knee replacement, cataracts or cardiac surgery. Nor do they include wait times for diagnostic testing, including MRIs, CT scans or ultrasounds.

There are some targets for emergency-room wait times. But even those are suspect, since the data used in the agreement does not align with current wait times in Winnipeg.

The accord requires the province to meet minimum hiring targets for front-line workers, but it’s silent on whether the new hires must be net increases.

Granted, this accord is an improvement over past ones. Under former agreements, provincial governments could use the extra money from Ottawa for almost anything they wanted, including tax cuts.

Under the new deal, there are specific outcomes that must be met. But those requirements are lacking in many areas.

For example, the agreement states that Manitoba must reduce its ER wait times from 6.6 hours (90th percentile) to 3.9 hours by March 31, 2026.

The 6.6-hour figure is supposedly a provincewide one. However, ER wait times in Winnipeg are far higher than that. According to the Winnipeg Regional Health Authority, the 90th percentile ER wait time at Winnipeg hospitals and urgent care centres was nearly 11 hours in December, up from 7.2 hours for the same month in 2022.

It’s unclear how they calculated the 6.6-hour figure, which includes all hospitals and urgent-care centres in Manitoba that keep track of ER wait times. There is no breakdown by facility. It seems unlikely the provincial wait time for ERs could be 6.6 hours when it’s almost 11 hours in Winnipeg, home to the province’s largest hospitals (including Health Sciences Centre, which acts as the trauma centre for all of Manitoba).

The ER wait time at St. Boniface Hospital was a staggering 15.77 hours in December (90th percentile). At HSC it was 13.19 hours. How much will ER wait times have to fall in Winnipeg for Manitoba to comply with the funding accord? That’s not in the agreement.

The only reference to surgical wait times in the accord is a requirement to eliminate backlogs that grew during the COVID-19 pandemic. Provincial data shows pandemic backlogs were reduced to zero last year, so Manitoba is already in compliance. It’s a pretty low bar.

Pandemic backlogs are largely irrelevant. What’s important is how long people are waiting now for all surgeries and diagnostic testing. That data should be included in the accord, along with enforceable targets for all procedures.

The reason the bar is set so low is it allows both levels of government to make claims that they’ve achieved their targets and are compliant with the accord. It gives the impression that progress is being made.

The main thrust of the agreement is to spend more money on health care, as if a lack of funding is the only thing preventing the system from improving patient care. The agreement adds $434 million in federal dollars to existing spending over three years and another $199 million over five years for home, community and long-term care for seniors. It’s not a massive amount of money in a $7-billion Manitoba Health budget, but it will help.

The main problem with that approach is it presumes the only thing that’s needed to “fix” health care is to spend more money. That’s a false assumption. The system requires drastic reform if government wants to significantly reduce wait times and improve patient care. There should be comprehensive targets for all major procedures and accountability for individual facilities that don’t meet them.

Unfortunately, none of that is part of this deal.

tom.brodbeck@freepress.mb.ca