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Opinion

Health care's sacred cows targeted

Manitoba faces tough choices when it comes to curing pricey, failure-prone system

Hey there, time traveller!
This article was published 12/7/2017 (1047 days ago), so information in it may no longer be current.

In the 15 months he has been Manitoba’s health minister, Kelvin Goertzen has demonstrated a clear and profound disdain for sacred cows.

The past 90 days alone, Goertzen unveiled plans to close and repurpose three Winnipeg hospital emergency rooms, shutter two dozen rural Emergency Medical Services stations, and cut tens of millions of dollars in operating funds from regional health authorities.

The assault continued this week with the announcement the Winnipeg Regional Health Authority is closing four QuickCare clinics, a hallmark initiative of the former NDP government, while also increasing fees for long-term care day programs, transportation and independent living supports.

These are decisions that strike deep at the heart of some of the services and facilities Manitobans hold most dear.

"I don’t think anybody would describe me as risk-averse," Goertzen said in a recent interview.

Indeed, he seems committed to even bigger changes in the future.

Included in the recent barrage of announcements was the 2018 launch of Shared Health Services Manitoba, an agency that will centralize back-office services for regional health authorities, including procurement, capital planning and contract negotiation.

However, it will also be the launching pad for what could become the next great assault on the sacred cows.

Although some of the decisions to date have been controversial, in reality nothing Goertzen has done will significantly slow the provincial health-care system’s voracious consumption of tax dollars. Real progress will only come when government and health-care practitioners work together to control costs and eliminate waste at the front end of the system.

Canada’s public health-care system was born out of a strange marriage between a taxpayer-supported administration and physicians who, for the most part, operate as independent contractors. Taxpayers may pick up the tab, but doctors make most of the decisions that ultimately drive costs.

Given they are highly trained experts, it only makes sense to grant physicians control over decisions on when and how people are treated. However, in recent years, many within the health profession have been forced to admit they are not always thoughtful or efficient in doing so.

In short, physicians perform or order too many unnecessary surgeries, MRI exams and laboratory tests. An April 2017 report from the Canadian Institute for Health Information estimated Canadian doctors are responsible for more than one million unnecessary treatments and tests every year.

Many consider this chronic waste to be the single greatest obstacle to a sustainable health-care system. It’s hardly surprising then, Manitoba has plans to tackle some of this chronic waste.

Dr. Brock Wright, president and CEO of Shared Health Services, said work is already underway to create provincewide standards of practice for clinical care, diagnostic imaging and laboratory tests that will help physicians make better decisions on what treatments or tests to perform — and when to perform them.

"There needs to be more accountability in the provincial system," Wright said in an interview.

A key to this initiative is a decision to create a provincial medical staff that will eventually include all physicians practising in Manitoba.

Wright said under the current system, physicians who do not practise in government-funded facilities and do most of their work in private clinics, operate almost at arm’s length from the provincial Heath Department, which has little influence over how and when they prescribe certain treatments and tests. Once fully enrolled in the provincial medical staff, all physicians will be held accountable to the provincewide standards, Wright said.

This will not be an easy process. Physicians have, in the past, fought strenuously to maintain their independence. Wright conceded he has not had time yet to engage in a meaningful discussion with physicians on how provincewide standards and central oversight will impact their practices.

However, Wright said, he believes most physicians understand less waste means, in the long run, less fiscal stress on the system and less conflict when it comes time to negotiate fees and other remuneration.

None of Goertzen’s initiatives to date — including Shared Health Services — are sure things. In fact, he will have to go to some lengths to convince Manitobans plans to close emergency departments and rural EMS stations are, in the long run, more efficient and effective. And he will likely have to do that before the next provincial election.

It’s also important to remember many of the advances or improvements Goertzen is seeking can only materialize if patients and physicians radically change the way they interact with the health-care system.

For example, the reorganization of Winnipeg emergency departments can only succeed in shortening wait times — the key goal of the initiative — if two things happen:

First, the province must improve home-care services and build more personal-care home beds to free up hospital beds. A lack of beds results in patients requiring admission to be warehoused in the ER, which leads to longer waits.

Second, the province must convince non-emergent patients to stay away from the ERs. Currently, the gross majority of ER patients do not, in fact, need ER treatment. Nonetheless, when you witness the bitter protests around the closing of the Concordia Hospital ER, you know many people in that area are not ready to make the transition.

Notwithstanding all the controversy surrounding Goertzen’s decisions, Manitobans should all be able to agree something has to change. The current system does a lot of great things, but it is too costly and fails too often to be considered a success.

Perhaps at this stage in the evolution of the province’s health-care system, a culling of the sacred cow herd is just what the doctor ordered.

dan.lett@freepress.mb.ca

Dan Lett

Dan Lett
Columnist

Born and raised in and around Toronto, Dan Lett came to Winnipeg in 1986, less than a year out of journalism school with a lifelong dream to be a newspaper reporter.

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