Avoiding big decisions creates huge costs

Hey there, time traveller!
This article was published 09/09/2024 (619 days ago), so information in it may no longer be current.

Paul Thomas has described the multifaceted nature of the “blurred accountability” in health care (Multiple accountabilities in Manitoba’s health-care system, Aug. 24).

What must be clarified in the mist of multiple accountabilities is that big decisions are the responsibility of the political leadership in the provincial government. Big decisions reflect major changes in direction; they guide the future and they are often costly, even when they can advance the quality of care and save money in the long run.

I will provide some examples. We are currently in a difficult time because big decisions in relation to planning for future health-care personnel needs were not taken.

Training personnel takes time. Because provincial governments failed over the last 25 years to develop and implement plans for human resources in health care, we now have widespread shortages.

Manitoba has failed for years to make the big decision to have all Winnipeg hospitals use electronic medical records (EMRs), and having the EMRs be all of the same type. During the COVID-19 pandemic, when only one of the six major hospitals in Winnipeg had electronic medical records, many extra people had to be hired to handle paper orders and paper records, which were inefficient and more subject to errors.

The failure to take the big decision for Winnipeg, and for all Manitoba hospitals, has left us far behind where we should be, has slowed down progress in our province and has led to poorer health-care quality.

When diabetes was declared an epidemic in 1996 in Manitoba, the big decision to have a major effort to prevent type 2 diabetes was not taken. The result: today we are short of health-care dollars (cumulatively, it has cost the provincial government $5 billion to $6 billion extra in the years since then) and we are short on space in our emergency rooms and hospitals.

If effective diabetes prevention had been implemented soon after 1996, we could now have 20 per cent fewer people in hospitals and many fewer people in our emergency rooms. Our health care system would be much better off.

In 2011, the government of the day recognized that every person in Manitoba should have a family doctor.

However, no plan was ever provided to do this, so one was never implemented. This major failure of provincial politicians of the time has had long-term consequences in contributing to more people using emergency rooms and more being in hospitals. It is important to have a model of primary care which works well and is affordable.

One example, the NUKA model of care, which originated in Alaska, is used in the Opaskwayak Cree Nation. It integrates care for mental and physical health and better integrates specialist care into primary care. It has been shown to achieve a 40 per cent reduction in emergency room visits, a 36 per cent drop in hospital admissions, 97 per cent patient satisfaction, 95 per cent employee satisfaction and a rating in the 75th to the 90th percentile on many health-care effectiveness outcomes.

We need to use a system of primary care which provides a “primary care home” (for mental and physical health) for each person in Manitoba and which can be shown to be effective in producing results. Yet over the last 25 years, successive provincial governments have completely failed to do this.

It is said that the last year of a person’s life is the most costly year in terms of health-care use. Winnipeg has an excellent system for providing palliative care, except for one aspect.

In Winnipeg, a person is not normally eligible for palliative care until after they make a decision to not have further active and potentially curative treatment. In other jurisdictions with a concurrent care model, palliative care can start even when a patient is under active treatment. Involvement of the palliative care team earlier considerably reduces emergency room and hospital use and results in a considerable decrease in health-care costs.

Yet provincial governments in Manitoba have not made the big decision to make this change.

In each instance above, failures of Manitoba’s provincial governments to make the big decisions has contributed to Manitoba having an overburdened health-care system. The challenge is holding governments accountable for failing to make big decisions. Manitobans need to better recognize that governments that fail to make important big decisions in a timely fashion must be held accountable.

Jon Gerrard is the former MLA for River Heights.