Nova Scotia government must consider bold health-care reform

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Appeared in the Halifax Chronicle Herald, October 17, 2023
Nova Scotia government must consider bold health-care reform

Last election, the Houston government ran on the promise of fixing health care in Nova Scotia. Unfortunately, now nearly halfway through the government’s mandate, many Nova Scotians struggle to find a family doctor, ER closures remain the norm, and wait times are longer than ever. The Nova Scotian health-care system remains in shambles, and if the government wants to make good on its mandate and election promise, it must implement meaningful reform.

Last year, the wait time between referral to treatment in Nova Scotia (58.2 weeks) was significantly longer than the 27.4-week national wait time. And you can’t simply blame COVID backlogs—the wait in 2019 (pre-pandemic) was nearly three times longer than Nova Scotia’s 11.5-week wait in 1993.

In other words, while the worsening of wait times in Nova Scotia has accelerated in recent years, it had already been deteriorating for decades.

And yet, in 2022 Nova Scotia ranked highest in Canada for provincial government health-care spending (as a share of the economy). So the province is one of the highest spenders in Canada, which is one of the highest-spending countries on health care in the world.

In response, the Houston government has implemented several potentially useful reforms, from recruitment efforts, funding new medical schools, hospital expansions, centralization of its electronic medical records, expanding scopes of practice, and even limited partnerships with private clinics.

While the breadth of reform is commendable, it’s yet to produce the necessary results. Some policies, of course, will take time. In the meantime, the Houston government should look at reforms from other countries, many of which perform better than our own. For example, Switzerland, Germany, the Netherlands and Australia all spend less (or the same) as Canada on health care, but report shorter waits for specialist visits and elective surgery.

The difference? All these countries approach health care in a fundamentally different way. For starters, they rely on their private sectors as either a partner or pressure vale when providing coverage. These countries also incentivize informed decision-making by expecting patients to share the cost of care (with generous safety nets and exemptions for vulnerable populations). And they all incentivize treatment by paying hospitals on the basis of their activity, unlike the Canadian approach.

Based on these examples of more successful universal health-care systems, the Houston government should consider further expanding existing partnerships with private clinics to expand supply. It could also introduce “activity-based” funding for hospitals to incentivize treatment. Unfortunately, however, the government remains limited in its ability to experiment with other potentially effective reforms (such as cost-sharing or a fully parallel private health-care system) due to the Canada Health Act (CHA). The Trudeau government has made it clear that it won’t hesitate to claw back funding if it perceives a violation of the CHA. The result is minimal policy innovation and a frozen status quo.

In reality, if the Houston government wants to make good on its election promise to “fix health care,” it must implement fundamental reforms, and Ottawa must get out of the way.

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