Nova Scotia can improve health care without breaking the bank

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Appeared in the Halifax Chronicle Herald, August 27, 2021
Nova Scotia can improve health care without breaking the bank

During his successful election campaign, incoming premier Tim Houston promised $430 million in new health-care spending in the first year of his mandate to tackle, among other things, Nova Scotia’s long wait times. Of course, improving health care is a worthy goal. But is more money really the answer?

Consider the 20-year period before the pandemic when the provincial government increased health-care spending by 78.5 per cent (after adjusting for inflation). Importantly, the Ministry of Health accounted for 39.8 per cent of all provincial government program spending in 1999 compared to 43.1 per cent in 2019. In other words, the government not only now spends more on health care but also dedicates an increasing share of total spending to health care. 
Moreover, according to data from the Canadian Institute for Health Information (CIHI), Nova Scotia spent more on health care than almost every other province, on a per-person basis (3rd highest in Canada) and as a share of the economy (2nd highest in Canada).

The result?

During the same 20-year period, wait times in the province increased 160 per cent. In 1999, the median wait between referral to treatment was an estimated 12.8 weeks compared to 33.3 weeks in 2019. Only Prince Edward Island and New Brunswick reported longer wait times among provinces. Clearly, more money has not translated into shorter wait times.

The Progressive Conservative platform identifies a number of important concerns including poor access to primary care providers and limited operating room time. While the party offers some innovative solutions (such as expended virtual care options), others involve simply throwing more money at the problem—a tried and failed approach by most historical accounts. This observation was not lost on “pre-election Houston.” When running for party leader, Houston repeatedly claimed that more money was not the solution to Nova Scotia’s health-care problems. “We need to ask the question,” he said, “why aren’t we getting results?”

The simple answer is because Nova Scotia—and Canada, more generally—have a unique approach to health care that stands in stark contrast to other more successful universal health-care countries such as Switzerland, the Netherlands, Germany and Australia. Unfortunately, many of the policies employed by these countries—patient copays, for example—would invite penalties from Ottawa thanks to the draconian Canada Health Act.

However, Nova Scotia can still improve health care without breaking the bank, based on the experiences of other provinces.

For example, the incoming premier could learn from the success of the Saskatchewan Surgical Initiative (SSI), which partnered with private clinics to provide publicly-funded surgeries and created a centralized pool for physician referrals. The result? A dramatic increase in capacity and more efficient referral system that helped cut that province’s average wait time from 26.5 weeks in 2010 to 14.2 weeks in 2014. (Incidentally, services provided by the private clinics were lower cost per procedure compared to public hospitals.)

The election result again confirms that better health care remains a top priority for Nova Scotians. Simply spending more money on this problem, however, has been tried. Rather than exacerbate Nova Scotia’s fiscal problems with more government spending, premier-designate Houston should heed these lessons (and his own advice) and seek genuine improvement in health care by doing things differently.