鈥淎lways read the fine print鈥� is a good rule for dealing with contracts. But it also applies when dealing with governments. Five years ago, George Abbott, then provincial health minister, changed the legislation that governs our medical services plan. In its original form, the Medicare Protection Act enshrined the basic principles of sa国际传媒鈥檚 health-care system: universality, comprehensiveness, accessibility, portability and public administration.
Abbott鈥檚 amendment seemed innocuous enough at the time. Indeed it comprised just a single word. To the five existing principles he added a sixth 鈥� 鈥渟ustainability.鈥�
However, the purpose of that change became apparent two weeks ago, when the current health minister, Terry Lake, announced an audit of the Fraser Health Authority.
Fraser has the largest and fastest-growing population of sa国际传媒鈥檚 five regional health authorities. It also has higher-than-average rates of heart-attack deaths, asthma, diabetes and hypertension. Several of its hospitals are in difficult straits.
At Surrey Memorial, patients are stacked in the hallways, while overworked physicians have threatened to stop responding to 鈥渃ode blue鈥� calls 鈥� where a patient goes into cardiac arrest. The director of the hospital鈥檚 intensive-care unit, a 27-year veteran, has resigned in protest.
Last month, Delta Hospital discharged a 90-year-old woman at 2 a.m., bleeding and wrapped in a bed sheet. Patients at Royal Columbian have been treated in the hospital鈥檚 coffee shop, because there were no beds available.
But that鈥檚 not what prompted the audit. Lake stepped in because financial targets aren鈥檛 being met. For the last two years, the region has run a deficit. If changes aren鈥檛 made, Fraser will come up short again in the current year.
If this were an isolated case, the minister might have a point. But it鈥檚 not.
Vancouver Coastal 鈥� the next most populous region 鈥� has also warned staff that a deficit is imminent unless cuts are made. Community services such as a mood-disorders clinic and an art-therapy program are being shut down.
Closer to home, the Vancouver Island Health Authority (now renamed Island Health) is in the midst of a controversial plan to replace nurses with care aides in some hospital duties. Care aides have less training, but their salary and benefit scales are much lower. Patients will pay more for discretionary services, and hiring in non-critical areas is being slow-walked.
Management accepts the need for economies and says that although money is tight, the budget will be balanced. But the question must be asked, at what cost?
Over the next two years, Island Health will receive annual funding lifts of only two per cent. Increases in that range do not keep up with the combined effect of inflation, population growth and aging.
This is where Abbott鈥檚 amendment comes in. Comprehensiveness and accessibility define standards of care. They establish guidelines for the treatment of patients.
Failures certainly did occur under the old regime, but ministers usually pledged to do better. The shortcomings were faced and admitted.
Sustainability means something different. It puts money management on the same page as patient safety.
Indeed, it appears to place money management at the top of the page. Fraser Health isn鈥檛 being raked over the coals for inadequate care. As Lake put it: 鈥淭he concern for us is Fraser Health has not been able to manage the budget targets and we want to understand why.鈥�
The provincial government has a duty to get its deficit problem under control. We all pay in the long run for mountains of public debt.
But there is something disquieting in the strong-arm tactics being used on health authorities. It鈥檚 a lot easier to get tough with them now, when they have no legal basis for answering back.
That, it appears, was the purpose of amending the Medicare Protection Act.
