A fine is a financial penalty imposed to punish and correct improper behaviour. It shouldn鈥檛 be a whip to force better health-care outcomes. WorkSafe sa国际传媒 has fined the Forensic Psychiatric Hospital in Coquitlam $75,000 for failing to take sufficient precautions to keep the workplace safe. The fine stems from three incidents, including one in 2012 in which an occupational therapist was stabbed by a patient.
Although it seems a little like robbing Peter to pay Peter, one public agency fining another public agency is not particularly controversial. WorkSafe is doing its job, trying to ensure that employers follow proper procedures in keeping the workplace safe.
It鈥檚 a different matter with the beleaguered Fraser Health Authority, sa国际传媒鈥檚 largest and fastest-growing, which faces $2.5 million in fines for not meeting the provincial Health Ministry鈥檚 rules for surgery wait times. It鈥檚 a dangerous thing to use money as an incentive or disincentive in health care. It could lead to health-authority managers trying to force doctors and nurses to do things differently, and not necessarily with the patients鈥� welfare foremost in mind.
Health care is the largest single item in the sa国际传媒 budget 鈥� about 40 per cent of the total 鈥� and it鈥檚 necessary to keep a tight rein on expenditures. Costs could too easily spiral out of control. But cutting costs at all cost is not the answer.
About six 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 added a single word 鈥� sustainability. That seems innocuous enough, but does it mean 鈥渁ffordable,鈥� or does it mean 鈥渁s cheap as possible鈥�?
For the past several years, the Health Ministry has penalized health authorities for not living up to expectations for treatment outcomes or process times.
The ministry is entitled to withhold funding for health authorities that are not performing satisfactorily, but the idea of applying marketplace approaches to get certain health-care results is disturbing.
Attempts to cut spending have consumed more than two decades. The easy cuts have long since been made. The next steps are more difficult, and they are more dangerous.
In Britain, the answer was to offer hospitals money for meeting government targets. These included moving patients through the system more quickly, cutting the cost of surgical procedures and reducing wait times in emergency wards.
While some improvements were made, dreadful things began to happen.
In one case, a young patient at St. George鈥檚 Hospital in London was so desperate for water, he called the police for help. In the most notorious case, patients at Stafford Hospital were left starved and thirsty in soiled bed linen. Several died of what could only be called neglect.
Managers were so intent on meeting government targets, they established a culture of fear. Nurses were told to falsify waiting times, and medical staff were threatened with dismissal if they failed to follow orders.
Cases this extreme are not occurring in sa国际传媒 In fact, the capital region鈥檚 three hospitals are performing well, according to a Canadian Institute for Health Information study, but we should be careful that balance sheets don鈥檛 replace patients鈥� charts.
Health managers鈥� feet should be held to the fire when the quality of health care is unacceptable, but to use money to threaten and to alter behaviour invites caregivers to become focused on the money, rather than on the quality of care. It鈥檚 a blunt instrument when precision is needed.
Not all cost-cutting measures are good health-care measures.
