Health care models, funding in for an overhaul in Manitoba budget

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Almost 40 per cent of the province's budget goes to health spending, and in less than a week Manitobans are going to learn if that will change under the Progressive Conservatives.

Between the budget dropping on Tuesday and a much-hyped announcement by the Winnipeg Regional Health Authority on Friday, Premier Brian Pallister's vision for health care in Manitoba is about to become clearer.

The premier has made it no secret that he feels under the former NDP government, "throwing money" at health care didn't work. Pallister and Health Minister KelvinGoertzen have repeatedly warnedtough decisions are being made in this year's budget.

• Manitoba government dealing with 'lots of asks' for money, says premier

"[The NDP] live with the regret of 17 years of breaking the health-care system, pouring billions of dollars, of taxpayers' dollars, into a system that never improved, never got better, that was always last," Goertzen said Wednesday during question period.

"We recognize that these are difficult decisions that have to be made and there will be difficult decisions made. But they will be made on the advice of experts, experts who are telling us how the system could be made better."

In the 2016 budget, $6.4 billion of a nearly $16 billion-budget was earmarked for health spending. It's a figure that rose year-over-year under the NDP, and Pallister insiststhis time around he is going to do it differently.

• Pallister promises health announcement will cause 'a lot of debate,' but won't give details

The specific details about the Progressive Conservatives' decisions remain shrouded in secrecy for now, but the government and critics havehinted at what could be coming down the pipe.

Emergency department closures

One of the experts Goertzen said his government is going to listen to is Dr. David Peachey, a Nova Scotia-based principal with Health Intelligence Inc.

An NDP-commissioned report by Peachey, released by the governmentlast month, called for three emergency departments within Winnipeg's four community hospitals to be closed and convertedinto urgent care centres, similar to the Misericordia Health Centre.

• Review of health care in Manitoba recommends massive changes

The four community hospitals in Winnipeg are Concordia Hospital, Grace Hospital, Seven Oaks General Hospital and Victoria General Hospital.

In rural Manitoba, the report recommends assessments on whether individual hospitals should continue to operate, how each facility uses its beds, and whether they should have emergency services.

According to data from Manitoba Health provided to CBC News, 28 emergency departments had to close for 24 hours or longer in the past year due, for the most part, to doctor shortages.

When asked about the measures in the Peachey report, Pallister left the door open.

"What good is it to have an ER four minutes away if you have to wait four hours when you get there? I want people to get into an ER, I am not going to run away from that," he said.

• Pallister government won't rule out ER closures in Manitoba

Changes to public home care

Manitoba Government and General Employees' Union president Michelle Gawronsky publicly voiced concern over the future of Manitoba's public home-care system after it changed its name from Manitoba Home Care Program to Home Care Services in January.

That move drew criticism that it was a precursor fora move towardpartial or full privatization of home care.

Ten days after a memo went out announcing the name change, the government released a December report on Manitoba's home care system.

The report outlined the growing costs associated with the public system, which costs the government over $300 million annually. With significant growthin the province's seniors populationexpected, the report by consultant Reg Toews said that figure could increase to $874 million by 2037.

• Manitoba faces financial crunch as home care demands expected to soar

The Filmon Tories famously tried to move toward private, for-profit home care in 1997 and saw significant pushback. That attempt was ultimately dropped after a brief pilot project was launched.

Gawronsky described it has a failed experiment and said a for-profit model doesn't make care better for patients.

"If we are talking about about a public home-care system that's going to provide a service for everyone, that doesn't include making someone rich," she said.

Consolidation of regional health authorities

There are currently five regional health authorities in Manitoba: Winnipeg, Interlake-Eastern, Northern, Prairie Mountain Healthand Southern Health.

Pallister has been known to borrow policies and ideas from our neighbours to the west in Saskatchewan.

Earlier this year, Saskatchewan announced it will reduce its 12 existing health regions to a single administrative entity by the fall. The government estimates the move will save $10 million to $20 million by 2018-19.

• Saskatchewan moving to a single health authority
• What lessons could Saskatchewan's budget hold for Manitoba?

Every regional health authority has been given savings targets and told by the government it cannot run a deficit in 2017-18. The WRHA, the province's largest authority, was ordered to find $83 million in savings.

Federal health transfers down

The government led the provincial charge against a decrease by the federal government to federal health transfers. Although they were not slashed like under the Chrtien Liberals in the '90s, for the first time since 2004, health transfers only increased by three per cent as opposed to six.

Pallister hasbeen silent on what this will mean for health-care spending in Manitoba and has so farrefused to sign on to the national health accord.

• Manitoba prepared to stand alone in health-care fight with Ottawa: Pallister

"The reality is the health-care costs are going to rise, every single study has said so, and we need to have a national dialogue around how we deal with health-care support and funding," Pallister said in February.

'Need to find major efficiencies': U of M prof

Dr. Alex Singer, a primary care physician and assistant professor at the University of Manitoba, argues if the province wants to change the system, improve wait times and save money in the long run,it must focus on innovation, not cuts.

"I think we really need to go down this road of innovation to innovate our way into a more efficient health-care system, rather then go back to where we were in the bad old days of cut, cut cut, until everyone gets frustrated and services get affected," Singer said.

Singer pointed to a recent studyby the Manitoba Centre for Health Policy which found that wait times in emergency rooms weren't necessarily caused by too many patients in the waiting room, but long waits for test results.

• Emergency room delays due to medical tests, not bed shortages, report says

He said an upfront investment inbetter digital record-keeping, decreasing the number of unnecessary tests and creating better digital warnings for doctors conductingtests would pay off in spades.

For example, he said Diagnostic Services Manitobasaved hundreds of thousands of dollars by decreasing the number of vitamin D tests it administered by adding a simple prompt that showed doctors the reasons whya patient needed, or didn't need, thetest.

"More isnot always better,"Singer said.

"In order to find major savings, you need to find major efficiencies."

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