Health reform debate must go beyond spending, analyst says

New Brunswick voters deserve an "honest, adult conversation" about the challenges facing the provinces health-care system during the election campaign, according to a political analyst.

Political debates over health care often revolve around what party is willing to spend more money or add new programs to the system.

When looking at the number of doctors, nurses, MRIs or acute-care beds in the province, New Brunswick often has a greater number per capita than the Canadian average.

But Tom Bateman, a political scientist at St. Thomas University, said New Brunswick voters and politicians need to realize that they will soon need to start working with less money in the system.

"It is time for an honest, adult conversation about the design and performance of the health-care system in this province and the country as a whole," Bateman said in an article written for CBC News.

"There is wide consensus on the principle that every person is entitled to care regardless of his or her economic status. Lets move beyond this and get into the details about system redesign for sustainability into a difficult and challenging future."

Bateman pointed to the provinces nearly $12-billion debt and string of deficit budgets as evidence of the worrisome fiscal climate.

He said the provinces aging population combined with a continued trend of outmigration will also put added strain on the health system.

Health Minister Ted Flemming told the legislature in May that his department came in $44 million under budget. This was celebrated by the Progressive Conservatives as proof of effective management.

But Bateman said this restraint is unlikely to continue in the future without broader changes.

"A lot of this restraint has been achieved through wage restraint and attrition," Bateman wrote.

"There is reason to think that this form of restraint cannot last forever. Similar declines in funding occurred in the 1990s as the federal government drastically reduced transfers to the provinces, some of them for health care."

The political scientist offered four health policy proposals to start the debate on health reform:

• New Brunswickers need to take more responsibility for their own health care. "Whatever the policy instrument, a significant culture change has to take place and voters should not expect politicians to solve all their health problems," Bateman said.
• Voters should not rate health care in terms of the amount spent, but focus on how efficient the system is and the value citizens are getting for what is spent.
• "Get out of the single-minded attention to hospitals and acute care." Bateman said people have diverse health needs and the focus of the health debate must go beyond hospitals.
• The government must match health spending to the shifting population.

There have already been a few health-related campaign promises in the first few days of the election campaign.

Liberal Leader Brian Gallant promised that every New Brunswicker would have a family doctor by 2018 if his party is elected. Gallant said the promise would cost $12.5 million.

NDP Leader Dominic Cardy has promised to increase medical residencies by 20 per cent in an effort to add more family doctors to the system. The party estimates the promise would cost $1.3 million a year.