January 24, 2002

Questions for Health Planning and Health Services
(click for government's Health Planning pdf file and Health Services pdf file containing the ministry quotes cited below)

Documents available on the government website as part of the Black Thursday announcements raise more questions than they answer. Here are a few excerpts from the Ministries of Health that require explanation.

One of the most revealing remarks was buried on page 4 of the Ministry of Health Service's Black Thursday release.

Ministry: "Changes will involve significant staff reductions across all regions as a result of the changes in how services will be provided to create a sustainable health system."

Question: Please provide estimates of the significant staff reductions in the regions that will occur as the result of the budget freeze and distinguish how those differ from reductions due to changes in how services will be provided.

The Health Planning document outlined a few initiatives.

Ministry: One of the initiatives is "a 10-year human resource strategy to enable B.C. to increase the numbers of health professionals to meet future needs."

Question: How will the human resource strategy be impacted by layoffs of nurses and other health professionals by the newly appointed health authorities?

Ministry: One of the initiatives is "implementation of performance management and accountability strategies that will create equitable access to services and improved patient outcomes."

Question: Is "equitable access" the same as the promise to get service when and where you need it, or does "equitable access" mean an equal opportunity to die while waiting?

Ministry: Initiatives include "strategies to improve access to specialized health services regardless of where patients live."

Question: Does that include Delta?

The Ministry of Health Services expanded on government's list of initiatives.

Ministry: Key actions include "introducing innovative new ways of delivering home, palliative and mental health care."

Question: How does that balance with regional health authorities talking about cutting homemaker services?

Ministry: "The cost pressures to be faced by health authorities over the next three years are significant." (Ministry of Health Services, p.3)

Question: Does that mean the New Era promise to "fund health regions at a level necessary to meet the needs of the people who live there, regardless of where a service is provided" is being broken?

Ministry: "The focus will be on essential services, and availability of appropriate care to meet health needs."

Question: Please define essential? Does that include hip and knee operations? Does that include the provision of an emergency room in the Delta hospital?

Ministry: Changes in programs include "re-alignment of laboratory resources to maximize efficiency and effectiveness and to reduce excess capacity in this area of health care."

Question: Does this mean increased privatization as work in hospital labs is shifted to private labs?

Ministry: "Consideration of changes to fees for the non-health care costs of home and community care services, based on the client's ability to pay for these services, to ensure the health budget can be dedicated to health care."

Question: Does this mean that housing the frail elderly is not a health service?

Ministry: "Addictions Services will be transferred to the health authorities."

Question: What is the difference between transfer and offload? Will addiction services continue?

Ministry: "Changes to where and how services are provided will be made by each health authority consistent with their performance contracts with the Ministry of Health Services."

Question: Who establishes and appoints the health authorities? What can a disgruntled citizen do to hold a health authority accountable or change who sits on its board?

Ministry: Changes in services include "some reduction of paramedic positions through attrition."

Question: Which municipalities have been targeted by the Ministry as deserving reductions in paramedic positions?

Ministry: Changes in services include "reduce demand for services by redirecting low priority calls to other resources (BC Health Guide Nurse Line, Poison Control, Social Services)."

Questions: Please provide the Ministry's estimates on the expected volume of calls to be redirected and the adequacy of funding to the alternative services.

Ministry: "Elimination of transfer fleet for non-emergency patient transfer."

Question: Is this part of the privatization of the ambulance service?

Ministry: "Funding for many supplementary benefits - physiotherapy, chiropractic, massage therapy, naturopathy, non-surgical podiatry - will be discontinued, except for people on income assistance."

Question: What are the estimates for any resulting increase in the utilization of services that remain covered?

Ministry: "Coverage for routine eye exams has been eliminated for adults (19-64 years), beginning November 2001."

Question: Has the Ministry estimated the number of cases of diabetes or degenerative eye disease that will be missed as the result of this change?

Ministry: MSP in-person client offices will close in both Victoria and Burnaby.

Question: When will MSP answer the phone?

Ministry: "Pharmacare coverage has been changed resulting in seniors now paying a greater share of their drug costs. Maximum annual costs to seniors will be $275, with seniors on premium assistance required to pay a maximum of $200 annually."

Question: What are the Ministry's estimates of the health effects resulting from this change?

Ministry: "Deductibles for B.C. families have increased by $200 dollars."

Question: How much further will the deductible increase next year?

Ministry: "Income testing will replace these initiatives effective January 1, 2003."

Question: How many people will be cut off from Pharmacare? What will the health effects be? What is the estimate of the increase in the non-compliance rate for filling prescriptions?

Ministry: "Home oxygen program will be devolved to the Health Authorities."

Question: What budget will accompany the change?

Ministry: "Debt servicing and operating costs for new capital projects will be the responsibility of the health authorities, who will prioritize projects with the other local needs."

Question: Hasn't government committed to consolidating the accounts for the health authorities with the government's consolidated financial statements?

Ministry: "Some previously announced projects may be delayed or canceled, following review by health authorities and the ministry over the next six months."

Question: Please provide the list of the projects the ministry will be reviewing.

Ministry: "BC Hearing Aid Program and technical support unit to be discontinued."

Question: Does this mean total reliance on private hearing aid dealers?

Ministry: "Clinical advice services for individuals with developmental disabilities to become the responsibility of health authorities."

Question: What resources are transferred with the shift in responsibility? What is the estimated impact on people who are developmentally disabled? Is this related to attempts in the Ministry of Children and Family Development to reduce its developmentally disabled caseload?

Ministry: "Ministerial advisory committees will be eliminated, including HIV/AIDs, Seniors, Women's Health and Injury Prevention with responsibilities for these areas to be transferred to regions which will be directly responsible for delivering services in these areas. Expertise in these areas will be consolidated in the Ministry of Health Planning."

Question: If expertise will be consolidated in the Ministry of Health Planning, why aren't the advisory committees continued so as to work with the experts in that Ministry?

Health Services and Health Planning: Ministry Resources

	Fiscal Year
	2001/02 (restated Estimates)	2002/03	2003/04	2004/05	Percent Change 2001/02 to 2004/05
Operating Expenses (million $)	9,542	9,537	9,537	9,537	-0.1%
FTEs	3,561	2,921	2,768	2,707	-24.0%