March 17, 2002

Impossible to Measure, Impossible to Prove
Mental Health Funding

It is hard to say whether multi-year announcements show good planning or whether they are a way of exaggerating the dollar amount involved in a program. A cynic might suggest they are attempts to get a news story today before anyone can determine whether the goods were delivered.

It will be 2009 before the full consequences of doubling the number of medical graduates are felt. The future cost increases for MSP resulting from that bold move will not be measured until a decade from now.

On the same day government announced plans for increasing the number of medical graduates, it also claimed to be showing a commitment to mental health. The news release spoke of dedicating $263 million to mental health over the next six years even though BC will have a general election just three years from now. In other words, don't count on measuring whether this promise was delivered when you next go to vote.

The $263 million claimed for mental health consists of $125 million in operating funds and $138 million in capital funds. Of course, there is an enormous difference. Capital is spent just once while operating costs can go on forever. It is meaningless to compare the sum of several years of operating expenses with the lump sum that will be spent on capital. In economic terms one is a stock and the other is a flow, one has a time dimension of dollars per year and the other is a lump sum of dollars. Proper analysis discounts flows to net present value in order to remove the time dimension, but this is about a news release and not about proper analysis.

In an attempt to determine what can be seen today to test the credibility of government's commitments, careful readers will note the only specifics in the government's news release are for $18 million for community mental health and psychiatric services in 2002-03 (operating costs) and for $20 million in capital costs to build three new facilities in Kamloops. No information is contained in the news release on when the facilities in Kamloops are expected to be in operation, what the operating budget will be for the 84 beds and associated programs, whether those operating funds will come out of the existing allocation for the Interior Health Authority or whether new operating money will be provided to fund the expanded facilities. These are important questions which get to the heart of the government's credibility.

Until this year with the new open and transparent government, the budget estimates provided a separate line item for mental health. For fiscal 2001-02, vote 33 showed $405 million for adult mental health. The budget note with respect to that $405 million said "Adult Mental Health provides for the management and delivery of mental health services to adults, on both an outpatient basis and in tertiary psychiatric care, as well as adult forensic psychiatric services. Government transfers are provided, and services delivered to, or on behalf of, individuals, corporations, community groups, and other organizations including health authorities, the British Columbia Mental Health Society, and the Forensic Psychiatric Services Commission."

This year things changed. The budget for the Ministry of Health Services is vote 31. In fiscal year 2002-03, it shows one single line item of over $6.3 billion dollars (a quarter of the entire government budget) simply listed as regional health sector funding. The only reference to mental health is when it is included in a long list of services that will be paid for out of that enormous sum.

During both estimates debate and question period, Opposition Leader Joy MacPhail and Jenny Kwan did everything humanly possible to get both the Premier and the Ministers to identify how much would be spent on mental health. The closest anyone got to an answer was when Colin Hansen said that mental health would be mentioned in the service agreements with the regional health authorities. In other words, no one will ever be able to actually determine whether the $18 million increase promised for this year was actually delivered yet alone whether the government actually dedicated $263 million in new money to mental health over the next six years.

---

Addendum: A reader has pointed out that the government's news release headlined "B.C. Doubles Number of Medical School Students" is misleading. Until the late 70s BC graduated 80 students. Under the urging of Pat McGeer (champion of Open Learning Agency that is now being threatened by the Campbell government), UBC medical school expanded to 120. This year it added another 8 to take it to 128. Twice 128 is 256 as originally mentioned in my article; however, in the world of government news releases it is only 224 as 24 are added at UNBC; 24 at UVIC; 24 more at UBC in Sept.2004 followed by another 24 more in Sept.2005 at UBC. That makes a total increase of 96 rather than the doubling indicated by the news release.

If the 96 remain in BC and traditional inflows from out of province continue, then when all enter practice in 2009, MSP billings will increase by $31 million per year. Over five years that will total an increase of $465 million rather than the $615 million it would have been in the case of a "true daily double" - doubling of graduates.

It is yet to be determined whether government is arithmetically challenged or whether it is simply has trouble with news releases.

------------------------------------------

March 16, 2002

What wasn't said - medical graduates
$615 million cost increase over 5 years not discussed!

On Friday, March 15, the Campbell government staged another cabinet meeting for the purpose of making three announcements. Rather than paying for a low cost news release, staged cabinet meetings involve three hours in front of TV cameras which beam the signal up to purchased satellite time for distribution to cable networks throughout the province. Transcripts of documents are subsequently made available on the Premier's website.

The recent meeting announced a bold initiative to double the number of medical graduates (from 128 to 256) in a unique venture that involves completing a UBC medical degree by doing work at the University of Victoria or at the University of Northern BC. That is clearly exciting for those universities as it will be for students who want to earn an MD in BC. The Minister of Finance went into great detail explaining the cost controls on the $134 million in capital construction for the three university campuses. The buildings are scheduled for completion 9 months before the next election.

No one, not even the Minister of Finance and not even the Minister of Health, asked what the impact of the expansion would be on billings to the Medical Services Commission in future years! When breaking the arbitration award for BC's doctors, Health Minister Gordon Hansen remarked that "B.C.'s per capita expenditures on doctors will increase to $602 in 2001-02, 21 per cent higher than what second-place Ontario spends, and 34 per cent higher than Alberta." Part of the reason for that is BC has 195 physicians per 100,000 population compared to 166 in Alberta and 180 in Ontario (data from year 2000, source Canadian Institute for Health Information) Using the same kind of long division used by Hansen when he said that BC doctors will get $50,000 each from government's imposed deal, each new physician costs an average of $323,000. If the extra 128 physicians are in addition to those already moving into the province, the cost of doubling the medical school will add $41 million per year to MSP billings. Over 5 years that amounts to $615 million in increased costs - and it goes up in the next 5 years! We can only wonder why there was no discussion of that little challenge during the staged cabinet meeting.