March 30, 2005

$6.5 billion for What?

Financial reporting for the provincial health authorities could win awards for nondisclosure. The Campbell government, which has taken to reissuing old news releases, boasted on March 29th that $6.5 billion is distributed to the five health authorities. The health authorities list their expenditures in four categories: 1) compensation, 2) supplies, maintenance and sundry, 3) contracted services and 4) capital asset amortization. There is no functional breakdown, no details on how much is budgeted or spent on mental health, public health, services to seniors and nothing on any other program. The format for financial reporting is consistent between the authorities, equally vague and illusive.

Notwithstanding the disappointing level of financial reporting, at least one of the health authorities is doing a good job on reporting performance measures. Unlike the financial statements, there is no consistency between the health authorities on performance reporting. There are performance agreements between the province and each health authority which specify various indicators in their appendices but the authorities have not taken a consistent approach on reporting to the public with respect to those measures. The appendices contain indicators expressed in terms of percentage increase or decrease relative to previous years without specifying any baseline quantitative indicators. For example, how can anyone know if the measure of a "Decrease, by 4 percent over three years (2002/03 - 2004/05), in the percentage of alternate level of care days spent by mental health and alcohol and drug clients (aged 15-64) in hospitals once the primary need for inpatient care has completed" has been met without a report indicating what the number of care days was in 2002/03, and is that a measure of cost control or of quality of service?

The Vancouver Island Health Authority's goal for "quality, client-centered care and service" is measured by five wait times for CT, MRI, total hip replacement, cataract surgerys, and residential care placement. It is sad that the most transparent Health Authority reveals dismal outcomes, maybe that's why the other authorities report little or nothing. A traffic light is next to each measure for the Island Authority: green for "satisfactory", yellow for "outside acceptable range, monitor trend", and red for "requires action". All of the measures are yellow except for residential care placement which is red.

The Fraser Valley's performance measures are buried in its strategic plan in a user unfriendly format . Anything resembling public reporting on goals is difficult to find for the Vancouver Coastal Health Authority. A few vague snippets are available in reports to board meetings but their website lacks anything resembling the job done by the Vancouver Island Health Authority. The Interior and Northern Health Authorities appear to have abandoned any attempt to report to the pubic on performance measures.

Public opinion polls indicate that health care is one of the top of mind issues for voters. The Campbell government isn't going to help voters by revealing how it plans to spend $6.5 billion, how it spent health money last year, or how it plans to measure outcomes. Voters are left to determine whether, in their personal experience, the heath system is better or not. Why would a government hide its performance unless there was something to hide?