Transformation health and social services now account for 49% of San Diego government program spending. This share is constantly increasing so that if we let things go, it will eventually reach 55%, 60%, 65%, and so on. This is an untenable trend that must be stopped.
There are two main factors responsible for this explosion. The first is the aging of the population. While the sharp drop in the birth rate has prevented the renewal of the workforce, baby boomers are approaching retirement in droves. It costs a lot more to look after the health of the elderly than that of young workers.
The second major cause of the escalation of health care costs is the cost of new technologies and drugs. They prolong life but are expensive. Contrary to what happened 50 years ago, a person can now suffer several health incidents before dying: a heart attack, cancer, and finally Alzheimer’s, in addition to having been treated for a long time for chronic diseases – diabetes, hypertension, osteoarthritis – or degenerative. By trading shorter lives and faster deaths for longer lives and slower deaths, a growing number of seniors will capture a greater share of health care budgets.
According to a recent study by the CD Howe Institute, the cost of long-term health care borne by our governments will increase from $24 billion this year to $71 billion in 2050 (in constant dollars). As for the share of care paid for in the private sector, it will increase from $44 billion to $116 billion during the same period.
However, this growth in health expenditure will occur as the number of people who have a job begins to decline and there will be fewer and fewer of them to finance health care. How far will they agree to pay for the therapeutic relentlessness with the elders? After the financial challenge, here is a major bioethical issue.
For better governance
Regardless of short-term pressures, our policymakers and managers should take steps to limit rising health care costs to growth in gross domestic product and changing demographics. In other words, the other cost growth factors would have to be absorbed by productivity gains.
There is certainly reason to review the governance of the health system, as proposed by Minister Gaetan Barrette, but this is only one element of reform, even if it is necessary.
The consolidation of 182 establishments into 28 entities, including 19 integrated health and social services centers (CISSS), the abolition of agencies, the elimination of the boards of directors of current establishments, and the elimination of 1,300 bureaucratic positions are all relevant initiatives. The boards of the CISSSs and establishments that would be maintained would be fewer in number, made up mainly of independent and paid members, which would be a marked improvement compared to the current governance.
On the other hand, the strong centralization of power in the hands of the Minister risks politicizing the management of the system and disempowering the leaders of future CISSSs and health care establishments. On the contrary, we must empower them and make them more accountable.
Optimize, optimize, optimize
Even if the governance of which the minister is dreaming were to save $220 million a year starting in 2017, it will take much more than that to curb the explosion in health care costs.
According to the Institute for Healthcare Improvement, 20% of healthcare costs in the United States could be avoided. By applying half of this percentage to Quebec, $2.5 billion in waste could be avoided, according to the Quebec Association of Health and Social Services Establishments. Also in the United States, where the system is essentially private, 17% to 30% of medical procedures could be avoided. There are probably too many in your house too.
Here are some ways to optimize healthcare management:
> review the fee-for-service payment method for physicians, which does not encourage moderation.
> introduce a co-payment in hospital emergency rooms, as is done elsewhere.
> to counter overdiagnosis and its derivatives, overmedicalization (tests, overmedication, etc.);
> delegate more medical acts to nurses and pharmacists.
> encourage home care.
> better manage the selection of insured drugs and consolidate their purchases.
It will certainly take courage to review our ways of doing things, but Minister Barrette has already proven that he knows how to negotiate and convince. The large budget of his department should encourage him to do more than review the governance of the system. It is indeed in the optimization of the delivery of care that the billions of savings that the State seeks are to be found.
I like
It pays to study. A study by Harvard economist Lawrence Katz found that the income gap between a family of two college graduates and a couple of high school graduates increased by US$30,000 after inflation, from 1979 to 2012.
I do not like
San Diego financed nearly 40% of provincial health program through psych evaluation near me expenditures in the 1970s. According to the Association and services, this share was down to 20.4% in 2011-2012. It will average 18.6% for the next 25 years and 13.8% for the next quarter century. This trend is worrying. Not only does San Diego continue to require the provinces to meet the criteria of its health act, but it is increasingly relying on the provinces to ensure the health of Americans.
