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Transparency Fail

Billions are spent on health care bureaucracy that harms patients and front-line workers, while people wait weeks, months, or years to see doctors. The government's primary concern is putting a positive spin on our broken system to ensure that it does not lose power. It uses our money to do it. And the last thing it wants to do is tell us how it's really being spent.

BC spends over $25 billion per year on health care. That's on average $5000 for every person, paid in taxes. But health care is failing. We entrust the government to use that money wisely. But because the details of that spending are carefully hidden, we're not permitted to question if our money is being used effectively. Without financial transparency, the government can't be held to account and our health care won't improve.

Adrian Dix is infamous for his use of cherry-picked data, isolated and frequently misleading figures intended to put a positive spin on the dismal performance of our healthcare system while obscuring the truth. It's easier to get away with when those are the only numbers the public ever hears.

The Growth of Head-Office Bureaucracy

The NDP has taken control away from experts and front-line workers, silenced them, and thrown money at lavish mega-projects that deliver dismal results. [Full Story: Under the Microscope]

This is supported by an ever-increasing growth of bureaucracy, within the Ministry of Health and our multiple and redundant health authorities, with all the vice-presidents, directors, sycophants, spin doctors, toadies, and expense accounts to match. All appointed by and obeying the whims of the government, answerable only to them.

Since Adrian Dix became Minister of Health, total annual health budget has grown by $8 billion per year. Head-office admin in MOH/health authorities (bureaucrats) counts for $1 billion each and every year. Up 59%. Well-outpacing, e.g., MSP payments which support doctors (up 37%).

Our health system is far worse now.
Is that $1 billion increase on bureaucrats delivering a good return on investment?
Is it a good use of tax dollars?
Does it show good management?

Based on what we see every day, the extra bureaucracy has not helped the health system. And those numbers represent only part of the story. Actual program spending (e.g. within hospitals) also has a hefty administrative component that's not included there.

BC Health Care Matters has called for the BC auditor general to do a performance audit of these head-office expenses to closely examine the value we're getting.

What else could that $1 billion per year increase be used for?

Here's a back of the envelope calculation...

Assume two million people in BC are without adequate primary care.

We could eliminate that entirely with 2000 new family doctors, each with a panel of 1000 patients.

At $400k per doctor per year, that would cost $800 million.

That would still leave $200 million per year left over.

And no, we could't pull 2000 docs out of our ass tomorrow. But with the right incentive structure, infrastructure, work environment, autonomy, respect, support (PA's, NP's, etc), we could get enough doing longitudinal primary care and extend their reach to fill that two million person care gap.

Choices Matter

$1B for bureaucrats?
Or primary care for everyone, with $200M left over?

I must have missed the Dix presser where he proudly announces how this NDP government has "taken action" to improve health care for all British Columbians by committing $1 billion per year more to hire bureaucrats far away from front-line care.

An independent audit of that $1B is needed to determine its value. And if other choices should be made.

It's our money, and Adrian Dix and Dave Eby don't have the right to squander it.

What Do We Know?
Only What the Government Wants Us to Know

What's really astounding is that for that $2.7 billion spent on head-office administration, the handful of lines shown above are pretty much all the public knows about how it was spent.

You can find the odd project here and there, or the salary of various health authority executives. But if you're looking for a comprehensive breakdown of the admin spending, you're not going to find it.

Compare that With MSP Payments

MSP payments, which are used to pay doctors and some others to provide health services, are just over 2x ($5.7B) what we spend on head-office admin.

But those payments to doctors (and other organizations) are detailed in a 66 page tiny print report, known as the Blue Book.

You have to wonder why its ok for the government to explain away $2.7B in admin spending in a handful of lines across multiple financial reports. But they need to detail all the billings (before expenses!) for every single doctor.

$2.7 billion in head-office admin? A few lines is good. But $3.6 billion in individual physician billings needs to be detailed to the penny! It's almost like they want to leave the impression that physicians are fat cats who are bleeding our system dry.

Double standard much?

Speaking of which, here is how those $5.7 billion in MSP payments break down:

The $3.6 billion to physicians is detailed in 54 pages of fine print.

The $689 million paid from MSP to health authorities? Represented by a total of 8 lines.

I assume this is "shadow billings" representing physicians who are paid on an alternative relationship plan rather than fee-for-service, but really, I have no way to know for sure...

The Data is There, But Not For Us to See

We know there's all kinds of data that's collected, but unless it makes the government look good, it's not released.

After a one year process, several people were able to obtain operational data on the Westshore UPCC (some details here).

This consisted of hundreds of pages of spreadsheets detailing very precisely every single expense, staffing levels, and operational efficiency. Which was of course horrible. That kind of information doesn't get pulled out at Dix's media events.

Enough is Enough

There will always be some money wasted. But when the life and health of 5 million people are being compromised, and billions of dollars in spending may be available to fix it, there's no excuse.

This government has failed on so many fronts in healthcare.

But they're accountable to nobody for their failures.

The government is the only one who benefits from hiding its failures and gross mismanagement.

This is not their province. It's ours. This must stop now.