Nova Scotia health-care system needs reform, not a blank cheque

“Pre-election Tim Houston” would often claim that that more money was not the solution to Nova Scotia’s health-care problems. And yet, for the second year in a row, “Post-election Tim Houston” is promising to ratchet up health-care spending to record highs. In reality, Nova Scotia is in desperate need of health-care reform—not just bigger cheques.

More bluntly, Nova Scotia’s health-care system is in shambles. Physicians are burnt out, hospitals face a shortage of nurses, and emergency rooms are so full that some patients have died while waiting for care. And last year, Nova Scotians faced the longest wait times for elective treatment on record—58.2 weeks between referral from a GP to receipt of treatment. This wait time was more than twice the average wait in Canada (27.4 weeks) and longer than every other Canadian province (except Prince Edward Island).

Of course, you can blame some of the challenges on the pandemic and associated surgical backlog. However, the province’s inability to provide timely care to patients long precedes COVID (in 2019, patients in Nova Scotia faced a median 33.3 week wait between referral from a general practitioner and treatment—the third-longest wait time in Canada and about three months longer than the Canadian average at the time).

So while the pandemic and associated government policies exacerbated the problem, long wait times are the result of a structural failure in the province’s approach to health.

But can, as Premier Houston suggests, the province solve the problem simply by increasing the health budget? The data suggest otherwise.

Consider the 20-year period before COVID when the provincial government increased health-care spending by 61 per cent (and that’s after adjusting for inflation and population growth). In 1999, the province’s Ministry of Health accounted for 40.3 per cent of all provincial government program spending compared to 43.1 per cent in 2019. Yet despite all this spending, the overall median wait between a specialist appointment and treatment across 12 specialties in Nova Scotia increased by 163 per cent during the same time period.

And while Nova Scotia ranked in the middle of the pack for provincial health-care spending per capita in 2019, estimates from 2022 suggest it’s now the second-highest spender (surpassed only by Newfoundland and Labrador). This comes with a great cost to provincial finances. Consider that over the past two budgets, the government has added $2 billion in yearly spending including $1.2 billion for health care. Subsequently, the government projects substantial budget deficits, which will contribute to an increase in provincial debt.

Now to a little bit of good news. There are commendable health-care initiatives in Premier Houston’s budget. For example, the government has committed to expanding virtual care, which can help take pressure off the system by introducing additional capacity and adding efficiency. However, programs like this should have been funded by reducing inefficient spending elsewhere—not further increasing overall spending.

Finally, we can learn about meaningful reforms from other countries. For example, Switzerland, Germany, the Netherlands and Australia all spend the same or less than Canada on health care, yet have much shorter wait lists for specialist consultations and elective surgeries.

How do they do it? For starters, they all embrace the private sector as either a partner or a pressure value. And they use co-pays so patients have better incentives to make informed decisions, and fund hospitals based on activity to incentivize treatment.

While Nova Scotia has taken some small steps in this direction by partnering with the private sector to deliver a limited number of surgeries, provinces are severely constrained by the federal Canada Health Act (CHA). Just recently, federal Health Minister Jean-Yves Duclos threatened to claw back funding from provinces that allow private clinics to operate. Nova Scotia’s health minister Michelle Thompson has noted that the CHA is in need of reform. However, it’s unclear what changes the province is seeking from Ottawa.

The recent Houston budget suggests the province’s plan for health care involves spending more money. If recent experience is any indication, this is not the way to improve care and shorten wait times. To truly improve health care, the Houston government must focus on reform.