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Back when it was first proposed, you may recall that one good reason was given to merge Nova Scotia’s nine district health authorities into the Nova Scotia Health Authority. It would save money on administration, and those savings would be put back into medical services.
It sounded good and, at the time, made for good politics for Stephen McNeil’s Liberals, but the promised savings haven’t materialized. In fact, the opposite is true.
Admin costs have increased and, when asked, bureaucrats at the Health Department revise history to claim the merger was done “to be more strategic” in delivering services. The promise of less money for administration is forgotten, at least by the administrators.
Since 2015, the NSHA’s first year of operation, the money Nova Scotians shell out for the health bureaucracies has increased in both real dollar terms and as a percentage of the overall health budget, according to data from the Canadian Institute of Health Information (CIHI).
The touted savings — the Liberal government claimed that the merger would save about $12 million a year — have turned into big increases, in the range of $34 million to $40 million more annually, depending on how you want to calculate it.
In fiscal 2015-16, CIHI says administration consumed four per cent of Nova Scotia’s $4.1 billion health budget, or about $164 million. The next year, the number jumped to 4.7 per cent and in 2017-18 — the last year for which CIHI has data — administration costs hit 4.8 per cent of the $4.26 billion spent on health, or about $204 million. That’s a $40 million increase, in real dollar terms, over just three years. Which patient services got a 25 per cent hike over those three years, or are those kind of increases only available on the inside?
Had the province managed to hold the cost of administration to the four per cent claimed in 2015-16, the 2017-18 admin bill would be reduced by about $34 million (0.8 per cent of that year’s $4.26 billion health budget).
So for one year, the government could show that the merger reduced administration costs, but that year turned out to be a singular, unrepeatable exception.
There’s a lot of numbers there, sliced and diced a couple of ways, but however you do the math, it points to the same thing. The promised savings are nowhere to be found.
The common claim from within the government that Nova Scotia’s health system is administered as efficiently as any in Canada is bogus, too. In 2016-17 and 2017-18, when administration was eating 4.7 and 4.8 per cent of Nova Scotia’s health budget, the national average was 4.5 per cent. The difference only seems trivial. If admin costs in Nova Scotia were at the national average, taxpayers here would save $12.7 million in one year.
With CIHI reporting that Nova Scotia’s health bureaucracies are more gluttonous than ever, the question had to be asked: Has the reorganization of the system benefitted Nova Scotians in any way?
That query, put to Premier McNeil’s office and the Health Department earlier this week, drew the promise of a response from the department and sure enough a couple of days later one arrived.
One health authority was needed, it said, to break down barriers between districts and co-ordinate stuff better. They offered examples, like the central intake for mental health and addictions services, which they’re working on and have been for four years. Meanwhile, it was far easier to get a shaking drunk in detox, in any district where there was a bed, before the merger than it is today.
“With the NSHA, the system has improved accountability ...” claimed the author of the department’s missive, channelling Kris Kristofferson’s Pilgrim — partly truth and partly fiction. There was no accounting for the burgeoning costs of administration.
Among the CIHI data, one year stands out as an anomaly. In the NSHA’s first year, admin costs fell to four per cent of the health budget. The prior year, admin costs were 4.6 per cent of the budget, and the following year they were back up to 4.7 per cent.
So for one year, the government could show that the merger reduced administration costs, but that year turned out to be a singular, unrepeatable exception. Coincidentally, that year’s data would have been the most recent available in 2017, which just happened to be a provincial election year. But only a cynic would suggest creative bookkeeping provided evidence of the promised savings in time for an election.
The Health Department offers no insight into the sharp increases in what they and the other health bureaucracies are costing Nova Scotians. Rather, in the spirit of alternative facts, they ignored the abject failure of the merger to achieve its original, stated purpose, and invented new ones.
Accountability is easy, after all, when you get to choose what you’re accountable for.