Health care reform in British Columbia

Health care reform in British Columbia

524 The Journal of Emergency Medicine (detox centres, drop-in centres, women’s shelters, free clinics) have relied on downtown emergency departments...

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524

The Journal of Emergency Medicine

(detox centres, drop-in centres, women’s shelters, free clinics) have relied on downtown emergency departments for medical support. New relationships will need to be formed so that this safety net continues.

total quality improvement are tremendous. There is always the specter of an alternative payment system for emergency physicians, but if planned for and negotiated properly, this may not be a negative thing.

THE FUTURE

IN SUMMARY

I feel that an attitude of “guarded optimism” is appropriate regarding our specialty in Calgary. Assuming, 1) there is support from the Regional Health Authority, other medical specialties, and the University for a strong emergency department; 2) the right person is hired as medical director; 3) all emergency physicians can overcome their differences and work together toward a common goal; and 4) the manpower drain stops, the future could be promising. In a system that coordinates the care of 252,000 emergency patients per year, the opportunities for teaching and research, the institution of practice standards and guidelines, and

HEALTH

CARE

REFORM

Due to random and inadequately planned cuts to health care spending and the creation of regional health authorities, there will be tremendous shifts and changes in the health care system for several years. This will affect emergency physicians in Calgary and their ability to deliver care to their patients. With the right planning and cooperation, these changes can result in a stronger and more efficient Regional Emergency Department, which has tremendous potential. I, for one, will watch with great interest from Saudi Arabia in my position as attending emergency physician at the Aramco Hospital in Dhahran.

IN BRITISH

COLUMBIA

Roy A. Purssell, MD, FRCPC Head, Department of Emergency Medicine, Vancouver Hospital & Health Sciences Centre, Vancouver, British Columbia Head, Division of Emergency Medicine, Depaltment of Surgery, University of British Columbia

Today’s headline in one of Vancouver’s daily newspapers reads, “Braced for Pain, Health Care Crunch as Feds Slash Funding.” The federal budget was announced 1 week ago. This budget contained news of significant spending cuts, including large reductions of federal transfer payments to provinces. These transfer payments are used to fund Health, Education, and Social Services. So, what does all of this mean? At the present time in Canada, we have an excellent health care system, equal to any in the world and viewed very positively by the public. The costs of this system in terms of gross national product also compare favorably with other countries. However, this system is changing rapidly and dramatically. Funding to health care in British Columbia has decreased by 20% in the last 10 years. It is expected that there will be a further 20% cut in the next 3 years. Already, one large teaching hospital in Vancouver, Shaughnessy Hospital, has been closed. These cutbacks will probably result in the closure of at least one more of the six hospitals in the city of Vancouver itself and several other hospitals around the province. British Columbia has one of the lowest

ratios of hospital beds to population in the country. There are many initiatives to decrease health care funding. One initiative that was introduced 2 years ago has been called, “Closer to Home.” The thrust of this initiative has been to provide care to patients in their home or local hospital, rather than large referral centers. As in other provinces in Canada, regionalization is coming to British Columbia, and the composition of many Regional Boards has been announced in the last few months. As well, there has been a rash of hospital mergers. All the hospital and health care facilities in Vancouver will be merged into three “clusters.” The health care unions are all very worried about job security, and there may be a health care strike before this article is published. There will be a provincial election in the next 6 months, and the new government is likely to be more right wing and more supportive both of further cutbacks to balance the budget and of the introduction of ‘ ‘user pay ” initiatives into a system that has been, essentially, exclusively government funded. As you can see, next year is going to be a very difficult and challenging year in health care in British Columbia.