Manitoba Health Minister Theresa Oswald at a recent announcement in Winnipeg. Letter writer Dr. Derry Decter wonders what plans she has for changes to health care.
The single biggest change to Manitoba health care in 15 years, so the minister of health described the upcoming changes she proposes to Medicare.
This left a lot of folks scratching their heads. Why not announce it in the budget? And if it was so major, where are the line-item funding elements of it in that budget?
In the budget the only significant change — the amalgamation of more health regions to slim the number to five — seemed to rule out the elimination of regional health authorities entirely, a move some have called for over the last few years.
What is left are two things that are possible and perhaps both are being considered.
The proposed expansion of the University of Manitoba medical school into rural and northern Manitoba in co-operation with Brandon University would certainly count and with the enlargement of health regions here it would make some sense operationally as well.
Especially so given the changes just made to the health regions.
Secondly, the idea that hospitals would be paid not as a lump-sum global budget grant on a yearly basis but rather would be paid for the work they actually do.
This idea is not new, having been introduced decades ago in England as part of the Conservative campaign to make the national health scheme "more efficient."
The jury is still out on the impact of that.
Here the impact on smaller rural facilities and those in the north could be dramatic.
If the funding follows the patient moved out of these remote locations to have procedures and care in Winnipeg, then many more rural hospitals may be doomed — starved of funds rendered uneconomic by a stroke of the funding pen.
Other provinces are looking or have implemented some of this with varying successes.
What rural and northern Manitobans should be concerned about is that this is yet another round of service cuts and facility closure wrapped up in the idea of efficiency which of course no one can argue against being that we all endorse the idea of efficiency.
The bold move of course is to reorganize Manitoba’s health-care system around the plan to deliver education to family doctors in rural locations.
In B.C., just such a diffused education program was started now with remotely located campuses in the north, in Victoria and the Interior.
The University of British Columbia med school has just been rated as the 25th best in the world largely as a result of its enlightened take on medical education.
Will we be bold and set our health-care system back on the fair and equitable road to recovery or will this be yet another exercise in the de-skilling of the rural health workforce and the devolution of the rural health infrastructure to the benefit of big Winnipeg institutions?
Every improvement to the Manitoba health-care system has come at a great price to the rural communities; to their hospitals and to their physician and nursing resources.
This is why folks who live in the country have poorer health outcomes.
Will this be yet again another attack on them?
We will find out soon.
DR. DERRY DECTER
Republished from the Brandon Sun print edition May 1, 2012