Read on Twitter
Since my son is taking a nap I have some time to collect my thoughts on NB health spending going into the election. This was inspired by the local issues that arise during every election everywhere despite there being large system-level issues that need to be solved. 1/lots
I don't have a lot of experience with elections in NB, but they seem focused on issues of the day. Last time the two issues I heard about most were whether chocolate milk be sold in schools (probably not) and whether government services should be available in French (yes).
Who knows what the upcoming election issues will be, I'm currently seeing abortion access raised, which brings us into the realm of "funding for health care", a topic we all agree on and never fight about. NB spends a lot of money on health care (all values from CIHI's NHEX):
NB seems to be at about $5100 per cap in terms of health spending, the national average is about $5000, let's just say "at or around the national average." Sounds reasonable, are we getting average health care?
NB is doing pretty good according to CIHI's hospital-based metrics for readmission (a proxy for receiving appropriate care, you don't come back because they fixed the problem). https://www.cihi.ca/en/an-in-depth-look-at-the-new-brunswick-health-care-system
Spending efficiency is always a concern, the IRDT published results showing that surgeons who do more surgeries are better at them, maybe that's unsurprising. https://blogs.unb.ca/newsroom/2020/01/research-shows-practice-makes-perfect-for-nb-surgeons.php
This leads to questions about where surgeons need to be and how many we need. Efficiency!
This leads to questions about where surgeons need to be and how many we need. Efficiency!
You might recall this efficiency question: Last year the government suggested closing 6 ERs in the province, the question was "Do we want to keep paying for these ERs considering the health gains we receive?" https://globalnews.ca/news/6559014/n-b-reverses-plans-close-er-backlash/
So it looks like health care received in hospitals is on par with the national average and there might be better ways to spend our money. So what? We should connect health care spending to health outcomes; if NB spends about the average on care do we have average health?
Health status in NB is... not great. Some CIHI stats suggest NB is lagging on things like self-reported health status, avoidable deaths (e.g., things that could be treated or prevented), and life expectancy past 65. What gives?
I'm going to take this opportunity to point out that health care is not the only determinant of a population's health, it's the downstream system that helps solve acute problems. Those problems are driven by the environment within which people live their lives.
There are literally thousands of papers on this topic and people intuitively get it. Less obvious: Spending on non-health portfolios by government can influence health to a greater extent than simply adding more health dollars, according to me and others. https://www.cmaj.ca/content/190/3/E66/tab-article-info
NB has issues with non-health spending that impacts health. Social assistance is low and single people who need to survive on public payments are essentially doomed to "deep poverty", being 50% being the poverty line, according to me and @herb_emery
https://tinyurl.com/y3u9b9sm
https://tinyurl.com/y3u9b9sm
Living in low income is bad for health (see: aforementioned thousands of studies). When people transition to other, more generous, forms of guaranteed income in Canada (e.g., old age security) things like food insecurity improve. https://www.uleth.ca/unews/article/study-finds-food-insecurity-issues-halved-guaranteed-annual-income
If a government wants to buy health, then addressing low income is probably relatively cheap versus building new health care facilities. We've neglected the problem for so long that marginal returns are likely higher with an enriched social serving sector.
I don't want to belittle the health care system-related struggles faced by many. Drugs are expensive, wait lists for family doctors that take years can have serious consequences, stigma in health care can be deadly, the list is depressingly long...
It is difficult to talk about population health while ignoring the equity aspect; the distribution of outcomes matter and those with the worst outcomes benefit most from non-health spending. This election it would be nice to see a comprehensive treatment of "health" by parties.
Should have tagged @NBIRDT_UNB , my son woke up and I panicked.
