Balancing the budget
A letter from the Winnipeg Regional Health Authority
BY MILTON SUSSMAN
Winnipeg Regional Health Authority President and CEO
Wave, March / April, 2017
As many readers will know by now, the Winnipeg Regional Health Authority is reviewing its expenditures for the coming year with a view to balancing its budget.
And, as a result, there has been a fair amount of speculation in the media about what that might mean for health-care services.
That is understandable. After all, the Region has run a deficit in each of the last four years. Given that funding from the province is expected to remain relatively flat for the foreseeable future, it’s pretty clear that something will have to give.
With that in mind, I’d like to take this opportunity to provide some background on our efforts to balance the books, and what that might mean for the delivery of care going forward.
Let’s start with the basics. The Region currently receives about $2.8 billion a year to deliver health care, and has been asked to trim a minimum of $83 million in the fiscal year 2017/18.
In order to do that, and to balance our budget in the years ahead, we will have to find ways to manage our resources more efficiently while still maintaining our focus on providing quality care, advancing health equity, and ensuring we remain an employer of choice among health-care professionals.
To that end, we have established two working tables at the Region. One has been focusing on identifying opportunities for savings and service enhancements in our clinical areas, while the other has been looking for similar opportunities in the non-clinical realm.
Since their inception a few months ago, these two groups have been busy generating detailed proposals that will form the basis of our budgetary plan, which we expect to unveil in the next few weeks.
It is important to note here that this search for efficiency is not something new. Over the years, the Region has consistently looked for ways to reduce or eliminate unnecessary expenditures. In some cases, achieving these efficiencies is simply a matter of following best practice.
The Choosing Wisely Manitoba initiative illustrates the point. Launched a few years ago as a collaboration involving the George and Fay Yee Centre for Healthcare Innovation and Diagnostic Services Manitoba, Choosing Wisely has a mandate to reduce unnecessary medical tests, treatments and procedures in order to ensure appropriate care and improve efficiency. One example of its work involves the decision to reduce vitamin D testing in Manitoba.
Until recently, Manitobans used to be tested for vitamin D deficiency even if there was no medical reason to do so. That changed in February 2016, after the folks at Choosing Wisely were able to demonstrate that there was no need to continue with this practice. The result was an 86 per cent reduction in testing and a projected savings for the health-care system of $659,000 in 2016, and $785,000 in 2017.
Now, I’m not suggesting that we will be able to balance our budget simply by doing away with unnecessary testing. But the truth is that there are many areas where we can implement efficiencies by confronting entrenched processes, procedures and working models that have been in place for some time, but may no longer be viable.
In some cases, that may mean re-organizing the way we deliver certain services and redeploying resources to meet some of our more pressing needs. To that end, we will be reviewing the findings of two provincial reports on potential health-care system efficiencies, one by Health Intelligence Inc. and Associates, the other by KPMG. The former is available to read online at www.gov.mb.ca/health/documents/pcpsp.pdf, and contains a number of interesting proposals for how we might be able to implement efficiencies and improve care at the same time.
In addition, we will be looking to see what we can learn from other jurisdictions across the country. It’s a little-known fact that our Region tends to be an outlier when it comes to providing certain services and medical equipment at no charge to the patient or client. It may be that some of these practices are out of date and will need to be changed to bring us more in line with what is happening elsewhere.
Where will this process end up?
It’s still too early to say. But one thing is certain: we can’t simply implement across-the-board cuts on our way to a balanced budget. Rather, we must redouble our efforts to identify potential areas for savings while still meeting our commitment to improve the level of care we provide to our patients and their families.
That won’t be an easy thing to do. But it is something we must do if we are to continue providing high-quality, sustainable health care – not just now, but in the years to come.
Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.
Read the March / April 2017 issue of Wave