Healthcare takes up astronomical amounts of funding and resources. The BC government keeps making questionable choices on how to use them.

Traditionally, the government gave funds and overall direction to the healthcare system. They’ve further bulldozed their way into delivering care, elbowing out independent professionals. This has led to an explosion in administration and bureaucracy that interferes with clinical practice.

They are micromanaging front-line workers (and patients) to the point of decaying care and death.

At the same time, nobody will admit flaws, failures, or bad results because of political consequences. Only good news is allowed. Managing any complex system without proper data is impossible. Yet, admitting any negative results goes against the government's interests. Not being able to admit failure or change directions costs money and lives.

Healthcare funding talks stall when the federal government demands the tiniest amount of accountability (“strings”). Provincial governments cannot accept these terms. They refuse to share even minimal data, which keeps them from providing the oversight and direction we need.

Having a single body control all aspects of healthcare is a recipe for abuse. We need external oversight and accountability.

Yet, the BC provincial government is increasingly the de facto entity that:

• defines legislation and standards

• allocates funding

• decides on priorities

• develops programs

• implements those programs

• monitors clinical and financial performance

• enforces compliance with legislation and standards

• reports on program performance

On the surface, having too few healthcare organizations in BC does not seem to be the problem. We already have the Ministry of Health, seven health authorities, Doctors of BC, College of Physicians and Surgeons, Joint Collaborative Committees, Divisions, and Primary Care Networks, to name only a few. How many organizations?

However, these “independent” organizations are heavily intertwined. The government influences many of them via governance or funding.

Oversight, accountability, and independence have suffered.

Urgent and Primary Care Centres (UPCCs) are owned and run by government health authorities. They control operational and policy decisions, including those affecting patient care. The government now solely funds, manages, operates, and reports on these clinics. Their failure in meeting their goals with UPCCs demonstrates much of what has gone wrong with the government’s approach to healthcare. READ MORE

The government seized roles previously held by others not directly indebted to them. For example Bill 36. The College of Physicians and Surgeons of BC (CPSBC) licenses physicians, sets practice standards and guidelines, and manages complaints and discipline. Similar Colleges exist for other health professions. Previously, College leadership was independent and autonomous (“self-regulating” within legislative constraints). The 2022 Health Professions Act allows the Minister of Health to directly appoint or approve all members of the Colleges' boards of directors along with unprecedented powers to unilaterally intervene in clinical practice. READ MORE

In the past, health professionals made most decisions about providing care, following clear sets of rules. We’ve replaced these fair and efficient systems. Now, bureaucrats dole out funding to “deserving” recipients.

In theory, licensed physicians can run their practice and bill the system for their services. They don’t need to ask permission to open a clinic. They don’t need a manager to approve their bills. They just follow well-defined and independently-enforced rules. Government can’t arbitrarily interfere or cut off their livelihood.

The rules around practice and reporting keep everyone honest. Governments provide funding and oversight. Independent physicians provide the services. It all works, is efficient, and is scalable.

Unfortunately, many government initiatives are moving more towards an employer-employee relationship with unspoken conditions. Conditions where your job, salary, and promotions depend on keeping your boss happy.

The situation described above is exactly what happened to doctors working at UPCCs. Getting paid is no longer about following MSP rules. Health authorities run the UPCCs, not physicians. They typically offer physicians two-year contracts to work there. If they want a UPCC contract, they need the approval of bureaucrats. That means pressure to do what they're told and not cause trouble. That's a big hit to their professional autonomy and ability to stand up for patients.

Physicians who depend on such funding are stuck. They need to stay on the good side of government decision-makers. Power and control shift to bureaucrats and their needs. The needs of patients suffer.

What happens when the same organization funds, manages, operates, and reports on itself? It puts accountability at risk. READ MORE

Members of the Government face an even greater conflict of interest because they have two priorities. One is delivering programs and services. The other is getting re-elected. Doing that means looking confident to the public even when matters are not well addressed.

They want to play up success stories, bury failures, and put any blame on someone else. That builds public confidence. But it leaves us with a system lacking accountability and transparency.

For example: We'd love to know how many millions were spent on the centralized flu vaccination registry that replaced the working pharmacy-based system. By any standard it was a disaster that made getting flu shots harder for millions. With so much invested in the system's success, the government could not report its blatant failures. READ MORE

The government took on many roles in healthcare. But it's abandoned its most vital role: competent management of the whole health system.

We trusted governments to manage our single-payer healthcare system. We counted on them to provide the services we all needed. We gave them money we paid through our taxes to do so. We trusted that it would be used wisely.

Managing a complex system demands accurate information, flaws and all. We don’t have that. Growing political control of health has created a fatal conflict of interest. The data we need to manage the system can’t be generated, analyzed, and published. It would be political suicide.

The same need for secrecy keeps those who could fix the problems from doing so. We're relying on a growing horde of bureaucrats. They’re often disconnected from the reality of front-line healthcare. Their needs clash with the needs of those the system should serve.

The government took on too many new roles related to delivering care. In doing so, they've abandoned the one critical role nobody else can fill.

Primary Care needs are being neglected. Ensuring that the primary care needs of people in BC are met is a fundamental responsibility of the government. But basic information is lacking. The number of people in BC lacking family doctors, and where they are, is unknown. There is no measurable plan to tackle this deficit. Instead, there are announcements of new UPCCs, and talk of training more doctors. All without metrics or targets. Because those metrics would show how bad the current situation is.

Information Technology must be a priority. BC is far behind when it comes to a centralized electronic medical record. Each health authority has its own major system, used by health authority facilities like hospitals. Community access to shared information is poor. Interoperability between the systems is poor. Given the massive expenditures on information technology and the benefits of province-wide standardization, the government should be taking a clear leadership role.