Nfld. & Labrador

How N.L.'s health system will spend $205K today on food alone

Discover how a province that spends more on doctors and nurses than it collects from offshore oil manages its health budget.

Province spent more money on doctors and nurses last year than it received in oil revenue

The government of Newfoundland and Labrador spends $3 billion annually on health care, the highest per capita of any province in Canada.

If you're ever stuck in traffic on the Prince Philip Parkway while driving by the Health Sciences Centre in St. John's, consider this: if it takes you a minute to pass by the sprawling health complex, it costs $866 to run it in those 60 seconds.  

That's every minute. Taxpayers fork out about $1.25 million every day to operate patient care at the province's largest hospital complex. 

This covers everything from salaries to sundries for the HSC, which includes the General Hospital, the Janeway Child Health Centre and the province's cancer treatment centre. (The expense doesn't include running Memorial University's medical, nursing and pharmacy schools.)

The cost to operate the Health Sciences Centre in St. John's in 2016-17 was more than $326 million. This includes everything from doctors' salaries to office supplies. (CBC)

But it doesn't stop there.

Every day, the province spends nearly $1.3 million to pay some 1,200 physicians.

It spends just slightly less than that on wages for about 5,200 registered nurses.

Sick leave for health-care workers? The daily expenditure is $144,000, or about $6,000 an hour.

Big breakfast bill

But the daily food bill is even higher. Food services for hospital patients and people living in long-term care facilities ring in at more than $205,000.

To put it another way, the province spends more than $68,000 to serve breakfast to patients and residents each day.

These figures are compiled from data that CBC News obtained through an access to information request.

They are just a few of the many examples of why health care — at just under $3 billion per year — is the single-largest budget area in the province.

It is also why health care is now at the centre of so much debate as the Liberal government of Premier Dwight Ball grapples with a staggering debt and massive deficits.

Newfoundland and Labrador economist Wade Locke is a professor at Memorial University. (Gary Locke/CBC)

"Right now it's not sustainable," said Memorial University economist Wade Locke, who describes health-care spending as the No. 1 challenge facing the government.

A workforce the size of Corner Brook

In 2016-17, health care accounted for roughly 36 per cent of the province's expenditures, and it's easy to see why.

Fifteen hospitals. Twenty-three health centres. Twenty-one long term care homes. Sixty-six medical clinics. 

Charles S. Curtis Memorial Hospital is located in St. Anthony. The province spent more than $44 million to operate this facility in 2016-17. (www.electives.net)

The number of people working at the four regional health authorities? Just under 19,000. That's equivalent to the combined populations of Gander and Happy Valley-Goose Bay.

The province paid more in compensation to doctors and nurses in 2016-17 — just over $1 billion — than it made in royalties from offshore oil.

It cost the government more money to operate the regional hospital in Corner Brook last year — $130 million — than it did to fund both the RCMP and the RNC.

Mapping the costs 

To help reveal what institution costs what, CBC produced this map. Each hospital, nursing home and community clinic is represented; mouse over the entry to see what it cost to operate in the 2016-17 fiscal year. Use the zoom in communities where there are several nearby institutions. 

Highest spending, unhealthy population

Newfoundland and Labrador spends more per capita than everyone else in the country, but without the expected results. The province leads the way in categories such as heart disease, obesity and diabetes.

The Canadian Institute for Health Information estimates the province will spend $5,455 per person on health care this fiscal year, which is about 25 per cent higher than the national average.

Health spending in the provinces
Province Per-capita cost
Newfoundland & Labrador $5,455
Alberta $4,994
Manitoba $4,770
Saskatchewan $4,606
P.E.I. $4,569
Nova Scotia $4,562
Quebec $4,301
New Brunswick $4,299
British Columbia $4,127
Ontario $3,960

But a deeper examination of the institute's data reveals that per capita spending on hospitals is nearly 50 per cent higher than the national average, while spending on long-term care homes is nearly 70 per cent higher.

It's not an unreasonable question to ask whether or not all of these institutions are needed.- Economist Wade Locke

"It's not an unreasonable question to ask whether or not all of these institutions are needed, and if they're not needed, what happens if we take one or two or a lot away?" said Locke.

Health spending accounts for 12.3 per cent of the province's gross domestic product, nearly a full percentage point higher than the Canadian benchmark.

The one category where the province may be getting better value is physician spending, which is below the national average, according to the institute.

Most agree that if the province is serious about addressing its dire financial situation, it cannot do so without tackling health care.

Robert Thompson is executive director of the Newfoundland and Labrador Medical Association, which represents physicians in the province. (Ted Dillon/CBC)

"If the government has to take hold of its fiscal position in some way, we understand that because we have to live within our means," said Robert Thompson, executive director of the Newfoundland and Labrador Medical Association (NLMA), which represents physicians.

Deputy minister ignites firestorm of controversy

But it's a touchy subject.

Should we close health-care facilities? Lay off nurses and doctors? Expect citizens to take more responsibility for their own health?

In some communities, health-care jobs and spending form the economic backbone. But that's no reason for inaction, said Locke. 

The province's deputy minister of health, John Abbott, ignited a storm of controversy last month when he suggested we have too many physicians and registered nurses.

He also said this: "We have put in a lot of services and facilities that we no longer need and no longer can afford. Now we have to figure out in a collective way how we can rewrite the balance."

John Abbott is Newfoundland and Labrador's deputy minister of Health and Community Services. (Sherry Vivian/CBC)

Health Minister John Haggie quickly distanced himself from his deputy's comments, saying Abbott had "just one voice of many" in the debate over health-care spending.

Haggie declined an interview request for this story, saying he looks forward to a "robust" discussion on health-care spending during upcoming public consultations in the lead-up to the 2018-19 provincial budget.

Debbie Forward is president of the registered nurses' union of Newfoundland and Labrador. (Eddy Kennedy/CBC)

The message from the registered nurses' union, meanwhile, is that more nurses are needed.

"Research shows when you have RNs in the system at the right numbers, you save money," said union president Debbie Forward. 

Politics a factor

But Locke says there's a problem with addressing the challenges in health care. It's called politics.

"The problem, I guess, is whether or not these kind of changes can be made in the short term, and in the short term people are focused on getting re-elected," Locke said.

Locke has been shining a lens on health-care spending and outcomes, and has called on the province to establish a special task force, or even a Royal Commission, to review a system that serves a rapidly aging population, spread thinly over a wide geographic area.

The NLMA has also suggested a systematic review of all facilities and services.

Newfoundland and Labrador Premier Dwight Ball has ruled out calls for an inquiry into the province's health-care system. (Colleen Connors/CBC)

The idea has been flatly rejected by the government.

"There's nothing new that will come out of a Royal Commission," Ball said recently.

MUN to host health-care forum

So Locke is taking another approach.

He's spearheading a public forum at the university on March 7 that asks this question about health care: "Can we afford to pay? And can we afford not to pay?"

All the key players, including nurses, doctors and government, have agreed to participate.

"Whether you dismiss it or not, that's fine, but the more information you have to take into account will allow you to make a better decision," Locke said

ABOUT THE AUTHOR

Terry Roberts is a journalist with CBC's bureau in St. John's.

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