Public health system walking into disaster

VICTORIA - The threat to our public health care system isn't from private clinics, or contracting out.
It's from within.
The people in charge - not just the politicians, but the professional managers in the system - have done a bad job, and their failure has undermined confidence.
The public has difficulty judging the system's performance. We don't know if the doctor makes the right decisions when it comes time to fix us up.
But there are some clear measures, like wait times. And they are enough to shatter our confidence.
It's not just the length of wait, though that is a concern. Median wait times for 10 of the 16 surgical procedures tracked by the government have increased in the last three years. Waits for two procedures have stayed the same, and the wait for four others is shorter.
That's a problem. But the greater problem, in terms of confidence, is the impossibility of getting a clear answer about why they are increasing, and what can be done.
Some answers are obvious. In many areas we're simply doing fewer operations than we were three years ago, despite a population that has grown by almost three per cent.
The case of a Vancouver woman who had waited eight weeks for surgery for a brain tumour, and been cancelled twice, sparked headlines and hand-wringing.
How could this be?
One obvious answer is that health care system is doing fewer neurosurgical procedures. Three years ago 4,369 people got the neurosurgery they needed; in the last fiscal year the number of procedures was six per cent lower. For five of the 13 procedures that can be tracked on the government's wait time web site the story is the same. Fewer operations were performed in the four months ending this March 31 than in a comparable period in 2001. Fewer surgeries means longer waits.
Not all areas of surgery have been cut back. The number of hip and knee replacements are up about 50 per cent over three years ago.
But why? Is it because baby boomers who want to get back to tennis are pushy and politically effective, or because there's a lot of good knee doctors right now eager to keep busy? There's certainly no evidence to suggest that the best professionals sat down and made an informed decision, system-wide, on what kinds of surgeries should be performed given limited money.
Health Minister Colin Hansen doesn't help build confidence. He responds to questions about wait times in part by saying he doesn't believe the data compiled by his government. He also dismisses other studies that show lengthening waits.
That raises a couple of questions. Why hasn't Hansen - after more than three years - able to come up with data he considers reliable on how long people are waiting?
And more critically, how can the government and health authorities manage wait times when say they don't even know what they are?
Health care costs each British Columbian an average $2,700 a year - $11,000 for a family of four. But the health care system can't say what people can expect for their money. We'll do what we can, they say. Maybe you'll get needed surgery this year, maybe you won't. Take what we give you, and don't ask questions because it's complicated and anyway we don't have answers.
It's not good enough.
Certainly, the system provides an extraordinary level of care. The problems are complex. And some excellent work is being done, like the Western Canada Waiting List Project.
But waits and access have been a concern for a dozen years, and there is still no accurate measurement of how long people wait, no definition of acceptable waits, no fair queue and no guarantee of treatment with a reasonable time.
The result is increasing frustration, and more demands for changes that undercut the important principle or universal, equitable access to health care for all Canadians.
Footnote: The system's inability to provide decent information means the public can't make an informed choice about spending priorities. Most British Columbians would have gladly foregone the sales tax reduction if there was a clear promise of reduced wait times for specific procedures. The health care authorities can't deliver.