BC takes ax to budget of a health system “in danger”

British Columbia is delisting some covered medical services, cutting its Pharmacare plan and slashing the administrative budget of its Ministry of Health in a bid to bring health spending under control. The system is “in danger” and must change, Health Minister Colin Hansen told CMAJ. “It's not sustainable.”

The ministry aims to maintain health care expenditures at $9.5 billion annually for the next 3 years, and this will mean annual cuts will be needed to negate the effects of inflation. But the province is already over budget. Last year, BC spent $9.6 billion on health care, which accounted for 40% of total spending.

To help keep spending in line, the ministry is trimming its administrative budget by 45% over the next 3 years. This week it also delisted several services that aren't required under the Canada Health Act. “BC is the most generous province” in terms of health coverage, says Hansen. “We're looking at bringing our benefits in line with other provinces.”

As of Jan. 1, the province will no longer pay for visits to physiotherapy, chiropractic, naturopathy, massage therapy and nonsurgical podiatry services. (Those who earn less than $20 000 will be insured for up to 10 visits.)

Pharmacare is also on the hit list. Previously, all residents over 65 years were fully covered for prescription drugs, paying only dispensing fees to a maximum of $200 a year. Now, most seniors will pay $25 for each prescription, to a maximum of $275 a year (those on premium assistance will pay $10 per prescription, to a maximum of $200 a year). Residents under 65 previously paid all prescription costs to a maximum of $800 a year, after which they paid 30% of costs up to $2000 a year. Under the new program, they will pay all costs up to $1000 annually, and 30% of costs after that to a maximum of $2000 a year. Residents who earn under $20 000 annually will now pay the first $800 of prescription costs; previously they paid the first $600. Hansen says these “changes” to supplementary services and Pharmacare are expected to save nearly $130 million annually.

And this is but the first phase of changes to the Pharmacare plan, which Hansen says is the most generous in Canada; 56% of drug costs in the province are covered by taxpayers, significantly higher than in other provinces. By 2003, all BC residents will face an income-based means test to be eligible for Pharmacare, and this will likely mean that middle- and upper-income residents will have to pay more for their medication.

The ministry is also considering more drastic cuts and a “whole range of ideas,” says Hansen. He says the province can't afford to wait for the federal report on health care being prepared by Roy Romanow. “We've had lots of reports,” he says, “and not enough action.”

Although he dismisses the idea of user fees, he says residents with nonurgent medical needs should have the option of purchasing services from private clinics. “We have to expand on services outside the system,” he says.

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