The first question period of the fall session of the Nova Scotia legislature began with a familiar theme – physicians and their numbers. But even as the opposition was excoriating for the umpteenth time the government’s failure to train, recruit and retain enough doctors to meet the needs of Nova Scotians, new data from the Canadian Institute for Health Information (CIHI) cast a somewhat different light on the issue.

Physician numbers, down slightly in 2017 (as reported here) were up significantly in 2018. As the table shows, the number of physicians increased by four per cent in 2018, with family doctors growing by almost five per cent. That brought to an abrupt end a four-year decline that began in 2013, when the Liberals made the pie-in-the-sky campaign guarantee of a family doctor for every Nova Scotian.

 20172018Increase
Total2,4562,5554.0%
Family doctors1,2341,2924.7%
Specialists1,2221,2633.4%

The surge in physician numbers maintained Nova Scotia’s top spot in doctors per 100,000 population – 271 compared with the national average of a 241. That’s a position this province has occupied since 2005, but it is sometimes suggested that because Halifax has a regional mandate to serve the Maritimes, we have a disproportionate number of specialists and not enough family docs. That may once have been the case. But in 2018 Nova Scotia was tied for second with British Columbia with 134 family doctors per 100,000 population, up from fourth highest in 2017.

The 2018 increase in family practitioners apparently had no immediate positive effect in reducing the estimated number of Nova Scotians without a family doctor or other regular health care provider. According to Statistics Canada data (Table 13-10-0096-16) there were about 101,000 Nova Scotians 12 years of age and over in that category in 2018, up from 92,500 in 2017.

However, according to the Nova Scotia Health Authority’s “Need a Family Practice Data” the number of people from that group who have registered on the provincial wait list for a family doctor was 51,014 on October 1, a sharp drop from the high of 59,225 last November. If the trend continues it should be reflected in Stats Canada’s 2019 estimates. And we may also see a shift in political focus away from the perceived doctor shortage to some of the other chronic deficiencies in the health care system, such as long term and mental health care.

Administrative costs 

The previous dive into health costs last February also addressed the issue of the high cost of health administration in Nova Scotia.  CIHI data showed that at $58.27 per capita, Nova Scotia’s health administration costs are the highest of any province and about 35 per cent above the national average. This tidbit, follow-up to 2015 piece which made the same observation, received no response until Chronicle-Herald columnist Ralph Surette referred to it his Aug. 24 column, headlined “N.S. needs to upchuck health bureaucracy hairball.”

For some reason the outgoing CEO of the Nova Scotia Health Authority felt the need to respond to Surette’s hairball column in the Aug. 31 Herald (“Health-care bureaucracy hardly bloated”), taking issue with a number of the claims therein, including the CIHI data on per capita costs of health administration.

There are two parts to the Health Authority rebuttal. Part one states that “none of our analysis has been able to reproduce data to support the claim that Nova Scotians pay 35 per cent more than the Canadian average on health care administration.”

Perhaps the NSHA analysts were looking in the wrong place, or overlooked the possibility of rounding. Had they looked at the source of the data (“Provincial/Territorial government health expenditures per capita by use of Funds” in the National Health Expenditure D4 series) and done the math they would have found the national average of $42.19 per capita and Nova Scotia at $58.27 – 38.1 per cent higher. Perhaps rounding down to “about 35 per cent,” confounded efforts to “reproduce data.”

The second part of the NSHA response involves introducing a different indicator on administrative expenses, also from CIHI. It measures administrative expenses as a proportion of all expenses, and according to the NSHA response in the Herald, “shows our ratio (4.8) as slightly higher than the national average (4.3)[i], but behind Ontario’s.”

As a rejoinder, second highest in the country for admin costs is hardly a slam dunk, unless 4.8 per cent represents an improvement. Unfortunately, it does not.

Administrative expenses by province and health region are available through CIHI’s yourhealthsystem. A bit of searching on the site turns up data enabling a comparison of costs in 2017-18 with pre-NSHA days. The table below shows costs for Canada as a whole, Ontario and the Atlantic Provinces for 2010-11, 2013-14 and 2017-18. The latter two periods are available on the website. The data for 2010-11, the first year they were compiled, were provided by CIHI on request.

 2010-112013-142017-18
National average4.8%4.6%4.5%
Nova Scotia4.9%4.6%4.8%
Ontario6.2%6.0%5.8%
Newfoundland & Labrador5.5%4.4%3.8%
Prince Edward Island4.4%4.5%4.6%
New Brunswick4.1%3.5%3.3%

Comparing data from different years comes with a caution about possible changes in methodology over time. However, the validity of comparing the last two columns of the table is supported by a CIHI graphic found here showing Nova Scotia’s admin costs rising between 2013 and 2018 while the national average goes down.It is also worth noting that New Brunswick, with the added responsibility of providing services in English and French, has significantly lower admin costs than Nova Scotia.

Your Health System (YHS), from which the graphic is derived, and the National Health Expenditure D4 series (NHEX D4), measure different costs. YHS measures the administration costs of operating the entire public health system – activities like running hospitals, clinics and long term care facilities. Separately, the NHEX measures just the cost of running health departments and providing health insurance programs.

As noted, Nova Scotia is 38.1 per cent above the national average in the latter category and – at 4.8 compared with 4.5 per cent – seven per cent above the national average in the administrative cost of providing the services measured by the YHS. Getting down to the national average in departmental overhead measured by the NHEX would save about $15 million a year. Achieving the national average cost of running the rest of the system would free up another $10 million or so for front line services – and much more if New Brunswick’s example can be emulated.

Hairball or not, administration costs need to be addressed.

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[i] The figure 4.3 may be a typo. Unless NSHA is singing from a very different songbook, according to CIHI the national average for 2017-18 is 4.5 per cent.