Provincial party leaders in a neck-and-neck contest headed into Saturday’s election were in Nanaimo this week promising thousands more health-care workers and a new catheterization lab, on top of building a patient tower.
Nanaimo Mayor Leonard Krog was delighted by the promises, but warned that “this mayor will be holding them to account after the election, whatever the outcome.”
Health-care leaders and policy researchers, meanwhile, worry the daily barrage of promises doesn’t reflect economic realities or “less sexy” structural health-care reforms that are needed.
Health policy researcher Andrew Longhurst said both the B.C. NDP and B.C. Conservatives are promising “more and more and more” in this campaign, without addressing the changes needed in a health-care system that is largely unchanged since the 1960s to meet needs beyond 2024.
In addition, with the province facing a nearly $9-billion deficit, both parties have tax cuts on the table, which reduces the province’s fiscal capacity and “is likely to widen health inequalities,” he said.
“The desire is to promise more and more — more doctors, more nurses — rather than actually understanding structurally what ails public health care in the province, which is not completely different than what ails health care in Ontario,” said Longhurst.
Longhurst, a PhD student at Simon Fraser University who is researching health-care reform in Canada and internationally, has studied care reform across the U.K., where he said there’s a movement toward larger primary-care facilities, similar to community health centres in B.C. operated by non-profits.
There, salaried physicians provide services to residents of the area and must meet basic criteria around access and comprehensive care.
All of the services and standards of care should look more or less the same in every community, said Longhurst
“That is very far from what we have right now where, in large part, we sort of hope that the medical profession itself will go out and organize itself in a way that these services and needs are met and that longitudinal care, comprehensiveness, team-based care — all those things — are sort of magically happening without any structure.”
The other thing every high-performing health-care system does is formally register every patient with a primary-care practice, said Longhurst. Payment to each group of providers is adjusted based on the complexity of their patient list.
“So if, if you are predominantly enrolling patients who are wealthier and healthier, your payment to that primary-care practice is going to reflect that,” he said.
“There’s a few examples of that in B.C., but by and large, it’s not being done at scale whatsoever.”
Longhurst said the province has done many positive things in recent years, such as bringing in a new payment model for family doctors that has increased the number hired — Doctors of B.C. estimates by 800 to 1,000 physicians — as well as efforts to ensure more people have a family doctor, and the creation of more medical-school seats, residency positions and a new medical school at Simon Fraser University.
The government has to do more, however, to measure health outcomes and prevent duplication of services, he said. Urgent and Primary Care Centres, for example, are less successful at recruiting doctors, don’t offer services that are as comprehensive as community health centres, and provide after-hours care that family physicians are already compensated to provide, Longhurst said.
If the small-business model of running primary care is deemed not conducive to delivering what society needs, we need to consider how to support creation of larger primary-care organizations and clinics, he said.
“I think the best evidence we have in Canada, really to date, is the work of community health centres.”
Longhurst said he’s most impressed by the B.C. Green Party platform on health, which includes accountability on how health-care dollars are spent, measuring outcomes and pledging reforms such as a community health centres run by non-profits in every riding.
Dr. Ahmer Karimuddin, president of Doctors of B.C., said it’s important for whoever wins on Saturday to make a “real and substantial commitment” to transforming the health-care system, whether it’s connecting people with a family doctor or reducing wait times for surgeries or diagnostic imaging.
“The status quo is one that really can’t continue,” said Karimuddin, who stressed the best solutions come when the government works closely with health-care providers.
As for talk of privatization, at a time when emergency rooms are closing, hospital wards are being closed due to a shortage of doctors and nurses, and tests aren’t done in a timely fashion due to too few technicians, it’s a false argument, he said.
“Where are those care providers going to come from? Where are we going to find the doctors and nurses to staff those private centres?” said Karimuddin.
“We’re actually going to take people away from the public system, so I think in 2024, talking about private health care like some kind of a magical solution to health-care challenges is really not accurate.”
Karimuddin said the health-care system doesn’t need “an ideologically driven agenda which could potentially set things back” and prevent meaningful and timely transformative change.
He suggested a short, medium and long-term strategy to increase human resources in health care — creating more medical-school seats and increasing training — rather than relying on bringing people from other provinces and countries.
“The challenge with that is that for most politicians, it’s not sexy to make an announcement about something that’s going to deliver dividends five, 10, 15 years down the road.”
As for the Conservatives’ platform on health, Longhurst and others say their proposal to increase health-care spending by $900 million in 2025-26 and $500 million in 2026-27 — or 2.5 per cent and 1.3 per cent, respectively — would actually translate into the equivalent of spending cuts.
Ayendri Riddell of the B.C. Health Coalition, a non-partisan group that advocates for the public health-care system, said public health-care spending needs to grow annually by about five per cent to maintain service as the population grows and ages, as well as to meet wage and salary obligations amid inflationary pressure.
The NDP government’s annual health-care budget increase was just over 5.1% in the last fiscal year.
Riddell said under the Conservatives’ capital plan, there is “no way” to fund major new health-care infrastructure such as the party’s promised Surrey children’s hospital, two new patient towers — including one in Nanaimo — and 5,000 new long-term care beds by 2030. “Their plan includes a $400-million capital funding cut in 2026-27,” she said.
Longhurst said he’s reviewed the platform several times and “the dollars don’t add up, there’s no sense to it.”
“Either they have completely no understanding of health-care, finance and fiscal policy, or they simply are flying by the seat of their pants and/or don’t care,” he said, noting B.C. Conservative Leader John Rustad has been in government since 2005 and should know better.
The revenue side of the platform is the “scariest,” he said, because there’s no way to make such big commitments without significant program cuts.
The B.C. health-care system has yet to recover from tax cuts that led to “deep program cuts” in health care, social services, welfare and disability during the Gordon Campbell-led B.C. Liberals era starting in 2001, Longhurst said.
The Conservative platform also proposes that B.C. follow Saskatchewan and Quebec in outsourcing publicly funded surgeries to private clinics. Longhurst said the two provinces have some of the longest surgical wait times in the country.
“If B.C. follows Saskatchewan and Quebec down the road of surgical and hospital privatization, as the B.C. Conservatives propose, then B.C. can also expect to have the distinction of some of the longest wait times in the country for hip and knee replacements and cataract surgeries,” he said.
B.C. has some of the shortest wait times in those areas. In Saskatchewan, for example, the median wait for knee replacements is over 3.5 times longer than B.C.’s, and for hip replacements and cataract surgery, it’s two times longer.
The costing of the Conservative platform also relies on an additional $10.4 billion in annual revenue by 2030 due to the forecast of economic growth of 5.4 per cent a year, compared with the NDP forecast of 3.1 per cent.
Both forecasts are well above most other predictions: TD Bank is forecasting 1.9 per cent real GDP growth in 2026 while the Conference Board of Canada estimate average is 2.1 per cent in 2027-2028.
“I mean, this is ridiculous,” said Longhurst of the 5.4 per cent growth projection. “No advanced industrialized jurisdiction right now has seen that kind of growth.”
It’s plausible that level of growth — dependent on commodity prices and the broader global economic picture — could happen over a longer period, but not within eight years to balance the books within a second mandate as promised, said Longhurst.
“It’s a B.C. election where we’ve had, I would say, a very un-serious approach to health-care finance and broader fiscal policy and public finances, with health care being the biggest social-program expenditure,” said Longhurst.
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