Look closely at your property-tax bill, and you鈥檒l see a payment to the local hospital district. And not a small payment, either. Homeowners in Greater Victoria contribute an average of about $150 to the Capital Regional Hospital District each year.
Almost nothing about this arrangement makes sense. It imposes unfair burdens, it messes up lines of accountability and it creates perverse disincentives.
Let鈥檚 start at the beginning. The provincial government came up with this scheme 60 years ago.
The idea was that communities that needed a new hospital should bear some of the construction cost. The Health Ministry would put up 60 per cent of the funding. District hospital boards, run by municipal politicians, were created to raise the remaining money from the local property-tax base.
Yet health care is a provincial responsibility, and a major one at that. It should be supported by the broadest possible revenue sources, such as income and sales taxes.
Municipalities have their own duties to perform, and their revenues are limited. Property taxes, narrow and selective as they are, were never designed to carry this weight.
Hospitals are extremely expensive to build. Why should small communities like Port Alberni or Tofino be saddled with such a large burden?
And those are just the obvious problems. Dig a little deeper, and others emerge.
The Capital Hospital District Board, for example, is a standing committee of councillors from the capital region. When it was first set up, most health facilities were still owned and operated at the community level.
But local ownership has long since disappeared, with the creation of regional health authorities such as Island Health. The result is we now have two oversight systems with competing jurisdiction. And that can mean trouble.
Consider what happened with new the Patient Care Centre at the Royal Jubilee site in Victoria.
Island Health managers were responsible for designing and running the facility. They wanted to build a large referral hospital for patients across the Island.
That is their mandate, but it鈥檚 also a necessity. Smaller community facilities can鈥檛 provide the range of complex care that tertiary hospitals offer.
However, the Capital Hospital District controlled the municipal financing. And the board 鈥� understandably perhaps 鈥� took a narrower view. Their jurisdiction is Greater Victoria. Why should they pick up the bill for people who live elsewhere?
In the end, the hospital district refused to pay more than 30 per cent of the cost, not 40 per cent as originally expected. That left Island Health $21 million short, and the deficiency had to be made up by asking the Victoria Hospitals Foundation for help.
Or look at the North Island Hospitals project. Two aging facilities, in Campbell River and Comox, had come to the end of their life.
Design experts believed it made little or no sense to build a pair of new hospitals so close together 鈥� just 60 kilometres apart. Island Health agreed, and decided to construct just one facility, at roughly the mid-way point.
But the local hospital district, with representatives from both communities, wouldn鈥檛 sign on.
Once again, Island Health capitulated. Two hospitals were built where only one was needed. The outcome was a hefty bill for local taxpayers.
The hospital tax rate for residential properties in Greater Victoria is $31 per $100,000 of assessed value. In the Comox-Strathcona district, it鈥檚 $84 per $100,000 鈥� well over twice as high.
It can be argued that local voices are carrying the day. Even so, this is an awkward arrangement.
Regional health authorities were meant to break down barriers between communities. District hospital boards, with their power of the purse, can perpetuate those barriers if they choose.
Perhaps it鈥檚 time for a rethink.
