Ambulance Services Account for Only 1.1% of Health Care Dollars

Last week the Canadian Institute for Health Information (CIHI) published their projections for 2006/07 provincial and territorial health care expenditures. Across Canada a staggering 35 cents of every dollar spent by Governments is spent on health care. According to CIHI, Manitoba ranks second only to Alberta in per capita spending in this area. Estimates suggest that Manitoba will spend almost $3,300 per person on health care expenses in this fiscal year. So where does that money go?

An editorial in the Winnipeg Free Press (Sat, Nov4) suggests in part that Manitoba is spending too much money trying to maintain too many hospitals. The CIHI estimates show that of the $3,300/capita spent on health care in Manitoba this year, costs associated with hospitals and other health institutions will gobble up over 57% ($1,890) of that money. Without doubt the closing of hospitals, whether it be in urban or rural settings, is a very unpopular political decision, but one has to ask whether or not that is money well spent.

Another very interesting, if not alarming, statistic is this...Manitoba will spend over $50 per capita on health care administration costs, while the money allocated for ambulance services in the province will amount to only $37 per resident, or 1.1% of the province's health care expenditures.

I don't suggest that there is a simple solution to curbing our rising health care costs. But our population is both growing and aging, and our expectations and demands are following suit. We can't continue to throw more and more money into our health care system thinking we'll "fix" the problem by simply hiring more doctors, nurses and other health professionals. We need to work collaboratively and think outside the box in an effort to reform health care delivery.

Among some of the many recommendations the Paramedic Association of Manitoba has made to Government in this area...Expanding scope of practice and fully integrating paramedics into health care to augment and improve current resources and programs...Using paramedics in emergency-care facilities to assist with triage, patient care and high workload efforts including resuscitative measures...Enhancing the use of appropriate paramedic treat and release protocols resulting in the need for fewer ER admissions...Increasing the number of Urgent Care facilities and enabling paramedics to transport or refer patients to appropriate health facilities in lieu of hospital ERs.

My reaction to the CIHI statistics has ranged from disbelief to disgust. How can anyone justify spending more money on health care administration than ambulance service? How does making decisions about health care outweigh ensuring Manitobans receive appropriate pre-hospital emergency care? Why doesn't the Government recognize that paramedics are a resource that would allow them to make difficult political decisions regarding hospital closures?

But the answer is simple...we're still not recognized as "health care professionals". As an association, when PAM talks about the benefits of using paramedics to augment health care delivery, the Government still fears our interests are somewhat self-serving. No doubt we've raised the bar within our profession...we've adopted national competencies for entry into practice, we expect our colleagues to adhere to professional ethics and conduct and we've promoted the need for higher educational and clinical standards for ourselves. But the reality is that we don't control those benchmarks, not do we have the ability to demand adherence through self-discipline. Until we become a self-regulated profession with the direct responsibility to protect the public interest, our goals will always been seen as self-serving.

I'm mad as heck that only 1.1% of Manitoba's health care dollars are spent on pre-hospital emergency services. I think, and I know many others agree, that additional money spent on paramedic services can not only offset expenses in other categories of health spending, but ultimately improve the health of many Manitobans along the way. But I'm more convinced than ever that the way to get that message across to those responsible for writing the cheques starts with self-regulation.