Every day we hear reports that our health care system is broken and having difficulty keeping up with the health needs of patients and people throughout BC and across the country. Politicians say it’s a lot of unexpected circumstances, they’re doing the best that can be done; they're following what the experts are telling them, and we should trust them to carry on with it.

Are these unexpected circumstances or are they foreseeable outcomes?

Either way, our health care system is broken. So, how do we fix it?

The problems in our health care system did not grow this big overnight. It’s been getting bigger over the decades. Just look at the last three decades.

In the early 1990’s in BC, the BC NDP government ushered in the New Directions mandate, a change that swept away all the existing community hospital boards and replaced them with the Regional Health Authorities (RHAs).

The RHAs were the management organizations reporting to government. What a relief and bliss for the Minister of Health. Gone forever, the annual meeting with community hospital board chairs to discuss their concerns. Replaced with a corporate management structure and priorities.

In those years, the early 1990’s, warnings were voiced by professionals including doctors and the BC Medical Association, and others throughout communities that: the New Directions were the wrong directions and would give rise to a growing administration cost and burden to the health care system. We continued to hear warnings through the years since.

The warnings went unheeded as government already had its own desired experts: health economists with the view that doctors were the drivers of costs and we should train fewer physicians throughout Canada. This became government policy across Canada and adopted for all medical schools. Enrollment numbers were reduced and kept low until more recently when it was reversed to increase enrollment of medical school students.

Meanwhile, a new health administration sector emerged and quickly expanded. Going from single administrators at the local hospitals, to Regional Health Authorities with many VP’s and layers of management and support staff. The bureaucratic style of government meshed well with the corporate style of RHAs, growing on both sides.

Health care budgets are already 50 percent or more of the entire provincial and federal budgets and it may be hard to believe: every year, governments spend as much on health administration as all physician payments, specialists and family doctors. Yes, we spend as much on health care administration as doctors.

The switch from community management of community assets, like hospitals, to a corporate structure can have other significant impacts including on professional practice.

This has been seen in governments on all levels, including municipal governments, and also associations and non-profit societies that have adopted corporate practices and undergone bureaucratic growth.

All individuals and professionals who participate in management are constrained to not share their thoughts publicly or to members, to abide by the ‘corporate code of conduct’; and to report all matters through the chain of management command.

In the early years of the Fraser Regional Health Authority, an illustration of this constraint on professionals was evident at the Royal Columbian Hospital medical staff meeting. Emergency physicians and others had been in the news, speaking out publicly and to the media. At the medical staff meeting, a newly hired VP, a nurse with experience in critical care, reported her observations were the same: that doctors and nurses at RCH were doing an amazing job with a shortage of resources. However, as part of management she could not say so publicly and appreciated the physicians doing it.

The switch to the corporate management of RHAs is very costly and also constrains professionals and employees to not share their thoughts publicly, only through the chain of management. Both are in stark contrast to that found previously under community management.

There is more to say and I will get to that later. But, first, we have heard it said so many times and ways: if you keep doing the same thing, you’ll keep getting the same results.

So, if we keep spending on health administration rather than health care we shouldn’t be surprised that health care continues to decline.

People throughout BC want a change in government and also a change in how government works.