Hospital Beds vs Bureaucrats

eric_hoskinsA friend’s dad scolded me years ago.

“Don’t ever say you don’t have time,” he said. “It’s a lie. You always make time for what you value.”

“Same thing for money,” he continued. “Don’t ever say you can’t afford something. You always sacrifice for what you want.”

Some grownups are really dumb, I thought. I can’t afford a motorbike. What’s he talking about?

As an adult, I realized the truth in what he said. We find time and money for what we value most.

Hospital Beds vs Bureaucrats

While voters hope logic drives tax spending, politicians just pay for what they value, what they promised to deliver. Government is not a business.

So when it comes to healthcare, what does Medicare value more: beds or bureaucrats?

Bureaucrats are generally smart, well-intentioned people who serve voters in good faith. Most people agree we need hospital beds AND bureaucrats. But how many of each?

Ontario closed 17,000 hospital beds between 1990 and 2013. Ontario has not cut a similar number of bureaucrats (If you know otherwise, please share it in the comments).

In Ontario, there are 1.7 acute hospital beds per 1000 people, ½ of the average for other OECD countries.

According to a recent presentation by Matthew Lister, there are 32,000 healthcare bureaucrats in Canada. That equals 0.9 healthcare bureaucrats per 1000 population. He also wrote about it in the National Post: Canadian Healthcare Needs to be Leaner.

Ontario has 1.7 acute care hospital beds per 1000 population.

And Canada has 0.9 bureaucrats per 1000 population.

Sweden has 0.4 bureaucrats per 1000 population. Australia has 0.255, Japan has 0.23 and Germany has only 0.06 bureaucrats per 1000 population.  Looking at it differently, Japan has 30,000 healthcare bureaucrats for 130 million people. Canada has 32,000 bureaucrats for 35 million. Does it make sense to have so few beds and so many bureaucrats?

Expensive Bureaucracy?

Steve Paikin of The Agenda asked whether $50 billion for healthcare was going too much to bureaucracy and not enough for health care in Ontario.

Others have said similar things:

Voters do not mind the cost of bureaucracy as long as public services perform. That changes quickly when politicians choose austerity.

Accountability?

Why does Canada have so many healthcare bureaucrats? Absent a convincing rationale, it seems politicians simply spend on things they value. And for now, they value bureaucrats, not hospital beds.

photo credit: thestar.com

16 thoughts on “Hospital Beds vs Bureaucrats”

  1. Nothing against bureaucrats personally (good work if you can get it). But that 3.15% BEFORE overhead that is vanishing from my pay every month is funding a bureaucrat’s paid vacation.
    And next year, if we get a big 10 to 20% additional clawback in a big lump, it will cover the salaries and benefits of the bureaucrats needed to calculate and administer that same clawback.
    Nice!

    1. Great point, John. Beds closed, doctors cut yet bureaucracy expands.

      Thanks for reading and commenting!

      Shawn

  2. Healthcare bureaucracy is a vortex that keeps getting bigger by feeding on itself and sucking ever increasing amounts of money into the hole. The bigger the bureaucracy gets, the more layers it has and the number of well meaning ‘projects’ increases. That these projects have the unintended consequences of creating more rules for accessing insured care and making the lives of the professionals delivering the care more miserable seems to be ignored.

    It is funny that those who decry the bureaucracy of the HMO’s and health insurance companies in the USA are unaware that Ontario’s one and only HMO is following in lock step with what goes on down south.

    We hear that there is only so much money for health care. The problem is the ever increasing pie going to over-regulation and micromanagement of providing that care is shrinking the pie that is going to the actual provision of care.

    1. Great comments, Paul. Bureaucracy begets bureaucracy. As physicians lose freedom to manage their practices, government has to hire more managers to oversee which leaves less money for hospital beds, etc.

      I agree, Canada has more in common with the American system in that both countries insulate patients from most of the control and costs associated with care. Very paternalistic.

      Thanks again for taking time to read and comment!

      Cheers

      Shawn

  3. I would say our salaries are 2-3 times those of Sweden, Germany and Japan. You should do a comparison of that.

      1. Are you suggesting that because Canada has to provide higher salaries to retain well trained physicians that we should defend the insane excess of bureaucrats in our system? Do you work for the Ministry of Health?

        Thanks for sharing the link!

        Cheers

        Shawn

      1. Really liked this article, you make some excellent points.

        Mark needs to check the link he provided, it’s the 2010 monthly income in Swedish currency, once converted to Canadian currency, they’re actually paid more then the Canadian average. Unfortunately the health care bureaucracy make well above the Canadian average.

        1. Thank Peter! I would never have gone back to highlight the currency conversion if you hadn’t mentioned it.

          Sure appreciate you taking time to read and comment!

          Best regards,

          Shawn

        2. Are you claiming that $94K is above the Canadian average for physicians in 2010? That’s the conversion from Swedish currency to Canadian dollar.

  4. Surely some of the reason for this is due to our Constitution: since provinces are responsible for health care, Canada has 11 health systems instead of one. The only way to solve that is a major restructuring of our political system into a federal one.

    Nearly all the stats in this article are pretty useless: inputs are not the relevant indicators of quality. I could impress you and say I use a lot of flour in my bread recipe, but what does that matter if it tastes bad? Similarly, I could have a lot of hospital beds or physicians or any other input, and still deliver poor health care.

    Who cares if ON is 7th in doctors per capita? What we care about is, how healthy are the people of ON, and how effective is their health system?

  5. I am disgusted by the bloated salaries of bureaucrats, and have watched our healthcare system erode as a consequence. My mother is at Baycrest, where the CEO there earns more than $750,000 and there are dozens of lower managers earning more than $250,000. Meanwhile, ALL the nurses were laid off.

    This is unconscionable. I wrote Eric Hoskins and told him how I felt. I got the usual political response.

    The system is broken. DOCTORS not bureaucrats are necessary for healthcare to thrive in this province. They deserve our respect and to get paid properly.

    1. I love the passion in your comments, Shirley. Sobering thoughts well said.

      The fact that the executives have very little power to innovate or change adds to the irony.

      Thanks so much for reading and commenting!

      Best,

      Shawn

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