Almost 40 per cent of the province's budget goes to health spending, and in less than a week Manitobans are going to learn if that will change under the Progressive Conservatives.
Between the budget dropping on Tuesday and a much-hyped announcement by the Winnipeg Regional Health Authority on Friday, Premier Brian Pallister's vision for health care in Manitoba is about to become clearer.
The premier has made it no secret that he feels under the former NDP government, "throwing money" at health care didn't work. Pallister and Health Minister Kelvin Goertzen have repeatedly warned tough decisions are being made in this year's budget.
"[The NDP] live with the regret of 17 years of breaking the health-care system, pouring billions of dollars, of taxpayers' dollars, into a system that never improved, never got better, that was always last," Goertzen said Wednesday during question period.
"We recognize that these are difficult decisions that have to be made and there will be difficult decisions made. But they will be made on the advice of experts, experts who are telling us how the system could be made better."
In the 2016 budget, $6.4 billion of a nearly $16 billion-budget was earmarked for health spending. It's a figure that rose year-over-year under the NDP, and Pallister insists this time around he is going to do it differently.
The specific details about the Progressive Conservatives' decisions remain shrouded in secrecy for now, but the government and critics have hinted at what could be coming down the pipe.
Emergency department closures
One of the experts Goertzen said his government is going to listen to is Dr. David Peachey, a Nova Scotia-based principal with Health Intelligence Inc.
An NDP-commissioned report by Peachey, released by the government last month, called for three emergency departments within Winnipeg's four community hospitals to be closed and converted into urgent care centres, similar to the Misericordia Health Centre.
The four community hospitals in Winnipeg are Concordia Hospital, Grace Hospital, Seven Oaks General Hospital and Victoria General Hospital.
In rural Manitoba, the report recommends assessments on whether individual hospitals should continue to operate, how each facility uses its beds, and whether they should have emergency services.
According to data from Manitoba Health provided to CBC News, 28 emergency departments had to close for 24 hours or longer in the past year due, for the most part, to doctor shortages.
When asked about the measures in the Peachey report, Pallister left the door open.
"What good is it to have an ER four minutes away if you have to wait four hours when you get there? I want people to get into an ER, I am not going to run away from that," he said.
Changes to public home care
Manitoba Government and General Employees' Union president Michelle Gawronsky publicly voiced concern over the future of Manitoba's public home-care system after it changed its name from Manitoba Home Care Program to Home Care Services in January.
That move drew criticism that it was a precursor for a move toward partial or full privatization of home care.
Ten days after a memo went out announcing the name change, the government released a December report on Manitoba's home care system.
The report outlined the growing costs associated with the public system, which costs the government over $300 million annually. With significant growth in the province's seniors population expected, the report by consultant Reg Toews said that figure could increase to $874 million by 2037.
The Filmon Tories famously tried to move toward public home care in 1997 and saw significant pushback. That attempt was ultimately dropped after a brief pilot project was launched.
Gawronsky described it has a failed experiment and said a for-profit model doesn't make care better for patients.
"If we are talking about about a public home-care system that's going to provide a service for everyone, that doesn't include making someone rich," she said.
Consolidation of regional health authorities
There are currently five regional health authorities in Manitoba: Winnipeg, Interlake-Eastern, Northern, Prairie Mountain Health and Southern Health.
Pallister has been known to borrow policies and ideas from our neighbours to the east in Saskatchewan.
Earlier this year, Saskatchewan announced it will reduce its 12 existing health regions to a single administrative entity by the fall. The government estimates the move will save $10 million to $20 million by 2018-19.
Every regional health authority has been given savings targets and told by the government it cannot run a deficit in 2017-18. The WRHA, the province's largest authority, was ordered to find $83 million in savings.
Federal health transfers down
The government led the provincial charge against a decrease by the federal government to federal health transfers. Although they were not slashed like under the Chrétien Liberals in the '90s, for the first time since 2004, health transfers only increased by three per cent as opposed to six.
Pallister has been silent on what this will mean for health-care spending in Manitoba and has so far refused to sign on to the national health accord.
"The reality is the health-care costs are going to rise, every single study has said so, and we need to have a national dialogue around how we deal with health-care support and funding," Pallister said in February.
'Need to find major efficiencies': U of M prof
Dr. Alex Singer, a primary care physician and assistant professor at the University of Manitoba, argues if the province wants to change the system, improve wait times and save money in the long run, it must focus on innovation, not cuts.
"I think we really need to go down this road of innovation — to innovate our way into a more efficient health-care system, rather then go back to where we were in the bad old days of cut, cut cut, until everyone gets frustrated and services get affected," Singer said.
Singer pointed to a recent study by the Manitoba Centre for Health Policy which found that wait times in emergency rooms weren't necessarily caused by too many patients in the waiting room, but long waits for test results.
He said an upfront investment in better digital record-keeping, decreasing the number of unnecessary tests and creating better digital warnings for doctors conducting tests would pay off in spades.
For example, he said the Winnipeg Regional Health Authority saved hundreds of thousands of dollars by decreasing the number of vitamin D tests it administered by adding a simple prompt that showed doctors the reasons why a patient needed, or didn't need, the test.
"More is not always better," Singer said.
"In order to find major savings, you need to find major efficiencies."