Is Newfoundland's increased health spending part of premier's bid to become PM?

CMAJ 2000;162:1337

Tobin — who in recent months has earned a national profile in his fight for increased medicare spending, using tactics that critics say have more to do with his own ambitions than with health reform — has been under considerable pressure to improve health delivery on his home turf.

To that end, overall health-care spending in last week's budget increased $136 million to about $1.2 billion. The total provincial budget is now $3.4 billion. "We have put our money where our mouth is," Tobin said on budget day, touting the plan as a wise reaction to demonstrated needs. He added that most other sectors of the government will hold tight to existing budgets because health is the top priority.

Tobin's gestures on health care at home are often derided by the political opposition, which says they are being motivated by his own career interests. Tobin is widely known to be interested in succeeding Jean Chrétien as Liberal party leader and as prime minister. A March Toronto Star poll of Liberals determined that Tobin ranks second only to Paul Martin as a potential successor to the prime minister.

Much of the extra money has been earmarked for one-time capital expenditures and hospital upgrading, including projects that were delayed in the belt-tightening 1990s.

The governors of the province's regional health care boards, which operate hospitals and nursing homes, have also been allotted extra money, but not enough to cover existing deficits. Moreover, they have been asked to find at least 1% of their budgets in cost-saving "efficiencies." Still, the extra financing was welcomed as a promising start by groups such as the Newfoundland and Labrador Medical Association.

The province is taking budgetary risks to bolster health care. After running consecutive budget surpluses, the province is forecasting a deficit this year of $34.7 million. As well, the reinvestment will consume all of Newfoundland's share of a one-time Canada Health and Social Transfer payment, announced in February's federal budget and amounting to about $43 million.

The disbursement could have been used over 4 years. Finance Minister Lloyd Matthews said he is "quite confident" that Ottawa will spend more on health care in coming years.

In an interview with CMAJ, Health Minister Roger Grimes remarked, "We're confident that our gamble is not going to be a gamble. We think the money will be there next year."

Part of the government's confidence is rooted in the turnaround in Newfoundland's economy. For the last 2 years, real economic growth in the province has led the rest of the country, and is forecast to do so again, thanks largely to offshore oil production and a diversified fishery.

Grimes said the provincial government has been under pressure to attend to health, in part because of frequent reports of inadequate access. He described such reports as "partially politically driven, partially based in reality."

Tobin himself had built high expectations for a budget focused heavily on better health care management. This winter, he gave several high-profile speeches across the country on the state of medicare. For instance, in Ottawa in January he described the "funding crisis in medicare" as a national "tragedy" and added his mission was to "issue a wake-up call." — John Gushue, St. John's

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