B.C. health authorities were hit with nearly $7-million in penalties by the provincial government last year for failing to meet waiting-time targets for hip, knee and cataract surgery.
Figures released to The Globe and Mail show that the specific fiscal punishments, believed to be a first for Canada's health-care system, were assessed against three of the province's five regional health authorities.
The money, in the form of withheld payments, went to general revenue to help the government's fight against the deficit, according to a Health Ministry spokesman.
All indications are that the government's no-nonsense approach is working.
"It's a significant amount of money, and it's been quite successful at getting people to pay attention to wait lists," said Les Vertesi, head of B.C.'s Health Services Purchasing Organization, the patient-focused funding arm of the government, which has taken over responsibility for meting out non-performance sanctions.
Before the penalties, said Dr. Vertesi, hospitals that allowed waiting lists to build faced no cost consequence.
"They were just letting people accumulate, so were doctors. … Now, people have got down to work and lowered their wait lists. A lot more surgeries are being performed," he said.
The Interior Health Authority took the biggest financial whack, losing out on $3.4-million for coming up short on prescribed time limits for patients to receive hip or knee replacements or cataract operations.
Donna Lommer, chief financial officer for Interior Health, said the authority does not begrudge the cash.
"There are certain conditions put around that money. We didn't meet them, and we got docked. We get it," Ms. Lommer said on Monday.
The penalties are a good thing, she added. "They have got our attention, absolutely."
Fraser Health, the province's largest health authority, had $2.8-million clawed back, while funding for the Northern Health Authority was cut by $790,000.
Both Vancouver Coastal and Vancouver Island Health authorities met the government's goals, and lost no money.
Assessments were applied during the 2010-2011 fiscal year. More will be handed out for non-compliance when the current fiscal year is complete.
For health authorities to avoid a financial penalty, 90 per cent of their hip patients must be treated within 26 weeks, 90 per cent of knee patients within 26 weeks, and 90 per cent of cataract patients within 16 weeks.
"Wait time holdbacks encourage health authorities to increase volumes for these procedures," ministry spokesman Ryan Jabs said.
"[This strategy]clearly ties funding to results for patients and holds health authorities accountable for how they spend money from their global budgets."
Fraser Health spokesman David Plug said the policy forces officials to look hard at improving how surgical waiting lists are managed. He noted that Fraser Health met its hip replacement target, but failed on knee replacements and cataract procedures.
"More people are getting surgery, and they are getting it faster," Mr. Plug said.
Ms. Lommer blamed several factors, including an outmoded sterilization department, for the failure of Interior Health to meet its targets.
"It's not one single issue. It's like trying to juggle 10 oranges," she said, adding that the authority will not meet goals this year, as well.
"We're doing more cases than we're funded to do, but once you fall behind, you have to run to catch up, so we need to do more. ... Being accountable is a good thing."
At the same time, however, there is a drawback to the way the penalties are applied, Dr. Vertesi said.
They are all or nothing, he said, meaning a health authority that falls only a few patients short of the targets is liable to be subject to the full holdback.
And health authorities, realizing that they are not going to meet the goals no matter how hard they try, might just chalk up the financial hit as a cost of doing business and pursue other priorities, Dr. Vertesi said.
"It's not that there shouldn't be any consequences, but they are a very blunt tool. If you're not careful and use them in the wrong way, you may get results you don't want."