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B.C. Health Minister Kevin Falcon.JENNIFER ROBERTS

After years of struggling to reduce waiting times for surgery in British Columbia, the province's hospitals are engineering a slowdown in services in response to the government's refusal this week to address a $360-million gap between budget and demand.

More than three months into the fiscal year, health authorities are now proposing belt-tightening measures that include cutting elective surgery, chopping jobs, selling assets and raising fees.

Although the health authorities have been given a 6-per-cent budget increase this year, most argued that additional money doesn't meet rising demand and higher costs.

"We're now growing beyond the resources we have available," Murray Ramsden, CEO of the Interior Health Authority, stated in a letter to staff and physicians this week.

Across B.C., health managers are trying to squeeze more services out of their dollars. Letters released this week to health-care workers were filled with self-congratulatory progress reports on shared supply chains, standardization of best practices and streamlining operations.

Beyond the buzzwords, however, there are cuts coming in health care that will have an impact on diagnostic and treatment levels.

Howard Waldner, CEO of the Vancouver Island Health Authority, warned that health-care jobs will be cut to meet the targets. "We will aggressively reduce administration, support and other discretionary costs as much as we possible can. These reductions will involve job losses."

Health Services Minister Kevin Falcon issued a letter yesterday to the province's health authorities confirming he will not move on the $8.9-billion budget to fund health-care services across the province.

Speaking to reporters, he said the health authorities will just have to cope with a shortfall, identified earlier this year, of $360-million, or 3.5 per cent.

"There is no more money," he said. "Given the way the economy is today, there are a lot of organizations that would give their right arm to manage 3.5 per cent cost pressure."

He added he is talking to heads of the six health authorities about imposing financial penalties on executives who fail to meet both their financial and performance targets.

"That's how most people in the real world operate, and it should be no different here," he said.

"The decision by the minister is an irresponsible one," said Lew MacDonald, co-ordinator for the B.C. Health Coalition. "The Health Minister seems to be using the current economic environment to justify budget cuts that will have immediate consequences to patient care."

The CEO of the Fraser Health Authority, with 12 hospitals spanning from Burnaby to Hope, said fewer staff and reduced services are the only ways to meet Mr. Falcon's targets.

"Some rationing and reductions in levels of services will need to happen," Nigel Murray wrote. "Changes to services can be expected to affect some of our employees, who will be redeployed, displaced or laid off."

Dr. Murray was not available for comment yesterday but a spokesman for Fraser Health, David Plug, said it's too early to say which procedures will be delayed. Cancer and cardiac operations will remain a high priority, but other elective surgery, such as hip replacements and cataract removal, may take longer.

"We're making every effort to be more innovative and effective," he said, but added, "When we reduce volumes, wait lists increase."

Although Fraser Health has the capacity to do an additional 2,000 MRIs this year, the number of diagnostic tests will be limited to 2008 levels. Parking fees at nine hospitals will increase 8 per cent next week.

Bonnie Pearson, a spokeswoman for the Hospital Employees' Union, said it's not clear how the cuts will affect health-care workers. But she said there is little doubt that patients will feel the changes.

"When you are reducing overtime and not replacing those hours, I don't see any way you can deliver the same level of service," she said. And slowing down elective surgery is a concern: "There are very few elective surgeries that are not medically necessary. There will be some impact on wait lists for surgery and diagnostic services."

SOME OF THE PLANNED CUTS

Vancouver Coastal Health Authority

- slowdown in surgeries during the Olympic Games

- five per cent reduction in overtime and sick time costs

- cuts to administration and support services

Interior Health Authority

- 100 administration positions have been cut, more job cuts to come

- Clinical hours kept to 2008 levels; overtime reductions

- looking at capping or reducing acute and community care, including additional slowdowns in elective surgery

Vancouver Island Health Authority

- job cuts, reduced overtime

- fee increases:hospital parking, business' health inspectionsand health services

- moratorium on non-essential maintenance

- programs capped at 2008 levels and "volumes of elective surgeries, procedures and diagnostics will be reviewed and adjusted as required."

- under consideration: selling off non-essential buildings

Fraser Health

- higher fees for parking and health services

- layoffs

- umber of MRIs will be capped at last year's levels

- reduced number of elective surgeries