Health and education : yes, the expenditure has increased!

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Germain Belzile

Wednesday, February 7, 2018 10:34

UPDATE
Wednesday, February 7, 2018 10:47

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With the collaboration of Patrick Déry, analyst in public policy at the MEI.

In November last year, Quebec announced an income tax reduction of $ 1.1 billion for individuals. Some have therefore argued that if the government could afford this decrease of the tax burden, it is because he had reduced the expenditure in health and education, and that these sectors had been starved by years of ratooning. According to these critics, the money of the tax cuts would have had to be re-injected in the public services.

Yet, as health care expenditures as those in education have increased considerably in recent years.

From 2008-2009 to 2016-2017 expenditures in health increased from 30.6 to 36.4 billion $, and those in education (excluding the post-secondary sector), from 12 to 13.4 billion $. These increases are expressed in constant dollars of 2016 and thus take into account inflation. They are also higher than the growth of the population in the case of health care and, in the case of education, those of the students.

In sum, if spending had simply kept pace with inflation and demographic change during this period, Quebecers would pay today’s $ 4.8 billion less for health and education. The rate of increase of current, these two departments will finish by devouring all the others.

Why the services do not improve they not?

If the expenditure had, in themselves, a direct impact on the quality of services, we would have had to see an improvement to be widespread and substantial in recent years. It is not the case. Indeed, a survey we learned recently that 71 % of Quebecers consider that the additional money injected in the course of the last ten years in health and education have not yielded results. Why?

The budgets of health and education increases to fund not only new programs, but also the working conditions agreed in collective agreements. They are also the result of choices made by the State in the delivery of public services.

In education, for example, the increase in spending in recent years derives mainly from the reduction in the number of pupils per teacher, of payments to the pension plans, the progress of the employees in the salary scale and the largest number of students with special needs. An important part of the rise has no link with improvement of the quality of services delivered.

Several commentators have nevertheless concluded that there was no urgency to reduce taxes, since there are pressing needs in the public services. Yet, it is the organization, the management and the performance of these sectors that are involved, much more than their funding.

The money, a bad indicator

When we compare the results obtained by the educational systems of different countries, the amount of money spent by the State is not always a good indicator of the quality of services. A study of 31 European countries has found that the level of public spending has “little influence” on the effectiveness of a school system. The autonomy of the institutions has much more impact.

In the same way, in health, the performance does not depend on the number of sunken billions. The United States is a good example : while their system is by far the most expensive in the world, it regularly happens in tail of classification comparisons between developed countries.

Quebec, which has the sad honour to host the worst emergencies of the western world, would do well to keep in mind an observation by the Commissioner to the health and well-being. His analysis could apply to whole sections of our public administration : “the difficulties of the system does not appear to be related to a budgetary allocation insufficient, a lack of human resources, and even less to a lack of material resources. They would be rather related to the organization of care and services and the allocation of financial and human resources “. Disturbingly, the ministry of Health decided to abolish the watchdog that criticised the regime from the inside.

A false dilemma

Oppose the tax cuts to the quality of public services in health and education presents a false dilemma. Over the years, huge sums have been swallowed up in these two networks, with the results to say the least, questionable. Before injection of additional resources, the Quebec would be well advised to rethink how to deliver public services, without which there is no reason to believe that it will get different results. In the meantime, there is no doubt that the money of the tax cuts is among the best hands in the hands of taxpayers than in those of the bureaucrats.