British Columbia’s Healthcare Overspending Crisis: Falling Behind Other Provinces
The financial sustainability of British Columbia’s (BC) healthcare system is under immense pressure. In the 2022-2023 fiscal year, Fraser Health Authority reported a significant budget overrun, exceeding its planned expenditures by $1.1 billion, a 20% overspend. However, this issue is not isolated; financial reports indicate that budget overruns and administrative inefficiencies are endemic across all BC health authorities, including Vancouver Coastal Health, Island Health, and Interior Health. Compared to other provinces, BC is lagging in key healthcare performance metrics, despite higher per capita spending.
The consequences of these failures are evident in extended patient wait times, worsening emergency room congestion, and declining access to essential medical services. British Columbians are increasingly dissatisfied with the quality of healthcare delivery, while frontline medical professionals report burnout and frustration due to systemic inefficiencies. Without significant reforms, BC’s healthcare system risks falling further behind the rest of Canada, with long-term consequences for patient care and overall public health.
How BC is Falling Behind Other Provinces
Fraser Health's overspending is part of a larger provincial issue. Recent reports reveal that:
Total provincial health authority expenditures exceeded $26.6 billion, with projections reaching $28 billion by 2026.
$3 billion in collective overspending was recorded across all health authorities, representing 12.5% of BC’s total health budget, higher than the overspending rates of Ontario and Alberta.
Hospital infrastructure projects in BC are routinely 20-30% over budget, whereas Quebec and Saskatchewan have implemented cost-control measures to curb excess spending.
BC has the longest elective surgery wait times in Canada, even though provinces like Alberta have adopted activity-based funding models that have significantly reduced wait times.
Primary care access is among the worst in Canada, with over 1 million British Columbians without a family doctor, while Nova Scotia has expanded nurse practitioner-led clinics to fill primary care gaps.
Specialist waitlists are growing at unmanageable rates, with 1.2 million British Columbians currently waiting for specialist care. The average specialist waitlist size is 282 patients, and only 8% of specialists feel the system adequately supports timely patient access.
Medical professionals across BC report increasing difficulties referring patients, leading to delays in diagnosis and treatment that further compound systemic inefficiencies.
Systemic Issues in Spending Across All BC Health Authorities
While Fraser Health's overspending is the most visible, financial mismanagement extends across all BC health authorities. Key areas demonstrating systemic financial inefficiencies include:
1. Corporate & Administrative Overhead Soaring
The Ministry of Health's "Executive and Support Services" budget increased from $335 million to $375 million, with no clear accountability for cost controls.
Reports indicate that corporate expenditures have increased in every BC health authority, outpacing healthcare delivery investments, whereas Ontario has implemented administrative cost caps to redirect funding to patient care.
Administrative bloat contributes to operational inefficiencies, diverting funds from frontline medical services to executive salaries and management structures.
2. Capital Project Cost Overruns Compared to Other Provinces
The Royal Columbian Hospital Redevelopment ballooned from an initial cost of $1 billion to $1.244 billion, whereas similar-sized projects in Alberta have remained closer to budget.
The New St. Paul's Hospital project in Vancouver has now reached $2.18 billion, exceeding original projections, while Saskatchewan has reduced construction costs by partnering with private-sector firms.
These overruns suggest inadequate project management oversight and an absence of stringent fiscal accountability measures.
3. Administrative & Outsourcing Costs Spiraling
The Clinical and Systems Transformation Project (CST), an IT initiative across BC health authorities, has seen its budget swell to $799 million, compared to Ontario's similar digital health project completed at half the cost.
Expensive private outsourcing contracts for non-clinical services continue to drive up costs, while Quebec has shifted these services back in-house to cut spending.
Inefficiencies in procurement and contract negotiations have led to massive unnecessary expenditures, reducing available funds for patient care.
4. Lack of Forensic Auditing and Sole-Source Contracting
BC lacks forensic auditing of sole-source contracts, leading to millions in uncompetitive spending, whereas Manitoba has strict competitive bidding policies for all healthcare contracts.
Several instances have been identified where administrators and clinicians hold exclusive, high-value contracts, avoiding competitive bidding processes, which Alberta has curbed through procurement transparency laws.
Are international accounting firms and consultancies adding real value if they rubber-stamp absurd expenditure increases, then rubber-stamp expenditure cuts? If these firms fail to provide independent, value-driven oversight, they should be replaced with ultra-lean, results-focused experts who can drive real cost savings and efficiency without compromising care.
Without strict financial oversight and transparency in contract allocation, healthcare budgets will continue to be mismanaged.
5. Mental Health Underfunding and Misallocation of Resources
Provinces in Canada allocate an average of 6.3% of total health budgets to mental health, but BC lags behind, despite having one of the highest rates of mental health-related emergency room visits.
Harm-reduction programs, including unsupervised drug provision, receive disproportionate funding compared to high-quality mental health care investments, whereas Alberta and Quebec have shifted funds toward integrated addiction treatment programs.
70% of specialists report an increase in their waitlist size over the past two years, while 63% report worsening wait times for access to specialist consultations.
Consequences for Healthcare Service Delivery
The continued budget mismanagement and escalating administrative costs are having tangible effects on patient care:
BC has the longest emergency room wait times in Canada, while provinces like Ontario have adopted rapid patient discharge programs to free up hospital capacity.
Primary care access remains inadequate, whereas Nova Scotia has expanded nurse-led and telehealth clinics to reduce strain on family doctors.
BC still relies on outdated funding models, while Alberta has moved toward activity-based hospital funding, which has cut wait times significantly.
Specialists in BC report extreme stress and burnout, with 64% experiencing moral distress due to long waitlists preventing them from providing adequate care.
What BC Can Learn from Other Provinces
For BC’s healthcare system to regain financial stability and public trust, immediate systemic reforms must be considered:
Independent Financial Audits – Introduce third-party financial reviews to match the auditing standards seen in Ontario and Manitoba.
Forensic Auditing of Sole-Source Contracts – Mandate forensic audits, following Alberta’s model, to prevent wasteful spending.
Investigate Physician Capital Gains from Public Funding – Ensure family practices receiving capital overhead support do not exploit funding for real estate gains, as enforced in Nova Scotia.
Leadership Accountability Measures – Require performance-based evaluations for executive leadership, similar to Ontario’s hospital performance tracking system.
Adopt Activity-Based Funding (ABF) Model – Implement evidence-based budgeting like Alberta, where hospitals receive funding based on services delivered.
Greater Spending Transparency – Make real-time expenditure tracking publicly available, as in Quebec’s online hospital budget tracking system.
Conclusion
Without immediate forensic audits and stronger oversight on procurement, BC risks continuing to waste billions on uncompetitive contracts and administrative excesses. It is time for the province to adopt best financial practices, performance-based hospital funding, and stronger accountability standards before the crisis worsens further.