A 2025 Independent Nova Scotia Healthcare Review

Paul Kidston
Feb 9
4 min read

By Paul Kidston, MBA, ICD.D. Senior Business Advisor and Consumer Advocate

Introduction

Nova Scotia’s healthcare system is a critical component of public services, largely funded by taxpayer dollars. Understanding how these funds are collected, allocated, and utilized offers insight into the effectiveness of the province’s healthcare policies and administration. This review examines the financial structure of healthcare funding, the distribution of resources, the role of government policy, and the effectiveness of ongoing reforms under Premier Tim Houston’s administration. It concludes with recommendations for improving healthcare outcomes for Nova Scotians.

Taxpayer Contributions to Healthcare

In the 2024-2025 fiscal year, Nova Scotia’s total budget was approximately $16.5 billion, with healthcare expenditures accounting for $7.3 billion, representing 44% of the total budget. This underscores the province’s commitment to funding healthcare services at a significant proportion of its fiscal capacity (Nova Scotia Budget 2024).

The primary sources of provincial revenue include:

Personal income taxes
Corporate taxes
Sales taxes (HST)
Federal transfers

While exact figures vary annually, it is estimated that personal income taxes contribute approximately 40% of the total revenue, amounting to $6.6 billion. Given the province’s healthcare expenditures, a substantial portion of personal income tax revenues is directed toward the healthcare system.

Distribution of Healthcare Funds

The Nova Scotia Department of Health and Wellness (DHW) oversees the allocation of healthcare funds, directing them to:

Nova Scotia Health Authority (NSHA): The central body responsible for managing hospitals, community health services, and mental health services.
IWK Health Centre: Specializes in women's and children's healthcare.
Emergency Health Services (EHS): Oversees ambulance services and emergency medical response.

These organizations ensure that healthcare professionals, including doctors, nurses, and administrators, receive compensation while maintaining facilities and services.

Effectiveness of Fund Administration

2015 Healthcare Consolidation: The government restructured Nova Scotia’s healthcare system by consolidating nine district health authorities into the NSHA, aiming to reduce administrative costs and improve service delivery. However, challenges persist. Reports indicate that doctors in Nova Scotia collectively spend over 1.36 million hours annually on administrative tasks, with 500,000 hours deemed unnecessary (Doctors Nova Scotia).

Government Initiative to Mitigate Administrative Burdens: The Nova Scotia government has taken significant steps to reduce the 500,000 hours of administrative burden affecting doctors. Through a series of over 45 actions across 14 government departments and health organizations, the province has streamlined paperwork, adopted digital health technologies, and updated outdated policies, eliminating nearly 425,000 hours of administrative tasks to allow doctors to focus on patient care. This initiative has been widely recognized as a crucial improvement in healthcare efficiency (Nova Scotia Government).

Policy Review and Reforms Under Premier Tim Houston

Since taking office in August 2021, Premier Tim Houston has prioritized healthcare reform, implementing initiatives aligned with key policy recommendations:

Reducing Administrative Burden
- The government eliminated nearly 425,000 hours of administrative tasks for doctors, surpassing its initial target of 400,000 hours.
- Investments in digital health solutions have streamlined processes, reducing paperwork and improving efficiency (Nova Scotia Government).
Enhancing Accountability
- The “Action for Health” plan, introduced in April 2022, addresses acute and primary care, long-term care, and mental health services. The plan establishes measurable outcomes for healthcare service improvements (Nova Scotia Budget 2024).
Investing in Healthcare Infrastructure
- The 2024-2025 budget allocates an additional $360.7 million to Nova Scotia Health and IWK Health.
- $59.2 million is designated for primary healthcare initiatives, including chronic disease care pathways and expanded access to care options (Capital Hill Group).
- A $355 million federal-provincial partnership aims to enhance mental health services, primary care, and technology-driven patient care (Nova Scotia Government).
Fostering Collaborative Care Models
- The introduction of Collaborative Emergency Centres (CECs) ensures that rural emergency services remain functional, facilitating interdisciplinary care models.

Revolutionizing Nova Scotia’s Healthcare: Fresh Funding Strategies for a Sustainable Future

To enhance sustainability, various democratic countries have implemented alternative healthcare funding models:

Results-Based Financing (RBF): Used in Rwanda, this model ties funding to specific health outcomes, improving service quality (The Global Fund).
Public-Private Partnerships (PPPs): Australia successfully integrates private investment into public healthcare infrastructure (The Times).
Participatory Budgeting: Brazil engages citizens in healthcare budget decisions, aligning spending with public needs (Wikipedia).

Implementing RBF in Nova Scotia:

Phase 1 (Year 1 - Adaptation): Healthcare organizations prepare by identifying key performance indicators (KPIs) and making necessary operational changes.
Phase 2 (Year 2 - Benchmarking): KPIs are tracked, and baseline data is collected to evaluate the program’s effectiveness.
Phase 3 (Year 3 - Implementation): Full-scale RBF rollout occurs, where funding is linked to healthcare providers meeting specific performance goals.

Allowing a two-year adaptation period ensures a smoother transition and provides time to fine-tune policy mechanisms before implementing performance-based funding across the province.

Conclusion and Recommendations

By integrating alternative funding models, supporting immigrant physicians, and continuing system reforms, Nova Scotia can ensure long-term healthcare sustainability and improved patient outcomes while maximizing taxpayer dollars.