THE HUB COLUMN: Bureaucratic bloat in B.C.’s health care system
By Bacchus Barua, research director at SecondStreet.org, a Canadian think tank.
Ask any British Columbian if they want their tax dollars spent on hiring doctors or bureaucrats, and the answer is obvious (unless they’re a bureaucrat). And so, it’s encouraging that British Columbia’s minister of health, Josie Osborne, was tasked with reducing “the cost of administration of the health-care system to focus resources on the front line.”
While the systemic issues that plague B.C.’s health-care system will require more significant reform, this directive deserves applause for two reasons: It acknowledged health-care dollars were not flowing where needed most, and it resulted in action.
But how significant is administrative spending?
Some reports, based on data from the Canadian Institute of Health Information [CIHI], claim about $400 million (1.1 percent of total health spending by B.C.’s government) goes to health-care administration annually. However, this understates the true cost as CIHI’s accounting does not include administrative costs of operating hospitals, drug programs, and long-term care in this category.
A review of audited financial statements by analyst Mark Roseman, combined with Freedom of Information data, reveals the true cost is closer to $3.8 billion. This includes corporate spending by regional health authorities and expenditures on executive and support services by the Ministry of Health. This amounts to over 11 percent of total health-care spending by the B.C. government in 2024-25. While there are clear differences in what is being accounted for, these numbers are significantly higher than the CIHI estimates widely quoted by media.
Moreover, corporate and executive spending has increased 176 percent since 2017, when the current government was elected—faster than increases in provincial authority spending on acute care (98 percent) and population growth (78 percent).
The Canadian Federation of Independent Businesses [CFIB] also reports labour costs for management and union-exempt positions (typically senior managers and executives) in health care increased 52 percent between 2019 and 2023, adding $1.2 billion annually. And while the Community Health Bargaining Association and Managers saw the largest headcount increases, the number of ambulance paramedics and dispatchers actually decreased 7 percent during this period. More generally, B.C.’s health-care system has one manager for every four other employees.
Minister Osborne is on the right track, but this is a non-partisan issue. B.C. Conservative finance critic Peter Milobar noted B.C.’s health-care system has significantly more presidents and vice-presidents (70) than Alberta’s (fewer than 10), despite the latter having only a slightly smaller population.
It’s not simply about the amount of health-care dollars being spent, but about how they are spent.
While B.C.’s provincial government is responsible for overseeing a massive increase in administrative bloat since 2017, it should be commended for finally taking concrete steps to address the problem it created. However, subsequent reforms are needed to prevent such wasteful spending in the future. Taxpayers and patients simply cannot afford to pay for more bureaucratic bloat at the expense of frontline care.
This column was published as a part of The Hub’s Need to Know roundup on September 25, 2025.
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