While we await release of the 400 or so recommendations of the Drummond Commission, its likely important to remember that Dwight Duncan is the finance minister of the province of Ontario, not Don Drummond.
Recent commentary has suggested the McGuinty government will likely use the Drummond Commission on public service reform as a means of lowering expectations before bringing in a budget that offers what the Premier described in last fall’s election as a more “steady hand.”
That doesn’t mean there won’t be significant pain for health care – we are already witnessing eyebrow raising cuts, including Monday’s revelation that $66 million in research grants to hospitals and universities have been eliminated. The impact will be much larger given research grants are usually collaboratively funded between different levels of government and the private sector. The Council of Academic Hospitals of Ontario – representing 24 teaching hospitals – estimates the real impact to be “potentially over $360 million.”
Globe and Mail columnist Adam Radwanski has suggested that Drummond’s recent musings about lowering health care funding increases to below 3 per cent may not be heeded at Queen’s Park. The province set 3 per cent as a target for annual increases long before Drummond, although getting there has not necessarily been easy. In 2011 Ontario’s health care system received a 5 per cent overall increase.
While Drummond told us that he has no mandate to look at raising taxes, it is likely the province will be forced to look at the revenue side, including cancellation of the last phase of corporate tax cuts, originally intended to drop from 11.5 per cent to 10 per cent.
When the Ontario Health Coalition (OHC) met directly with Drummond, they challenged his ideas around opening up more of the health care system to private delivery, suggesting the province may instead want to look in the opposite direction if it intends to find ways of saving money and making health care services more efficient.
Drummond’s response is we should look at where health care services can be best delivered, not just looking at cost, but at quality as well. That could include moving delivery back to the public sector if there is a case to be made, he said.
If Drummond truly believes this, then the message is not getting through to the media, who continually write about Drummond’s mission to privatize more public service delivery.
Present at the OHC meeting with Drummond, we gave the example of the government’s decision to end community lab testing performed by rural and northern hospitals despite overwhelming evidence of the benefits. This is all public medical lab testing ordered outside the walls of the hospital – including doctors offices and clinics. Not only did these hospitals turnaround these tests faster than the centralized private sector labs, but were more easily accessible to local doctors. The community volumes enhanced the efficiency of the hospital lab, helped to purchase more hospital lab equipment and saved considerable money. An RPO Consultants Report stated that for every $22 spent on a typical round of tests at one of these hospitals, it cost $33 for the equivalent at the large private sector labs. So why is the McGuinty government preserving the Harris-era ban on public hospitals performing this work? If the small hospitals can achieve these kinds of results, imagine what could be possible at a large automated hospital lab facility in downtown Toronto.
Labs are just one of many examples where private delivery of public service has not been the panacea it was intended to be.
Ontario has more private for-profit long-term care beds than any other province in Canada despite growing evidence that quality is impacted by the type of ownership. It is the only province that relies entirely on the costly and destructive competitive bidding system to contract home care services. The Auditor General of Ontario questioned claims of efficiency around developing new hospital infrastructure as public-private partnerships when he examined the details of the William Osler Health System in Brampton. Day surgery clinics are now the subject of some scandal after the province had to bail out Ottawa’s public health unit which spent $750,000 to track down nearly 7,000 patients who attended a doctor-run clinic that failed to follow proper sterilization procedures. (Shouldn’t the errant clinic be footing this bill?)
If we look at the evidence, there is far more of an upside to public delivery. We don’t know why the chicken crossed the road, but good advice is to always look both ways before doing so. Unfortunately we’ve had recent governments only willing to look right.
Interested in having your say? The Public Services Foundation of Canada is presently conducting hearings and town hall forums across Ontario — the open hearings that never took place under the Drummond Commission. Find out more about the PSFC Commission on Quality Public Services and Tax Fairness by clicking here.