Don Drummond wants to provide every health care provider with their own pony while the system gets squeezed another notch tighter.
In his report released this week, the Commissioner on Public Sector reform wants to implement everything from increased salaries for the CEOs of the Local Health Integration Networks to triple the per capita spending on public health.
All this is to take place while restraining health care spending increases to 2.5 per cent per year – about half the funding increase from 2011.
Where the savings come from with all this new investment is not clear, nor is there an explanation on how so much can be done with so little. In fact, there is very little costing associated with any of these recommendations.
In all Drummond makes 105 recommendations dealing with the health system, many of them either already in progress, or complete.
While the Commissioner calls for enhanced funding for almost all sectors, it is clear the focus on restraint will be aimed at hospitals and physicians.
For hospitals Drummond still plans on increasing funding, but at a slower rate than other sectors. However, he wants to create incentives for other health care providers, such as the Family Health Teams, to keep patients from going to hospital.
Despite the debacle at ORNGE, Drummond wants to open the door to more for-profit delivery of public health care, making them part of the “competition” to deliver services. Once services are placed in the private for-profit sector, a veil of secrecy automatically drops over spending details of these entities. Private for-profit entities are not required to post salaries on the sunshine list.
The Health Restructuring Commission of the late 1990s brought about many costly mergers of public hospitals. Drummond is calling for more mergers across the spectrum, claiming there are too many health care providers. These mergers would be mostly administrative in nature, separately incorporating senior management to avoid major labour disruptions.
The biggest change would be the super-sizing of the LHINs, including a possible merger with the Community Care Access Centres to give the LHINs case management capacity. Drummond suggests the Ministry of Health could be further gutted to transfer personnel to the LHINs, effectively creating 14 mini-ministries across the province. While CEO salaries have been the object of public wrath, Drummond wants to increase the salaries of LHIN CEOs to prevent them from jumping ship to the public hospitals. He proposes no cap on hospital CEOs, but does prefer more pay for performance.
The LHINs would expand their jurisdiction, including playing a major role in primary care delivery. They would also serve as “scope of practice police,” making sure the hospitals are not employing skilled professionals doing work a lesser qualified individual could be doing at less cost.
While Drummond was told he could not recommend privatization of health care, he has no qualms about increasing premiums and disqualifying seniors from the Ontario Drug Benefit Plan depending on their income.
He suggests there could be considerable savings by doing so, but he wants to apply those savings to expanding Pharmacare coverage to all Ontarians below an undetermined income level.
Drummond has embraced taking the “politics” out of health care, making the system less vulnerable to angry citizens upset about hospital closures, lengthy waits for home care, and other “service improvements.” By placing more decision-making in the hands of the LHINs, the government can wash their hands of adverse impacts on communities. Drummond has no plans to make the LHINs accountable to the regions they serve.
Some of the other ponies the 2.5 per cent increase is expected to fund include:
• Enhanced mental health;
• Upload the public health units from the municipalities;
• Accelerate implementation of e-Health;
• Increase enrollment in medical schools, including more placement for nurses and other health care professionals;
• Enhance the role of the Institute for Clinical Evaluative Studies and Health Quality Ontario, including enforcing evidence-based practices in primary care;
• Expand telehomecare;
• Focus on “assess and restore” care for seniors in long-term care so that they can go home;
• Enhance community-based care, especially home care;
• Improve health human resource planning;
• Move more primary care doctors into Family Health Teams
• Expand Medicare coverage, including pharmaceuticals, long-term care and “aspects” of mental health;
• Create bodies similar to Cancer Care Ontario for Mental Health in addition to Heart and Stroke and Renal disease;
• Establish a Commission to guide health care reforms.
Drummond wants health care providers to compete for procedures, creating a race to the bottom and totally disregards planning that takes into account into community need.
He also expects hospitals to specialize, a process that has already been taking place under the LHINs.
Watch for more analysis on the Drummond report in the coming days.
To download the full Drummond Report, click here.