The Ontario Hospital Association must be finally feeling the pinch of fiscal restraint and so-called “funding reforms” that have worked against their bottom line for at least the past four years.
The OHA is asking that the government begin doing capacity planning – forecasting the specific need for a full range of specific health services. That not only includes forecasting the need for hospital services and beds (including types of beds), but also includes (but is not restricted to) a provincial needs assessment for long term care, assisted living, home care, primary care, and mental health services.
The ask was part of a rare Saturday press release, itself a follow-up to the OHA’s presentation to the Standing Committee on Finance and Economic Affairs last Thursday.
No doubt the OHA sees capacity planning as the first step in getting them out of the stranglehold the province has placed them in with declining real funding. The OHA has seen freezes in base funding for the past two years, and the two years before that funding was restricted to 1.5 per cent – well below what is needed to maintain the status quo.
The OHA says average per capita hospital funding in Ontario has shrunk to $1,433, well below the national average of $1,696. That translates to a difference of $3.6 billion in funding. In Alberta hospitals are funded at a rate of $2,208 per capita.
The OHA points out that is a large dividend that the government has been able to apply to other community-based health services. While the OHA is generally supportive of the government’s numerous system reforms, they note “it is too early to rely on them to bridge this foreseeable gap” in hospital funding.
It is the first time we’ve seen the OHA publicly express concern about their bed counts, noting in their presentation that among developed countries only Mexico and Chile have fewer beds per capita than Ontario.
The OHA also wants a more “flexible payment system” for fee-for-service funding targeted to non-elective procedures. At present “quality-based procedures” are capped for each hospital. When Hamilton St. Joseph’s announced they were going to cancel 600 cataract surgeries early last week, that’s what happens when you hit that cap. (In the end the government relented and found more cataract money for the Hamilton Niagara Haldimand Brant LHIN). As politically difficult as the cancellation of hundreds of cataract surgeries can be, non-elective surgery is where the rubber can hit the road. The OHA points out that fee for service caps on funding around congestive heart failure are “typically beyond a hospital’s direct control, as patients must be care for as they are admitted through the emergency room.”
While the OHA makes two important points here, we think the third plank of their presentation needs a rethink.
Tired of trying to rig the arbitration process against workers (noticeably absent in this year’s presentation) the OHA now wants to mess with the Public Sector Labour Relations Transition Act (PSLRTA).
The Act was originally drafted to facilitate the transition of skilled health professional and support staff from one health setting to another. When that takes place, the collective agreement (including wage rates) of those workers travels with them for up to a year until a new agreement can be reached or the workers vote not to have union representation.
Now the OHA suggests that if costs savings are to be maximized, that “hospitals’ employment cost structures should not also be transferred to the community sector.”
Essentially the hospitals are telling the government they should pay their own transferred workers less when they arrive in the community sector. Isn’t that a kick in the pants for years of service?
Given the government is trying to sell health care professionals and skilled support staff on the benefits of moving to the community, this would poison the well and likely create additional friction around such transfers.
A cheap labour policy in health care will not work – the government should look at the incredibly high turnover of personal support workers to realize what a foolish idea this is. Imagine how it would play out for nurses, therapists, diagnostic imaging professionals and others?
Hospitals realize they have to pay market rates for needed health professionals; is it they would rather not see the community sector able to compete with them?