Bell starts as deputy minister days before Ontario goes to the polls

Just days before an Ontario election Dr. Bob Bell is taking up the post of Deputy Minister of Health.

A former orthopaedic surgeon, Bell is likely most familiar to Ontarians for his place on the annual sunshine list. In 2012 Bell was top earner among Ontario hospital CEOs, drawing $753,992 in pay at Toronto’s University Health Network.

Now he will be the highest paid deputy minister, albeit earning $436,488 in salary and taxable benefits – or slightly more than half of his previous compensation.

Bell also recently waded into the controversy around Medical tourism, telling the Toronto Star that health care is a “potential source of wealth for Ontarians.”

The Star reports the UHN made $50 million over three years treating 380 international patients in Toronto as well as offering consulting services.

Given finite resources within Ontario’s health system, Canadian Doctors for Medicare and the Canadian Health Coalition argue medical tourism compromises access to health care by Canadians, CDFM’s Dr. Ryan Meili framing UHN’s income-generating initiative as a “slippery slope.”

Bell has already suggested that Ontario’s health system can do better without any more money – a comment sure to raise eyebrows in some corners. No doubt his new masters – whoever they will be – will find music in that suggestion. Implementing such a plan may be a very different experience.

It’s one thing running a $1.9 billion downtown hospital with three multi-million foundations providing an endless flow of dollars, and another if you are sitting in Scarborough or Walkerton trying to figure out how to make ends meet without cutting needed community services. Ontario hospitals were about to enter their third year straight of frozen base budgets before the election was called.

If there is any clue to his thinking on health reform, Bell told the Globe and Mail that Cancer Care Ontario is a model that could be applied to other parts of the health system, noting its obsession with measurement and evidence-based decision-making.

Bell is being described as an outsider to the Queen’s Park bureaucracy, although he is hardly a stranger to Health Minister Deb Matthews, whose office was within walking distance of Bell’s.

In a lengthy and otherwise flattering feature in last weekend’s Toronto Star, journalist Theresa Boyle suggests there are “unnamed critics” out there who say he’s respected in the hospital world but not in the community.

Bell may very well find that running the well-funded and internationally respected UHN may be a very different experience from shaping a fragmented provincial system of which per capita public funding is well below the Canadian average.

He will also have to deal with changes to the federal funding formula the provinces say will further shortchange $36 billion out of health systems over the next decade.

Ontario also has the lowest share of public funding as a percentage of overall health costs – only 67.7 per cent of health care costs are publicly funded in Ontario, compared to a Canadian average of 70.1 per cent (CIHI).

Having a greater share of the health system outside the public realm gives the government fewer levers to draw upon to better integrate the system. Having already contracted out much of the system to private for-profit players, Bell will have less room to maneuver than if the system were under full public stewardship.

Bell replaces Saad Rafi, who departed last November to get the 2015 Pan Am Games preparations back on track. Bell takes charge next Monday.

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