Hospital funding freeze, high admin costs show up in quality indicators

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For all the shortfalls in Ontario’s health system, the reality is that despite having among the lowest per capita levels of funding, the province is matching if not excelling the Canadian average in many categories measured by the Canadian Institute for Health Information (CIHI).

Whether this reflects well on Ontario or badly on the rest of the Canada is an open debate.

CIHI is widely respected as being an unbiased source of information for health planners although they remain at the mercy of local health providers who provide the inputs.

Mortality rates, for example, have been known to fluctuate widely once a hospital has learned to game the system. Only unexpected deaths count, so most deaths become expected.

CIHI has established a site where you can compare provinces on 37 indicators. Just enter your province and determine whether you want the summary or the detailed report. (Click here to access the site)

Where Ontario does stand out at present is access to primary care. According to CIHI, 91.2 per cent of Ontarians have access to a regular family doctor compared to the Canadian average of 84.5 per cent.

Ontario also does much better when it comes to limiting the use of restraints in long term care, but is below average for nursing homes when it comes to the administration of potential inappropriate medication.

Where the numbers are less impressive is where the indicators reflect on the performance of hospitals – not particularly surprising given hospitals have been subject to flat funding to their base budgets and have the lowest per capita public funding in Canada.

Ontario hospitals are also notable for a higher rate of in-hospital infections. Per 1,000 patients, 5 cases of sepsis are reported in Ontario hospitals compared to a Canadian average of 4.5.

Hospital executive salaries may be playing a role in the higher than average administrative expenses – at 5.8 per cent of operating budget compared to the national average of 4.5 per cent.

The CIHI report should be a wake-up call to Ontario health planners who are using the blunt tool of funding freezes to carry out a realignment to the health system. This is not only leading to underperforming hospitals, but also a home care system that is beginning to implement severe forms of rationing as a result of the number of patients discharged early from hospital.