Category Archives: Health System

The new Sunshine lists are out. To find out what the executives at your hospital/health care provider earned last year, go to:

http://www.fin.gov.on.ca/en/publications/salarydisclosure/2010/

The CAW’s Corey Vermey has done some interesting math around Finance Minister Dwight Duncan’s assertion that health care could reach 70 cents of each program dollar the province spends within 12 years.

Vermey writes:

The 2010 Ontario Budget contains one clear example of faulty math and logic that wouldn’t fool a sixth grader. 

Here is the example as noted in the provincial budget:

“Just 20 years ago, 32 cents of every dollar spent on government programs were spent on health care. Today, it is 46 cents.  In 12 years, if we don’t take action, it could be 70 cents.”

That is alarmist to say the least.  If health care spending expressed as cents per dollar of government program spending increased from 32 cents to 46 cents over 20 years; that is an increase of 14 cents over 20 years and an average annual increase of 0.7 cents per year. 

Therefore if that trend continued, in 12 years at 0.7 cents per year health care spending would be only at 54.5 cents. That has much less impact than 70 cents. We need to ask where did the 70 cents projection come from? 

Check the facts on health care spending. In 2008 and 2009 the provincial budget reported that health care spending represented 43 cents for every dollar of program spending.  In 2007, the budget reported that health care spending represented 46 cents for every dollar of program spending.  Over the past three budgets, the annual average net increase in health care spending relative to program spending has been zero.  If it is 46 cents currently, that is the level it was at in the 2007 budget.

To get to our mythical 70 cents of every dollar in program spending being directed to health care in 12 years, health care spending would need to increase by 2 cents of program spending in each and every year. There is no evidence that that has ever happen over the last 20 years.

Ironically, the 2010 Budget in fact indicates that health sector spending as a percentage of program expense will only be 40 cents – at $46.1 billion.  A footnote reveals that it is only after controlling for time-limited investments and the method of presenting education sector expenses that health sector expenses account for 46 cents in 2009.  Even on that accounting basis – health sector expense falls to 45 cents in 2010 — trending back to 34 cents and not 70 cents.

The McGuinty government committed $2.269 billion more in direct health care spending in the 2010/11 provincial budget — not enough to stave off impending cuts.

Hospitals will receive a 1.5 per cent increase to their base operating budgets, about half of what the Ontario Hospital Association had said was needed to maintain the status quo.

While the government continues to fear monger about runaway health care costs — the reality is health care (including health promotion) actually dropped as a percentage of program spending – from 46 cents on the program dollar, to 40 cents.  However, the government claims that it amounts to 45 cents for this coming year, but only after “controlling for time-limited investments and the method of presenting education sector expenses.”  That’s still suggest health care costs are trending down, not up, as a percentage of the provincial budget.

As a percentage of total provincial expenditures, health care represents 37 per cent.

Spending on health promotion increased to $408.7 million from $380.9 million. This figure is often included in health spending figures, although health promotion includes such programs as upgrades to hockey arenas and other recreational facilities.

Few specifics were available on new health care initiatives, although $100 million was set aside to reduce wait times in emergency rooms, an initiative that has had little success to date.

According to CUPE, Growing sectors for health care spending have been OHIP Physician funding and drug costs, having grown 57.6 per cent and 33.7 per cent since 2003. By comparison, hospital spending only grew by 23.8 per cent during the same period.

Government has promised legislation that will bring down the cost of generic drugs.

Finance Minister Dwight Duncan indicated in his speech that while he will respect existing collective agreements, the fiscal plan provides no funding for incremental compensation increases for any future collective agreements.

$599.6 million less was spent on health care expenditures budgeted for 2009/10 due to lower than expected H1N1 costs and delays in recreational capital projects.

Real growth in the economy is expected to be 2.7 per cent in 2010 and 3.2 per cent in 2011.

The budget includes $4 billion in personal and corporate tax cuts this year.

What other health care organizations are saying:

“Ontario’s nurses want to be able to take pride in the work they do. They want to provide high quality care and make positive differences in the lives of the people they care for.This simply isn’t feasible with a 1.5% funding increase – we’re likely to see nurses with increased patient loads, resulting in a higher incidence of sick days and more overtime, adding significant costs to the system.” – Dianne Martin, Executive Director, Registered Practical Nurses Association of Ontario

“The government will increase base operating funding for the hospital sector by 1.5% in 2010-11. However, many critical details about hospital funding in 2010-11 remain unknown. The Budget does not provide information about funding sources other than the base operating increase and as a result, it is premature to assess potential impacts on services and staff.”  –OHA President and CEO Tom Closson.

“A 1.5% increase in global funding for hospitals means that there is a gap between hospital funding and inflation for the third year in a row. The evidence is that hospitals cannot continue to sustain the underfunding of their global budgets. Deficits will continue and more services will be threatened.” – Dora Jeffries, chair of the Ontario Health Coalition.

“While we recognize the difficult fiscal situation the government faces, we will be very disappointed if investments to increase staff fall short of the need. We are willing to work with the government to increase our capacity to care for seniors coming out of hospitals, but we can’t perform this role without adequate staffing and resources,” – Donna Rubin, CEO of Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS)

The Registered Nurses Association of Ontario said they were pleased with budget, including reaffirmation of the McGuinty government’s commitment to open 25 additional nurse practitioner-led clinics before the next election. “These clinics are needed now as the lack of access to primary care in dozens of Ontario communities means people are forced to go to hospital emergency rooms,” says Doris Grinspun, Executive Director of the RNAO.

“Every Ontarian should brace themselves for yet more cuts to the health care they need and count on. ONA has been tracking the deletion of registered nursing positions for about eight months now, and we’ve seen more than 1,800 RN positions cut, totaling more than 3.5 million hours of patient care per year that are gone forever.” said Linda Haslam-Stroud, President of the Ontario Nurses Association.

“While we don’t have specific details, it is our understanding that current care and service funding levels will be retained with adjustments in recognition of increasing cost pressures. We appreciate that government continues to recognize the need to invest in the important role that homes play in meeting the healthcare needs of long term care residents.” — Christina Bisanz, CEO of the Ontario Long Term Care Assocation

There are significantly fewer hospital beds per capita in Ontario than there were two decades ago. Since 1990, the number of Ontario hospital beds per capita has dropped by 56 per cent. That number could rise again if this week’s provincial budget does not include sufficient cash for hospitals. … Margaret Mottershead, chief executive of the Ontario Association of Community Care Access Centres, says the community sector has not been adequately funded to manager higher demand coming from divested patients from the hospitals. Mottershead told the Toronto Star that the CCACs have introduced many programs in the last few years to ease pressure on hospitals, but have not been fully funded for them. She said some CCACs are reducing hours of support. … The Sault Area Hospital is proposing to keep all of its mental health beds. Seven beds were to be closed April 1st, but the hospital maintains it needs all 30 beds. SAH’s mental health facility is regularly at 95 per cent capacity. “While there have been additional revenues and program put in place in the community, the need is still there,” SAH spokesperson Mario Paluzzi told the Sault Star. The North East Local Health Integration Network will make a final decision on the hospital’s proposal. … Toronto Star columnist Bob Hepburn questions why Federal opposition leader Michael Ignatieff is ignoring medicare as an issue. Hepburn says that Ignatieff recently wrote to Prime Minister Stephen Harper outlining Liberal priorities, including 13 initiatives. Not one of them dealt with health care. “Ignatieff’s failure to even mention health care was a huge mistake because Canada’s cherished medicare system is under siege,” writes Hepburn. The federal health accord, signed in 2004, expires in 2014. The 2004 accord gave the provinces $41 billion extra to help lower hospital wait times and improve overall health delivery. … A study of California hospitals by the non-profit Center for Studying Health System Change reports that, like Ontario, hospital mergers in the State actually ended up costing more. They say that insurance payment rates to the hospitals in some cases increased more than 200 per cent. … In Britain many hospitals are requiring friends and relatives to stand up during visits with hospitalized patients. They are also asking them to leave the flowers behind. “It is considered good practice by some (hospitals) that visitors and staff should not sit on beds, in order to reduce the risk of transmitting infections from one patient to the next,” states the guidelines from Britain’s department of health. In an article in the British Medical Journal, Dr. Iona Health argues the recommendation is unjustified and denies patients the chance to be close to their loved one. According to experts, there is no evidence to suggest preventing people from sitting on beds or banning fresh flowers results in lower infection rates. Some UK hospitals have extended the no sitting rule to include chairs.

Dr. Michael Guerriere is back. The Managing Partner of the Courtyard Group recently appeared at a Longwood’s forum with his own prescription for changing the health care system.  Guerriere is known recently for being at the centre of the e-Health scandal.

Now Courtyard is engaged on a six-point platform they are promoting for changing the health system. As Globe and Mail reporter Andre Picard once wrote, “politicians can hire consultants that share their political bent and then marvel at their ‘independent’ advice.” Given the connection between Guerriere and the McGuinty government, his comments are worth taking note of.

Guerriere says the health system is operating “massively below its potential” with a potential to remove 20 per cent of the costs from that system.

Guerriere says managers in the system are “ill equipped,” with appallingly little invested in management development. His first plank is to invest in management, including a province-wide institute for excellence in health management where managers would spend at least 10 days a year learning the finer points of such topics as financial literacy, data analysis and HR management. He would also like to see managers rotating through the health system, so hospital managers would have experience with other health settings.

“We have thousands of managers in the system with no financial training and we wonder why so many hospitals run deficits,” he said.

Guerriere suggests at least 20 per cent of management compensation should be based on a bonus system – “if you don’t hit targets, you don’t get a bonus.”

He says compensation should be more rational with the establishment of executive compensation guidelines. Guerriere also advocates for more detailed disclosure in the sunshine lists. Those lists should begin at $150,000 per year to be meaningful.

For front-line workers he suggests all new contracts should be based on inflation, nothing more – this despite criticism of the effects of poor morale within the system and the effects it had on the departure of needed health care professionals during the Harris government.

The Courtyard consultant also believes that administrative overhead could be reduced, including reducing the size of the Ministry of Health by as many as 2,000 employees – a figure he says would be more comparable proportionally to Alberta.

While critical of the size of the Ministry, Guerriere sees a bigger role for the Local Health Integration Networks.  While he agrees the LHINs have not had much impact, he says they need a clear mandate, including direction from government.

He sees the LHINs organizing centralized facilities for hospitals, including one lab, one IT department, one data centre, one HR department and one management reporting office.

Guerriere defends the newly proposed volume-based funding formula, although admits that the last time it was tried resulted in failure. He says the government needs to look back at what went wrong and fix the problem. Once a formula is developed, all other funding would be amalgamated into it, including wait time incentives.

“Bailouts of hospitals have a pernicious effect on the formula,” he says. He argues that bailouts should only be one-time events, and not permanently added to the operating budget.

“We need to distinguish between underfunded hospitals and poorly managed ones,” he said. “At present neither the LHINs or the Ministry can tell the difference.”

If hospitals are unable to balance their budgets, he says supervisors should be appointed with one difference – poor performing hospitals could be merged with more efficient ones.

Other ideas he offered including

• Cancer Care Ontario would take on diabetes management
• An Annual $100 million restructuring fund
• Ban hand-written prescriptions by 2015 and paper prescriptions by 2018 to reduce adverse drug reaction
• Ensure system data is timely and accurate so managers are not making decisions on information that may be two years old
• Install electronic medical records in every community-based practice
• Accelerate the creation of Family Health Teams

To see a video of Guerriere’s full presentation, go to  http://www.longwoods.com/events.php?mode=past&selected=119&series=2009/10

The Throne speech dominated most the week in the Ontario Legislature, the changes to health care taking up a substantial part of the NDP’s response, tax, debt and deficit dominating the Tory reply.

PC Leader Tim Hudak criticized the McGuinty government for not living up to their promises in the 2007 Throne Speech, including the promise to hire more nurses and establish more long-term care beds.

“Just ask the patients, seniors and families in places like Ottawa, London, Fort Erie or Port Colborne,” said Hudak, “who have seen services like ERs close down and nurses being laid off.”

“This throne speech includes a lot of lofty talk about reforming Ontario’s health care system,” said NDP Leader Andrea Horwath, “but no language that offers any peace of mind for families and communities across Ontario-families that received a phone call during these past few weeks to tell them that the surgery they’ve been waiting for had been deferred or cancelled because the hospital was out of money.”

Horwath suggested that the speech hinted at picking winners and losers, pitting people and communities against each other for the right to provide care.

“We’re tying funding procedures-trying to put people’s health problems in a box and solve them all separately,” she said.

Horwath said the road the McGuinty government is on will have a devastating impact on smaller and rural hospitals.

Southern Ontario Tory MPP Toby Barrett echoed Horwath’s concerns: “In rural Ontario, we have a gnawing concern about which end of the stick we’re going to be at with respect to this one.”

“The Ontario Health Coalition is quoted as indicating that expanding pay for performance to small hospitals would lead to further disparities between the level of care available in rural and urban Ontario,” said Barrett.

In question period, the Tories focused on U.S. brokered contracts the Ontario set up with American-based hospitals to provide care to Ontarians. Health Minister Matthews said the contracts were for very complex cases arranged by the Canadian Medical Network. Matthews said CMN looked after about 35 cases per year. Durham-area Tory MPP John O’Toole pointed to a Metroland newspaper report that said the McGuinty government had signed health care contracts with 40 American hospitals and clinics, making them “preferred providers.”

Matthews said the biggest group of patients Ontario was exporting was for bariatric surgery. “We are repatriating that program right now,” she told the legislature. “This year, over 1,000 people who would have gone out of country for bariatric surgery received that program here in Ontario. Next year, that program will expand even further.”

The Premier refused to apologize for sending patients out of country for treatment. “I think it’s about assuring ourselves that, from time to time when we lack that subspecialty expertise here in Ontario, we avail ourselves of that for Ontarians where that might be found south of the border.”

Both the NDP and the PC’s criticized the government’s management of alternatives to hospital care.

Former PC Health Critic Elizabeth Witmer was critical about wait lists for long term care beds expanding. “We’re now in the third year of the four-year aging-at-home strategy,” she said. “The wait-list for long-term-care beds is increasing, and there is no community care support. Today, there are 26,000 people waiting for a long-term-care bed. Compare that to 12,000 in 2005.”

NDP Health Critic France Gelinas challenged the government to end competitive bidding and fix the home care system. “Right now, the Sudbury Regional Hospital has 89 beds occupied by alternate-level-of-care-ALC-patients,” she said. “Meanwhile, six patients are stuck in the emergency department because they can’t find a bed for them. Many of the people who are now ALC patients could have been safely looked after at home if we had a robust home care system.”

The lack of resources by CCACs to carry out the job was echoed by PC MPP Sylvia Jones: “I’ve heard from a personal support worker in my riding who was told that the local community care access centre ran out of money in February and has not accepted any new clients, and will not accept any new clients until the new fiscal begins. Why are these workers being told that taking on new clients who need care simply isn’t in the budget?”

Matthews attacked the Tory record in long term care while avoiding any issues related to competitive bidding in home care. She reiterated the funding record for CCACs.

The NDP’s Peter Kormos made a statement in the house about incontinent products, arguing that many seniors on fixed incomes could not afford up to $3,000 a year for these products.

“If you lived down in Niagara, you’d know Jack O’Neil of Port Colborne.” said Kormos. “He has been writing to the Minister of Health since 2004 asking for funding to assist seniors with incontinence products. There is still no funding through OHIP, assistive devices or even Trillium, and there was no mention of it in the throne speech.”