Former Saskatchewan Premier Roy Romanow calls them tepid.
Finance Minister Jim Flaherty is saying no means no.
There is likely more frustration at Victoria’s Premiers’ meeting this week than among the coaching staff of the wilting Toronto Maple Leafs.
The Premiers first arrived after discovering the Federal government had unilaterally decided on what the funding side of the next health care accord would look like.
It is very possible Canadians are confused about what the Premiers want from the federal-provincial meetings taking place this week in Victoria, BC.
A lot of it has to do with language and meaning.
For example, some provinces are saying they want the new federal-provincial health accord linked to innovation.
Posted in Health System
Tagged Health Accord, Health care privatization, Premier's Meeting
While we await release of the 400 or so recommendations of the Drummond Commission, its likely important to remember that Dwight Duncan is the finance minister of the province of Ontario, not Don Drummond.
Recent commentary has suggested the McGuinty government will likely use the Drummond Commission on public service reform as a means of lowering expectations before bringing in a budget that offers what the Premier described in last fall’s election as a more “steady hand.”
That doesn’t mean there won’t be significant pain for health care – we are already witnessing eyebrow raising cuts, including Monday’s revelation that $66 million in research grants to hospitals and universities have been eliminated. The impact will be much larger given research grants are usually collaboratively funded between different levels of government and the private sector. The Council of Academic Hospitals of Ontario – representing 24 teaching hospitals – estimates the real impact to be “potentially over $360 million.”
Saskatoon health policy consultant Steven Lewis agrees with NDP leader Andrea Horwath that there needs to be a cap on Ontario hospital CEO salaries.
While calling the issue mostly symbolic – he says the income of hospital CEOs barely covers Frank Stonach’s tip money – Lewis asserts that most CEOs are not motivated by the pay rate. Nor is there any evidence that CEOs are leaving for megabucks jobs in the private sector. Given hospital CEOs make far more than their counterparts in the public service, why shouldn’t there be a reasonable cap?
To read Lewis’ essay on the Longwood’s site, click here.
We’ve long been used to the Canadian Medical Association politically advocating on behalf of the nearly 60,000 doctors they represent.
It shouldn’t therefore be surprising that the Canadian Psychiatric Association has decided to go public in its criticism of the Harper government crime bill. Some say its about time.
The CPA says the Harper’s “get tough on crime” agenda may impact people with mental illness disproportionately, adding to their present over representation with the criminal justice system.
Posted in Health System, Mental Health
The media have been on a feeding frenzy today around Tuesday’s disclosure of hospital executive compensation packages. Like the sunshine list, it is a chance for the private sector to paint a picture about how the public sector has been wining and dining on the taxes of the downtrodden, even if it is less than true.
The real story is there are really no big revelations here.
The most shocking example we found appears to be the work of sloppy reporting rather than executive excess.
The Toronto Star reported that Dr. Robert Howard, CEO of St. Michael’s Hospital, was receiving “a $75,000 allowance for a car.” This would lead most people to believe Howard was getting $75,000 each year to apply to a lease or purchase of a vehicle. In fact, had the reporters been a bit more careful, they might have figured out that it was for a lease or equivalent for a car whose retail value was up to $75,000. Nice, but at this level, ho-hum.
Less than a week before Christmas Federal Finance Minister Jim Flaherty marched into a luncheon meeting of his provincial counterparts and told them what the Federal contribution to health care funding would be to 2024.
“They just landed this on the table over the lunch hour,” Manitoba’s finance minister told the Globe and Mail. “It caught us all by surprise.”
The “take it or leave it” deal includes:
Diablogue is about to take a hiatus to finish out 2011. With more than 400 postings, you may want to check out some of the stories from the last 24 months. Or you may want take advantage of the festive atmosphere and take a break with us.
Next year promises to be a challenging one with the potential for major change in health care:
We’ll be here providing news, comment, analysis, and debate starting in January. We hope you’ll be here too!
Posted in Health System
The government speaks regularly about moving services out of hospitals and into community-based care, including nursing homes and home care.
They tell us that it is not only more cost-effective, but it is preferred by patients.
So what is the deal with holding the line on CCACs and nursing home beds at a time when the hospitals are being placed under extreme pressure to move alternate level of care patients into the community?
The latest conflict is in Windsor, where the LHIN has refused to give the Community Care Access Centre a waiver to run a $5.2 million deficit.
The CCAC is arguing demand is on the rise and patients will be stranded in hospital if they are unable to provide home care services. Just yesterday Windsor Regional Hospital CEO David Musyj was urging patients to go elsewhere in the anticipated post-Christmas rise in demand for ER services.
No home care. No hospital care. People in the Windsor area must be truly wondering about the direction of their health care.
The CCAC says the overall increase in home care patients is rising by 1,000 to 1,500 per year in Erie St. Clair, and coming out of hospital sooner, these patients are more costly to serve. The cost of the CCACs end-of-life program is rising by 11 per cent per year.
The CCAC is also facing more demand because of delay in the building of a planned 256 bed long-term care home at St. Clair College. They say that delay is costing them $3 million annually.
The LHIN is willing to help out with a one-time grant of $1.5 million while they “study” the needs of the CCAC. In an unusually frank retort, CCAC Executive Director Betty Kutcha told the Windsor Star that “in my view, they’ve got a $1.5 million solution, so they’re trying to fit our problem into that.”
We are hearing that the Home First program – an initiative where hospitals are supposed to discharge patients home to wait for long-term care placement – is increasing overall community referrals to the CCACs by 10 per cent or more. This is a significant strain on their budgets.
Even the Auditor General of Ontario was skeptical in his summer report of the government’s plans to reduce the rate of growth in hospital spending based on service from home care and long-term care where the level of restraint is expected to be even more severe.
When the Health Restructuring Commission of the late 1990s made its recommendations around the transfer of mental health services to community-based agencies, they were adamant that no beds should close until community-based resources were established. The government cut the beds, didn’t provide anywhere near adequate service in the community, and left us with a system that has been the subject of one report after another calling for better.
Are we to repeat the experience as the government pushes hospitals to discharge patients before adequate community resources are put in place?
Seems we never learn.
The threshold for CEOs receiving pay-for-performance bonuses in Ontario hospitals can be very low. Today’s panel report commissioned by the Ontario Hospital Association suggests some hospital CEOs receive bonuses on targets that are set below existing performance levels.
In other words, a hospital’s performance can decline and the CEO can still get his or her bonus.
The report – put together by executives from the public and private sector – calls Ontario hospital CEO compensation reasonable at a median of $266,000 annually, but suggests there are inconsistencies particularly among mid-size hospitals.
During the last election the NDP had called for a cap on hospital CEO salaries at twice the salary of the Premier: $418,000 per year. The report indicates 25 per cent of Ontario hospital CEOs make more than twice the compensation of the Premier.
The report says hospital CEO salaries are slightly less than university presidents – its nearest comparator. They do not compare hospital CEOs to provincial deputy ministers, who have a compensation guideline of about $220,000 a year.
This spring the provincial budget called upon hospital CEOs to reduce their executive office budgets by 10 per cent over two years. However, as reported in this BLOG, the Ministry later clarified that this did not necessarily mean a reduction in executive salaries, that clerical and support staff could be laid off instead.
Did this occur? The report is coy in stating that “to date there have been no legislative provisions to support this action.”
The report puts hospital CEO salaries in the bottom 25 per cent of private sector executive salaries. They recommend private sector compensation be used as a future benchmark even though there is broad consensus that corporate executive salaries have been rising at an unsustainable rate. Last year average CEO compensation in Canada’s top 100 corporations rose an average of 13 per cent. Does that mean hospital CEOs should have a similar raise as long as they remain in the bottom 25 per cent?
The report also indicates that what we are seeing in the sunshine reports may not entirely reflect the whole story. For example, some CEOs receive a SERP – a supplemental employee retirement pension plan. Four Ontario hospital CEOs receive SERPs that are over and above contributions to HOOP – the Hospitals of Ontario Pension Plan. Others receive a SERP in lieu of HOOP. Public contributions to a SERP – which is fixed benefit plan – can range from below $50,000 to above $200,000 a year. Hospitals are not required to report SERPs as benefits in the sunshine list.
The report says total individual CEO compensation should be made public. The sunshine list can often distort the real story given CEOs can start or leave midway through a year, the reported compensation can contain retroactive or severance pay, and not all benefits are included (such as the SERPs).
While Ontario legislated a pay-for-performance component to CEO compensation, some hospitals have made it an insignificant amount – as low as 2 per cent. The report states: “hospitals that introduced pay-for-performance in response to Bill 46 have struggled to identify performance expectations and to introduce performance-based compensation while at the same time complying with a two-year salary freeze for non-union employees.” The report says a number of hospitals have set “unambitious quality improvement targets” as part of this scheme.
While hospital CEOs have long told rank and file staff to suck it up with regards to austerity, the report indicates that changes in compensation practices appear to have “hurt morale” and made it more difficult to attract qualified senior managers.
Yet the background of existing CEOs suggests that only 40 per cent had previous experience as a CEO, most coming up the ranks. Only 47 per cent of hospital CEOs have clinical education credentials and just one has a PhD in management education. Slightly more than half – 55 per cent – have a master’s degree in management education.
Other recommendations from the panel include the use of a standard hospital executive compensation framework and template, pay-for-performance bonuses set at between 10-30 per cent of base compensation, standardized severance agreements, and enhanced training for boards in executive compensation issues.
The panel believes that CEO compensation should still rest with the hospital boards.
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