Ontario confirmed in its Throne speech what has been rumour for the past week – that funding for hospitals and other health service providers will dramatically change.
Most of the speculation hangs on the government’s commitment that “money will follow the patient,” suggesting hospitals could be competing either for patients or procedures – or possibly both.
The Globe and Mail suggested this morning that the McGuinty government will be adopting a Health Based Allocation Model (HBAM), which diverts more money to hospitals in regions with high levels of population growth and/or aging.
The HBAM would also reward hospitals that are more efficient – this despite the fact that the communities served by these hospitals have little influence on the day-to-day operations of those hospitals. That means communities could find themselves rewarded or punished based on the activities of hospital boards they have no democratic control over.
“It’s hugely controversial because there could be winners and losers,” confirmed a hospital executive who asked not to be named by the newspaper.
For days the Toronto Star has suggested this funding could follow the path of competition based on cost to deliver services, leaving significant geographic gaps in care.
Tom Closson, speaking to the Sarnia Observer, said a model where hospitals compete to deliver in-patient services won’t work for small and rural hospitals. He suggested the Star’s story was a “reporter’s fantasy.”
However, the province is already paying set prices for a select number of hospital procedures, including cataract surgery ($625/procedure) hip and knee replacements ($8,930/procedure), CT scans ($250/hour) and MRIs ($260/hr). It is likely that some procedures will be subject to bidding by hospitals.
In the Throne speech the government suggested that patients will have a greater choice about where they can access the best quality treatment. This follows a similar movement in Britain in which patients were, by legislation, to be given at least four elective care providers, one of which was private. Not only did this open care up to privatization, but there have been suggestions that it actually boosted wait times when larger numbers of hospitals were offered as choices.
If competition for patients is introduced, one thing is for sure – hospitals will spend more marketing themselves – potentially driving up costs. Not only does marketing drive patients into a specific hospital, but it has the potential to drive up overall use of the health system.
In the Throne speech the government also plans to take another run at bringing down drug prices. Faced with opposition from the drug companies in 2006, the Ontario government weakened its last attempt to achieve significant savings through volume discounts for all drugs purchased for the Ontario Drug Benefit Program.
The government has also said in intends to open the Public Hospitals Act and introduce legislation to create a hospital system that taps into the expertise of community partners and all health care professionals. One suggestion is that the McGuinty government plans to expand the roster of medical advisory committees beyond just doctors, or perhaps introduce quality committees.
Opening the Act could pose other threats. With so many hospitals losing key services, it may be tempting to redefine what a hospital is under the Act.
Despite accountability agreements, the government promises further legislation to make health service providers and their executives more accountable. The CBC has reported that could include adjustment executive bonuses based on health outcomes.
Other health care commitments include:
• An independent, expert advisory body to provide recommendations on clinical practice guidelines;
• More input into the planning of francophone health services;
• Ontario will work with the public and private sectors to develop a strategy to promote better health for children.
The Throne speech says the government will engage Ontarians directly in the conversation about changes to the health system.
OPSEU Diablogue 