Category Archives: Hospitals

Hamilton Health Sciences is the latest hospital to begin cuts to services in anticipation of underfunding from the province. In a memo distributed on Wednesday, CEO Murray Martin said notifications would go out next week to affected staff along with offers of early retirement. Matthews indicated to staff that costs were rising by 4 per cent while the best case scenario was for a 2 per cent funding increase from the province. That means a shortfall of $17-$35 million on the hospital’s $1 billion budget. “Because we are already a very lean organization, operating in the most efficient way possible, any further savings we implement will, at this point, affect services,” Martin wrote. Across the city, St. Joseph’s is expected to cut $7-$13 million from its budget to make ends meet. Ontario hospitals have been told to plan three scenarios – a funding freeze, a one per cent increase and a two per cent increase. When contacted by the Hamilton Spectator, Health Minister Deborah Matthews said she couldn’t say whether or not hospitals have a chance of getting a base increase of more than two per cent. “We’re very much in the planning stages right now,” she told the newspaper. 

Have your say!

 OPSEU has set up a web site where you can quickly assemble an original e-mail to your MPP about the proposed funding freeze. Choose from a series of points and add in your own original thoughts. The site allows you to copy the letter to the premier, health minister and two opposition health critics. Go to www.avoidingzero.ca

Hospitals continue to decline as a share of Canada’s health care spending according to recent data from the Canadian Institute for Health Information (CIHI). In 1975 hospitals accounted for 44.7 per cent of Canada’s health care spending. In 2008 CIHI estimates hospitals will represent 28 per cent of health spending – a drop of 2.7 per cent from 1998. The biggest increase in health spending has been on drugs, which now take up a greater share (17.4%) than physicians (13.4%). In 2008, spending on drugs was expected to grow by 8.3 per cent, compared to 5.8 per cent for hospitals and 6.2 per cent for physicians.

By Warren (Smokey) Thomas
OPSEU President

The peer review of Peterborough’s new hospital is the latest review by the Local Health Integration Network (LHIN) that will likely ignore the central problem – there isn’t enough funding for the hospital and supporting community services.

 This territory has been covered before – and recently.

Last year the Central East LHIN sent in an expert team to look at how the Peterborough Regional Health Centre (PRHC) could reduce the number of patients occupying so-called “alternate level of care beds.” By definition, these patients have completed their acute care treatment but are unable to leave their beds for a variety of reasons, including wait lists for home care and a significant shortage of nursing home beds.

The review found Peterborough was serving a much older population than the rest of the province and by extension, enduring additional cost. In Ontario 12.9 per cent of the population is over the age of 65 years. In Peterborough City and County, that percentage jumps to 18.5 per cent. In Haliburton Highlands, almost one quarter of residents are seniors.

In addition, Peterborough serves a regional function, providing specialty services that cannot be offered at a ring of smaller hospitals, including Haliburton Highlands, Ross Memorial, Northumberland Hills, and Campbellford Memorial.

During the 1990’s, the Health Restructuring Commission recommended a target of 100 long term care beds for every 1000 people over the age of 75. That would translate to 1,750 long term care home beds in the Peterborough region. Today there are currently only 1,111 beds – just 62 percent of the recommended number. These beds are operating at 99 per cent capacity.

These factors all suggest that Peterborough Regional Health Centre is being asked to take on much more relative to its size, yet its funding is considerably lower than comparable hospitals of the same size.

For example, the new Brampton Civic hospital was built at the same time as the PRHC. It opened with fewer beds than Peterborough, yet receives almost $30 million more in annual operating funds.

This situation has been compounded by province-wide funding levels that have remained below the costs hospitals are facing through inflation, population growth, aging, competitive wage settlements and spirally drug and equipment costs.

Last year most hospitals needed between 3.5 and 4 per cent to simply stand still. They received 2.1 per cent from the province. This year the province is threatening to freeze funding. If real costs go up by an estimated 3 per cent, that means Peterborough will be additionally short-changed by about $6 million.

Last year’s review found Peterborough Regional Health Centre was already doing a lot of things right.  Many of that committee’s final recommendations will require more investment in staffing, administration, and training. The report also recommended the creation of a 12-bed specialized geriatric behavioural support unit, an 18 bed interim long term care unit, and an out-patient follow-up clinic.

Is it any wonder PRHC can’t balance its budget?

Peterborough MPP Jeff Leal needs to stop making excuses and find the money Peterborough needs to fund its new hospital, build more long term care beds, and improve home care services.

Meanwhile the Peer Review committee would be well-advised to listen to the community. Given Peer Reviews constitute a committee of health care executives from outside the community; the LHIN should attach community representatives to the project.

Peterborough is too important to the LHIN to start cutting jobs and services at the hospital. Identified by the LHIN as one of two future cardiac care centres, Peterborough should be planning for future growth, not looking at ways of getting even smaller.

 This article was also submitted to the Peterborough Examiner.

Want to send MPP Jeff Leal an e-mail about the situation? Go to www.avoidingzero.ca

The Ontario government is considering ending provincial health payments for Vitamin D tests, according to a front page Globe and Mail story on Thursday.

While delisting is not new for the McGuinty government, of particular interest was the reporting of the costs.

According to the Globe, the cost of these tests done in a private laboratory is $52 compared to $32 when conducted in a hospital.

Yet increasingly the government is forcing hospitals to abandon community-based testing and send more work to three major private-sector for-profit laboratories.

This has always been an irrational policy given the private sector laboratories have always cost more and in most cases, take longer to turnaround results. The loss of payment for community volumes also affected the ability of hospitals to keep their labs better equipped and staffed.

After the fight to keep community testing at Muskoka Algonquin Healthcare in 2007, the government commissioned a study by RPO Consultants into a ten-year “pilot” in which 12 small hospitals were paid a fixed amount to do testing ordered from doctors in their community.

The envelope funding to the hospitals was initially calculated on expected volumes funded on 85 per cent of what OHIP normally pays to the private labs.

For the first seven years of the project the government did not give the hospitals any increase in this funding envelope despite significant increases in the number of tests some hospitals were being asked to perform. Volumes had increased by as much as 144 per cent during this freeze. The private labs were under no similar constraint.

The result has been an increasing spread between costs of performing tests in the hospitals and the cost of sending them to the private sector.

RPO reported that by the time of the study, it cost an average of $22 per community patient visit when the tests were conducted by the small hospitals, $33 when sent to the private labs – a difference of 50 per cent.

RPO tried to play down the difference, suggesting the hospitals were subsidizing their lab overhead costs from their global budgets – something the Ministry denied to us.

All hospitals consulted by RPO submitted briefs which touted the benefits of keeping the testing in-house. Two of the original 12 hospitals involved dropped out due to an inability to maintain increased volumes with static funding.

By conducting all testing in the hospitals, it allowed doctors to find all lab information in one place and avoid duplication. While the province plans to integrate lab information as part of its e-health initiative, no such integration has yet to take place.

Hospital also indicated that the community volumes allowed them to purchase new equipment, provide a wider scope of testing, and allow more hours of coverage.

In the end, RPO recommended the community volumes be given to the private sector, giving the flimsly excuse that the model didn’t work well within the structure of the Local Health Integration Networks. Hospitals are within the scope of the LHINs, private labs are not.

The impacts are already being felt. Muskoka Algonquin, the first hospital from the pilot to lose its community volumes, is proposing to eliminate its night shift from the lab and require a reduced number of ER nurses to conduct limited point of care testing.

If the province was serious about saving costs in health care, it would look at RPO again and realize incredible efficiencies could be realized by using assets we already have in our communities – the hospitals.