OPSEU Diablogue

“Generally speaking, staff satisfaction in our sector is bad,” says Rob Devitt, CEO of the Toronto East General Hospital. Speaking at a Longwood’s Breakfast with the Chiefs forum November 23^rd, Devitt and Dr. Josh Tepper, Assistant Deputy Minister (HealthForce Ontario) were invited to address the issue of healthy work environments, from policy to practice.

While winning a Great Places To Work Award, Devitt said when comparing against bad it’s easy to look good. He said that when his hospital looked at leading private sector employers who had taken the award, they were shocked at how poorly they stacked up.

 Devitt said while there isn’t always agreement, “organized labour has a lot of good ideas.”

The CEO highlighted the turnaround at his own hospital, including quarterly staff satisfaction surveys, conducting threat assessments, establishing an on-site gym and wellness center for staff, and developing a mental health wellness strategy.

Devitt says he is resisting every temptation to cut these programs in difficult economic times given the results, which include measured increases in productivity and reduced sickness and lost time.

“There’s such an important and wonderful focus on patient safety and quality of care,” Tepper told the forum. “I would argue the healthy work environment  — the well-being of our front line care providers is the flip side of the same coin. You cannot truly have a quality agenda for patient-centered care without have a healthy work environment strategy.”

 This forum is available on video at http://www.longwoods.com/audio-video

The Canadian Institute for Health Information has recently updated its National Health Expenditure Trends (1975-2010).

It’s the first time we are able to look at actual numbers for 2008.

Here’s some highlights that may surprise you:

The United States actually spends more than Canada on public health care as a percentage of the size of the economy. Canada spent 7.3 per cent of GDP on public health care, the U.S. 7.4 per cent. In other words, if the US adopted Canada’s model of health care, it is currently spending enough to cover all of its citizens. Canada is 10th out of 26 select countries in public health care spending. When private spending is included, Canada is ranked 6th out of 26.

Our current annual growth rate likely reflects the need to catch-up from the period of 1991 to 1996, when government restraint reduced the average annual growth rate to less than one percent. From 1996 to 2008 reinvestment in the health system took the annual growth rate to 3.6 per cent per year. From 1975 to 1991 annual growth was 2.6 per cent. All measurements are in constant 1997 dollars.

Is health care spending out of control? According to CIHI, the real rates of increase after adjusting for inflation are expected to be 1.6 per cent in 2009 and 1.4 per cent in 2010. In 2008 real growth was 3.3 per cent.

Ontario spends more on private health care than any other province. 32.6 cents of every health dollar is spent privately, compared to 22.1 cent in Newfoundland or 22.7 cents in Saskatchewan.

Hospitals continue to decline as a share of health expenditures. In the mid-1970s hospitals represented about 45 per cent of total health expenditure and 56 per cent of provincial expenditure. In 2008 Canadians spent 28.7% of total health expenditures on hospitals. It is expected to dip slightly to 28.6 per cent in 2009 and come back up to 28.9 per cent in 2010.

Total per capita health expenditures – public and private – in Canada was $5,154 in 2008. It is forecast to grow to $5,397 in 2009 and $5,614 in 2010.

More to come!

Dr. Michael Rachlis has got a great story to illustrate the folly of the current hysteria around health care spending. He talks about a family where one of two sons has died. The remaining son is told the family can no longer afford to feed him because he now takes up 33 per cent of the family’s food, compared to 25 per cent of the food when his brother was alive.

Rachlis told an Ottawa meeting of NUPGE’s Canadian Health Professional Secretariat November 25th that public health care spending is only slightly higher than its previous peak in 1992. When the economy shrinks in a recession, health care appears to consume much more as a percentage of that economy. Like the surviving son, it has little to do with increased costs and much to do with the economy it exists within.

As Canada recovers from the recession, already health care spending is decreasing as a share of the economy.

However, there is more to the story than the ups and downs of the Canadian economy.

Since 2000, taxes have been cut by 5.3 per cent of the size of the Canadian economy. That means there is $85 billion less available each year for all public services, including health care. “What if you only cut taxes by half that amount?” he asks. “Imagine what we could with $40 billion more each year?”

Rachlis has heard the stories of how health care is taking money away from poverty reduction, housing and other important social objectives. While health care is continually accused of “eating everybody else’s lunch,” he says, the actual facts tell a different story. Health care spending has slightly increased its share of provincial program spending since the late 1990s. This is mainly due to cuts in other areas rather than increases in health care spending. In the past eight years health care has remained relatively static as a percentage of provincial program spending across Canada. This is contrary to government-led hysteria that suggests 70-80 cents of every health care dollar will soon be consumed by health care spending.

While the United States continues to stand out for its high health care costs, Canada’s spending is comparable to other wealthy nations. Spending in France, Switzerland, Germany and Austria is slightly more than Canada’s. Belgium, Portugal, Netherlands, New Zealand, Denmark and Sweden are slightly less.

Rachlis says we should be proud of Medicare and its principles – but the job is yet complete. Tommy Douglas warned that the second phase would be much more difficult to implement.

“We should acknowledge that there are problems with Medicare,” Rachlis says, “but these problems are because it has never been fully implemented.”

Few Canadians know that the original vision of Medicare went well beyond public payment for the old system. The original vision of Medicare included new ways of delivering care.

Models based on group practice and integration of public health care have been shown also to be cost-effective.

Rachlis says Canadians still believe strongly in Medicare. “We believe strongly all Canadians share access to health care.”

He says immigrants tell him that they chose to come to Canada because of Medicare.

This graph shows public spending has gone from 6% of GDP to just over 8% in 30 years. The last upturn reflects the shrinking of the economy in the latest recession, not a large increase in spending. The dotted line shows where spending would trend had the growth in the economy remained stable -- below 8%. This is hardly the image of health care spending out of control. The level of growth has been particularly flat during the last decade.

Canadian provincial program spending as a percentage of GDP. Public spending on health care has been relatively flat for 30 years. Declines in non-health care expenditures owe more to the impact of tax cuts that increases in health care spending.

Long thought to have more generous social programs, Canadians have historically spent more of their economy on public services than Americans. In 2009 Canadians and Americans spent about the same percentage of their economy on government services.