Tag Archives: Health Care Funding

New jobs prohibited by one-time funding

Some good news and some bad news.

The good news is many health care providers in the Central East LHIN (and likely others) will receive substantial increases in funding, some for the first time since 2011/12.

The bad news is that this will only last for a little over two months more. Then the funding levels go back to where they were before.

Here’s the kicker – all this additional service has to be done without hiring any new staff. That’s because new hires represent a commitment beyond March 31st. That’s a no-no in one-time funding.

The government does this every year resulting in a sudden influx of cash to select targeted programs, and then suddenly it all dries up again.

The Ministry routinely comes up with pockets of one-time cash given to the LHINs on short notice. For example, December 16th the Ministry made available $8 million in one-time funding to support the Health Action Plan’s “Assess and Restore” policy. That policy aims to focus on preventative programs for seniors. The LHINs each had until December 20 to figure out how to spend that money – just four days.

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Election 2011: Funding restraint ahead for health care

In 2011-12 health care represents an expenditure of $47.1 billion on a $124 billion annual budget – an increase of $2.1 billion over 2010-11.

No matter which party gets elected, we can expect annual increases substantially below $2 billion. This will add considerable stress to the existing system. Any promise of new investments should be seen in this context. This may also be the reason why candidates have been so reluctant to talk about health care.

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Tax cuts or health care?

During the leader’s election debate September 27 NDP Leader Andrea Horwath repeated the phrase “blank cheque” when it came to corporate taxes.

The NDP want to roll back recent corporate tax cuts to 14 per cent. The Tories and Liberals favour a 10 per cent rate.

The NDP argue that nothing has been required of corporations for the tax cuts.

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LHINs – Funding in a time of scarcity

This spring’s provincial budget set aside a three per cent base funding increase for community-based health care agencies this year. That doesn’t mean Community Care Access Centres, Canadian Mental Health Association branches or other local agencies will necessarily receive that amount.

The dilemma for the Local Health Integration Networks is whether to pass on an across–the-board increase that amounts to less than this spring’s Consumer Price Index, or whether to split that modest increase to address specific problems within the regional health care system? Do you make the situation worse for some agencies by slashing their funding increase to improve the situation for high-priority agencies faced with significant challenges? Either way, you know somebody is going to be unhappy. Worst still, does the absence of adequate funding for some agencies show up in new unforeseen challenges for next year?

The Central East LHIN passed a motion today that effectively cleaved the across-the-board funding increase in half – to 1.5 per cent – while using the remaining funds to address some serious problems within the LHIN. For those receiving only the 1.5 per cent, they will be in good company with the hospitals, most of whom will receive a similar base increase for a second year in a row.

 What is important to stress is that these are base increases, not total increases.

As we have seen with the hospitals, while the base was 1.5 per cent, many hospitals increased their bottom line by more than 4 per cent last year thanks to a variety of budget envelopes and increases in own-source revenues. For some agencies, particularly the very small ones, 1.5 per cent could turn out to be the total they do receive. James Meloche, a Senior Director with the CE LHIN, said 1.5 per cent could amount to as little as $900 for some agencies.

The 1.5 per cent the LHIN is reallocating is not a huge amount – about $5 million to support a population of 1.4 million, or about 11 per cent of Ontario’s population.  That’s about $3.50 per resident. This is on a provincial health budget of $47 billion.

While Don Drummond hammers away at unsustainable costs, there are no huge funding increases here at the health care coalface.

Clearly the region has a capacity problem, particularly when it comes to placing seniors into care following a hospital stay.

The LHIN has decided that it will address the problem by targeting the problem further upstream. By providing improved supports in the home, the LHIN hopes to avoid the arrival of seniors in the region’s already crowded emergency departments. Keeping people healthy is far more likely to be a winning strategy.

That does not necessarily mean more money for the CCAC – in fact, even with an allocation of almost half the available money, the CCAC will receive slightly less than the three per cent.

The LHIN is betting that more assisted living – including home making and falls prevention, among other services – will help keep seniors healthier in their homes and avoid hospital admissions.

The Oshawa/Whitby area will also be targeted, particularly for increased support for mental health and addictions. With a struggling economy, the communities have been hard hit by the recession, a situation that is putting pressure on health care providers.

“Clearly we have an issue at Lakeridge Health,” said Meloche. “People live in the park and they come to the emergency department for care.”

Fortunately one of the few mental health agencies in Ontario that will receive patients with concurrent addictions problems is already in the Oshawa community.  While several years ago Pinewood/Destiny Manor faced closure from a Ministry that wanted the hospital to cut unfunded mental health services, the service is now considered a major asset for the LHIN.

The LHIN is also trying to take some of the pressure off the Northeast part of its region by providing about $259,000 to establish a rural-based palliative care team.

While these are the priorities of the Central East LHIN, it does not necessarily mean that other LHINs will treat the funding in this manner.

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The Central East LHIN used their “Urgent Priority Funding” to increase the volume of MRIs available in the region.  Senior Director Paul Barker pointed out that while the government was generously funding new MRI machines in the region, the actual funding for scans had gone down. The LHIN is tapping into this fund to provide $285,327 to buy 1,096 more MRI hours. Most hospitals can conduct about 1.5 scans per hour. The average wait for an MRI scan in the LHIN was 77 days as of July. One board member asked how it was Ontario hospitals could perform MRI scans for $260 an hour when they were charging $1600 for the same service in the United States. Barker pointed out that it may have something to do with the free market and profit-taking.

 As part of its planned to establish an umbrella organization to coordinate specialized geriatric services, the LHIN named the Northumberland Hills Hospital the “host agency.” A small secretariat will be set up at the hospital to work on a strategy to better deliver services to frail seniors. The immediate task will be to hire a project manager, recruit staff, establish office space and work on governance issues. The LHIN had found service providers, seniors and their families were largely unaware of what services were available in the LHIN. 2,100 seniors account for a third of all acute spending on seniors in the LHIN.  By focusing on the needs of this population, it could have a substantial impact on the overall use of acute care services in the LHIN.

NDP platform takes on dysfunctional home care system

Ontario NDP leader Andrea Horwath recently told the media she would not be revealing the NDP platform all at once, but the party web site does already contain a comprehensive platform.

The platform includes four major headings –  Making Life Affordable; Creating and Protecting Jobs; Building Healthcare That Works For You; and Living Within Our Means.

The NDP is the only party to commit to taking on the dysfunctional home care system which the most conservative estimates suggest 30 per cent of costs are tied up with administration surrounding the competitive bidding. The NDP would conduct a review of home care with the goal of bringing back a publicly-owned and accountable system. They would also target funding to increase the supply of home care by a million hours within four years.

The NDP see fixing home care as part of unlocking the puzzle of patients stuck in hospital waiting for community-based care. They also plan to add long term care (LTC) beds to eliminate the 2,650 Ontarians presently on the wait list. A recent OHA survey did suggest there were alternate level of care patients waiting for home care, although the majority – 61 per cent – were waiting for LTC. Patients in ALC beds were also waiting for rehab, complex continuing care, palliative care, convalescent care, assisted living/supportive housing as well as placement in mental health care.

The NDP would also add 50 round-the-clock health care clinics to alleviate emergency wait times. The goal would be to increase alternative options to cut hospital emergency department wait times in half.

The NDP commits to bringing more health services back under public OHIP coverage, including the elimination of ambulance fees.

The platform includes a hard cap on CEO salaries, limiting compensation to twice the Premier’s salary. They make the point that it would still compensate CEOs at seven times the level of a nurse. The NDP would also crack down on the use of outside consultants.

An NDP government would also forgive student debt to new doctors willing to locate in underserved areas with the goal of adding 200 doctors over four years to these communities.

The party would make drug costs a priority in any negotiations with the Federal government around a new health accord.

The NDP would open up hospitals to the scrutiny of the ombudsman – something Andre Marin has been asking for in his annual reports.

Like the Tories the NDP would scrap the Local Health Integration Networks (LHINs), however, unlike the Tories, they pledge to replace them with some undetermined form of local decision-making.

No platform would be complete without a promise around prevention, and the NDP do that with a pledge to make mandatory physical education in post-secondary schools, ban junk food advertising to children and force large chain restaurants to label calorie counts.

Liberal think tank salutes Harris era health care cuts

The McGuinty government established the Mowat Centre in 2010 with $5 million in seed money, but they may want to ask for their money back after Will Falk’s op/ed last weekend in the Toronto Star. Falk, an “executive researcher in residence” at the Mowat, suggests Mike Harris got it right when he restrained funding for health care, leading to hospital closures, reductions in beds, compensation restraint and cuts to medical school spaces. He even appears to commend Bob Rae for starting it off with his Rae Days (ignoring the fact that it ended up costing hospitals more to pay for overtime to cover the missing ‘Rae Days’ personnel).

Quick to cast off the perception that such ideas may paint him as a neo-Con, Falk points out that straight-line Malthusian projections of gloom and doom seldom work out that way. He indicates that studies by the Fraser Institute and the C.D.Howe ignore the level of growth in health care spending the previous decade averaged 0.9 per cent and represented real declines when compared to the size of the economy.

He might have added that Don Drummond, the McGuinty government poster boy for change, also uses such deceiving straight-line projections.

Falk argues that rising health care costs are a self-fulfilling prophecy – that if you provide increases of six per cent per year, health care will spend six per cent per year. He says Canadians need government to bend the cost curve, not fund it.

To be fair, Falk is not advocating more of the same – the obvious end game of such activity would be a demolished health system. You can’t cut beds forever – especially when hospitals are already functioning at capacity. Nor can you expect professionals to continue working without a raise. He instead makes the vague suggestion that technology and IT will save us. Give him points for audacity, but it doesn’t seem to be grounded in evidence.

If you stop funding health care, there is no question that we could be over the tipping point long before technology comes riding in on a shining white horse to save us all.

Falk may think we’re beyond the need for such cuts, but starving the health care system could start us down the same draconian path again.

Even Don Drummond acknowledges that the slash and burn approach by the Harris Tories took some time to recover from – and may account for some of the spending in the ensuing years. When it comes to deferring health care costs, it’s a safe bet that those costs will be much higher at a later date.

Falk, like the Chicken Littles he criticizes, doesn’t make the distinction between public spending and total spending.

The charts accompanying his article appear to lack the most recent health spending data which shows spending already in decline relative to the size of our economy. By ignoring 2010 it looks like health spending took a sharp turn upwards as a percentage of our economy. In fact, it was a shrinking economy, not an upswing in health care costs that bent the curve upwards.

His expenditure chart has no adjustment for inflation. Any expenditure will look like a straight-line upward without adjustment. The notion that better management of health care could take us back to the days of national spending of $400 per capita is silly.

By extending his graphs over 35 years it also makes it difficult to notice that as a percentage of our overall economy, spending has been relatively static in this last decade of supposedly runaway spending.

Then again, if we simply recognized that, this whole new industry of scaring the wits out of Canadians would lose much of its mojo.