7/30/10

Centralizing control over hospitals. Ontario brings the market to hospital funding and turns it into a PR opportunity

Well, we found out a little bit more about where the government's hospital funding is going with the announcement of $100 million for 'payment for results' funding yesterday. 

And it pretty much summed up what's wrong with this approach.

First: unlike global funding (set at a mighty 1.5% or less) this funding is centrally controlled.  Local hospitals have to spend it as directed by the central government, whatever local needs actually are.  

Second: the government (and local Liberal MPPs) primarily see these announcements as a media opportunity, parading it to the media as their latest accomplishment.  If you keep everybody guessing where the money is going and when it is coming, you can always manufacture a media story.  Think of a manipulative and stingy Santa Claus. 

Moreover, this model favours whatever item is politically expedient at the moment.  How can the government get headlines?  So much for a rational process focused on human needs.

Third: The model moves us further from a cooperative, collaborative system, and towards a market-based, competitive, non-system.  Although the government's preferred name is 'payment for results' a more accurate name might be 'price based funding' or 'fee for service'.  More and more, the hospitals will have to compete for this sort of  funding as more and more funding goes this way.

It's hard to create an integrated system when hospitals have to compete with each other, or with other providers. It's hard to even have a real 'system'.  This takes us closer to the US model. With all of its glorious success and efficiency (JK, man, JK!). 

It is good to see that the government's PR plans didn't always work out so smoothly yesterday.   A news story Roy Brady of the Peterborough Health Coalition sent me this morning led with this:   "Even with almost $1 million in hand to reduce emergency room wait times at Peterborough Regional Health Centre, Peterborough MPP Jeff Leal faced heckling and criticism Thursday over layoffs and bed cuts taking place to balance the hospital's budget....Leal faced sarcastic laughter from the crowd when he began the announcement by defending the government's support of health care in Peterborough."

So how much more money is still to come?  Good question.  Here's my estimate.  Hospital funding is supposed to go up 4.9% this year (some say 4.7%).  Global funding increases are supposed to be 1.5%.  The $100 million announced yesterday is worth about 0.7%.  So, apparently, we are still awaiting word on how the government plans to spend another 2.5% to 2.7%.

That's about $360 to $390 million.  Definitely not chicken feed.  (And that is assuming local communities do not force the government to revise their hospital spending estimate upward this fall as the hospitals face rack and ruin.)
 
The Niagara Health System (a hospital) got $49 million extra last year.  So my advice to local communities: get your dibs in.


Thoughts? I'd love to hear them -- dallan@cupe.ca

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