12/22/11

Hospital closures on the Drummond agenda?

The Toronto Star reports that the Drummond Commission is looking at the Saskatchewan hospital closures of the 1990s as a model of reform, with the support of the Minister of Finance, funding hawk Dwight Duncan.

Next month, the treasurer will get some political cover from a commission engineering a massive overhaul of Ontario government services, headed by influential economist Don Drummond. Health care is at the top of the hit list.
After working on two recent studies of health-care inefficiencies, Drummond's reform agenda is no secret: reintegrating the system; and reallocating more money to health promotion, community care, home care and long-term care....
They are also looking at a far more painful and protracted restraint exercise, one that gets relatively little attention: In the early 1990s, Saskatchewan's new NDP government faced a financial reckoning when credit rating agencies started downgrading the province's debt. Then-premier Roy Romanow resolved to close 52 hospitals and reopen them as well-being centres offering community-based care. He ignited a firestorm.
Drummond has looked closely at the Saskatchewan experiment because it comes closest to a sustained transformation of government finances.
It's a lesson Duncan has also heeded. The treasurer has taken to telling his fellow Liberals in caucus and cabinet that the prairie New Democrats pioneered an ambitious reform model - and provide an example of how good government can be rewarded by voters in the next election.

Why they might think the two models are comparable is unclear.  The 52 small hospitals closed in Saskatchewan in the 1990s are nothing like the hospitals in Ontario.  In total, Ontario has 155 hospital corporations operating 211 hospital sites for a population of 13 million.  As many cities have multiple hospital sites, we probably have hospitals in about 190 towns and cities.

If Saskatchewan had the same number of hospitals per capita, it would only have 12 or 13 hospital corporations with about 16 hospital sites in 15 towns.

But the story in Saskatchewan is completely different.  Even now (may years after the 52 closures) there are hospitals in 40 towns spread around the province.

If Ontario had the same number per capita, we would have hospitals in 520 towns.    We would need to open up hospitals in another 330 towns to get to Saskatchewan's level of service.  

Moreover, Drummond and Duncan have the tricky business of explaining why they want to follow a hospital model that costs about 20% more per capita than Ontario's system does.   

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