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PC Government Plans Many More Health Care Cuts

The Financial Accountability Office (FAO) Budget and Economic review has identified planned government spending savings that come via [1] announced program changes (program cuts like the government’s cut to OHIP+), [2] announced efficiency targets (identified areas where the government hopes it will find savings without service cuts), and [3] cuts that have not yet been announced by the government.
While the government has identified some spending cuts of type 1 or 2 above, the government’s spending plan needs billions of dollars in extra, unidentifiedand unannounced cuts to meet its savings targets according to the FAO (type 3 cuts, as above). For health care, this amounts to $5.2 billion in unidentified and unannounced cost savings needed for the government’s health spending plan to work in 2023-24.  Even though the cuts identified to date have been major and painful, $5.2 billion is many times more than the cuts announced and implemented to date. [1]
The unidentified and unannounced …
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Ford Plans to Cut Health Care Worker Benefits by $250 million

Attack on health care worker benefits: The Ontario Ford government has specifically targeted in the Budget health care worker compensation  through cuts in premium payments (e.g. shift payments), overtime, and sick leave. "Improving" scheduling is also part of the plan.  The stated goalis to cut $250 million annually through such changes by 2021-22.

This is squarely aimed at hourly paid employees. Managers don't get overtime and premium payments, and they are not likely to be targeted by attendance management programs or scheduling "improvements". 

With about half a million hourly paid employees working in health care a $250 million cut would mean about a cut of about $500 per employee per year.  

The Ford government claims in the Budget that this will have "no impact on patient care or front-line staff."

In fact, a $500 cut may be low -- as it will be especially hard to harvest such amounts from contracted, for-profit corporations (e.g. in home care).  T…

Health Care Funding Means Cuts are Coming (and its Armageddon for other programs)

The group that will do the best out of the recent provincial Budget are the doctors.  According to the just released Budget Estimates, OHIP funding (which  goes overwhelmingly to physicians and practitioners) will go up $1.2 billion or 8% compared to last year's Estimates. 

(Note -- this is a little different, and less accurate, than the comparisons with last year's interim amounts reported in the 2019 Budget and used elsewhere in this note.  It is the only comparison publicly available for OHIP as of the moment, however. The Financial Accountability Office has suggested that the actual OHIP spend last year would be less than in the Estimates by several hundred million. So the actual increase this year may be larger than $1.2 billion. We will know for sure when the Public Accounts finalize the books for 2018-19 in September.)  

This large increase is likely due to the February 2019 interest arbitration award for doctors, an award that was praised as "fair" by Christine…

3000 more hospital beds? Rhetoric falls short of realty with Doug Ford's government

Soon after the Budget, the government announced they would spend $27 billion on hospital infrastructure over ten years and create 3,000 more hospital beds.

For a moment, it may have seemed that we had prized a small victory from the Ford government.  The movement did, after all, force them to run on a promise of ending hospital hallway healthcare, and squeezed out a bit more in-year funding for hospitals last fall.  

Unfortunately, as with so much from this government, the rhetoric does not match the reality.  Here's why this is much less than it might appear on first blush.
[1] While the government promises to “create” 3,000 more beds over ten years, they do not promise that the hospitals will operate 3,000 more beds than they currently do. There is no promise to increase hospital bed capacity.

There isn't even a promise to have 3,000 more spaces for beds.  As our hospitals are aging, spaces for some existing beds will no longer be usable in ten years. Will they be replaced?  The…

Are health care administrative expenses out of control in Ontario?

The Progressive Conservative government has justified its health restructuring plans with the claim that administrative expenses are much higher in Ontario than in Canada. 
When introducing the reforms, health minister Christine Elliott claimed, “Over the last five years, Ontario has spent 30% more than the Canadian average in administrative expenses on its health care system.”  
Elliott did not indicate her source of information. Presumably, however, the Progressive Conservatives are referring to the CIHI simplified and user friendly “Your Health System” graphs. Those graphs show “administrative expenses” in Ontario at 5.8% in Ontario while it is 4.5% in Canada.  
This CIHI measure is actually fairly narrowly defined. It is the percentage of “the legal entity’s” total expenses associated with the administrative, finance, human resources and communications functional centres.
However “the legal entity” used for this estimate is [1] only for certain types of health care providers, and [2] …

Very low hospital capacity in Ontario

A key result of low hospital funding (discussed in the previous post) is that Ontario has fewer beds than the rest of Canada and far fewer beds than other developed countries.

The rest of Canada has 27.4% more beds per capita than Ontario (i.e. a difference very similar to the funding difference with the rest of Canada).
If Ontario had the same beds per capita as in the rest of Canada, we would have 39,385 beds.That is an 8,489 extra beds.
In Windsor that would mean an additional 137 beds at Windsor Regional (500 beds reported x 27.4% = 137), 71 beds at Hotel Dieu, and 16 at Erie Shores for a total of 224 in Essex.
The 35 (mostly) rich nations in the OECD average 4.7 hospital beds per 1000 population.If Ontario had that level of capacity that would mean 66,347 hospital beds in Ontario, more than double the current number.For the three Essex hospitals, that would mean an additional 937 beds.[1]
What does this mean for Ontario? Bed occupancy is very high in Ontario as a result of the lack of…

Under-funding of Ontario hospitals and health care

Hospitals typically benchmark against each other to determine care levels and efficiency.But when Ontario hospitals are bench marked against hospitals in other provinces, a pattern clearly emerges – under-funding and under-capacity.  This post will loo at under-funding, a later one will look at under-capacity

Provincial hospital funding per-capita is 28.3% higher in the rest of Canada than in Ontario — $404.09 more per person per year.

The gap between Ontario and the rest of Canada is a relatively new phenomenon. For decades we were in lock-step with the rest of Canada.We have fallen far behind since 2006.
Provincial health care funding as a whole is 14% higher per person in the rest of Canada compared to Ontario.That amounts to $561.08 higher per person, per year.The gap in overall health care funding between Ontario and the rest of Canada developed at the same time as the gap for hospital funding developed.Hospital under-funding accounts for almost three-quarters of health care under-…