Hospital restructuring picks up (but very quietly)

Community pressures to preserve small hospitals: Local opposition to hospital cuts has driven Prince Edward County residents to demand that their local hospital be allowed to break away from the multi-site Quinte Health corporation.

This is becoming a more common community demand as small hospitals trapped inside much larger multi-site hospital corporations are particularly vulnerable to cuts. At worst, their ongoing viability is threatened.

As expected, there is no appetite for such proposals at the mother house. Health Minister Deb Matthews has written back declaring that "de-amalgamation" is not under consideration (while, at least, also offering assurances that the government is committed to all sites in the Quinte Healthcare Corporation.)

Government pressures to merge: Indeed, the direction of the government is very much in the opposite direction. The Central East LHIN has just announced that two large hospitals, Rouge Valley and Scarborough, will proceed with stakeholder engagement to determine the benefits of a merger. A report is due in October.

Scarborough Hospital Board member Lyn McDonell told the Scarborough Mirror, "We felt strongly that merger seemed to be the (option) that had the most potential."

Scarborough Hospital president Robert Biron added that as the province forces hospitals into “a more competitive model” those in Scarborough need a way to “obtain our fair share”. “We’re much better positioned if we do that together.”

Complex Continuing Care and Rehabilitation on the down slide: Small hospital cuts continue elsewhere, with 15 complex continuing care beds reported to go in Ingersol and Tillsonburg.

This is part of a broader trend in Ontario hospitals where fewer complex continuing care and rehabilitation patients are being treated (even while the overall number of patient cases is increasing, due to increases in other areas of care).

In the most recent year reported, Ontario hospitals provide 53,963 fewer "weighted cases" of complex continuing care and rehabilitation compared to two years earlier. That is a reduction of 2.9% -- or 360 fewer weighted cases per hospital.

More on the changes in the nature of hospital services in a future post.

Photo: Tim Suess

Deficit? Public spending ain't the cause. Revenue, however...

With the election over, pressure to cut public programs has become quite intense. In almost all of the corporate owned media someone is barking on about it.

Another option -- increasing revenue from corporations and the wealthy is not mentioned. However, data clearly indicates that Ontario does not have an overspending problem compared to the other provinces.

Instead, it indicates Ontario has very low revenue.
Ontario has the lowest public spending of all the provinces on a per capita basis (see the chart from the 2014 Ontario Budget below). So there is little reason to suspect that we have an over-spending problem. If anything, this suggests we have an under-spending problem.

The Ontario government has also now reported in the 2014 Budget that Ontario has the lowest revenue per capita of any province. This is particularly notable as other provinces are quite a bit poorer than Ontario and therefore have a much more limited ability to pay for public spending. (Also notable in this…

Budget underwhelms on health care. Bait and Switch is such a nasty term

Last year the government promised a 4.64% health care funding increase in 2018/19. Then, earlier this month, they announced they would deficit spend to improve hospitals, mental health, home care, and child care. Three of the four items cited by the government for improvement were part of health care.

As it turned out the government did in fact promise in today's Budget to deficit spend $6.7 billion. (Due to a $1 billion fall in expected revenue, the extra spend amounts only to an extra $5.7 billion for 2018/19 programs – but that is still a significant chunk of new found cash for program spending.)
If health care had gotten even a proportionate share of this new $5.7 billion in program spending, it would have added an additional $2.4 billion to health care -- in other words about another 4% increase.

But all health care got -- despite the government’s health care rhetoric -- was an extra $284 million. That may sound like a lot but with a total health care spend of $61 bill…

Ford government promise falls far short of solving hospital hallway medicine problem

Tens of thousands of new Long-Term Care (LTC) beds needed just to offset aging
The new Progressive Conservative government in Ontario has promised 30,000 new long-term care beds over the next ten years, often connecting this to their promise to end hospital hallway medicine. But how does this promise stack up with growing demand for these facilities?
Most people 85 and older live in collective dwellings (LTC facilities, seniors residences, multiple level of care facilities). The setting with the largest number of elders 85 and older is LTC facilities, with about 35% of the population 85 to 89 years old and almost 40% of the population 90 to 94 years. Older people are even more likely to be in a LTC facility.
The population 85 and older is the main driver of the need for long-term care beds.
An additional thirty thousand LTC beds by 2028 will only partially offset the rapid growth in the 85+ population. The ministry of finance projects 42.5% growth in the most relevant population (85 a…

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