Defend Public Healthcare

The Ford government re-released its spring Budget this week with a new first quarter fiscal and economic update  providing a little bit more information -- albeit from a government with a track record for wildly inaccurate Budget plans.    The increases in spending announced (e.g. for people with disabilities on a fixed income) are so insignificant in the scheme of things that they can be handled within government contingencies.  Overall program spending is still exactly as planned in April.  Total spending , which also includes the debt expense, is up a modest $105 million due to higher interest rates. As a result, the total spending plan is up by five one hundreths of one percent (0.05%).  They are not even writing down their $1 billion reserve by a few kopeks.  With increased revenues, the deficit is planned to be $1.1 billion lower and the debt to GDP ratio is also planned to be a full percent lower.  Keeping with the new health minister's (preposterous) claim that there is n

The long term fiscal and economic outlook released this week by Ontario's Financial Accountability Office (FAO) shows that big increases in health care spending are required in the years ahead.   The FAO forecasts that provincial government spending on health care will increase from an average of 6.4% of gross domestic product (GDP) to 7.6% for years 2024 through 2031. It will then go to 8.3% in the 2030s and 9.1% in the 2040s. An increase from 6.4% of GDP to 9.1% is a big increase in health care's share of economic activity.   A key factor driving this is an aging population.  Older people need more health care. For the current decade (2020-30), the FAO forecasts provincial health care spending increases at 5% per year:   A key take away from this is that the health care workforce will need to expand.  The staff shortages that currently bedevil health care are going to get worse if there is not a concerted effort to recruit and retain health care staff by making health care a

With as much fanfare as it could muster, the Ford PC government re-announced its Budget plan of $300 million for hospitals to deal with the backlog of surgeries and procedures caused by the COVID-19 shut down of hospital services.  Despite the (attempted) fanfare, the Financial Accountability Office (FAO) has reported that the government’s budgeted plan for dealing with the backlog will fall hundreds of millions of dollars short of what is required to clear the COVID-19 backlog over three and a half years . The government says it is not working with the FAO estimates (indeed) and declined to make an estimate of how long it would take to deal with the backlog. The government did, however, state that it will “closely monitor” surgical outputs and wait times and will “implement additional measures if needed”. The government claims the funding will enable hospitals to operate at 110-115% capacity. Operating room hours will be extended into the evening and weekends.  That's a lot

Ontario's Financial Accountability Office (FAO) reports that the nominal health care funding increases planned by the Ford PC goverment between 2019/20 to 2029-30 fall well short of the nominal increases over the previous nine years (2010/11-2019/20, the period of public sector austerity that followed the last recession). Indeed, as the increase planned on a go-forward basis (between this year, 2021-22, and 2029/30) amounts to only 2% annually , we are looking at significantly harsher austerity than the 2010/11-2019/20 period , where funding increased 3.2% annually. As the FAO notes, the health care austerity imposed over 2010-20 "included a number of significant spending restraint measures, including: freezing base operating funding for hospitals from 2012-13 to 2015-16; reducing physician payment rates in 2013 and 2015; and limiting investments in new long-term care beds, with only 611 new beds created between 2011 and 2018."   This time around the plan is to impose h

The pandemic led to a brief reprieve from the austerity that has bedevilled Ontario hospital care since the great recession. After decades of being on par with other provinces, hospital funding fell far behind the rest of Canada. At the start of the pandemic the Ontario government was obsessed with the lack of capacity in Ontario hospitals, tragically compounding the crowding in long-term care by ordering hospitals to discharge patients to long-term care.  Despite the mass death in long-term care, very few sick or dying resients were transferred for treatment in hospital. They died in their homes.   But the government also moved to increase hospital funding in 2020-21 -- increasing it by more than ever before. That new money is temporary, however.   Cuts are coming: The government established a budgeting system in 2020-21 which would see much of the COVID-related funding budgeted under special funds distinct from the normal ministry line items. So, much of the increased funding for th

In the 2019/20 Ontario budget health care was budgeted at $59.97 billion.  That was subsequently increased by over $450 million to $60.42 billion, mostly through Supplementary Estimates late in the fiscal year. The Financial Accountability Office (FAO) now reports (based on current, but not yet final figures) that actual health care spending was  $59.96 billion – in other words, $466 million less than the revised health care budget.  So, despite increasing the health care budget by $453 million late in   the fiscal year, the government s pent $13 million less than it first budgeted.  That is about a 0.8% reduction compared with the revised budget plan.  It's a little hard to take Ford's protestations that he has no money for pandemic pay, and won't pay for more time to care, when he spends $466 million less on health care than he budgeted. One area with lower than  projected expenditures was the line item for local health agencies.  This is odd as public health is rather

Ontario’s third quarter finances came out yesterday.  They confirm that although planned health care funding has increased $404.1 million since the 2019/20 Budget, no further increase has been achieved since November's Ontario Economic Outlook and Fiscal Review.  While the lack of new progress since the fall is disappointing, the $404.1 million is a 0.64% funding increase   for health care since the Budget.  Total health care funding for 2019/20 is now planned to increase 3.1% since 2018/19. Also notable: Total revenue is projected to be $157.2 billion in 2019–20, $3.1 billion higher than the 2019 Budget projection and $1.68 billion higher than expected in the fall 2019 Ontario Economic Outlook and Fiscal Review. Program expenses are $2.45 billion higher than in the 2019/20 Budget . The total increase for the year compared to last year is $3.9 billion (so far).  So, in the Budget, program funding was increased 0.91%, while, since then, program fundin

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, unidentified and 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 unidentifie

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 goal   is to cut $250 million annually through such changes by 2021-22. This is squarely aimed at hourly paid employees. Ma nagers 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 i t will be especially hard to harvest such amounts from  contracted , for-profit corporations (

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