Defend Public Healthcare

The massive cut in the number of hospital beds in Ontario in the 1990s is, by now, well known. Community and labour movement campaigns over the last fifteen years stopped the decline in the  number of beds, but the push for cuts is relentless.  Hospital beds per capita have continued to decline right up until the most recent data reported. Moreover, Ontario remains a low capacity outlier -- with far fewer beds per capita than other provinces.   This chart excludes Neonatal ICU beds and bassinets.  CIHI does not report data, in this case, for Quebec. This Canadian Institute for Health Information (CIHI) chart (above) shows a 6.9% decline in hospital beds per capita from 2009/10 to 2018/19 .   Ontario had fewer beds than any other province reported per capita.  The next lowest (Alberta) had 12.2% more beds in 2018-19 . There was even a decline in the absolute number of Ontario ICU, Obstetric, Pediatric, and Complex Continuing Care ("LTC") beds, with th...

I was surprised to see that Ontario has fewer acute care beds per capita than any country in the    Organization for Economic Cooperation and Development  (OECD) so I went back and looked at the total number of hospital beds per capita (i.e. not just acute care beds, but also other sorts of hospital beds:  rehabilitation, complex continuing care, and psychiatric beds).   The results, however, are much the same.    Figures in the new  health care report from the  OECD  indicate that the average number of hospital beds per capita of its 34 member countries averaged 5.14 beds per 1,000 population in 2008.   Canada is a member of the OECD and it has an average well below the OECD rate: 3.3 beds per thousand population in 2008, the last year the OECD reports for Canada.  That's about 64% of the 2008 OECD average.  The OECD average went up a little in 2009  to 5.3 beds per thousand:  compared to that, the C...

OPSEU has announced that after eight days of bargaining with the Ontario Hospital Association (OHA) for their central paramedical bargaining group, they are now preparing to take unresolved issues to arbitration.  OPSEU notes that due to government policy, the OHA could not agree to any item put forward by the union if there was a cost attached to it.  Some other modest issues have been settled.   Arbitration dates have been set for June 11-12, with employer and union responses to submissions to be completed by June 28. By agreement, the arbitration panel chaired by William Kaplan will issue its decision by mid-September 2011, i.e. before the fall provincial election. The bargaining process is still continuing between the hospitals and the Ontario Nurses Association.  ONA has completed four days of mediation with the Ontario Hospital Association, meeting on March 8, 15, 16 and 17, 2011 for its Registered Nurses group.  The parties ha...

The 2010 Budget continues the government’s spending on corporate tax cuts, with a reduction in the rate from 14% to 12% this year and 10% next year. The Small Business tax is lowered to 4.5% and the Small Business surtax is eliminated. Here is the government’s comment on this in its media release 3 June 2010 : TAX CUTS FOR BUSINESS Starting July 1, 2010, the government will be providing tax cuts totalling more than $4.6 billion over three years for large and small businesses: • The general Corporate Income Tax (CIT) rate will be lowered from 14 per cent to 12 per cent and then to 10 per cent over three years; • The Corporate Income Tax rate on income from manufacturing and processing, mining, logging, farming and fishing will be lowered from 12 per cent to 10 per cent; • The small business Corporate Income Tax rate will be cut from 5.5 per cent to 4.5 per cent; • The small business deduction surtax of 4.25 per cent will be eliminated. • These tax cuts are in addition to the m...

Health care in Ontario is efficient compared to other provinces, and efficient public hospitals are the main way this has been achieved. • Provincial government health care spending in 2010 is $173 per capita less than the other provinces • All of this (and more) is accounted for by spending less per capita than other provinces on hospitals. Ontario spends $262 less per capita than the other provinces. In total that is a saving of $3.5 billion for all of Ontario. • The gap between what Ontario spends and what other provinces spend has increased every year since 2005 when the difference was only $86 per capita. • In contrast with hospital funding, Ontario spends more per capita than any other province on physicians: $192 more per capita than the other provinces. The gap between what Ontario spends and what other provinces spend has grown since 2005 when it was only $126 more in Ontario. • Ontario also spends more per capita on drugs, even a little more than Quebec which ...

The Ontario Hospital Association (OHA) has just released a fairly interesting report entitled The Changing Face of Ontario Healthcare .   Here's what I draw from the report: Provincial government health care spending in 2010  is $173 per capita less in Ontario than other provinces.  That means $173 less for every person in the province for the year.  And that means a saving of $2.3 billion province-wide. All of this ( and more ) is accounted for by spending less per capita than other provinces on hospitals.  Ontario spends $262 less per capita than the other provinces.  In total that is a saving of $3.5 billion for all of Ontario. The gap between what Ontario spends and what other provinces spend has increased every year since 2005 when the difference was only $86 per capita. Unlike hospitals, Ontario spends more per capita than any other province on physicians: $192 more per capita than the other provinces. The gap between what Ontario sp...

The Toronto Sun reports that tomorrow the Ontario Auditor General Jim McCarter will release a follow-up to his  report on contracting-out by eHealth Ontario, a report that set out some pretty rotten contracting-out practices. The Auditor General told the Sun his office was asked to conduct spot audits on the use of consultants at the Ontario Ministry of Health, Local Health Integration Networks (LHINs) and hospitals. “We look at the procurement and oversight of consultants at the ministry,” McCarter said of his 30-page report. “We picked a few LHINs to have a look at and we went out to a number of hospitals to have a look at consultants’ procurement and use and ... (the report says) here’s what we found”. When the Auditor General's report on eHealth came out in October 2009, Toronto Star columnist Jim Coyle noted that the Auditor General had highlighted the near total reliance on outside consultants at e-Health. By 2008, the eHealth Program Branch had almost ...

The press secretary to Minister of Health Deb Matthews, said Friday the province is planning for a funding increase for the Hamilton Niagara Community Care Access Centre (CCAC) “in the very near future.”  The Hamilton Spectator   reported   just prior to this announcement that the CCAC was cutting home care services to deal with a deficit shaping up to be in the $10 to 12 million range this fiscal year. The government's increase for the CCAC however will only amount to$2.3 million, or 1%.  So the cuts, it seems are going to keep on coming. The increase for homecare (such as it is) is still 1% more than  earlier reports had suggested  -- and we are more than half way through the fiscal year.  But I don't think this announcement quite qualifies as a "step forward". The 1% is reportedly part of the province-wide increase for CCACs.  The (acting) boss of the "Hamilton Niagara Haldimand Brant ...

Yesterday, the Institute for  Clinical Evaluative Sciences (ICES -- funded by the Ontario Ministry of Health and LTC) released a detailed study on seniors health care entitled  Aging in Ontario .  The study reports a number of interesting results: The number of Ontario seniors aged 85 and older increased by 36% over six years (2002-3 through 2008-9), This is more than any other age group in the adult population.  There was also a 13.7% increase in seniors 65 and over. The number of acute care hospital beds per 100,000 Ontario seniors decreased (Quite significantly: from close to 1,000 beds to, perhaps, 850 beds -- D.A.). The number of "ALC patients" (i.e. patients in acute care beds who no longer need acute care services) waiting for a bed at an LTC home (i.e. a nursing home)  almost doubled between 2005/06 and 2008/09. Patients in hospitals waited 55 days in the last quarter of 2008/09 for admittance to an...

Competitive bidding is coming back. Or so it seems.  As of yesterday, the Ontario Association of CCACs had on their web site a link to a letter reporting that competitive bidding for home care services will come to four communities between October and December of 2010. As of today, however, the link to the letter is no longer to be found.  But while the link has disappeared, the web page still works. The letter, dated August 13, indicates these plans only reflect "the current planning  among CCACs and is dependent on the issue of MOHLTC Directives for CCAC procurement."  The Conservative Harris government introduced this model to home care in 1996: it requires Community Care Access Centres to contract out all home care services.  As a result, for profit corporations have taken over many of the home care services provided by nurses and personal support workers in the province.  There has been major pr...

Starting September 21, the Ontario Health Coalition  (OHC) is sponsoring summits in six cities around Ontario dealing with significant changes proposed for Ontario’s hospitals. The provincial government is moving towards a type of fee-for-service hospital funding (usually referred to by the government as "patient based funding", and by critics as "price based funding").   This is a potentially revolutionary change. The OHC notes that this funding system will encourage: - Major hospital restructuring and cuts - Centralization of services into fewer towns & pressure on the workforce - A host of new administrative costs - The end of community hospitals as we know them This system has already been tried in the United Kingdom. There, it resulted in: - Near-bankruptcies in large hospitals - ballooning administrative costs - instability - privatization - major cuts - demoralized staff - chaotic health planning and the undermining of t...

The province has announced $143.4 million more for its "Aging at Home" program.  That sounds like a pretty significant increase for a program scheduled to receive only $330 million this year.  An increase of over 50%.  Many in the media have picked this up and, with touching innocence, given the government a lot of positive PR.  Instead of cutting health care (as the critics keep saying) they really are doing something! However, this is just another way for the Local Health Integration Networks to fund hospitals, home care, nursing home services, community health services, etc., etc, etc.,  (i.e. just about any health care service you care to mention).  So the increase is  really more like a drop in the health care bucket.  Hospitals get about $15 billion in funding, while home care and nursing homes combined add about another $4.6 billion. So $143.4 million amounts to an increase of well less tha...

Local Liberal MPP Rick Bartolucci announced an extra $4.9 million for Sudbury Regional Hospital last week.  (The Liberal MPPs often seem to be able to free up their schedules for these cash announcements.)  In fact, most of the money ($4 million) is just the 1.5% base hospital funding increase that was announced five months ago in the provincial budget.  (Although there are now reports that some hospitals won't even get that.)   I have yet to hear anyone suggest that 1.5% will cover hospital inflation costs. So this isn't much of an announcement.  And the rest of the cash? Well there's some to make up for costs associated with last year's H1N1 epidemic ($60,000 -- whoppee) and $500,000 to cover extra operating costs associated with moving into a new facility.  More encouragingly, there was $400,000 for new neurosurgical procedures. We are now five months into the  province's fiscal year, and...

A couple of pics from the recent OCHU / CUPE Local 2875 rally to stop bed cuts at the Queensway Carleton Hospital in Ottawa. It was a great day. (And thanks for the pics to Louis and Local 1974 at Kingston General!)  Also -- the People's Healthcare Coalition, has collected more than 5,000 signatures calling for an investigation into what led to the decision to close the emergency rooms at Port Colborne and Fort Erie hospitals in Niagara. "We've had tremendous support so far," Coalition representative Pat Scholfield said, noting she collected several hundred signatures at the Market Square Friday morning. "Our goal is Queen's Park".

As reported a few days ago, the Ontario government (quietly and) retroactively, revised the 2009-10 budget deficit downwards another $2 billion when it released the Public Accounts.  And as reported way back on July 12 (before any public mention of the current consultations with unions on a compensation freeze), Finance Minister Dwight Duncan had predicted that the 2009-10 deficit would decrease. But he also predicted  that the 2010-11 deficit estimate would be revised downwards too. “If you're starting off with a smaller deficit for the year ended, presumably if you follow the plan we've laid out, then the numbers will improve down the line — assuming no cataclysmic or unanticipated event”. While the revision for the 2009-10 deficit has now happened, the revision for the 2010-11 deficit has not.  Or at least not yet.  The deficit is now forecast to be higher this year (when the economy is growing) than it was last year (when the economy ...

The City of Port Colborne passed a motion Monday night to seek legal advice on legal actions it might take  regarding the shutdown of the local hospital's emergency room, the Tribune reports . "We have made the move to seek that legal advice and take the appropriate steps," said Mayor Vance Badawey.  Barbara Butters, a councillor for Ward 4 in Port Colbourne was even franker:  "Do whatever it takes to make sure these charges get laid because there's no way those SOBs should be getting away with this," Butters said as citizens cheered from the public gallery.  Municipalities are playing are bigger role defending local hospital services. Good on them!

Of the provincial deficit and Dwight Duncan, the provincial Finance Minister, the Toronto Star suggests that the “spectre of looming shortfalls … helps bolster Duncan’s case for a planned wage freeze for more than 1 million public servants, including nurses, teachers and bureaucrats.” Well, that argument is weakening. The Public Accounts for the province have now come out for 2009-10 and the deficit is a lot smaller than Finance Minister Dwight Duncan and the Liberal government forecast. In fact, another $2 billion was lopped off the provincial deficit. The Liberal government also reduced its deficit estimated by $3.4 billion the day before the March provincial budget. That makes the 2009-10 deficit $5.4 billion less than the Liberals had estimated it to be half way through the year. (When I see discrepancies this size, it does make me wonder if I've put too much faith in Finance Ministry forecasts.) In any case, the government will not get one-tenth of...

The Cornwall Standard Freeholder reports that the Association of Municipalities of Ontario (AMO) has established at its annual conference a committee with representatives of municipalities from all over Ontario to deal with the shortage of beds for long-term health care patients and lobby the provincial government for help.  (This sounds connected to some work by municipalities at the AMO conference reported earlier.) Cornwall mayor Bob Kilger said the AMO is putting a document together to incorporate feedback from municipalities all across the province with similar problems. Then the committee will meet with stakeholders, such as hospital officials and government representatives. Councillor Sid Gardiner added the committee should make  progress as it puts pressure on the provincial government with the weight of 90% of Ontario municipalities. Meanwhile the cuts continue.  After the closure of the adult diabetes clinic at the Northumberland Hills Hospital ...

The provincial government Estimates (a document where the government lays out in some detail how it intends to spend the money in the provincial Budget) indicates that health care 'provincial programs' are going up $943,146,400 this year compared to last year.  (Line item 1412 .)  Just shy of a billion dollars. Now that's a whopper of an increase: a 37.5% increase in fact ! While the provincial government is giving its own 'provincial programs' a massive increase, the LHINs (the main funder of hospitals, home care, and long term care) will be getting a miserly 1.5% increase. In fact the total increase for the LHINs, $322 million, is about a third of the $943 million increase for the (much smaller) 'provincial programs' budget. A cynic might suspect the government is giving itself a free hand to make funding announcements, while the LHINs are stuck with the job of telling hospitals, homes, and home care providers that 'There's no money, ther...

Health care slashers and right-wingers are beginning to understand the pickle they are in over the falling faith in the the LHINs, the Liberal government's instrument of choice to cut health care services.  Here's the conclusion of today's Ottawa Citizen editorial : With an aging population and rising health-care budgets,it is difficult to imagine a year in which every health network in the province doesn't face some very tough decisions involving a region's crucial health-care services. Without public trust, those decisions will be much harder, if not impossible. Which is why Marin's (the Ombudsman) findings are crucial. Indeed, LHIN imposed cuts will be harder now that the LHINs have been discredited.  (What a pity!)  But this won't stop those cuts. And here's another troubling thought.  If the LHINs are becoming blunt instruments,  another instrument may be introduced to make the cuts down the road.  In other provinces the tr...