Defend Public Healthcare

Forget all the government Budget rhetoric about better home care.  The real winners are the docs. The Ontario Budget Estimates are out and  the line item primarily covering the doctors ("Ontario Health Insurance") is going up 2.9 per cent to $13.3 billion.   The rest of the health care sector got an increase of  0.3 %, just over one-tenth as much. In dollar terms, the Ontario Health Insurance line item got an increase of $374 million.  The total increase for all of health care (capital and operating expenses) is only $486 million , so this will eat up more than 3/4 of the total health care increase. A relatively small group of people are getting most of the total increase in health care spending -- and  about 10% of the total $3.6 billion increase in all provincial spending. Every $100 million split between 25,000 Ontario physicians means another $4,000 per physician, on average. The pathetic LHINs (which are the main funders of hospitals, home and community ca

Scarborough General Hospital. Photo by  Benson Kua While physicians and surgeons have not usually been at the forefront of campaigns against cutbacks, more of them have begun to express concerns about hospital cuts in Ontario. Here are three recent examples. with a different emphasis from each. At a Rotary Club meeting May 3, Dr. Robert Ting, president of the Medical Staff Association at the Scarborough Hospital, noted the issue isn't management, it's a lack of funding, and it's getting  worse. " The politicians, they can  criticize  the management and everything, but even if they had  the best  management in the world, they wouldn't be able to keep the hospitals open under this kind of scenario... This is just the tip of the iceberg, " Dr Ting warned .   The hospital is facing $19.6 million in cuts and more than 300 doctors have signed a petition decrying the cuts. In Perth-Smith Falls, the Lanark County Medical Society organized a well atte

Dr. Michael Rachlis , a well known expert on the health care system, suggests there is more to the recent deal the province hatched with the Ontario Medical Association than has been reported. He estimates that increased utilization and "fee drift" will mean an extra $200 million for doctors.   With about 24,000 full time (equivalent) doctors in the province, that works out to an extra $8,333 each.  That is small change compared to some of the income improvements the docs have achieved over the last decade, but it is pretty significant by anybody else's measure.   Certainly it's a lot better than what the McGuinty government is offering to the rest of us further on down the pecking order (see the McGuinty government's list of concessions demands for its own workers here ) . OCHU long ago flagged the mighty increases the doctors were getting from the McGuinty government, but this was only identified through a retrospective review of annual government Budget

A lot has been made about the announcement in the Ontario Health Action Plan that the Local Health Integration Networks (LHINs) would expand their role to include the doctors. But in the fine print, the government did not actually promise to hand over funding responsibilities for the family doctors to the LHINs. Au contraire, they specifically promised  that the government would continue to have a funding role for the doctors. The government only promised to 'integrate' family health care into the LHINs, and then mumbled something about identifying some model that brings planning and accountability "for the full patient journey" under the LHINs. Well, as the LHINs have done not too much planning for any health sector, this may not amount to much.  The LHINS most powerful tool has been money.  The government has kept the major portion of the new health care cash for itself and passed on only scraps for the LHINs to dish out to the hospitals and other health sect

The new Ontario Health  Action Plan puts a lot of emphasis on primary care.  Changing the way the doctors practice in order to divert patients from hospitals seems to be a major goal.   But how is the government going to do this? It's unlikely the doctors will agree to change their practices simply to keep the government happy. In the past we have seen a lot of efforts by the Liberal government to change primary care practices. The establishment of Family Health Teams (FHTs) come to mind.  But a recent study indicates the doctors who made the switch to FHTs saw WHOPPING big increases in their incomes. And certainly government funding for the docs has gone, way, way up.   Negotiations between the doctors and the Ontario government are upcoming.  The Health Minister recently suggested to the Ottawa Citizen editorial board that the doctors will take zeroes. We will see if that is the whole story, or just for the fee schedule. 

According to the newly released  Budget Estimates , the provincial government plans to increase OHIP spending (basically, spending on doctors) by $652 million over the current estimate of last year's spending.  That's a 5.3% increase.  Since 2009-10 (two years ago) the increase is $1.35 billion, or 11.5%.   A pretty hefty increase, continuing the generous increases in OHIP spending over the last number of years. For many years, the drug companies also did well through provincial government spending increases.  This year, the government plans to increase drug spending 4.6%  ($165 million) over the current estimate for last year. This is only modestly higher than the overall budgeted health care increase of 4.24%. Moreover, with a cut in drug spending in 2010-11, drug spending will still be $40 million less than it was two years ago in 2009-10.

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 spends and what other provinces spend

With most of the focus on squeezing hospital budgets, it's good to see that some others are beginning to pick up on the rapid increase in public spending on drugs and doctors, a point OCHU has been making for some time.  Following the release of a health care spending report from the Canadian Institute for Health Information (CIHI) even Toronto's national newspaper (of the Establishment), the Globe and Mail, has raised concerns: Public spending on physicians has become the fastest-growing expense to Canada’s health-care system, a trend sparking growing calls for an overhaul to the payment system for doctors. The findings are contained in a new report released Thursday by the Canadian Institute for Health Information, which also found drug costs are eating up an increasing portion of Canada’s health-care budget. The report provides a stark glimpse of the future of Canada’s health-care system in a world where recessionary forces are squeezing hospital budgets but demand from

Leftwords reported last week that some Ontario doctors got a big raise through the McGuinty government's 'wait times' strategy (a funding system that CUPE has long opposed as it opens the door to privatization and contracting out work from hospitals). This brings to mind that ANOTHER McGuinty government initiative that has ALSO driven up doctor incomes. The government has been pushing "Family Health Teams" (FHTs) since 2004. While doctors run the FHTs, the FHTs employ a range of health care employees and take on a broad range of health care services, some well beyond family doctor services, including services until now done in hospitals.     As usual, this government is trying to take more work out of our hospitals. With last month's announcement of another 30 new Family Health Teams the total number of FHTs is now 200.  When these new FHTs become operational, 3,000,000 people will receive health services through them (an average of 15,000 patients p

The Globe and Mail is raising concerns in its lead news story today about rapidly increasing payments to physicians.  OCHU/CUPE had raised similar concerns several months ago, uncovering a 57.6% funding increase for doctors between 2004-5 and 2009-10. Notably, the Globe also ties the rapid increase to the development of wait time funding by the Ontario government.  OCHU / CUPE has also raised concerns about wait time funding as it is a form of price-based funding that opens the door to privatization and a market for health care. Judging from the Globe's account, the market has resulted in handsome increases for some doctors, with 259 now billing over $1 million annually. One group of docs that have benefited in particular is the opthamologists who do cataract surgeries through the wait times programs (sometimes at clinics like the new Kensington Eye Clinic in Toronto rather than at hospitals).  The Globe notes that health-care experts say the fee structure for doctors h