Defend Public Healthcare

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

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

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

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 ver

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 t

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. Source; Statistics Canada 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 p

Buried in this week's Financial Accountability Office (FAO) report on the Ontario government books is a very quiet admission that Ontario ran a surplus of $700 million in 2017/18 (when using the government's accounting method for pension surpluses and hydro).  Just a year ago, the FAO claimed there would be a deficit of $500 million. This $1.2 billion over-estimate is not surprising. The FAO has consistently cried wolf.   A year ago, they put the 2016/17 deficit at $2.8 billion  (when using the government's accounting methods) .   Now they put it at $1 billion with the same accounting methods.   Towards the end of the 2015/16 fiscal year they overestimated the deficit for that year by $3.3 billion to $5 billion more than they subsequently admitted.  Even after that fiscal year ended, they put it at $2.2 billion more than they later admitted. Now the FAO has changed its accounting methods (following the Auditor General) to claim a much higher deficit.  Accordingly it t