Ontario health care conundrum: Reduce deficits or end hallway healthcare
Ontario’s goal of ending the infamous hallway healthcare and reducing budget deficit may not be viable despite a slew of cuts, the province’s financial watchdog said in a report released on May 27.
The provincial government slashed its health care funding growth to 1.8 per cent, the second time in 40 years, the report released by the Financial Accountability Office said.
Among the cuts was a move to reduce to 10 from 35 the number of public health units, which offer disease prevention and healthy living programs such as vaccinations, flu clinics and nutrition programs.
In addition, funding for mental health programs was stripped by 63 per cent, while spending on health policy and research saw a drop of $52 million from last year.
The government also plans to end health care for out-of-country travelers, who previously received coverage of $400 for inpatient services and up to $200 per day for any other level of care.
However, Paul Barker, associate professor of political science at Western University, said such cuts won’t have a significant impact.
“When you compare it with other expenses such as hospital expenditures, such expenditures were miniscule in the first place,” Barker said.
Additionally, overtime and premium rates offered to the workforce will be axed along with the introduction of a more stringent attendance management program.
The savings from these cuts would be offset by spending on alternate levels of care, the report said.
The budget allotted funds to create 15,000 new long term care beds and upgrading an existing 15,000 beds at a cost of $1.8 billion, in addition to an increase in spending for Community Care by $257 million.
According to a report published by Health Quality Ontario, 4,000 hospital beds of the province’s 31,000 were occupied by patients who were waiting to be treated elsewhere, half of which were awaiting long-term care placement and one-quarter requested for a publicly funded home care.
This, the report said, created a scarcity of hospital beds which led to a huge number of patients to be treated in non-traditional spaces such as hallways.
In addition, the daily cost of occupying long-term care or home-spaces is $150 and $40 respectively, significantly lower than a hospital bed in Ontario at $650.
This is why one of the main objectives of the budget was to end hallway healthcare by investing in ALC.
Barker said he commends the government’s decision.
“I applaud the government to some extent for its allocation towards community care, because it seems to me that someone is thinking that we need to shift away from institutional care towards home care and other community care services,” Barker said.
Questions about viability
However, FAO’s report raised questions about the viability of achieving both objectives: reducing the deficit while annihilating hallway healthcare.
“It is not clear whether targeting spending to the long-term care homes, community programs and health capital program areas, while restricting base hospital operating funding growth to less than one per cent, will allow the Province to achieve its objective to end hallway health care,” the report said.
Barker said it will be difficult but he sees this happening.
“The hospital spending growth is 1.3 per cent which is under the inflation rate and is a good thing. So it can be offset. I see this happening,” Barker said.
Another significant change outlined in the health care budget was the integration of six autonomous health agencies — Cancer Care Ontario, eHealth Ontario, HealthForceOntario, Health Shared Services Ontario, Health Quality Ontario, and Trillium Gift of Life NetworK — into one health care system.
The agency will be responsible for planning and delivering provincial health care, managing health care system performance and quality of care, as well as performing system oversight.
Ontario projects the integration of these agencies would result in administration savings of approximately $350 million annually by 2021, the report said.
This would also see the inception of Ontario Health Teams — groups of health care providers and organizations that are clinically and fiscally accountable for delivering care to a defined geographic population.
The goal of this model is to package the care provided by primary care providers, acute care providers (hospitals), long-term care, community care and mental health and addictions services.
A single Ontario Health Team will comprise these various providers that will share patient information and coordinate the care of a specific patient population.
However, the report raised questions about the method used to calculate savings and reach the $350 million figure outlined in their budget.
The report said the government did not mention how the government will save the funds through the Ontario Health Team.
“There are simply smaller versions of local integration networks. I don’t think they would make cost savings since they would have administration costs,” Barker said.
However, he said it is possible. “Given that it is in the budget they could be left with no option but to make do with it.”
He said this was the biggest challenge of health care.
“The main thing is to manage healthcare systems and at the same time not compromising on the quality,” he said. “This is, in my opinion, the biggest challenge that the government faces.”