Budget will see tough decisions in health care

The province faces enormous budgetary demands from a multitude of health-care groups. Many will inevitably be disappointed.

Thestar.com
April 22, 2015
By Theresa Boyle

Ontario’s number of hospital beds per capita is among the lowest, not only in Canada but across the developed world.

The province makes no apologies for this. In fact, downsizing hospitals and diverting resources to home-, community- and long-term care - all cheaper alternatives - is central to the government’s strategy to transform the health system.

But selling the idea to the public is another matter.

Last Thursday, in the run-up to this week’s provincial budget, the Ontario Health Coalition held a news conference outside the Legislature to decry ongoing hospital cuts.

The coalition is one of more than 50 health stakeholders that have made oral or written pre-budget submissions to the province’s Standing Committee on Finance and Economic Affairs over the past three months. Most have come with hat in hand, making compelling arguments as to why their causes are deserving of more public dollars, as well as reform.

They warn that patients are being placed at risk and are increasingly forced to pay out of their own pockets for some services no longer available in hospital.

But every budget year, it gets harder for the province to meet the rapidly growing demands, fuelled by a growing and aging population. With a $10.9 billion deficit, the government is trying to squeeze more out of every health-care dollar. Tough decisions must be made.

On Thursday, when Finance Minister Charles Sousa tables his budget, we will learn which lobbying efforts were successful.

Ontario’s health budget currently stands at $50.1 billion. That represents 41.9 per cent of all program spending in the province and a 2.8 per cent increase over the previous year.

The increase in spending likely won’t increase much this year.

The Star went through the prebudget submissions, which give a good indication of where the biggest pressure points are in the health system.

The health coalition, which has for years been staging regulars protests over hospital cuts, has been among the province’s loudest critics.

For the last three years, base funding for hospitals has been frozen and is expected to be again in Thursday’s budget. (There have been targeted increases in funding to reduce wait times for surgical procedures and MRIs.)

Ontario has only 1.4 acute care hospital beds per 1,000 residents, the lowest level of all province’s except British Columbia, which has 1.3 beds per 1,000 population, according to the Canadian Institute for Health Information. (Nationally, there is an average of 1.7 beds per 1,000 population.)

On an international scale, Ontario has fewer beds than eight countries in the Organization for Economic Co-operation and Development that are comparable to Canada. The average for these countries, which include the United States and United Kingdom, is 3.4 beds per 1,000 residents.

The province sees this as a good thing and boasts that Ontario’s hospitals are among the most efficient in the developed world.

But the health coalition sees it differently. It keeps a rolling list of cuts, which include: Leamington District Memorial Hospital, which is planning to axe birthing and maternity services; Temiskaming Hospital, which is closing its operating room half the time, and Timmins and District Hospital, where 26 beds are slated to be closed.

“A significant portion of Ontario’s hospitals in larger communities are gridlock. This means the hospital’s beds are full. Surgeries have to be cancelled and there are no beds in which patients can recover,” the coalition warned in its submission.

It also says that people often have to pay out of pocket for services such as physiotherapy when they are moved out of hospitals.

Provincial New Democrats made an eleventh-hour appeal to stop hospital cuts on the eve of the budge.

“All of them are struggling to balance their budgets and they have no choice but to cut programs, services and positions,” she told the Legislature on Wednesday.

But on the other side of the debate are groups like the Canadian Medical Association, which not only supports the downsizing of hospitals but argue the pace should be picked up.

Hospitals are congested because there are too many seniors occupying beds while waiting for long-term care or home care, both of which are in short supply, says CMA president Dr. Chris Simpson, head of cardiology at Queen’s University and the partner hospitals of Kingston General Hospital and Hotel Dieu.

It’s time to “dehospitalize” the system, he says, noting that patients generally prefer to receive care in their homes. It costs approximately $842 a day to care for a patient in hospital, compared to $126 a day for long-term care and $42 for home care.

Tom Closson, former president of the Ontario Hospital Association, points out that there are currently 4,100 hospital beds occupied by people who no longer need hospital care.

“This community capacity problem has continued for the past seven years and does not appear to be getting better,” he said.

Seniors currently eat up half of health-care costs. If nothing changes in the health system, they will account for 59 per cent of health costs by 2031 because of their increasing numbers, Simpson warns.

But the health coalition argues that hospitals are placing seniors at risk by pushing them out too quickly to keep costs down. At the other end, seniors don’t get enough home care because hours are rationed and long-term care because homes are understaffed.

The coalition will also be looking out to see if the province makes good on an election pledge to cut hospital parking fees. Observers say they have been getting higher as hospitals learn to make do with less funding from the province.

Nurses are adding their voices to the chorus of those concerned about hospital cuts. The Ontario Nurses’ Association, the profession’s union, points out that 1,743 registered nurse positions have been eliminated since the start of 2012.

“The cuts we’re seeing to RN positions completely ignore the evidence linking RN care to improved health outcomes for patients,” Vicki McKenna, first vice-president of the association, said in a speech to the committee.

Doctors have also been making noise about cuts to their profession. The province imposed a three-year contract on the Ontario Medical Association in January. It calls for a 2.65 per cent across-the-board reduction in physician payments.

Like the nurses, the OMA says the province’s treatment of the profession is placing patients at risk. Underfunding of medical services means too many Ontario’s don’t have family doctors most family health teams can’t recruit new physicians. It also accuses the province of making doctors pay for a growth in demand for their services, fuelled by a growing and aging population.

“The government is creating a track record of cutting funding to health-care services across the province as a way to take the $10.9 billion deficit it created, but this means a decrease in access to quality care for patients,” says OMA president Dr. Ved Tandan.

In their pitch for more funding, long-term care homes warn they are having trouble keeping patients safe. Understaffing combined with an increasing number of aggressive dementia residents is making for a dangerous mix, they charge.

Almost half of residents exhibit aggressive behaviours with about 11 per cent considered severely aggressive.

“As I am sure you can understand, these behaviours pose a huge risk to resident safety and well-being,” Tim Siemens, chair of the board of the Ontario Association of Non-Profit Homes and Services for Seniors said in his speech to the committee.

Residents should be getting four hours of care a day, but because of understaffing they receive only 3.4 hours, he says, adding that it would take $385 million, phased in over three years, to close the gap.

The association is also looking for more money to feed seniors. Currently long-term care homes get $7.87 per day to feed each resident three meals and snacks. Meantime, food inflation has grown by 11.5 per cent over the last five years, but funding for raw food has increased by only 6.7 per cent.

Other organizations and causes that have made compelling arguments for funding hikes include Home Care Ontario, mental health groups, the Association of Ontario Health Centres, the Multiple Sclerosis Society of Canada, and the list goes on.

Many are likely to be disappointed.

Says Closson: “There are many health-care needs that cannot be entirely addressed given limited resources unless we can get ... services to be delivered more efficiently. We need to get better value for every dollar that we spend on health care.”