Progress has been made in reducing wait times for care in Ontario over the past year, the Ontario Health Quality Council says in its fifth annual report released Thursday. However, it warns that roadblocks to patient flow are causing backlogs.
There have been “solid improvements” in cardiovascular care, including declining rates for heart attack mortality and hospital readmissions.
Wait times are also considered “good” for both cardiovascular surgeries and cataract removals, and have improved for hip and knee replacements as well. The Council furthermore sees “cautious signs for improvement in care for diabetes and other chronic diseases.”
But it says wait times for long-term care have tripled since 2005 and stand at 105 days overall. Fully 16 per cent of hospital beds are occupied by patients who do not need to be there, but are waiting for a place in community care.
The report points to the success Lethbridge, Alberta has achieved in using assisted living and supportive housing to reduce reliance on long-term care. Wait times there are under a month, yet it uses one-third fewer long-term care beds than Ontario.
The issue with long-term care came as no surprise to the Association of Non-Profit Homes and Services for Seniors in the province. In a news release commenting on the Council’s report, it pointed out that there are about 76,000 long-term care beds in the province which are 98 per cent full and there is a wait-list of over 25,000 people.
On other matters, the Council is pleased that the use of electronic medical records in physicians’ offices increased from 26 to 43 per cent between 2007 and 2009. But it is perplexed that access to primary care remains a problem despite a steady increase in the supply of health professionals. About seven per cent of Ontarians (some 730,000 people) do not have a family doctor.
Recent legislation in the province aims to expand the mandate of the Council to promote evidence-based care. It will also be given the job to make recommendations to the government on the “provision of funding for health care services and medical devices.”
The Council’s report can be found at www.ohqc.ca/pdfs/2010_report_-
Ontario’s health minister is open to some of the ideas in last week’s report from TD Economics calling for “urgent” reforms to health care. The report said rising health care costs are unsustainable.
In an interview with reporters last Thursday, Health and Long-Term Minister Deb Matthews said the report’s recommendation of limiting drug plan coverage for wealthier seniors was “something we can look at.” She was similarly interested in another recommendation to shift more physicians from fee-for-service to salary-based compensation.
The report said “a healthy and vigorous debate” on the future of health care is needed – again something Ms. Matthews supports.
In fact, this has become a standard refrain from the minister and Premier Dalton McGuinty since the need to engage Ontarians in an “important conversation” about the funding challenges of health care was first mentioned in the March Speech from the Throne.
That Speech promised a period of unrelenting reform in health care, and the government has already taken a number of steps in this direction including radical changes to the drug plan and the abolition of lucrative professional allowances or rebates pharmacists receive from generic drug companies for stocking their products.
Pharmacists are still fighting the initiative which is due to come into effect this month.
The TD report saw distinct advantages in using capitated payment models whereby physicians get paid a certain amount per patient, as well as salary arrangements which have been put in place for new team-based primary care practices.
“Once doctors have moved away from billing for services performed towards a blended per-capita, salary and volume structure, further incentives can be put in place through the payment mechanisms to reward effective practice, increased number of patients, etcetera.”
The report’s focus on aligning physician compensation with performance is again something that was mooted in the Throne Speech. It promised legislation “to make health care providers and executives accountable for improving patient care.” However, the legislation that was tabled in early May (Excellent Care for All Act) only tied hospital executive compensation to meeting quality objectives.
There is a certain willingness on the part of Ontario physicians to consider different ways of being remunerated. The 2007 National Physician Survey found half would prefer some form of blended payment.
The three most desired components of this formula were fee-for-service, on-call, and benefits/pension payments. Salary and task-related (sessional) payments were further down the list.
Ontario was lucky the H1N1 pandemic was not worse, the province’s Chief Medical Officer of Health says in a report this week on how Ontario fared. Dr. Arlene King says the province had a plan and was prepared, but had more people swarmed emergency departments for longer than they did “that might very well have tipped the system.” She says there is a need “to take a hard look at our immunization system” including ways of tracking and managing vaccination programs which were inadequate during the outbreak. Dr. King says there is also a need for strong central oversight and management during an outbreak. This includes giving her office the authority to direct what the province’s 36 public health units do “in real time.” Her report can be found at www.health.gov.on.ca/en/
