The Ontario government is planning to have a serious conversation with the people of the province about the sustainability of health care which currently consumes 46 cents of every program dollar and could reach 70 cents in another 12 years.
In a Speech from the Throne which opened a new session of the legislature Monday, the government said the question is how to continue funding health care without crowding out other priorities like education and economic development.
“That is a discussion that will happen, sooner or later, in every Canadian province and territory,” the Speech said, adding that Ontario plans to lead the “national dialogue.”
No timetable or process was mentioned in the Speech for how the government intends to hold this dialogue, but it listed a number of changes the government has in mind.
To begin with, it will be taking steps to achieve savings in the drug plan. The government wants to lower the price it pays for generics which could mean a further reduction in rebates pharmacies receive from manufacturers to stock their products.
Health and Long-Term Care Minister Deb Matthews told the Toronto Sun after the Throne Speech that the government has been “in pretty intense conversations over the past month” with various groups over the issue, but she is optimistic of reaching a new deal.
The item which really grabbed people’s attention is the government’s intention to use a patient-based approach for funding hospitals where the “money will follow the patient.” This suggests a shift to what is called activity-based funding or ABF in which hospitals are paid for services actually delivered. However, at this point, it is not exactly clear what the government has in mind.
Over the last few years, it has been introducing a new method of divvying up the health budget between the 14 Local Health Integration Networks (LHINs) in the province.
It is called the Health-Based Allocation Model or HBAM and takes into account such things as health status and demographics of the LHIN population to ensure equitable distribution of funds. The LHINs then spread the money around the various institutions, but there is no precise formula for doing this and it is still largely based on historical spending patterns.
And there is also a pay-for-results program that is part of the province’s Wait-Time Strategy. It provides incentives for hospitals achieving targets for wait times and patient volumes in certain areas.
The list has been expanded over time to seven services: general surgery, cancer and cardiac care, pediatric and orthopedic surgery, cataract removals and diagnostic scans. About half the province’s 154 hospitals apparently receive funding from this program and the government would like to see it expand.
Activity-based funding is being pushed by the Canadian Medical Association, and it has the support of the Ontario Hospital Association although it says it cannot fairly be used for teaching hospitals and those in small communities where competition between facilities for the patient business is not practical.
Health Minister Matthews agrees that rural and small hospitals will still need a global funding model, but she told reporters Tuesday that the transition to more patient-based payments will drive efficiencies in the health system.
The Ontario Council of Hospital Unions disputes this. It says the government is undermining the most efficient hospital system in the country by bringing in competition. Ontario has the lowest per capita hospital costs of any province.
The Council says the UK equivalent of activity-based funding has been controversial, and notes that a recent study by the London-based Civitas Institute concluded that the National Health Service has incurred the costs of competition without reaping any of the benefits.
Mixed in with these developments is the promise in the Speech that “Patients will have greater choice about where they can access the best quality treatment.” Again, no further detail was provided, but it may suggest the creation of centres of excellence where patients, willing to travel, may be able to get treatment.
NDP Health Critic France Gélinas says what the government will be doing is forcing people in rural and remote areas to make long treks to the big cities for needed care.
Other things promised in the Speech are an overhaul of the Public Hospitals Act, and legislation making health care providers and executives accountable for improving patient care. An independent, expert advisory body will also be created to provide recommendations on clinical practice guidelines to “ensure future investments get results and improve public health.”
The government says it will be “pursuing a path of constant reform” and this has Linda Haslam-Stroud, president of the Ontario Nurses’ Association, worried. “RNs understand that some reform has been necessary, but have suffered through constant restructuring for more than a decade,” she said in a news release. HE
Canadians are concerned about the sustainability of health care, a recent Ipsos-Reid poll for the Canadian Medical Association has found. Six-in-10 respondents agreed that health care will eclipse other public spending priorities.
Asked what their remedies would be, Canadians were almost unanimous (91 per cent) in saying that making the health care system more efficient and effective was the best way to slow down growing health care costs. However, only a third (35 per cent) are confident that governments and administrators are up to the task.
Respondents were also asked about ways to fund health care, and only about a third were in favour of raising taxes. The idea which got the most support was to “develop a contribution-based Canada Health Plan” similar to the Canada Pension Plan to set aside financial resources for people who need health care.
Two thirds liked the idea of a Registered Health Savings Plan for people to save money on a tax-free basis for health services that are not included in public health plan coverage.
A link to the report can be found at: www.cma.ca/index.cfm/ci_id/
Major health-care lobby groups in Ottawa were pleased that last week’s federal budget kept the government’s promise not to touch health transfer payments to the provinces and territories.
“Canada’s doctors are pleased to see that the federal government isn’t planning to balance the budget on the backs of Canadian patients,” CMA President Dr. Anne Doig said in a news release.
Dr. Doig’s sentiments were universally shared by other groups who were also pleased that the delayed $500 million funding for Canada Health Infoway in the last budget will finally be released.
Dr. Karen Cohen, the executive director of the Canadian Psychological Association and co-chair of the Health Action Lobby, a consortium of some 37 groups, was also relieved to see the Infoway money would be forthcoming. She said accelerating the introduction of new information technologies “can have a powerful and transformative impact on the health system.”
The Canadian Healthcare Association was disappointed there was nothing in the new budget to reduce poverty among seniors even though the Speech from the Throne said the government will be addressing the demands of the aging population.
The CHA mentioned two things it would have liked to have seen: adjusting pension plan rules to exclude low-earning years when people have been providing care to sick family members; and, the introduction of a social insurance model for long-term care costs.
The Canadian Nurses Association said the budget did not go far enough at what it sees as a critical juncture for health care in Canada.
“We see this federal budget as a missed opportunity to initiate a much-needed transformation of the health system,” CNA President Kaaren Neufeld said in a news release.
The CNA says strategic investments are needed to put more emphasis on keeping people healthy although it was pleased there was some spending in this area. ParticipACTION, for example, received $6 million in the new budget.
The nurses did like the fact that there is more money for health research, but CNA CEO Rachel Bard said the amounts are “far too modest to fuel the significant changes needed to build the health-care system of tomorrow.”
However, the Association of Canadian Academic Healthcare Organizations (ACAHO) said the research investments show the government recognizes the role that research hospitals and their research institutes play in advancing the country’s innovation agenda.
It pointed to the $16 million for the Canadian Institutes of Health Research, $45 million over five years for post-doctoral research fellowships, and $8 million to support the indirect costs of research programs, among other spending items in the new budget.
The government has also introduced the Northern and Rural Recruitment and Retention Initiative which will provide grants to doctors and new doctor graduates who agree to practice in a northern or highly rural community. It replaces the underserviced area program which provided incentive payments to small communities for them to use in attracting physicians.
The government has introduced a rating system to assess the eligibility of communities for Initiative. (News release at www.news.ontario.ca/mohltc/en/
