Taking Stock: With a New Health Minister it is Timely to Assess Where Ontario’s Health System is at and Where We are Going

Posted: July 18, 2014

(July 18, 2014)

With the appointment of a new Health Minister, it is timely to take stock of where Ontario’s health system has come from and where we are going. There have been significant improvements in Ontario’s health care system. The number of MRIs has vastly increased. Wait time management has improved and there has been an upsurge in the number of hip and knee and cataract surgeries over the last decade. The early investments of the McGuinty government resulted in wait time reductions across a whole range of surgeries and diagnostics, with the numbers worsening in the last few years as hospital cuts have taken hold.

And indeed, there have been cuts. For the last seven years, hospital budgets have been subject to constraint, increasing at less than the rate of inflation. For the last two years, they have been frozen, with 0 % increases, meaning that funding in real dollar (inflation-adjusted) terms has been cut. As a result, hospitals are more overcrowded than ever and patient readmissions are extremely high. Community care remains a patchwork and has been deeply privatized. After two decades of almost non-stop hospital restructuring by successive governments, Ontario has been left with the fewest hospital beds per person in the country. Most Ontarians don’t know the numbers, but they experience the results when they try to access care.

Despite repeated public relations messages decrying health spending as “out of control”, about to “eat up” the provincial budget if not checked, in fact, Ontario’s health care spending has been in decline as a proportion of the provincial budget for more than a decade. In fact, health care cutbacks are being made to finance more than a decade of tax cuts that have mainly benefited the high-income Ontarians and corporations. According to the Ontario Ministry of Finance, health care spending has declined from 47% of the provincial budget in 2002 to 42% in 2011. Overall public health care funding in Ontario had dropped to 8th out of 10 provinces by 2012 both on a per capita basis and as a percentage of provincial GDP. By 2012, Ontario’s funding for its public hospitals had dropped to last in Canada.

Home care funding has increased, but the number of patients offloaded from hospitals into home care has increased faster. After a big dip in which home care funding per client was reduced every year for almost a decade, recent Ontario Budget funding increases serve to restore funding levels per home care client back to the rates of the early 2000s. Thus, the former Health Minister’s rhetoric about home care growth was very misleading.

Access to primary care has improved, the supply of family physicians has increased and will continue to do so as new doctors graduate. New nurse practitioner-led clinics are operational; community health centres have seen some increases; midwife birthing centres have been opened; and wait lists have been reduced for a whole range of hospital services, creeping back up slightly with the budget freeze (real dollar cuts) to hospitals in the last two years. But primary care costs are escalating significantly. Increases for doctors, supposedly for 24-hour-7-day access has not resulted in significant improvements in access. Funding incentives for family health teams appear to be so rich that some rural doctors no longer see a financial incentive in doing emergency department call shifts, imperiling local emergency departments.

But overall, the worst cuts have been to hospitals, to longer-term care for seniors, and to publicly funded rehab services. Rationing of community and long-term care remains deeply problematic. Outpatient physio has been cut from hospitals all across Ontario. Any claim that it is replaced in publicly funded homecare physio is patently untrue. Patients now face long wait lists and severe rationing for physio and other health professionals’ services. Despite the overwhelming evidence that hospital overcrowding is at critical levels and small and rural hospitals are at grave risk, the current budget plans to hold the course and continue with the hospital cuts.