My consideration today is on the government practice of cutting back in healthcare, specifically on hospital and physician services in Ontario, and the impact this has had over the past few years.
Let’s begin with the hospital cutbacks. This month, in my community, three hospitals have announced staff reductions in order to match this year’s reduction in funding by the Government of Ontario. On March 11, 2015, the Children’s Hospital of Eastern Ontario announced that it would have to cut 40 – 50 positions in order to balance its budget. (Reference: http://ottawacitizen.com/news/local-news/cheo-to-cut-40-to-50-jobs-to-meet-budget-target). Then on March 24, 2014, The Ottawa Hospital announced that 35 full time positions would be cut. ( Reference: http://www.1310news.com/2015/03/24/job-cuts-at-the-ottawa-hospital/ This is on top of 80 jobs lost last year and 290 the year before at the region’s largest hospital. My own hospital, The Royal, will cut 18 jobs. (Reference: http://ottawacitizen.com/news/local-news/mental-health-funding)
For the next few months, these hospitals will do their best to work out how they will cut back their spending while trying to maintain the level of care they provide. They will cut positions by not replacing people who are retiring, or sick, or on parental leave. In some cases, there will be no option but to shut down operating room for a few weeks in the summer, or manage acute units, outpatient clinics or emergency rooms with fewer staff. All of these measures are service cutbacks, no matter what the Minister of Health or Deputy Minister say. On a one time basis they may be manageable but our hospitals in Ontario have had similar cutbacks for years. According to the Ontario Hospital Association, for the past three fiscal years, Ontario hospitals have received 0% increases in base operating funding. This is despite the fact that our hospitals are among the most efficient in the country, with the second lowest per capita funding after Québec. Ontario also has the lowest rate of age-sex standardized acute care hospitalization, clearly the work of those fewer but harder working health professionals and diligent care by physicians and their allied health colleagues in communities. (Data from: http://www.oha.com/Pages/Default.aspx )
It’s possible that patients do not notice the cutbacks, especially if they are not aware of what the cutbacks are. Perhaps they never knew a time when wait times were so long. Perhaps it would be more evident if hospitals could call parking fees what they really are: user fees in a so-called publicly funded health care system. The change in amount of care is evident if you have a chronic condition. You may suddenly notice that your doctor is now working without a nurse or a social worker. During this past year, I worked without a nurse for about six months. During that period, because of managing the week to week care of outpatients who required a more intense level of care than their monthly appointment with me, I was unable to provide new consultations, increasing the wait list from 2 months to 9 months. The funniest thing was my learning to use the newfangled blood pressure cuff from the inpatient nursing staff. Thanks to my nursing colleagues, I have not had to use a blood pressure cuff since I was in private practice. Everybody, patients and staff, realized that I was outside of my usual scope of practice and, amusing as it was, it was not the best use of my time. Also, everyone else, patients included, were very much aware of the change in care. Patients and staff are also aware that health professionals are going the extra distance to offset government cutbacks. The government can rely on this because of the intrinsically caring nature of those who choose healthcare as a career. But the government has cut back too much and the change is evident. Fewer health care providers ultimately manage fewer patients. Patients get less care and less access to care. The government pretends that it is managing spending, but it is passing its deficits down to the hospitals which can be mistakenly blamed for poor productivity and high parking fees.
The government is now attempting to transfer this model of cutback to physician services. It has plans to limit the budget for physician services by just not paying anymore year after year – no matter how many babies are born in Ontario, how many people move here or if there happens to be a public health emergency, like the SARS epidemic. Never mind cutting back on actual physician numbers because the Minister and his Deputy are, as usual, pretending that they’re not actually cutting care and so the number of physicians can continue to grow.
The cutbacks to the overall Physician Services budgets mirror exactly what happened to hospital budgets. While the necessary care by doctors to Ontario’s increasing and aging population grows by 2.7% annually, the government has decided to limit what it will pay for to 1.25%. They are also imposing cuts to primary care and care for chronic diseases – two areas of physician services that can least sustain cuts. How does one explain that to the 900,000 patients in Ontario who need a family doctor? New family doctors and rural family doctors are absorbing greater cuts – no logic there either.
The Ontario Medical Association has offered that doctors’ fees could be frozen for two years – a measure not undertaken in any other Canadian jurisdiction. In other jurisdictions – for example, British Columbia and Manitoba – governments continue to fund the natural growth in the system and to provide doctors with small fee increases. The doctors in Ontario know better than to expect increases and so a fee freeze has been offered. It has learned from the experience of our hospitals that you can’t get blood from a stone.