Canada's "Monty Python" health care system
Globe and Mail
March 1, 2005
Ontario hospitals chief pleads for more funds
By Oliver Moore
The head of the Ontario Hospital Association called Tuesday for a new funding arrangement, saying that the current system “would be better suited to a Monty Python movie.”
Hilary Short said that a “dramatically different” approach will be needed to prevent patient care being “cut deeply” when government rules against running a deficit come into play.
“Hospitals have until March 31, 2006 to achieve balanced budgets,” she told The Economic Club in Toronto Tuesday morning.
“The Ontario government, like most other governments, sets hospital budgets at a level it feels it can afford,” she said.
“This year, although the cost of operating hospitals increased by almost 8 per cent, the hospital sector received a 4.3 per cent base increase in funding from the provincial government. But because much of this increase was earmarked for specific initiatives, individual hospitals received an average base funding increase of 1.8 per cent.”
Not only were the increases insufficient, she said, the current funding method forces hospitals to guess how much money they will get and then spend accordingly. Only near the end of the fiscal year do they find out their actual funding, by which time they regularly have to borrow money to make up the shortfall.
“Enough is enough … the time has come to adopt a dramatically different approach. To protect patient care, Ontario needs stable, multi-year funding that is realistic in covering the real cost of providing care.”
http://www.theglobeandmail.com/servlet/story/RTGAM.20050301.whosp0301/BNStory/National/
Excerpts from Hilary Short’s speech:
The Economic Club of Toronto
Since its election in October 2003, the Ontario government has embarked on an ambitious agenda for health care reform — an agenda driven by Roy Romanow’s Royal Commission Report.
It’s come to be called the “Transformation Agenda,” and it consists of several different component parts, parts it must be added that like an engine, need to work perfectly together if they are to run smoothly.
First, the government is investing significantly in community care with the goal of easing pressure on hospitals.
Put plainly, this means shifting money to the community sector so it can serve more people. Over time, this will ease pressures on hospitals and help save money.
Second, the government is requiring hospitals to cut spending and divest themselves of certain services that, in their view, can more appropriately be delivered in the community setting.
The government is implementing this policy deliberately, to allow hospitals to focus exclusively on doing what they alone can do - providing the most complex care.
Third, the government is creating and implementing a plan to reduce waiting times for patients in five key areas - cardiac care, cancer care, diagnostic services like MRIs, hip and knee replacements and cataract surgery.
Fourth, through Family Health Teams, we also know that the government is pursuing the goal of improving access to primary care for the hundreds of thousands of Ontario families without a family doctor.
Fifth, the government is investing heavily in health promotion to ease the burden on our hospital system.
And finally, the government intends to improve the way in which the health care system works at the local and regional level, by creating Local Health Integration Networks.
Taken together, the component parts of this transformation agenda are designed to accomplish a simple goal - drive down costs, while improving access for patients to Ontario’s treasured public healthcare system. And…
To protect patient care, Ontario needs stable, multi-year funding that is realistic in covering the real cost of providing care.
We need a transformational, innovative, new funding model that would help to rejuvenate the entire health system. One idea, highlighted recently by a Senate Committee Chaired by Michael Kirby is called service-based funding.
Service-based funding would provide stable and predictable funding to hospitals.
It would fund them for the volume and complexity of care they provide, and reward them for their efficiency and performance while recognizing the real cost of providing care.
The OECD believes this model has potential. In an October 2004 report on Canada, the OECD noted that moving towards service-based funding would help improve performance and efficiency as well as reduce wait times.
And…
As I close, let me say this.
Hospitals have signed on for the “Transformation Agenda”. Progress is, and will continue to be made, by governments and healthcare providers working together.
What hospitals are asking for are the time and the resources to get it right.
Let’s move forward on primary care reform and investing in services in the community and in the home.
Let’s cooperate and support hospitals as they seek further savings in non-clinical areas like purchasing and accounting.
Let’s look at the facts, listen carefully, and move steadily to better integrate healthcare.
And finally, in the upcoming Ontario Budget, let’s reconsider the fiscal plan for hospitals to sustain our incredibly valued healthcare professionals while protecting patient care through this time of change and transition.
http://www.oha.com/Client/OHA/OHA_LP4W_LND_WebStation.nsf/page/The+Economic+Club+of+Toronto
Comment: The Canadian press seems to prefer to characterize their medicare program as a system that “would be better suited to a Monty Python movie.” Although Ms. Short did use that phrase in describing the difficulties of readjusting budgets during the fiscal year, you would think from the press coverage that the entire health care system was a Monty Python nightmare. That is unfortunate since the all-too-common, doom-and-gloom press coverage of the Canadian system is used to discredit single payer as a model for reform in the United States.
Ms. Short’s actual message is quite clear. The Canadians have an excellent health care system, and they can make it even better. We should be so fortunate.