With the federal contribution to Ontario's health care funding set to slow down in five years, it's time to look for better ways of keeping us well.
This week, the federal government arrived at—or more accurately, mandated—an agreement with the provinces to keep a steady stream of health care cash flowing into provincial coffers. The no-strings-attached deal has federal health care transfers growing at 6 per cent annually until 2017, after which increases will be pegged to inflation and economic growth.
Predictably, Ontario Finance Minister Dwight Duncan grumbled that pain and suffering would follow from the fed’s attempt to tap the brakes on health care spending, currently around 42 per cent of the provincial budget—and climbing. Of course, Stephen Harper could send a fleet of dump trucks loaded with apparatchiks hurling gold coins down hospital row and Duncan would still whine; that’s how the game is played. However, the complaints ring particularly hollow since Duncan has already said that with Ontario in a fiscal bind, growth in health care spending will need to drop to 3 per cent going forward anyway.
Medicine wasn’t always expensive. Time was, when you got the flu or the plague, the local doctor/barber drained a few quarts of blood, slapped on some leeches, and told you to make your peace with God.
Medical treatment that doesn’t kill you is necessarily more costly, though, for a variety of complex reasons, not least of which is that when a service is paid for out of everybody’s taxes rather than your own pocket, there’s no compelling reason not to use lots of it. Another reason frequently cited is the emergence of Canada’s demographic gray-bomb of aging Boomers, who are likely spending more time than they used to investigating newfound aches, pains, and debilities.
However, a recent report by the Canadian Institute for Health Information found that neither rampant hypochondria nor the geezering of society were critical cost drivers for health care, with the share of spending on seniors remaining relatively stable from 1998 to 2008 in spite of a growing population of oldsters.
In fact, beyond the unavoidable reality of population growth, the key factor for higher costs was inflation specific to the medical sector, particularly compensation for physicians and overall hospital costs (there’s a relationship here, as an average 60 per cent of hospital costs are salaries). While we don’t like to begrudge dollars for doctors, these are the areas the province will need to address if we’re going to keep our health care system robust without giving up on education or taxing everyone into penury.
One answer: free up hospital beds by funding more home-care and long-term facilities for chronic patients who don’t need expensive hospital facilities. Last week’s story about an 84-year-old stroke victim whose family was “blackmailed” with the threat of a $1,900-per-day hospital charge because they weren’t moving her to a nursing home fast enough was heart-rending, but somewhat understandable. If that hospital bed could mean life or death to another patient—well, it can’t be an easy call.
This week, Martin Regg Cohn observed in the Star that even the Ontario Hospital Association made a case to the provincial cost-cutting commission that dollars for home care, long-term care, and mental health services should be increased, even at the expense of hospital funding. The OHA did that not because they’re already lining bedpans with hundred dollar bills, but because they know that as available resources diminish, allocating them more efficiently is in everyone’s best interests.
During the fall election campaign, all three parties saw the economic and social value in getting people the right kind of care in the right place. Presumably, the next budget will reflect that consensus.