Health care funding January 2013

7/30/2019 Health care funding January 2013

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OCHU/CUPE Bargaining Conference

January 10, 2012

Doug Allan

CUPE Research

cope491:djk


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Ontario Ranks 8th of 10 Provinces

in Health SpendingPublic Health Care Spending by

Province Per Capita 2010

Ontario 8th of 10 Provinces

Newfoundland $ 4,982.9

Alberta $ 4,762.9

Manitoba $ 4,611.5

Saskatchewan $ 4,602.1

PEI $ 4,389.6

New Brunswick $ 4,210.5

Nova Scotia $ 4,192.9

Ontario $ 3,911.7

British Columbia $ 3,801.8

Quebec $ 3,603.3

Public Health Care Spending by

Province 2010

as a % of Provincial GDP

Ontario 8th of 10 Provinces

PEI 12.8

Nova Scotia 11.0

New Brunswick 10.8

Manitoba 10.7

Newfoundland 9.3

Quebec 8.9

British Columbia 8.5

Ontario 8.4

Saskatchewan 7.9

Alberta 6.6

SummaryOntario spends$3,911.7 perperson on healthcare.Rest of Canada(average): $4,351

Difference:$440 per personx population(13 million)= $5.72 billion

Source: CIHI NHEX 2011 (Ontario Health Coalition)


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Health Care is Declining as Share

of Ontario Spending

0

10

20

30

40

50

2002 2005 2008 2011

Health Spending as % of Program Spending

Health Spending as % ofProgram Spending

Year

Health Spending

as % of Program

Spending

2011 42

2008 46

2005 46

2002 47

Source: Ontario budgets2002, 2005, 2008, 2011

(OHC)


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Hospital Spending Declining as

Share of Health Spending

0

10

20

30

40

50

60

1981 1990 1995 2003 2007 2010

Public Spending on Hospitals as % of PublicHealth Care Spending, Ontario

Public Spending on Hospitals as% of Public Health CareSpending, Ontario

Source: CIHI NHEX 2011(OHC)

Year Public Hospital

Spending as % of

Ontario PublicHealth Care

Spending

1981 50.34

1990 44.65

1995 42

2003 36.14

2007 35.15

2010 34.04


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Ontario Hospital Funding 2nd

Lowest In CanadaSummary

Ontario is second from the bottom of all

provinces in terms of public spending on

hospitals per person.

2010 average per person hospital spending by

provinces outside of Ontario: $1,771.7

Ontario: $1,331.7

Difference: $440 per person

X 13 million (Ontario population)

= $5.7 billion

We spend $5.7 billion less than the average of the

rest of Canadian provinces on hospitals.

Province Public Spending on

Hospitals Per Person

2010

Newfoundland 2,380.8

Alberta 2,046.2

New Brunswick 1,924.0

Nova Scotia 1,771.2

Manitoba 1,716.5

P.E.I. 1,694.1

Saskatchewan 1,571.2

British

Columbia

1,564.8

Ontario 1,331.7

Quebec 1,276.2

Source: CIHI NHEX 2011(OHC)


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18,500 Hospital Beds Cut:

Occupancy at 98%Ontario Hospital Beds Staffed and in Operation 1990 2010Year Acute Psychiatric Complex

Continuing

Care

Rehabilitation Total

1990 33,403 2,505 11,435 2,048 49,391

1991 31,907 2,430 11,506 1,975 47,818

1992 29,826 2,331 11,425 1,902 45,484

1993 27,940 2,276 10,935 1,926 43,0771994 26,097 2,166 10,592 1,905 40,760

1995 25,386 2,182 10,325 1,853 39,746

1996 24,014 2,147 9,639 1,890 37,690

1997 21,929 2,142 8,678 1,875 34,624

1998 20,317 2,094 8,149 1,815 32,375

1999 19,740 2,062 7,788 1,802 31,392

2000 19,558 2,505 7,505 1,924 31,492

2001 19,912 3,444 7,455 2,137 32,948

2002 19,355 3,709 7,428 2,240 32,732

2003 18,781 3,620 6,896 2,349 31,6462004 18,552 4,547 6,537 2,362 31,998

2005 18,433 4,511 6,402 2,397 31,743

2006 18,444 4,368 6,094 2,478 31,384

2007 18,445 4,305 5,972 2,415 31,137

2008 18,702 4,333 6,039 2,410 31,484

2009 18,773 4,332 5,927 2,392 31,424

2010 18,355 4,335 5,798 2,322 30,810

Difference

1990 - 2010

-15,048 +1,830 -5,637 +274 - 18,581

Difference - 45%

+ 73%

- 49%

+ 13%

- 38%

Source: Ontario Hospital Association


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Ontario: Fewest Hospital Beds Per

Person of all Provinces

Average hospital beds per 1,000 in Canadian

provinces outside Ontario: 3.6

Ontario hospital beds per 1,000: 2.5

Difference: Ontario has 1.1 fewer hospital beds for

each 1,000 people.

Aggregate shortfall: 1.1/1000 x 13 million

(population) = 14,300

Hospital Beds Staffed and in Operation

Per 1,000 Population

by Province 2008-09

PEI 4.3

Newfoundland 4.1

New Brunswick 4

Nova Scotia 3.8

Manitoba 3.7

Saskatchewan 3.4

Alberta 2.8

British Columbia 2.6

Ontario 2.5

Note: CIHI data does on hospital beds does not include Quebec. Sources: CIHI Hospital Beds Staffed and in Operation 2008-09,

StatsCan population demographics 2008. (OHC)


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CIHI: Hospital cost pressures1998-2008: 6.7%

2.8

1.0

1.0

1.9

0%

1%

2%

3%

4%

5%

6%

7%

8%

General Inflation Population Growth Population Aging Other


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Canada a hospital outlier Second fewest hospital inpatients in 34 nation OECD.

Only Mexico lower.

Hospitalizations in Ontario declined 28% in thefourteen years (ending 2009/10).

More than any other province and hospitalizations inOntario are now much less than any other province.

Not lower than Mexico (yet), but we are getting there. Next lowest province is Quebec7.6% more.


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Bed Occupancy

dangerous levels Canada has one of the highest bed occupancy levels.

Ontariomuch higher97.9%.

Scottish physicians complain about 82% bedoccupancy driving up hospital acquired infections.

Health Officials are silent on this in Ontario.

Ambulance Code Zeroes beginning to occur.


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The first 8 years of Liberal governmentAll program spending increased 7.2% per year.

Health care spending just slightlyless.

Health care spending increases declined in recentyears.


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Pre-election Liberal plans Cut program funding increases from 7.2% annual

average to 1.8% annual average over next two years.

Health care would get biggest increase: 3.6%. Social services, education, training, colleges get

smaller increases.

Justice: - 1.8% annual decrease.

All other areas: - 5.6% annual decrease.


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The pre-election plan (contd) LTC: 4.2% annual increase.

Community Care Access Centres (mostly home care):2.2% annual increase.

Hospital: 3.3% annual increase.


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Auditor General wades in Like CIHI sees hospital cost pressures at 6% - 7%.

Auditor General found those funding proposals forhealth care over to be optimistic.

Hospital funding increases to be cut almost in half.

"The expense estimates assume that the hospital sectorwill achieve savings totalling $1 billion between 2011/12and 2013/14.
http://www.auditor.on.ca/en/reports_en/2011pre-election_en.pdfhttp://www.auditor.on.ca/en/reports_en/2011pre-election_en.pdf


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The Auditor General (contd) The Auditor concludes: "if hospitals do not find

$1 billion in savings and do not succeed in freezingcompensation, they will likely run deficits or may havelittle alternative but to cut services."

Ministry is "still working" on its cost saving strategiesand "was unable to provide detailed plans or quantifythe savings that it hoped would result".


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The Election promiseVery quietly, Liberals reduced health care funding

promise in election platform.

3.6% over first two years fell to 3.2%.

Also: 3.2% for the following two years.

Exactly the same level as promised by the ProgressiveConservatives$53.7 billion for health care by2015-16.


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Worse than Mike Harris In his first term (1995-1999) Harris increased health

care 17.33%.

Annual average increase was 4.07%, well above Liberalpre-election promise.

Second term PC government (1999-2003) saw biggerhealth care increases: 25.6%.


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Much worse after the election Despite promises, the Liberals reneged on funding

promise after the election.

Instead of 3.6%, or even 3.2%, health care funding setat 2.33% this year and 2.1% average over this year andnext two.

This is even worse than recommendation from Bank

boss Don Drummond.Worse than overall program funding increase (2.7%).


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Hospital funding worse still 2.0%;

But funding is segmented;

Some extra funding for specific items; But for ourexisting jobs and serviceshospital

funding is frozen.


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The plan is to make it much worse 2.7% average increase for all programs in 2012 - 2013

1.0% planned for 2013 - 2014;

0.7% planned for 2014 - 2015;Austerity until (at least) 2017 - 2018.


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Hospital funding process is changing [1] Global funding: local decision making, similar

funding increases for all hospitals. This is on the wayout.

[2] HBAM funding: different funding increases ordecreases for different hospitals. This is on the wayin.

Some hospitals will do badly, others much worse.

[3] Fee for service for funding surgeries. Suchsurgeries will only take place in hospitals where theycan be provided at the cost point. Result:Specialization and centralization.


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Cuts to quality and support services Government (via LHINs) requires hospitals to meet

certain goals to get funding via HSAAs: e.g. number ofsurgeries.

Implicitly, everything not required is open to cuts.


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Major areas under threat: Quality of services (most required HSAA goals are

quantative rather than qualitative).

Food, cleaning, office, maintenance, and other supportservices (not covered by HSAAs).

Beds (not usually protected by HSAAs).

Jobs (definitely not protected by HSAAs).

Non-acute clinical services.


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Cuts will compound One year, its a squeeze.

But every year of austerity after that, the hospital willfall further and further behind cost pressures,implying more and more cuts of some sort.

Assume an extra 1% in efficiencies found each year:

Year 1: 2% funding, 5% cost pressures3% behind;

Year 2: 2% funding, 5% cost pressures

6% behind; Extra problem: The plan is to squeeze funding even

tighter in years ahead.


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Strategies to date... (contd) Bed cuts

Shutting down (or even selling) smaller hospital sites

Cutting non-core services Converting ERs to Urgent Care

Speed-up

Work short

Lay-offs and job cuts

Attack on sick time

Others?


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Austerity driven by politics,

not economics Despite wide consensus on funding plan, there is no need for it.

Auditor General identified there is $1.4 billion in, mostlycorporate, taxes that the Ontario Liberal government plans to

walk away from. This is exactly equal to the amount of money Finance Minister

Dwight Duncan claims he absolutely has to save in the first yearof the so called "provincial compensation framework".

Duncan and McGuinty practically declared the War MeasuresAct to get their "wage freeze"

even though some

unions startedbargaining by proposing a wage freeze.

But corporate taxes? Fahgettaboudit!
http://news.ontario.ca/mof/en/2012/07/broader-public-service-negotiations.htmlhttp://news.ontario.ca/mof/en/2012/07/broader-public-service-negotiations.html


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Deficits constantly over-estimated200910 201011 201112 201213 Total

2010

Budget 21.3 19.7 17.3 15.9 74.22012 Fall

Economic

Statement 19.3 14 13 14.4 60.7Reduction

in Deficit 2 5.7 4.3 1.5 13.5


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Deficits much less Deficit reductionsfargreater than governments

estimated savings from its attack on collectivebargaining, which they claim will be $8.4 billion over

the next three years.


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Government will reduce deficit

estimate again Remember: You heard it from me first.

But here is the bad news: once again it wont make onejot in difference for their austerity policy.

Its about politics, not economics: a continuation of thelong term trend where the incomes and security ofworking people are undermined.

Attacks by McGuinty and Duncan on collectivebargaining were branded as a wage freeze but sincethis summer were always really about take-aways andconcessions.


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Remember when teachers,hospital workers, and public

servants ruined the economy?

Neither do I. But we are supposed to pay for it anyway.

Employers and compliant governments are responding

to labours situation by making us pay for the crisis. Solet the bad times roll...


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But we can respond Because attack is politically inspired, when we respond

politically, we can mitigate these attacks

Cornwall

Ottawa Grace Hospital shutdown

P3s

Superbugs

Local, fresh food

Mike Harris hospital cuts completely turned aroundwhen public saw the cost


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Does fighting back work? Fighting strategically is better

Advance notice key

Focus on community needs


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More... Updates two or three times weekly at

Defending Public Healthcarehttp://ochuleftwords.blogspot.ca/ on OCHU web site
http://ochuleftwords.blogspot.ca/http://ochuleftwords.blogspot.ca/

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Health care funding January 2013