FOLLOW THE MONEY:
WILL THE TORIES' NEW HEALTH CARE POLICY REALLY MAKE PATIENT CARE THE TOP PRIORITY?
Susanna Kelley's new feature looks at how government and party policies will affect the average Ontarian.
Ontario Progressive Conservative Leader Tim Hudak is promising to transform the health care system into one where taxpayer dollars are going primarily into patient care.
So what are Mr. Hudak's plans to make that a reality, to bring the average person excellent health care?
Health care is always the number one issue in Ontario polls. But it never seems to be the ballot question when election day rolls around.
Health care has also been a migraine inducing issue for every Ontario finance minister that has graced the Frost building on Queen's Park Crescent in Toronto for decades.
It is eating up our provincial budget at an enormous rate, according to experts in the field.
And we've all heard how the demands are going to get worse as the population grows and the baby boom generation continues to age.
There are few who know their way around the health care file better than Michael Decter. Before leaving government, he acted as Deputy Minister of Health in two provinces, Saskatchewan and Ontario. Then he co-launched the Canadian Institute for Health Information (CIHI) before moving on to the private sector.
Mr. Decter says what scares him most about the future of health care in Ontario are those pesky baby boomers. He recently commented that, as teenagers, their generation stopped the war in Vietnam, and they haven't stopped organizing politically for what they want ever since:
Mr. Decter says that such a politically organized generation won’t settle for the limited kind of long term care that's available now. Boomers will want choices, lots of choices.
But who will pay for them?
In 2010 the Ontario government spent over $50 billion on health care. That's creeping up near half the total provincial budget, and it's increased $7 billion in four years.
Where is all that money going?
According to CIHI, the two biggest drivers of health care spending in Ontario are hospitals - over $17 billion in 2010; and physicians' compensation - over $11.5 billion.
Successive Ontario governments have tried to put the clamps on hospitals, with some limited success.
But the most stubborn cost has been doctors' compensation.
Nationally, the doctors' take-home pay is the fastest rising health care cost. It's expected to increase by 6.9% this year, according to CIHI figures.
No Ontario party, no matter its political stripe, has ever been able to win when it comes to negotiating remuneration with the Ontario Medical Association for its members.
In Ontario, doctors are paid in a variety of ways. Some in "family health teams" have a base salary model, others have separate contracts with hospitals and universities. But the lion's share of physician services is paid for under the Ontario Health Insurance Plan, or OHIP. It is a fee-for-service model - a doctor gets a certain fee, for instance, for performing hip surgery, a different one for an office visit and so on. The fees are negotiated in an agreement between the OMA and the government every few years.
The problem with the model is that doctors are their own overseers, controlling how many patients they see and thus, how much money they make.
A cap on the OHIP fees a doctor could charge annually was dropped some years ago under OMA pressure.
Politicians do not seem to be able to exert any control. Jim Wilson, former PC health minister under Mike Harris, calls the OMA the most powerful interest group in the province. He had to step down in the middle of negotiations in his time in order for the government to get an agreement.
Negotiations with health care professionals are often preceded with a cry of alarm, says Mr. Decter.
"Whether it's the nurses, or the doctors, or the pharmacists ... generally people start negotiations by saying, 'Unless we get what we're asking for, Medicare will end, a crisis will engulf us ... and the solution to it is: our new contract.'
What ends up happening, he says, is other parts of the health care system, like the Community Care Access Centres, which provide homecare services, get squeezed for money ... and that's what's happening now:
Governments are afraid of doctors. Politically, they can't be touched. That's because while people see teachers and other public servants as self-interested, doctors are revered by the public. If you want to send a government over the edge, just mention the words "doctors' strike."
Which may explain why, when Mr. Hudak was asked several times recently if he would rein in doctors' compensation to free up money for the frontline patient care he is promising, he did not provide a clear answer.
"Well, you know, I'll have more to say about details around our plan in the time ahead. Today I'm announcing that we're making health care our number one funding priority," he said.
Mr. Hudak promises to shut down Local Health Integration Networks (LHINs), which he says have cost $300m so far. He also pledges to stop the loss of millions on scandals such as the e-health fiasco.
But he also pledges to provide 5,000 new long-term care beds. He'll keep the 35,000 that are already scheduled to come on stream and commits to spending more than $6 billion over four years, much of which will be transferred from the federal government.
And he is determined to bring more doctors to communities that need them.
Judging by past performance, doctors will need a financial incentive to commit to servicing those communities. That will increase the size of the $11.5 billion they're getting now as the second largest portion of the health care budget.
Mr. Hudak says his policy is to put more health care resources into patient care.
Unless and until he actually provides more details on how that will be achieved, it's hard to see how his policy will actually change things for the average person on the street.