Ontario Government – Hospital Restructuring and Cuts Planned constraints on hospital global budgets to force restructuring

Restructuring Process LHINs legislation – restructuring powers to Minister and LHIN LHINs – governed by accountability agreements with government, required by legislation to integrate defined as encompassing coordination to transfers of service, reductions or eliminations of services. Minister has powers to order dissolution of non-profit organizations. Provincial budget set global hospital funding well below the rate of inflation (2.4% in 2008/09 and 2.1% in 2009/2010) to force service rationalization/cuts. Hospitals required to sign Accountability Agreements with LHINs to eliminate their deficits. If no agreement, LHIN can order the hospital board to sign the Accountability Agreement.

Government-set funding levels less than inflation = growing funding gap In deficit: 50 % hospitals this year – 70+% hospitals upcoming (April Mar 2010) Hospitals of every size (small, medium, large community hospitals and teaching hospitals) Hospitals in every geographic region of Ontario This is not a question of efficiency. It is provincial problem of underfunding by the McGuinty government. Hospital budgets are set at a level below inflation and utilization rates – budget levels are forcing restructuring.

Ontario s Hospitals are the Most Efficient in Canada No evidence that costs out of control Ontarios hospital have the lowest average length of stay (patients in and out quicker and sicker Ontarios hospitals have lowest staffing levels Ontarios hospitals are the most efficient by key measures: The Hay Group Study/CIHI comparative data Ontarios hospitals have been restructured for more than 15 years

Public and Private Health Expenditure per Capita, G7 Countries, 2006 Source: OECD Health Data, Note: Japan, Expenditures are converted to US dollars using 2000 purchasing power parities (PPPs) rates which are designed to eliminate differences in price levels between countries.

Public Expenditure on Health as a Percentage of Gross Domestic Product, G7 Countries, Source: OECD Health Data 2008.

Ontario Hospitals Shrinking as share of Provincial Health Budget % % % %

Ontario spending on services and programs as a proportion of our economy and on a per-person basis compared to other provinces

Characteristics of Restructuring/Cuts Target on small and rural hospitals – esp. those already amalgamated Centralization of services out of town, across wider geographic regions than under Harris restructuring HAPS stepped program for cuts – divorced from population need Privatization – eg. physiotherapy & 1% challenge Large-scale lay offs and attrition (downsizing) Cuts to programs, services, beds Movement of patients out of hospital to inappropriate care settings (retirement homes) Removal of democratic hospital boards Former policy abandoned. No clear policy, feedback, meaningful input, checks and balances.

Problems Loss of capacity for the long term In hard economic times we need our hospitals more than ever Restructuring = high costs, instability, lost capacity No vision for small and rural hospitals/large hospitals already overburdened and are facing cuts No transportation systems between communities Downloading of costs to municipalities/risks to patients Implausible assumptions about ALC beds and ER utilization High costs of restructuring – likely to cost more for diminished services Worsening shortages Longer wait times Increased medical accidents/injury/hospital-acquired infection Privatization

Vision for Restoring and Protecting Public Health Care Public community hospitals are crucial Principled approach to solving our problems –Access is primary, and is a function of reasonable wait, reasonable geographic distance, removal of barrier of cost for care –Equity, based on community need first –Democratic –Supports and upholds the principles of the Canada Health Act –The values and priorities of Ontarians hold that closing our local hospitals and Emergency Departments should be the last cut, after all other options have been considered. It should not be the first.