Health-care budgets hit the wall

Posted on October 20, 2008 in Governance Debates, Health Debates – – Health-care budgets hit the wall
October 20, 2008. Carol Goar

The report landed like a missile on the desks of Ontario’s 2,500 hospital administrators and medical decision-makers.

“Health system leaders who believe there will be another bailout need a reality check. We have hit the brick wall on finances.”

The author of the 15-page analysis, Ted Ball, is one of the best-informed health policy analysts in the province. He has worked in the field for 25 years, first as chief of staff to former health minister Larry Grossman, then as a consultant. He has excellent connections at Queen’s Park and an encyclopaedic knowledge of the health-care system.

Ball has told health leaders before that they must start spending smarter rather than spending more. But successive governments – Liberal and Conservative – undermined his message, increasing the health-care budget in hopes of alleviating the pressures in the system.

This time it won’t be happen, he says. “In a stagnating economy, when we are already spending 50 cents of every provincial dollar on health care, cries for more money from the traditional health vested interests will not be well-received.”

And it shouldn’t happen, he adds. “If the provincial government were to invest another dime in our health-care system, it would make our society sicker. Why? In a shrinking economy, increased spending on health-care services must come at the expense of children’s services, education, the poverty agenda, climate change and pollution abatement.”

What should happen, Ball says, is a rethinking of the way health care is delivered.

First, the people who run the system have to face the fact that they aren’t serving patients and their families well enough. Ontarians have difficulty navigating the system. They find it confusing, bureaucratic, unfriendly and unresponsive.

A study, released in early September (Euro-Canada Health Consumer Index 2008), backed up their frustration. It ranked the Canadian health-care system 23rd out of 30 from a consumer perspective. In terms of value for money, it placed Canada last.

“Canadians love their health-care system,” Ball says. “They have supported increased spending. But they want to know: What’s in it for us?”

Next, he advises leaders of health organizations who are waiting to see if newly appointed Health Minister David Caplan will decide to redesign the system, as George Smitherman and Tony Clement did, to abandon any such hopes.

For one thing, he can’t afford to dismantle the costly local health integration networks (LHINs) that Smitherman put in place. For another thing, Ontario doesn’t need another grand strategy. It needs to get moving on the existing one.

“Prudent leaders will realize that Minister Caplan will be more likely to spend his time actually implementing the reforms the Liberals have promised.”

Finally, Ball urges health managers to get serious about reallocating resources, starting with the billions of dollars they waste.

Anticipating skepticism, he provides concrete examples. Get rid of unnecessary tests, stop taking a patient’s medical history repeatedly as he or she moves through the system, don’t allow operating rooms to sit empty, don’t gather useless information, don’t overprescribe drugs and don’t use scarce dollars for public relations or political lobbying.

“When are we going to change this?”

It won’t be easy, he acknowledges. There will be resistance from doctors, nurses, technicians and department heads who feel threatened by change. There will be resentment from those who tried to innovate in the past, only to be slapped down. There will be organizational inertia to overcome and longstanding habits to break.

But maintaining the status quo, with regular injections of cash to reduce wait times and clear emergency room backlogs, is no longer an option, Ball insists. “Smart people will step back, calm down and notice they aren’t going anywhere very fast.”

Health managers will soon find out whether Ball’s financial forecast is right. The government delivers its fall economic update on Wednesday.

What is already clear is that Ontario taxpayers, who spend $40 billion a year on health care, are tired of structural reforms. They want improvements they can see and feel.

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