Sometime within the next six months or so, the party that wins the Ontario election will be presented with a bill for up to $3 billion a year in new spending, and it won’t be able to do a thing about it.
That extra money will pay for a new doctor fee deal, the product of binding arbitration underway between the province and its 38,000 physicians.
But there has been virtually no mention on the campaign trail of the impending decision, and limited discussion of health care generally, despite widespread complaints about issues like wait lists and over-crowding.
The NDP and Liberals have promised major new spending in the area, while the Progressive Conservatives have pledged less concrete measures to curb “hallway medicine” and shorten wait lists.
Little of it has been debated. And no party is taking a wide-angle look at the system and how it could be made more efficient — even though it already eats 40 per cent of the provincial budget, a health-policy academic and a doctors’ advocate said Wednesday.
“You end up basically with short-term crisis management that involves spending a lot of money really quickly once something becomes a political hot potato,” said Livio Di Matteo, a health economist at Lakehead University in Thunder Bay.
“Before you spend another dollar, (parties should ask) ‘What are you getting for what you’re spending now? … How do you get the value for money?”
The outcomes of health care in Ontario — like the rest of Canada — still lag near the bottom among industrialized countries, while costs are in the upper third, he noted.
The Liberal government’s record on health care has been at least a minor issue during the campaign, with criticism from the other parties, especially over emergency-room crowding. Statistics suggest Ontario hospitals often run at or above capacity, leaving little or no surge room for spikes in health-care use.
The province’s Financial Accountability Office reported in March that increases in health spending in the last half-dozen years had not kept pace with the pressures of inflation and a growing and aging population. Health-care access or quality will likely suffer without significant cash infusions, the office said.
Then there is that arbitration. The Ontario Medical Association — hoping its members can recover some of the fees cut over recent years — has made proposals that would reportedly add $3 billion in costs per year. The province’s starting bid is much lower; the ruling is expected near year’s end.
Dr. Nadia Alam, the association’s president, said in an interview Wednesday the province will have to pay doctors more, and also boost funding to other parts of the system. Bloated administrations could be shrunk to offset some of that extra cost, she said.
But Alam complained that no politician is talking about broadly overhauling the sector, making what has become a “lumbering beast” of disconnected programs more streamlined and efficient.
“I see all the different parties … nibbling on the edges of our health care system, glomming onto a particular issue and wanting to fix that,” she said. “What physicians would really like to see from these politicians, from our government, is a commitment to look at the health-care system as a whole, to do a revamp.”
So what are the parties offering?
The NDP would boost hospital spending to match inflation and growth, build new hospitals and add 15,000 nursing home beds in five years.
New Democrats would also create a separate mental-health ministry, hire thousands more mental-health workers, and set up programs to provide dental care and limited drug coverage to anyone who does not already have it.
The Liberals are pledging to expand their pharmacare program for senior citizens and people under 25; provide subsidies to others for dental care and drugs; expand mental health care and create 30,000 nursing-home beds over 10 years.
As well, they would increase hospital funding, and pay for 40 major hospital building projects.
The Conservatives promise $190 million a year for mental-health care; free dental care for low-income senior citizens and 15,000 new nursing home beds within five years.
Leader Doug Ford has also pledged to consult with front-line workers about how to improve the system, and often notes he is being advised by the former CEO of what is touted as North America’s first all-digital hospital.
Yet at the same time, he has said he will cut four per cent — about $6 billion — from the province’s overall budget, and without any layoffs.
(Story modified June 7 with to correct spelling of Dr. Nadia Alam)