In a major speech Monday, Ontario Health Minister Deb Matthews unveiled An Action Plan for Health Care which she described as “obsessively patient-centred.” It is also a plan which is focused on what she sees as major challenges facing the province – putting the brakes on health-care spending increases so the government can erase a $16 billion deficit by 2017, and preparing the health system for an aging population.

Ms. Matthews, a demographer by training, told her Toronto Board of Trade audience that something needs to be done to bring down the cost of delivering health care to a seniors’ population that is going to double in the next 20 years.

“If we continue doing what we do today, caring for the increased number of seniors would cost $24 billion more by 2030 - 50 per cent more than today - not including inflation,” she warned.

Much of the reason for the high per capita cost of seniors’ care is undue reliance on hospital care. Many seniors end up there, and stay longer than they need to, because of the lack of community-based options.

Ontario is planning to roll out a new seniors’ strategy to address that. Most of the ideas Ms. Matthews mentioned in her speech were contained in the Liberal government’s election platform last October and include the introduction of care coordinators for seniors when they leave hospital, and three million more hours of home support.

All of this is part of delivering “the right care, at the right time, in the right place” – one of the three pillars of the Action Plan – and also involves more emphasis on evidence-based care to produce better value-for-money.

“We are going to accelerate our evidence-based approach to patient care. We will strengthen Health Quality Ontario so that we increasingly shift funding to services that are known to get the best results for patients,” she said, noting that evidence-based changes have saved $125 million in 2011-12 which has been re-invested in “more effective patient care.”

Last week, Ms. Matthews delved into this subject in media interviews when she said the public health plan would no longer pay for things that do not improve outcomes, and seemed to suggest this might include some caesarean sections because of the high rate of these procedures in the province. She subsequently clarified that the government has no plans to delist C-sections.

Still, she is looking for cheaper ways to do things, and has indicated that the government may fund independent “birthing centres” staffed by midwives as an alternative to more expensive hospital deliveries.

In her speech, the minister also said more routine procedures could be farmed out to specialized not-for-profit clinics (there are approximately 18 in the province) if they can provide better care at a lower cost.

The second pillar of the Action Plan is a focus on health promotion and prevention, fuelled by some other promises the government made in the last election, and the third deals with “faster access to stronger family health care.” Here the minister delivered the surprise announcement that the 14 Local Health Integration Networks (LHINs) in the province will assume responsibility for planning primary care services.

“LHINs are the air-traffic controllers of health care,” she said. “And when they can plan primary care in a community, they will help improve access to care and save money.”

The LHINs have been after this role for some time, arguing that it is difficult to fulfill their planning and integration mission when a major aspect of care delivery is outside their control.

Ms. Matthews said it is also time to bring the voice of family doctors to the planning table “so they can be part of finding local solutions.” This change will improve accountability too, she said, and she has pledged to equip family doctors with quality improvement tools similar to those that exist in hospitals.

The model for bringing planning and accountability for primary care under the LHINs is still to be determined, but the Action Plan emphasizes that the health ministry will continue to fund physician services.

The LHINs will be expected to tackle some persistent access-to-care problems with family health teams and other team-based primary care models that exist in the province. A December 2011 report from the province’s auditor general said physicians in these practices are making more money than fee-based physicians but are failing to provide adequate after-hours access to care.

Nonetheless, physician groups have welcomed the move to have primary care come into the LHIN fold. Dr. Stewart Kennedy, the president of the Ontario Medical Association, said it makes sense as long as doctors have a role in the decision-making process.

He is also looking for more details on what the government has in mind, something that will be undoubtedly revealed in upcoming contract negotiations.

The Progressive Conservative and NDP opposition parties were critical of an expanded role for the LHINs given that in the last election they both vowed to abolish them. NDP MPP Cindy Forster said it was irresponsible for the government to give the LHINs more power before completing a statutory review of these organizations which is due to be conducted this year.

The Action Plan does not mention this pending LHIN review, but it does say the government “will introduce further reforms to promote more seamless local integration, with fewer layers of administration, to ensure we have a system truly structured around the complex needs of an aging population.”

Another notable inclusion in the Plan is a commitment to change the funding model for hospitals to one that is based on the services provided while continuing to support the unique needs of hospitals in smaller communities. It also talks about rewarding providers for ensuring better patient outcomes which is something the government has experience with in its wait-time reduction initiative.

The Ontario Hospital Association was pleased that some of its reform proposals were included in the plan including patient-based payments for hospitals. In addition, it has pitched the need to better integrate family doctors in the health system, and expand access to community-based care.

These things have also been mentioned by Don Drummond, the economist who is soon to table his report for the government on reforming public services. As such, the Drummond report and the Action Plan are bound to match up on the major elements. One potential difference, however, is the government’s insistence that it will not use private clinics to deliver services even if the public sector continues to cover the costs. Some other provinces have done this, and Mr. Drummond has supported the idea.

He has also warned about the need to rein in health spending increases, as Ms. Matthews has said. However, he might go further than the three per cent annual growth rate that has been targeted.

In her speech, the minister said there will have to be budgetary trade-offs if more money is to be found for community care. She pointed out that the two biggest items, accounting for almost 60 per cent of her $47 billion budget, are hospitals and physician services.

She said a one per cent increase in physician compensation could buy home care for 30,000 seniors and the same increase in hospital budgets could purchase over five million more hours of home care.

All of this will unfold when the government presents its new budget next month.

The Action Plan can be found at www.health.gov.on.ca/en/ms/ecfa/healthy_change. HE

Program spending growth in Ontario, including health care, will have to be kept to just 0.7 per cent a year if the government is to erase its $16 billion deficit as planned by 2017-18, the Conference Board of Canada says in a report released Thursday.

If the government sticks to a projected three per cent increase for health care, modest increases for education and social services, and a five per cent cut for other programs, the budget will not be balanced until 2021-22, the report says.

However, the Board says a more realistic forecast for health care spending increases is in the 4.7 to 5.6 per cent range once inflation, demographic changes and increased health-care utilization are factored in. But with that kind of spending growth, the budget would never be balanced looking ahead to 2030-31 unless the provincial sales tax is increased from eight to 15 per cent.

The report can be found at www.conferenceboard.ca. HE

G20 countries, including Canada, have been told that their credit ratings are at risk if they do not soon keep their rising health care expenditures in check. The warning was issued Monday in a report by credit rating service Standard & Poor's.

"Population aging will lead to profound changes in economic growth prospects for countries around the world as governments work to build budgets to face ever greater age-related spending needs," Standard & Poor’s credit analyst Marko Mrsnik said in a news release. "Governments' main policy actions so far have consisted of decreasing pension outlays; however, we believe that getting a firmer grip on rising health care spending is at least equally important."

According to the report, health care will be the fastest-growing expenditure between 2010 and 2050 and without policy changes health care expenditures will consume an ever-increasing amount of GDP and reach about 11 per cent on average for most advanced economies — almost double what it was in 2010.

France, Germany and the U.K. are expected to lead the list with a health-care cost burden of over 14 per cent of GDP by 2050. Canada is not far behind at over 13 per cent.

Countries such as China and India, are not expected to be as affected because their demographic and economic conditions are seen to be slightly more favourable.

Mounting Medical Care Spending Could Be Harmful to the G-20's Credit Health can be found at www.standardandpoors.com. HE

A $67.5 million competition for research projects into personalized medicine has been announced by Health Minister Leona Aglukkaq and Science and Technology Minister Gary Goodyear. Evolving from the current “one-size-fits-all” approach, personalized medicine takes into account the patient’s individual circumstances and genetic make-up and is expected to lead to better health outcomes, improved treatments, and lowered risk of adverse events. The competition is open to researchers in a number of fields such as biomedical, population health and health policy. The funding is coming from Genome Canada ($40 million), the Canadian Institutes for Health Research ($22.5 million) and the Cancer Stem Cell Consortium, a non-profit group of researchers, public and private sector partners ($5 million). To qualify, researchers must obtain matching funding from other sources. (News release at www.cihr-irsc.gc.ca/e/44825.html)

A framework for personalized medicine in cancer has been developed by the Ontario Institute for Cancer Research (OICR). Published in the journal Cell, the framework supports improved diagnostics for cancer patients based on DNA analyses of tumours. The results of these analyses could be used to predict a patient's response to novel therapies. More immediately, it could be used to predict how drugs currently approved and in use today could help to treat other types of cancer. An OICR news release says that while the framework does provide a path forward for establishing a role for genomics in everyday clinical practice in the future, more research is needed before such practices can be implemented more widely. (News release at http://oicr.on.ca/files/public/OICR_NR_February_02_2012.pdf)

The Ontario government is being asked to boost its spending on health promotion and disease prevention. Members of the Ontario Chronic Disease Prevention Alliance have launched the “Better health is worth 0.5 per cent” campaign, saying the government currently spends 0.35 per cent of its budget on health promotion. It believes that by investing an additional $170 million and raising this level to 0.5 per cent a significant step forward can be made in keeping people healthy (News release).

Concerns are being expressed about Alberta’s plans to pilot two new Continuing Care Centres which provide a continuum of care in one location and allowing seniors to “age in place.” However, Public Interest Alberta says if this model eliminates designations between different levels of care seniors may lose the protection of established care standards that are currently legislated. It is also concerned that the model “lays the foundation for a lot of public dollars going to private corporations to provide the care.” The advocacy group Continuing Care Watch says the announcement, made last week, lacks detail and wonders if it is just a pre-election ploy by the government. (Calgary Herald, Jan. 27)

A task force to examine abuse in Ontario nursing homes will be launching a three-month investigation this month. The Toronto Star says the task force, with representatives from 16 different groups, will be creating a website and survey to elicit recommendations for change. The task force was formed last November at the request of the health minister following persistent and disturbing reports of residents being mistreated. (Toronto Star, Feb. 1)

Informal caregivers are feeling the burden of their responsibilities, a survey for the home care company We Care has found. The Angus Reid online survey found over a third of female caregivers feel overwhelmed and do not know how to cope, and a quarter do not know where to go for help and feel there is a lack of available resources. News release at www.wecare.ca/home-healthcare-in-the-news.

A new way of alerting patients about expected wait times at Quebec walk in clinics is being criticized by a pro-medicare physician advocacy group. The technology, which could be in place in some clinics this spring, involves a sort of electronic take-a-number machine. Patients waiting to see a doctor would not have to wait in the clinic but would get an electronic message when it is almost their turn. For this service, they would be charged $3. But the group Médecins québécois pour le régime public (MQRP) says this is another form of extra billing, a practice that it says is increasingly being tolerated by the government. In fact, a health ministry spokesperson told La Presse that anything that improves access to care is “good news.” (News release; La Presse, Jan. 24)

Electronic health records are being tested in nine First Nations communities in Manitoba. The $3.4 million program is aimed at integrating patient records, a process that is expected to be completed by 2013, and linked to other parts of the health system which will also facilitate greater use of telehealth solutions. (Winnipeg Free Press, Jan. 27)

An inventory of the 88 organizations involved in health policy research in Canada has been produced by the Conference Board’s Canadian Alliance for Sustainable Health Care. It can be found at www.conferenceboard.ca/CASHC/inventory/default.aspx.

La Presse columnist Alain Dubuc (Feb. 1) says it is unfortunate that people tend to avoid saying “health” and “economy” in the same breath. Mr. Dubuc, who has a masters degree in economics, says economic discipline would be helpful for health care since its objective is to find the best possible use — in quality and quantity — for limited resources. He says this is something the health system lacks as evidenced by the fact that despite massive infusions of money there have been no appreciable improvements in health outcomes. “To stabilize our health system, and ensure its sustainability, it will be necessary to institute major reforms which the (health) minister refuses to consider,” he says. These are systemic reforms for reconsidering the way resources are allocated. In his opinion, this explains why the most promising reform initiatives of recent years have come from the Ministry of Finance not Health.

The Ottawa Citizen (Feb. 1) says the new Action Plan for Health Care in Ontario “feels more like an election platform than a prescription for reforming health care.” It says the government’s challenge is to reduce the annual rate of health-spending growth and “Any health care plan has to work within that budget and show how changes will save money and improve patient care. This document falls so far short of that level of detail that it feels more like a placebo than a cure.”

National Post columnist Scott Stinson (Jan. 31) wonders how the “blue sky” proposals in the plan will be rolled out. “Will hospitals have their funding models changed next year, or three or five years from now? How long until they off-load procedures to specialized clinics? Do many of such clinics, other than a handful of them already operating, even exist?” he asks. Toronto Star columnist Thomas Walcom (Feb. 1) also finds the plan “vague.” While he agrees with the goal of improving value-for-money “The historical reality, however, is that deficit-obsessed governments focus far more on a cost reduction than quality maintenance.”

The House of Commons resumed Monday. On Monday, NDP Health Critic Libby Davies asked about the government’s decision before Christmas on health transfer payments. It was a surprise announcement that is not open for discussion. “Fixing our health care system must be done by collaborating with the provinces. That is what Canadians expect. Why is the government slamming the door in their faces?” Ms. Davies asked.

Health Minister Leona Aglukkaq denied Ms. Davies’ assertion that health transfer payments are being reduced. She said the government is providing “a long-term, stable funding arrangement with the provinces and the territories that will see transfers reach historic levels of $40 billion by the end of the decade.”
But Ms. Davies said the “take it or leave it ultimatum is in direct opposition to the principles of the Canada Health Act. Canadians are rightly worried that it will lead to greater privatization, undermining the foundation of medicare.” She also asked what happened to the government’s commitment to accountability.

Ms. Aglukkaq replied, “I will continue to work with my provincial and territorial colleagues to make sure that Canada's health system is more sustainable, and to improve accountability and deliver better services to Canadians.”

The Senate Social Affairs, Science and Technology Committee met in camera this week to discuss their draft report on the 2004 health accord. It is expected later this month or early next month.