Defending Public Healthcare

Cut back and hope no one gets hurt?

2013-06-11T18:25:00.002-04:00

In May, as the chemotherapy drug mixture scandal swirled, the Ontario Hospital Association tried to distance the contracting out of chemo mixtures from the cost cutting that is so widespread in hospitals at the moment:

"Contrary to the assertions of some commentators and unions, the outsourcing of compounding by hospitals was not driven primarily, or even secondarily, by cost considerations in most cases."

Hmm... OCHU's release on this issue did not suggest the contracting out was done to cut costs -- there was no evidence on this point at the time. Instead, among many other points, OCHU noted examples of contracting out costing more.

The OHA claims hospitals were motivated by the health and safety of their employees (god bless 'em), patient safety, best practices, etc, etc., etc.

But not money.

Despite the OHA claims, however, hospitals are mixing their own drugs, without reports of duff chemo mixtures -- unlike the contracting out situation.

Cash Money: As it turns out, unions probably should have raised questions about the role of cost cutting in the scandal.

In the last few days it has been revealed that the private company that won the chemotherapy mixing contract quoted a rate of $5.60 to $6.60 per bag of chemotherapy medication. The previous private contractor charged $21 to $34.

It takes some believing to swallow the idea that the extreme cost cutting seen here (73% to 84%) was of no account in the bidding process.

It also takes some believing to think that such cuts would not result in some corners being cut.

Apparently, that is a thought that did not occur to the hospitals. Pressed by government austerity, that is perhaps not so surprising.

For the record, the private contractor states that there is “no rational connection between pricing and this incident.”

More contracting out claims: The contractor that lost out on the last mixing contract claims it was told that the new contractor won because it had "superior labeling".

If this is true, it raises other questions about the contracting out process.

It was the lack of detail on the labels that first raised concern among hospital staff about the chemotherapy mixtures. Indeed, the labels did not report the exact concentration of the drugs as required, according to (yet another) contractor hired by the hospitals to purchase the drug mixture.

What's going on?
From this vantage point, it looks like the government is experimenting: squeeze hospital budgets and hope things work out.

The good news (so to speak) is that we can get them to respond if the disasters that result are publicly exposed. This week's announcement that they will more than double the number of long term care inspectors is a case in point.

There's a lesson for opponents of austerity in that.

But, unfortunately, public exposure isn't a guarantee of better outcomes, at least on the first go-round. On chemo contracting out, they are signaling that they won't change much.

The investigator brought in by the Ministry of Health and LTC to examine the chemo muck up, Dr. Jake Thiessen, appeared before a legislative committee in late May. He doesn’t like describing the confusion over the provision of chemo drug mixtures by a private corporation as a “grey area”:

"I've never felt this is particularly grey ... I've felt this is part of the customary evolution of service that professionals provide," Thiessen told the committee.

Privatization as a “customary evolution”. That doesn’t sound good.

The multiple levels of contracting out (from the hospital, to, possibly, a group of hospitals, to a purchasing corporation, to the mixing corporation, and then back to the hospitals) almost ensures that there will be misunderstandings and contractual confusions. The secrecy required by commercial confidentiality wouldn't help either.

Nevertheless, it looks like the government will simply promise to privatize better next time.

Photo: Tax Credits

Ambulances and Public Health get cash (while other sectors starve)

2013-06-07T08:15:00.000-04:00

From time to time there are rumors that EMS (ambulance services) and municipal public health services may move over to the tender mercies of the Local Health Integration Networks (LHINs), which fund hospitals, home care, long term care, and other health services.

Fortunately-- for these services -- that has not happened yet.

The government is starving the LHINs. According to the recently released Budget Estimates, the LHINs are going to get $300 million less than what they got two years ago.

In contrast, public health services (provided by municipalities but funded to a considerable extent by the province) are budgeted to get about a 6.4% increase from the provincial coffers this year. Over the last two years the increase is 12.2%.

Not too bad.

"Emergency Health Services" (aka EMS) are also largely provided by municipalities but funded almost 50% by the province. And EMS has also done okay, with a 3.8% increase this year according to the Estimates. Over the last two years, the increase is an impressive 9.2%, continuing a long trend that has seen big increases for ambulances.

While the increases are significant, the funding for EMS and public health remains small potatoes compared to what the LHINs get -- at about $1.5 billion together they are about 6.5% of the LHIN budget.

But they are big enough that they might help ease the pain of a $300 million cut.

Bottom line for EMS and public health: if the Borg ever gets them in its mitts, they might look like tempting little morsels.

Provincial Programs: With most of the new Budget money going to the doctors, the tradition of handing over major increases to the murky Budget line item called "Provincial Programs" (and especially the sub-line item "Community and Priority Services") has come to an end.

The total increase here is a measly $42 million -- a little more than a 1% increase, about the same as the overall increase for health care. The previous year saw a $1.5 billion increase to this line item (an eye-popping 69% increase).

Effectively the government had put the LHINs in charge of saying no to everyone, while leaving themselves some cash to play with.

Now? Not so much.

Photo by Xiaozhuli . The Ottawa EMS base.

Doctors get lion's share of Budget funding

2013-06-03T09:01:00.000-04:00

Forget all the government Budget rhetoric about better home care. The real winners are the docs.

The Ontario Budget Estimates are out and the line item primarily covering the doctors ("Ontario Health Insurance") is going up 2.9 per cent to $13.3 billion. The rest of the health care sector got an increase of 0.3 %, just over one-tenth as much.

In dollar terms, the Ontario Health Insurance line item got an increase of $374 million. The total increase for all of health care (capital and operating expenses) is only $486 million, so this will eat up more than 3/4 of the total health care increase.

A relatively small group of people are getting most of the total increase in health care spending -- and about 10% of the total $3.6 billion increase in all provincial spending.

Every $100 million split between 25,000 Ontario physicians means another $4,000 per physician, on average.

The pathetic LHINs (which are the main funders of hospitals, home and community care, and long term care) got a whopping $5.5 million. That's a tiny increase of 0.02% (yes, that's correct, 2 one-hundreds of one percent).

The extra cash for the doctors is part of a long pattern under the Liberals of big increases for doctors. For a while, during bargaining with the doctors, it looked like the government might try to keep a lid on it. In public, at least, the McGuinty / Duncan government had to take this stance as they were planning on sticking their lesser paid employees (who were entering bargaining right after the docs) with bona fide wage freezes.

But even at that time there was skepticism about what was really going on -- some thought that they would quietly find ways to keep the cash flowing.

Judging by the way they buried this, the Liberals would prefer that no one finds out about the increased funding. So expect to hear more yattering about better home and community care - and very little about extra cash for the docs.

Note: this piece has been clarified to reflect total health care expenditures, increasing the relative portion of new health care money going to the "Ontario Health Insurance" line item. Photo: The Ontario Legislature, 103 years out of date, courtesy Toronto Public Library