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OHC 2016 Pre-Budget Briefing

Posted: February 25, 2016

(February 25, 2016)

2016 Pre-Budget Briefing

Where We Stand: Ontario’s Ranking in Public Service and Health Care Expenditures & Cuts

Ontario’s government is making budget choices that cut and privatize public services and health care. These are choices, not necessities. Here’s how we compare relative to other provinces and jurisdictions on some key measures.

The Notable Trends Are:

  1. Ontario ranks at the bottom of the country for hospital beds per 1000 population (Chart 1).
  2. Ontario ranks near the bottom of the entire OECD for hospital beds per 1000 population (Chart 2).
  3. Ontario is at the bottom of the country for nurse to patient ratios (Chart 3).
  4. Ontario and Quebec continue to compete for last place in hospital funding per person (Chart 4).
  5. Ontario is second last in the country for public hospital funding as a percentage of provincial GDP (Chart 5).
  6. Ontario is near the bottom of the country for public hospital funding as a percentage of all provincial program funding (Chart 6).
  7. Ontario’s hospitals are running over capacity. In many instances bed occupancy rates exceed 100% (Chart 7).

Priority Recommendation: Stop Devastating Hospital Cuts & Restore Funding to Average of Other Provinces

Hospital global funding increases have been set below the rate of inflation since at least 2008. Since 2012/13 global hospital budget funding levels have been frozen. In sum, this means that global hospital budgets have been cut in real dollar terms (inflation-adjusted dollars) for 9 years in a row. This is the longest period of hospital cuts in Ontario’s history and there is no end in sight. The evidence shows that the hospital funding formula and austerity measures that have cut global hospital budgets in real dollar terms for almost a decade, have resulted in a dramatic reduction in needed services. By key measures, Ontario now ranks at the bottom of comparable jurisdictions in key measures of hospital care levels.

As a result, hospitals large and small in every geographic region of Ontario are cutting needed services. Hospitals are now at dangerous levels of overcrowding; staffing levels have dropped precipitously; and patients are suffering as they are forced to wait longer and drive further to access care and are discharged before they are stable.

A sampling of recent cuts:

  • North Bay – 30 – 40 beds closing and 140 staff positions to be cut.
  • Brockville – 17 Registered Nurses cut affecting departments across the hospital.
  • London – up to 500 surgeries including hip, knee, gall bladder and others cancelled until next fiscal year due to inadequate funding of surgery budgets.
  • Woodstock – hip, knee and other surgeries cancelled until next fiscal year.
  • Trenton – virtually all surgeries cut and closed down along with half the remaining acute care beds.
  • Minden – the hospital CEO is speculating openly about closing the Minden hospital.
  • Niagara – five entire hospitals to be closed and replaced with one.
  • Windsor — >45 nurses and staff positions to be cut affecting departments across the hospital.
  • Kitchener-Waterloo – 68 staff positions to be cut affecting departments across the hospital.
  • Midland – at risk: birthing, cafeteria, OR closure 2 days per week, ICU beds to be cut, along with beds and other services.

The Ontario Health Coalition is deeply concerned about the cuts to our province’s public hospitals and has focused on one key recommendation for the 2016 Ontario Budget:

Recommendation: The hospital cuts must be stopped immediately. Hospital funding must be restored to the average of the other provinces in Canada and funding must go to restoring and improving service levels to meet population need.

Chart 1: Ontario ranks at the bottom of the country – Hospital beds per population

Hospital Beds Per 1000 (population)By Province2013-14
Newfoundland & Labrador 4.6
New Brunswick 3.8
Saskatchewan 3.6
Nova Scotia 3.4
Manitoba 3.3
PEI 3.3
British Columbia 3
Alberta 2.8
Ontario 2.3
Average other provinces 3.5

Source: Canadian Institute for Health Information, Data Table: Hospital Beds Staffed and in Operation 2013-14. Population statistics from Canadian Institute for Health Information, National Health Expenditures Database 2015.

Chart 2: Ontario ranks near bottom of the entire OECD – Hospital beds per population

OECD Hospital Beds Per 1000 Population2013
Japan 13.3
Korea 11.0
Germany 8.3
Austria 7.7
Hungary 7.0
Poland 6.6
Czech Republic 6.5
France 6.3
Belgium 6.3
Slovak Republic 5.8
Luxembourg 5.1
Estonia 5.0
Finland 4.9
Greece 4.8
Switzerland 4.7
Slovenia 4.6
Norway 3.9
Australia 3.8
Italy 3.4
Portugal 3.4
Iceland 3.2
Israel 3.1
Denmark 3.1
Spain 3.0
United States 2.9
Ireland 2.8
New Zealand 2.8
United Kingdom 2.8
Canada 2.7
Turkey 2.7
Sweden 2.6
Ontario 2.3
Chile 2.2
Mexico 1.6
OECD Average 4.8

Source: OECD, Health Statistics 2015 at http://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_REAC

Chart 3: Ontario ranks at bottom of the country – Nurse to patient ratios

Nursing Inpatient ServicesTotal Worked Hours per Weighted Case
2007-2008 2008-2009 2009-2010 2010-2011 2011-2012
NFLD 52.2 53.26 54.48 55.9 52.9
PEI 83.48 N/R 62.19 62.46 61.66
  1. S.
56.79 57.34 U U 54.95
N.B. 54.98 55.46 56.26 57.29 58.13
Quebec 49.73 50.06 50.82 50.73 52.47
Ontario 44.98 44.76 43.71 42.81 42.88
Manitoba 54.41 54.27 53.87 53.06 53.97
Sask. 49.37 51.42 51.28 52.95 54.18
Alberta 54.12 54.65 54.52 54.24 54.36
B.C. 44.24 45.27 45.03 45.87 46.27
NWT U 83.05 88.51 69.48 N/R
Yukon 48.84 48.97 50.25 56.31 54.51
Weighted Average 48.59 48.8 48.36 48.2 48.98

Source: Canadian Institute for Health Information, 2013.

Chart 4: Ontario and Quebec compete for last place in hospital funding

Public Hospital FundingPer Person, 2015Current $
Newfoundland & Labrador $2,406
Alberta $2,245
Prince Edward Island $1,995
New Brunswick $1,971
Nova Scotia $1,907
Manitoba $1,818
British Columbia $1,797
Saskatchewan $1,761
Ontario $1,419
Quebec $1,382
Average of the other provinces $1,920
Difference between Ontario and the average of the other provinces Ontario funds hospitals at $501 per person less

Source: Author’s calculations from CIHI, National Health Expenditures Database 2015

Chart 5: Ontario 2nd to last in the country – Public hospital spending as a percentage of provincial GDP

Public Hospital Fundingas % of Provincial GDP2015
PEI 4.73 %
New Brunswick 4.45 %
Nova Scotia 4.31 %
Newfoundland & Labrador 3.82 %
Manitoba 3.59 %
British Columbia 3.35 %
Quebec 2.97 %
Alberta 2.67 %
Ontario 2.64 %
Saskatchewan 2.38 %
Average of the other provinces 3.59 %

Source: Author’s calculations from CIHI, National Health Expenditures Database 2015

Chart 6: Ontario at bottom of the country – Public hospital funding as percentage of all provincial program funding

Public Hospital Fundingas % of All Provincial Program Funding2014
Nova Scotia 20.72 %
British Columbia 19.44 %
New Brunswick 18.95 %
Alberta 18.91 %
Newfoundland & Labrador 18.61 %
Manitoba 17.94 %
PEI 17.56 %
Ontario 15.34 %
Saskatchewan 14.73 %
Quebec 11.16 %
Average of other provinces 17.56 %

Source: Author’s calculations from CIHI, National Health Expenditures Database 2015

Chart 7: Ontario’s hospitals over capacity – Hospital bed occupancy rates

Sampling of hospital bed occupancy rates (final quarter 2013)

  • Napanee/Lennox/Addington: 123%
  • Sault Ste Marie area: 114%
  • Toronto Hosp. for Sick Kids: 110%
  • Toronto Central: 110%
  • London Health Sciences Centre: 108%
  • Exeter South Huron: 106%
  • Burlington Joseph Brant: 106%
  • Hamilton Niagara Haldimand Brant: 106%
  • Niagara Health System: 104%
  • Windsor Hotel Dieu Grace: 101%
  • Erie St. Clair: 101%
  • Oakville Halton Health: 101%
  • Mississauga Halton: 101%
  • The Ottawa Hospital: 101%
  • Barry’s Bay St Francis: 101%
  • Thunder Bay Regional: 100%
  • Newmarket Southlake Reg.: 100%

From Ministry of Health data accessed by Jonathan Sher, London Free Press.
See: http://www.torontosun.com/2014/03/07/ont-health-ministry-data-on-hospital-overcrowding-riddled-with-errors

Chart 8: The conesequences of emergency department overcrowding

The Consequences

  • Patient suffering, dissatisfaction and inconvenience
  • Poor patient outcomes
  • Increased morbidity and mortality
  • Poor quality of care
  • Contribution to infectious disease outbreaks
  • Violence aimed at hospital staff and physicians
  • Decreased physician and nursing productivity
  • Deteriorating levels of service
  • Increased risk of medical error
  • Negative work environments
  • Negative effects on teaching and research

Source: Physician Hospital Care Committee Report to the Ministry of Health and Long-Term Care, Ontario Medical Associaiton and Ontario Hospital Association Tripartite Committee, Improving Access to Emergency Care: Addressing System Issues, August 2006.

 OHC 2016 Pre-Budget Briefing (PDF)

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