The Policy Challenges Affecting the Healthcare Sector in Ontario

Purpose

The purpose of this briefing note is to highlight all the most important health policy challenges that will impact the functioning of the Ontario Ministry of Health and Long-Term Care in the next five years.

It is important to note that the highlighted are not exhaustive; however, those that are most pressing at the moment have been given a bigger spotlight.

The contents of this briefing note are not only relevant to the minister in charge, but also to all other stakeholders and players in the sector including the healthcare workers, professional associations, other government agencies, and concerned individuals; and the recommendations should not be taken as arbitrary instructions but as guidelines to future actions stemming from the discussion of the briefing at an appropriate time in the near future.

Background

The people of Ontario and of Canada as a whole are very proud of their healthcare system; they not only consider the universal healthcare system as a basic human right but they also see the system as a symbol of the success of the Canadian spirit [1].

Recently, however, there has been a growing discontent regarding the perceived deterioration of the quality of healthcare in Ontario; questions have been raised particularly regarding the time patients have to wait in emergency rooms to be attended to; or to see a specialist. The citizens are also deeply concerned about the sustainability of the system; with many foreseeing a problem of funding arising in the near future [2].

There have been opposing arguments about the involvement of the government in the provision of health services to the people; the majority of respondents reiterated that the citizen should be guaranteed for all regardless of economic status [3]. However, a significant number argues that universal health is a trade-off for quality and efficiency; and that a person should be able to spend more money to buy better services [4].

There has also been a growing concern among the general citizenry that the Ontario health system is not adapting quickly enough to new techniques in the practice of medicine and new technology. Therefore, there is a feeling that one may not be getting the best possible treatment there is for the ailment presented at a hospital.

The respondents are also raising questions regarding the transparency and accountability of the system; the expenditure of the vast amount of taxpayers’ money for the provision of universal care need to have more checks and balances to ensure that the money is utilized optimally [5].

The residents of Ontario deeply value their healthcare system and they would like it to remain part of their life; however, there is a general concern that there is a need to institute some reform in the sector to make it better.

Deterioration of services

As mentioned before, the feeling among the populace is that medical care is getting worse in Ontario [1]. Some of the sighted things are a reduction of the amount of staff in hospitals, therefore, increasing the time a patient has to wait either in a waiting room or to see a specialist. The issue of unavailability of some procedures in the system’s hospitals has also been pointed out [6].

There is however a general understanding that universal healthcare is more or less a trade-off with quality of the service [7]; since to be able to pay for the treatment of everyone, some of the more expensive procedures will be unavailable; and the hiring of new staff will be constrained by the tight budget.

The populace has now been left with a tough choice to make; either they pay more taxes to fund a wider range of services in the hospitals or opt to stay with the current system [8].

Sustainability and accountability of the healthcare system

Many users of the public health system have a pessimistic view of the future of the Canadian model of universal health care. With the growing demand for health in Ontario [6], they feel that it may come a time that the people will no longer be able to fund the system as a result of escalating costs.

Health care will thus inevitably go down the privatization road and most likely end up in the trap that has caught so many other similar systems in other countries; that of accessibility [9].

One of the biggest dangers that Canadians foresee is that of lack of accessibility to healthcare due to economic inability; simply put, Canadians are afraid of losing their cherished health system to capitalists.

The other alternative therefore would be to cut spending on other areas of the government and redirect the money to funding the system. This may not however be realistic as it would start to affect the economy of the country which is not a favorable outcome of the move.

With the issues of future funding being raised, then the way that money is being spent in the system is being queried. It is being demanded of the administrators to have more inhibition on how money is spent. Accountability demands are also being made on the physician and the patient as a way to discourage unnecessary procedures and tests [3].

Sentiments are rife that most doctors prescribe unnecessary visits and give unwarranted referrals; and that some patients misuse the system at the expense of the taxpayer. These have generally led to a less efficient system that wastes funds at the expense of legitimate medical needs.

Measures to limit just how much money a physician can splash on one patient have been suggested. Additionally, many believe that a reduction of bureaucracy in the system will make it more efficient [1].

The inefficiency of operations and poor spending of allocated money is a very serious problem; this is because an attempt to solve this problem by addition of funding will not have any impact; this is because the reason for the poor performance will not be the lack of funds but the wasteful spending of it.

In addition to this, a change in attitude among individual users who tend to clog the system unnecessarily is required; thus affecting less wastage in the system.

Effects of change in demographics

There has been a growing concern about the ability of the healthcare system to sustain a future change in the demographic composition. This concern arises from the fact that the population of people aged 65 years and over is expected to grow by 141.86% by the year 2050. This growth can be attributed to the ‘baby-boomer’ generation that was born between 1945 and 1967. The change in the demographics can also be attributed to the advances in medical technology that allowed people to live longer healthier lives. the effects of this population on health expenditure were not being felt; however, the proportion from this generation will start entering retirement age between 2010 and 2032, that’s when the effects will kick in.

Quality versus Accessibility: The future of Healthcare in Ontario in the face of an expected demographic shift

In Canada, the responsibility of healthcare is left to the provinces which fund up to 85% of the total cost of the service. Therefore, the effects of an increase in the demand for health care precipitated by the aging of the baby-boomer generation will have a devastating effect on their respective economies.

This is no doubt the biggest headache for the healthcare policymakers in Ontario.

The majority of the users favor a situation where everyone gets at least basic medical care. However, this system has its drawbacks; for example, some of the more expensive medical procedures are not available, and purchasing of new technology is not as enthusiastic. This stems from the attempt to spread limited resources over a large number of users [10]. This condition may be made worse by a sudden increase in demand for healthcare services without a corresponding enlargement of the service.

The relatively wealthier Canadians are advocating for a system where they can pay a premium for the expensive procedures as they can do so. This system would however also allow them to pay for the procedures entitled to everyone but allow them to (in a manner of speaking) jump the queue of waiting. The issues of payments separate from the tax contributions made by every citizen raise the issue of accessibility [11]; in a universal healthcare system, everyone should ideally be entitled to the same form of treatment regardless of their economic or social background. When some services are reserved for the rich, the system ceases to be universal.

Increased funding of the healthcare system may be one of the solutions for the perceived deterioration of the services; this however should be accompanied by increased supervision of the administration to prevent any wastage of the precious funds. There also should be increased evaluation of the system on a regular basis so as to measure the impact of the increased funding, and of the accountability measures installed.

In addition to this, some of the funding money should be allocated for projects to upgrade the hospital equipment, hire more staff, and train the existing staff on the new techniques in the practice of medicine.

The complete privatization of the healthcare system can be done. This however is opposed by the proponents of equal access; they argue that the system is an identity of Canada and it represents the fact that Canadians believe that equal access to health care is a fundamental human right, and thus an abolishment of this system would be an infringement on that right. The system of equal access is understandably favored by the lower-income groups [12].

On the other hand, privatization would give the citizens more control over where they want to go for healthcare thus giving them more choice and more freedom with their money. This would also allow them to look for and choose quality service as they perceive it. This system would definitely favor the ‘well-off’ individuals.

This, thus, is the clash between quality and accessibility in the healthcare system.

References

  1. Mendelsohn M. Canadians’ Thoughts on Their Health Care System: Preserving the Canadian Model Through Innovation. Commission on the future of health in Canada 2002.
  2. Rappolt SG. Clinical guidelines and the fate of medical autonomy in Ontario. Social Science & Medicine 1997 Volume 44, Issue 7, Pages 977-987
  3. Epp Jake Achieving health for all: A framework for health promotion. Health Promotion International 1: 419-428.
  4. Charles C, DeMaio S. Lay participation in Health Care Decision Making: A Conceptual Framework. Journal of Health Politics, Policy and Law 1993 18(4):881-904. Duke University Press.
  5. Vissandjée B, Weinfeld M, Dupéré S, Abdool S. Sex, gender, ethnicity, and access to health care services: Research and policy challenges for immigrant women in Canada. Journal of International Migration and Integration 2001 Volume 2, Number 1
  6. Reinhardt UE. Does The Aging Of The Population Really Drive The Demand For Health Care? Health Affairs, 22, no. 6 (2003): 27-39
  7. Church J, Barker P. Regionalization of Health Services in Canada: A Critical Perspective International Journal of Health Services Volume 28, Number 3 / 1998
  8. Gostin JD. Legal and Public Policy Interventions to Advance the Population’s Health. Promoting Health, ed. Smedley and Syme, 390–416.
  9. Lavis JN. Ideas at the Margin or Marginalized Ideas? Non-medical Determinants of Health in Canada. Health Affairs (2002): 107–112.
  10. Wolfson M. Relation between Income Inequality and Mortality: Empirical Demonstration. British Medical Journal (1999): 953–957.
  11. Berkman LF, Glass T. Social Integration, Social Networks, Social Support, and Health. Social Epidemiology, ed. L.F. Berkman and I. Kawachi (New York: Oxford University Press, 2000), 137–173.
  12. Kindig DA. Purchasing Population Health: Paying for Results (Ann Arbor, Mich.: University of Michigan Press, 1997).

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