Ontario Medicine has gone Corporate

The medical- and surgical-driven health care provided in Ontario has gone corporate, or so it seems. Beneath the surface, of course. The Canada Health Act prohibits doctors from charging private fees for providing mandatory health care in the vast majority of cases. Some exceptions apply, most notably in Quebec, (but their MediCare service is certainly distinct!)

Hospitals in Ontario are funded by the Provincial Government, which is crying the story of no money. Stories of Governmental waste through poor decisions aside, it’s true: the Government has no money. As a result, hospitals have no money, and are now required to compete against each other to gobble up as much of the available funds as possible.

We, as health care professionals, have now been called upon by our hospital administrators, to help them “improve the numbers”, and thus rise on the rungs of the Local Health Integrated Network, the notorious LHIN, to qualify for more funding. As an aside, while I see the performance-driven motivation behind the plan, I still cannot understand how taking away money, or disqualifying struggling hospitals access to funding, will ever help said struggling hospitals from emerging from the red or improving the quality of health care to their population. If a health centre is already performing poorly, cutting beds, staff and programs is not going to save money if the people they serve no longer have access to quality – or any – health care.

Now the doctors have to play the corporate game. We have to see more people, in less time. We have to see more sickly people, ie: those with higher acuities. To summarize, we have to see more sicker people in less time. How is that helpful? How is that safe? By increasing the acuity of each patient who presents to the Emergency Department, this brings in more funds. However, with each up-triaged patient, the wait time to see them is expected to decrease. In other words, someone who presents with a CTAS-4 (non-urgent) who would normally be expected to be seen within 2 hours may be classified as a CTAS-3 (urgent); and now would be expected to be seen within 1 hour. But all the CTAS-3’s are now marked as CTAS-2’s (emergent) and have to be seen within 30 minutes. The result is that no one will be seen any faster, but the new numbers will just show that the wait times have increased. We have already seen this in the recent Ontario publication of wait times, where there has been an increase despite the Ministry of Health’s declaration to reduce wait times. And what becomes of the hospitals with the poorer wait times, in other words, the ones that need the extra help? Reduced funding!

On the medical and surgical floors, doctors have to contest with what is called “conservable days”, which means the number of days a patient should be admitted given their admission diagnosis. If someone is brought into the hospital because they have pneumonia, they are expected to be discharged home within 4 days. If for any reason said patient remains in hospital longer than 4 days, the hospital loses money for wasting the bed. The doctor is now pressured to discharge the patient by 4 days, or possibly earlier. Sometimes patients can safely go home early. Great. Often, due to the increasing number of co-morbidities (other medical issues that also affect an individual), patients cannot be safely discharged home. This is usually because of a lack of rehabilitation available in the hospital (due to lack of funding for such allied health professionals), or lack of community support to enable a safe return to the community (due to a lack of funding for such community supports). But the hospitals are under pressure to stay in the black, and the administrators put pressure on the doctors to help improve their numbers. Patient safety is what is at risk.

Our healthcare system, long financially ailing, is now reaching the point where harm will no doubt occur. Why does change to anything healthcare-related only take place when it enters crisis mode or a fatality results?!

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