Biting the hands that feed them

We all know the old cliche that says “don’t bite the hand that feeds you”. It appears that the Ontario Ministry of Health and Long Term Care (MOHLTC) may be doing just that.

Hospitals receive funding based on the number of people that use them, as well as through efficiency markers set forth by the Ministry. If a hospital sees a lot of people and gets them out of there quickly and efficiently, then a hospital gets additional funding.

At the same time, Family Doctors across Ontario are being punished for not being accessible. The MOHLTC claims that the high use of the Province’s Emergency Departments, walk-in clinics and Urgent Care Clinics is a direct result of poor accessibility to an individual’s Family Doctor (if they have one), or the inability of an individual to find a Family Doctor.

Now if the two above paragraphs are put together, a problem develops. If Family Doctors become more accessible, theoretically, less non-urgent issues will go to the Emergency Departments. This is obviously a good thing. The Emergency Departments are flooded daily with non-emergent and non-urgent issues, such as coughs, colds, sore throats, bladder infections, cuts, aches, etc.

When someone goes through triage at an ER, what is really happening is the nurse assessing this person is deciding how much of an emergency they are. A super duper emergency is labelled as a CTAS-1 (Canadian Triage & Acuity Scale). Someone who comes in for a sick note is a CTAS-5. Most people that come to the hospital vary between CTAS-2 and CTAS-4. It’s the CTAS4’s and 5’s that really have no business being in an ER. However, they are the majority of presentations each day.

If a hospital is able to quickly and efficiently get through a lot of CTAS-4’s and 5’s, it’s good for their numbers, meaning it’s good for their funding requests. If the MOHLTC gets their way, less of these people will go to the Emergency Department and they’ll see their Family Doctors. This is good, as it should theoretically reduce the wait times in the ER… Except, this means the hospitals will have reduced numbers and will be at risk of receiving reduced funding. Reduced funding means accessibility to that ER may be at risk.

Meanwhile, if Family Doctors are mandated to increase their accessibility, even with advanced access, wait times to see them may be jeopardized as well.

The Ministry is creating two vicious circles in its attempts to feed Primary Care. The losers are obvious, but the winners are less so. Perhaps this is what the Ministry wants: an excuse to withhold more funding? In these scenarios, patient care will continue to suffer.

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