Northern Economist 2.0

Monday, 20 April 2020

Improving Ontario's Public Health Care System

Acting on the advice of the Chief Medical Officer of Health and other health care professionals, the Ontario government has significantly expanded hospital capacity in preparation for any COVID-19 outbreak scenario. The province has added 1,035 acute care beds and 1,492 critical care beds and taken steps to ensure hospitals have the staff available to care for a sudden surge in patients. Based on Ontario’s population and 2017-18 total hospital bed numbers from the CIHI, this should boost the total number of hospital beds per capita in Ontario to 2.5 per 1,000 population.  Moreover, there are plans to add further  capacity in terms of bed numbers.  

 



Expansion of capacity and associated funding to staff those beds is necessary to deal with the COVID-19 outbreak but it is also necessary to deal with future health demand because hospitals in Ontario have seen their per capita hospital bed numbers and real per capita hospital spending stay flat for years. Real per capita provincial government health spending in Ontario from 2000 to 2019 grew 39 percent but growth varied across the health expenditure categories.  Hospitals in Ontario over this period only grew by 14 percent with much of it before 2010 and since 2012 has been essentially flat.  The largest increases were in per capita public health (133 percent), other health spending including home and community based care (101 percent) and drugs (59 percent). 



Across Canada’s ten provinces, Ontario currently has the second lowest number of total hospital beds per 1000 people after Quebec at 2.3 beds per thousand (which will grow to 2.5 with this announcement) with Quebec coming in at 1.9.  Newfoundland comes in the highest at 4.6 beds per thousand followed by New Brunswick at 3.8 and Manitoba, Prince Edward Island and Nova Scotia all tied at 3.4.  Ontario, like many Canadian provinces has developed a “just in time” hospital care system with little spare capacity.  In the past, winter months often saw surges resulting in hallway medicine because of surges in demand from seasonal flu.



Currently the reports are that hospitals in Ontario have been coping well as the anticipated peak surge due to COVID-19 appears to have been held back by the implementation of public health protocols such as physical distancing and shutdowns of activity.  Assuming the additional beds and staffing can be put in place quickly, it better positions Ontario hospitals for any surge in COVID-19 and boosts capacity for the period afterwards.  That is good news because to date the expansion in the current ability to free up beds has been done by rationing access to services.  Essentially, beds have been freed up by sending as many patients as possible home, delaying elective surgeries and postponing deemed non-urgent surgeries.  As well, demand for emergency services is down as people delay going to seek treatment which has ramifications for future need as people put off seeking medical care.



Given that we may be nearing a slowing down in the growth rate of total confirmed cases in Ontario Covid-19 cases, I think the ability of the health care system to deal with Covid-19 will be even more secure especially as more beds come on stream and supplies of critical materials and PPEs increase.  This will hopefully result in hospitals starting to resume dealing with elective and non-urgent surgeries and their usual diagnostic testing services given that almost all of this has been put on hold.  The postponing of other health procedures is detrimental to the long-term health of many Ontarians and is an additional cost of the Covid-19 pandemic in terms of both its potential effects on general future mortality and morbidity as well as future health care costs.  



Running a “just in time” public health care system at capacity with most activity – diagnostic, acute care, surgeries and emergency services - mainly concentrated at large centralized hospitals will need to be revisited.  We need a more resilient health care sector that able to cope with surges in demand in crisis situations as well as continue to provide other needed health services.  One can hope that in future, along with a reinvestment in hospital capacity and proper maintenance of public health equipment stockpiles, one will see an expansion of broader function “Urgent Care Centers” across the province that will provide a range of emergency type services outside of hospital settings as well as more decentralized diagnostic clinical centers that are able to do minor elective procedures outside of a major hospital setting.  The current approach to the health care system in Ontario is essentially akin to putting all your eggs in a very small and fragile basket.