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.
