‘Efficiencies’ in health care should be a plan, not a buzzword

OPINION: Nobody’s arguing for wasteful, indulgent spending in medicine — so the Tories need a better answer for Ontario’s health-care system than “efficiencies”
By John Michael McGrath - Published on Jan 19, 2021
Hallway health care didn’t start with COVID-19, and it won’t end after Ontario is fully vaccinated. (Rachel Verbin/CP)

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The latest season of TVO’s Political Blind Date is a very 2020 document: the first episode deals with “hallway health care” in Ontario and how best to address chronic resource shortages in our hospital system. And, as this is a very 2020 document, the filming of the episode was (spoiler alert) interrupted for several months by the onset of the COVID-19 pandemic.

The episode, featuring PC MPP Natalia Kusendova and NDP MPP Sara Singh, illustrates that even relatively minor changes in spending in the health-care system can have life-changing effects on the ground level: one man’s dialysis nurses are shifted from a Brampton hospital to one in Etobicoke, and he faces the prospect of having to totally reschedule his life to get life-saving treatments.

Kusendova — who went back into active duty as a nurse when the pandemic began — defends her government’s policies ably, stating that the Tories are emphasizing the need for efficiency in the health-care system and shifting some of the money that’s currently spent on administration and bureaucracy to more and better care. The pre-pandemic creation of Ontario Health was intended to consolidate the alphabet soup of LHINs and other bodies into a more streamlined system, and Ontario Health CEO Matt Anderson has been praised for his management during COVID-19.

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And that’s fine, as far as it goes: nobody is making the argument for wasteful, indulgent spending on gold-plated bedpans or anything. Efficiency is good, and the government should be as efficient as it can be to meet its objectives. But it’s the second part of that — meeting its objectives — that goes unaddressed when one simply invokes “efficiencies.” What is it that we want efficiency to do, exactly?

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People can and will debate how Ontario has performed during the pandemic — if nothing else, it’s likely to be the kind of thing voters judge the current government on in 2022 — but hallway health care didn’t start with COVID-19, and it won’t end after Ontario is fully vaccinated either. (One of the under-emphasized stories of Doug Ford’s spring 2018 election victory is how it directly followed a bad flu season and heavy coverage of sick patients backed up in hallways.) There are numerous reasons for this, but it’s hard to avoid the fact that Ontario and Canada simply have a relatively low number of hospital beds per capita when compared with other wealthy countries. When people get sick, there are simply fewer beds per person available. And when lots of people get sick — yes, in a pandemic, but also in a bad flu year — they pile up wherever space can be found.

The root cause isn’t mysterious: while Canada’s health-care system overall spends more than some countries, our hospital spending, specifically, is well behind that of other wealthy countries, according to the Canadian Institute for Health Information. We aren’t spending more to get less; we’re spending less and getting less. We can, and should, debate how best to get the most out of every dollar. There are important debates to be had about how best to do that — should we, for example, invest more in home care and telemedicine so that hospitals see only the people who absolutely need to be admitted? That’s a totally reasonable argument for the political sphere. But we should acknowledge the limits to these debates: you can’t “efficiency” your way out of real shortages of real resources.

All of this has been thrown into high relief because of the pandemic, of course. But the pandemic will end, and Ontario will still face serious long-term health-care challenges. The province’s population is still aging: according to the Ministry of Finance’s projections, the number of people 75 years old and over will grow from 1.1 million in 2019 to 2.7 million by 2046; the number of people 90 and above will grow from 130,000 to 443,000. These people will be vastly more likely to need medical attention of various kinds, and they are very likely to be considered high-risk for such things as infectious diseases, novel or otherwise.

And, though I hesitate to say it when we’re still in the middle of one pandemic, the 20th century saw multiple pandemics, and there’s no guarantee that COVID-19 will be the last one in our lifetimes. Thinking about how we should prepare the health-care system for the next one isn’t at all a foolish thing to do right now.

Efficiencies are good and important and necessary. But if efficiencies in health care get committed to tax cuts or more visible spending increases elsewhere in government (high-profile transit projects, for example), Ontario won’t actually have answered the question of what to do about hallway health care, and we’ll still only ever be one bad flu season away from another crisis.

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