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Where Are Your Health-Care Dollars Going?

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HEALTH CARE COST
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Several weeks ago I had the opportunity to be on "The Agenda with Steve Paikin." The topic of the debate was the failed Tentative Physician Services Agreement (tPSA) that was foisted on physicians in a surprise move this past summer. During the course of the debate, Dr. Richard Reznick mentioned (starting at the 10: 45 mark) that we spend 11 per cent of our gross domestic product on health care, far more than other countries.

I thought that was an interesting point to make, so I decided to look up some statistics, to see if that statement was true. The numbers, alas, are very disheartening.

It's been reported that Canada spends the fourth most per capita on health care of all of the industrialized countries in the world, behind the United States (an odd country that when it comes to health care), Netherlands and Switzerland. Ontario spends about the national average, so we clearly do spend a lot on health care.

Yet, despite all that money being spent, Canada's health-care system currently ranks 30th in the world, according to the World Health Organization and last amongst all OECD countries in terms of wait times. Clearly, all Canadians, not just Ontario residents, should expect more from their health-care system.

But the real story of why our health system is in such disarray comes when you look at the expenses. Quite frankly, the expenditures show that the priorities are badly skewed against the provision of high quality health care.

First, in Ontario, we have 2.1 doctors per 1,000 people (which is the Canadian average) and puts us 57th in the World (!).

Canada has 9.3 nurses per 1,000 people, which ranks about 15th in the world, but Ontario only has 7.1 per 1,000. If Ontario was a sovereign nation, we would rank about 24th in the world for nurses per capita. Ontario currently has 1.7 acute care hospital beds per 1,000 people, which is less than half the average of the OECD countries. Again if we were a sovereign nation, we would rank about 85th (!!) in the world.

All of which, when put together, makes me ask on question. Where are our tax dollars going?!

On a per capita basis, we spend the fourth most of any country in the world. But we're certainly not spending money on doctors. We have fewer doctors per capita than Mongolia (no really, go look at the link).

We're not spending that money on nurses. We have fewer nurses per capita than Uzbekistan.

In Ontario, we're not spending that money on hospitals. We have fewer hospital beds per capita than Armenia.

So where are we spending it?

Well, this is where I would follow up on a point where I disagreed with one of the other panelists, Dr. Michael Gordon. I pointed out (starting at the 17:49 mark) that Ontario has three times as many health-care bureaucrats per capita as Sweden and four times as many as Australia. (I didn't get a chance to point out we have ten times as many health-care bureaucrats per capita as Germany).

Dr. Gordon argued immediately after that it's easy for physicians to denigrate administration, but that they did an important job. I think he's missed the point. I've met many bureaucrats who are all hardworking and dedicated to their jobs. The reality however, is that if the Ontario Ministry of Health has more employees (3,800) than Turkey's Ministry of Health (3,600), and Turkey has six times our population, well, frankly, you have too many employees, regardless of how hardworking they are.

Sadly, this fact seems to be completely ignored by politicians and media. When federal Health Minister Jane Philpott recently expressed concern that Canadians were not getting the bang for their bucks in health-care spending, she suggested "innovation" was needed. But not once in her speech did she mention the obvious, that all of the better performing countries with respect to health care metrics have more physicians/nurses and hospital beds per capita than Canada does.

Similarly, the Toronto Star pointed out that Britain, Italy, Spain, Norway and more, better health outcomes than Canada in their op-ed pages. Did the fact that every single one of the countries listed have more physicians/nurses and hospital beds per capita dawn on them? Nope. Instead, the Star's solution was to add universal daycare, pharmacare and denticare. Yup, more government run programs, run with usual government efficiency.

In Ontario, Health Minister Eric Hoskins and Premier Kathleen Wynne have taken an incredibly haphazard approach to health-care funding. In the past year they have embarked on numerous targeted areas of funding. A little money here for hospital expansion, some there for addiction, more here for community health services. The goal seems to be to target politically favourable areas, hoping this will generate good will and votes.

The people of Ontario don't want, or need, new, opaque transformation plans for health care.

Their overall solution for health care however, is in the Orewllian Patients First Act, an act that, as my colleague Dr. Alam points out, will drastically increase the bureaucracy while diverting precious resources from front line care. Instead of actually hiring more PSWs/nurses and doctors, Hoskins wants to hire more administrators, and create 80 sub-LHINs instead of the 14 LHINs (Local Health Integration Networks) they have now.

Not only that, Hoskins invoked closure to cut off debate on Bill 41 early, and remarkably, even has limited Standing Committee time, so that he doesn't have to hear the justified criticism of the Bill. So much for respecting democracy.

The people of Ontario don't want, or need, new, opaque transformation plans for health care. They don't even need targeted funding (no matter how justified). They just need their leaders to look at the evidence from other countries, and run their current health system more efficiently, and wisely. It's high time that Kathleen Wynne and Eric Hoskins realized that.

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