“You can’t run a hospital business like it’s a car”: Here’s why Ontario hospitals weren’t ready for Omicron

OTTAWA — Wayne Redekop has seen hospital care in his city shrink for more than 20 years.

Fort Erie’s five-term mayor remembers when, in the mid-1990s, the local hospital’s obstetrics unit closed and moved to Niagara Falls, 30 kilometers away.

He remembers more clearly the anger in 2009, when the whole hospital closed after more than 75 years.

And just this week, amid a massive surge in COVID-19 infections fueled by the Omicron variant, the regional health unit shut down the Fort Erie emergency care center – a temporary blow due to a staff shortage that will force the city’s roughly 33,000 residents to drive 20 minutes west of Port Colborne for emergency needs, Redekop said.

For him, it’s all part of the same unfortunate story: that a generation of cost restrictions has left Ontario health care strained and vulnerable. And then came COVID-19.

“The pandemic has fully brought to light the shortcomings of our hospital and healthcare system, as well as the lack of resilience,” said Redekop.

“Resilience takes money,” he added. “We don’t have this and we haven’t had it for quite a while.”

For experts, it’s no surprise that Ontario is struggling under the Omicron wave. Despite the widespread use of vaccines and predictions that Omicron is less likely to cause serious illness, indoor meals are again banned. Gyms are closed and schools closed. Once again, the provincial government fears that hospitals could be overrun, with their limited beds and staffing shortages, as infections of this particularly transmissible variant of the coronavirus soar to record highs.

The potential shortcomings of Ontario’s hospital system have been known for a long time. Hospitals in the province were operating at near full capacity (96% on average) even before the pandemic, in 2018-19, when nearly a quarter of hospitals in the province were in fact operating at more than 100% of their capacity, according to the report. Ontario fiscal responsibility watchdog.

In December 2019, the same month that COVID-19 emerged as a disturbing new respiratory virus in China, the Ontario Hospital Association released a report indicating that the province was tied with Mexico for the lowest number. hospital beds per capita of all countries tracked by the Organization for Economic Co-operation and Development (OECD). “The current situation,” the report concluded, “cannot realistically be sustained”.

And that, again, was before the pandemic.

“You took a system that was really faltering and pushed it back,” said Dr. Katherine Smart, president of the Canadian Medical Association, which has long called for increased funding for health care from the provinces and the federal government.

The result was the need to cancel surgeries that are not considered life-saving and redeploy staff to intensive care units, a strategy that resulted in about 560,000 fewer surgeries in the first 16 months of the pandemic. compared to 12 months of 2019, according to data released last month by the Canadian Institute for Health Information.

Over the past 30 years in Ontario, annual health care spending has sometimes increased and sometimes decreased, but the government’s overall position has been to contain costs, said Anthony Dale, president and CEO of the Association of Ontario hospitals.

Health care costs take up a huge chunk of the provincial budget – even before the billions of dollars Queen’s Park and Ottawa have spent to fight the pandemic. In 2019, for example, health care accounted for 41% of total program spending in Ontario, and the province’s 141 hospitals accounted for the largest share at 36%.

With this huge line-up, successive governments of all stripes at Queen’s Park have tried to control spending as the population grows larger and older, Dale said.

Former Prime Minister Kathleen Wynne admitted this in a recent interview with Maclean’s magazine.

“During my time as Prime Minister, we worked hard to balance the budget. We were keeping health care costs low, ”she said. “If I had to do it again, given what I know about COVID, I probably wouldn’t. ”

Part of the problem is that provinces have come under pressure to pick up a larger chunk of health care spending as the federal contribution to the shared public health care project has declined over the years, Smart said. In the 1970s, Ottawa shared the cost 50-50 with the provinces. In 2019, the federal share was around 23.5%, according to a Library of Parliament report.

Meanwhile, Dale said, the overarching political focus in recent years has been to find ways to strengthen the forms of care that keep people from landing in expensive hospital beds. But he said this so-called “revolution” in healthcare never happened.

Instead, hospitals were pressured to become more “efficient,” which Dale said he actually accomplished. His association’s report on the eve of the pandemic said Ontario, with the lowest per capita hospital spending in Canada, also had the shortest average stays for acute care patients. His standardized hospital-based death rate – a way to measure standards of care – was also in line with the national average, according to the report.

This came even as the report says the total number of hospital beds in the province declined in the 1990s and remained relatively stable between 1999 and 2019, a 20-year period in which the population Ontario increased 27% and the number of people over 65 increased. by 75 percent.

Yet despite this “efficiency,” Ontario hospitals were operating at near full capacity all the time. There wasn’t a lot of slack in the system for an emergency like the pandemic.

“You can’t run a hospital sector like it’s a car, with the gas tank empty all the time,” he said. “Sooner or later you’ll see that gas light flashing and you’ll be in trouble by the side of the road. ”

While this has its drawbacks in a crisis like the pandemic, there are obvious reasons Ontario’s hospital system was so close to its limit before the pandemic, says Bob Bell, a former Deputy Minister of Health. from Ontario who led the University of Toronto. Health network for nine years.

“I’m giving you as the CEO of a hospital $ 100 million to run your hospital, okay? What do you think I expect from you as the government agent of the system? Do you think I expect you to have a bunch of nurses doing nothing? he said. “What I want you to do is fully employ everyone in your hospital in providing patient care.

“It’s not really good, but that’s why Ontario costs $ 1,000 less per capita than Alberta. ”

For CMA’s Smart, the pandemic has shown the insanity of operating so close to the limits of the system. She argues that governments across the country must inject billions more into health spending – including Ottawa, as Premiers collectively pushing to increase its share of total health spending in Canada to 35%, a difference which would cost around $ 28 billion per year.

Bell argued that it is better to spend the extra money to increase capacity outside hospitals in the area of ​​”transitional” care, where specialists can treat patients who need attention but do not. no need to be in the hospital. In 2019, according to the Ontario Hospital Association, these patients occupied a record 17% of hospital beds in the province.

Others, like Dr Andrew Boozary of the University Health Network, want to see more money alongside reforms to integrate parts of health and social systems that operate in silos, as well as improvements like consistent use of records. electronic medical.

But increased funding cannot come out of nowhere; it requires compromises, like cutting spending in other areas, increasing government borrowing, or the politically difficult decision to raise taxes, said Phil Triadafilopoulos, a political scientist at the University of Toronto.

And when the system appears to be working reasonably well – outside of the pandemic – there is little political incentive to make tough decisions to prepare for a potential disaster or for future challenges like the health needs of an aging population. , did he declare.

Triadafilopoulos compared the situation to Aesop’s fable about the ant and the grasshopper: the ant kept food and prepared for winter, while the grasshopper did not and remained hungry.

“Most governments look like grasshoppers,” he said.

They have, however, pumped more money into healthcare during the pandemic. Since the start of the crisis, for example, the Ford government has invested an additional $ 5.1 billion in hospitals and claims to have created 3,100 beds. In Ottawa, the Liberal government also pledged an additional $ 25 billion over the next five years to hire more nurses and doctors, end pandemic surgery delays, and improve long-term and nursing care. Mental Health.

Redekop, the mayor of Fort Erie, said the current crisis should spark a public conversation about increasing overall healthcare spending in the years to come.

“What do you want to have at your disposal as a citizen, as a taxpayer? Do you want a health care system that meets your needs and those of your family and neighbors in your community or not? he said.

“If you want it, you have to pay it. ”


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