HEALTHCARE CRISIS IN CANADABY: PAUL YOUNG, CPA, CGA

AGENDA

• Who is responsible for Healthcare• Federal Government Funding • Healthcare Dollars Flow• Ontario Healthcare Transfer Analysis• Healthcare Ranking• Letter to local MP• Liberal Supporter Debate / Blog• $36B Shortfall / Council for Canadians• Healthcare forced cuts to frontline services

SUMMARY

• This presentation will look at funding of healthcare along with the issues facing the delivery of healthcare dollars by the provinces and territories as part of improving patient care.

PROVINCIAL POWERS• The administration and delivery of health care services is the responsibility of each

province or territory, guided by the provisions of the Canada Health Act. The provinces and territories fund these services with assistance from the federal government in the form of fiscal transfers.• Health care services include insured primary health care (such as the services of

physicians and other health professionals) and care in hospitals, which account for the majority of provincial and territorial health expenditures.• The provinces and territories also provide some groups with supplementary health

benefits not covered by the Act, such as prescription drug coverage. The level and scope of coverage for supplementary benefits varies between jurisdictions.

Source - http://healthycanadians.gc.ca/health-system-systeme-sante/cards-cartes-eng.php

FEDERAL GOVERNMENT FUNDING• he Canada Health Transfer, or CHT, is the largest major transfer to provinces and territories.  It provides long-term predictable

funding for health care, and supports the principles of the Canada Health Act which are: universality; comprehensiveness; portability; accessibility; and, public administration.

• CHT transfer payments are made on an equal per capita basis, and include both cash and tax point transfers. Starting in 2014-15, provincial and territorial CHT transfers will be allocated on an equal per capita cash basis only.

• As announced in December 2011, total CHT cash levels are set in legislation to grow at 6 per cent until 2016-17. Starting in 2017-18, total CHT cash will grow in line with a three-year moving average of nominal Gross Domestic Product, with funding guaranteed to increase by at least 3 per cent per year.

• The move to an equal capita cash allocation is part of a long-term plan announced by the Government in Budget 2007 to provide comparable treatment for all Canadians, regardless of where they live. The Government will ensure that the transition is fiscally responsible by implementing a by-province and territory protection that will ensure that no province or territory will receive less than its 2013-14 CHT cash allocation in future years as a result of the move to equal per capita cash.

Source – Government of Canada

HEALTHCARE RANKING

https://www.fraserinstitute.org/sites/default/files/comparing-performance-of-universal-health-care-countries-2016.pdf or http://www.bloomberg.com/news/articles/2016-09-29/u-s-health-care-system-ranks-as-one-of-the-least-efficient

HEALTHCARE FUNDING FLOW

Federal Government (Canadian Health Transfers)

Provinces (Canadian Health Transfer and taxation from general revenue)

Doctors/Clinics(OHIP/Provincial Plan Billing)

Hospitals Transfers of funding

Other Programs• Homecare• Mental Health Programs• Substance Abuse Programs• Assisting Living

HEALTHCARE TRANSFERS

6% growth year over year

Federal Transfers to Ontario Ontario Healthcare Funding

Hospital Example /Royal Victoria Hospital Barrie

HEALTHCARE RANKING

LETTER TO MP / HEALTHCARE • Here are facts about healthcare including the government commitments.• http://globalnews.ca/news/2042725/health-ministers-urging-pharmacare-program-to-pay-for-prescription-drugs/ • It is all about money and not looking at cost to serve models, right? It seems to me that there are deep issues with delivery of healthcare dollars,

but that is never discussed. I guess when we have governments like NDP/LP across Canada at the provincial level it is all about handouts!• During the past two elections the nursing association called out Harper for not funding healthcare to extent was required as part of the service level.

Yet, the nursing association received money for training that never made it to training. • Videos• https://www.youtube.com/watch?v=hS4_VLc59kM • https://www.youtube.com/watch?v=p0ijr_Gp2os• Here are comments on Healthcare • Mr. Harper has funded healthcare on average 6% per year. (Please refer to the government F/S - http://www.fin.gc.ca/afr-rfa/2014/index-eng.asp )• The new accord ties healthcare to GDP growth that will ensure that healthcare spending not below 3% (link:

http://www.slideshare.net/paulyoungcga/provincial-transfers-and-program-spending or • http://www.fin.gc.ca/access/fedprov-eng.asp. • The provincial governments need to take some responsibilities when it comes to delivery:

http://www.thestar.com/opinion/commentary/2014/02/26/kathleen_wynne_must_clean_up_homecare_mess_hepburn.html"• Or • Spending Issues: • http://www.procurementoffice.ca/2015/02/12/post-ehealth-audit-uncovered-more-health-sector-spending-abuses/• Pharma Options• http://www.cbc.ca/news/health/pharmacare-is-not-unaffordable-drug-policy-experts-find-1.2994857

LETTER TO MP / HEALTHCARE  • Source:• http://www.slideshare.net/paulyoungcga/provincial-transfers-and-program-spending• http://www.bloomberg.com/visual-data/best-and-worst//most-efficient-health-care-2014-coun

tries• http://www.theglobeandmail.com/globe-debate/apples-to-apples-canadas-health-system-und

erperforms/article19351870/• http://www.ctvnews.ca/health/canada-ranked-last-among-oecd-countries-in-health-care-wait-

times-1.1647061• http://www.huffingtonpost.ca/michael-bolen/canadian-health-care-ranking_b_5503898.html• http://www.thestar.com/news/ontario/2009/10/07/ehealth_squandered_1b_auditor_says.html• http://www.progressive-economics.ca/2014/12/12/the-ontario-auditors-damning-report-on-p3

s/, • Where are government on Retirement Living:

https://www.sfu.ca/uploads/page/10/GRC_030.pdf

DEBATE WITH LIBERAL SUPPORTER• Healthcare accord:• http://www.fin.gc.ca/fedprov/his-eng.asp (the health accord was change to GDP growth)

• The growth will be at least 3%. The previous deal replaced the 6% growth rate. Transfers could be higher depending on GDP• The based amount of transfers to the provinces is at 34B Billion.

• If you use 3% growth rate then the transfers will be $401B as compare to 414 using 6% growth rate. The difference would be $13B• If you use 12% growth rate then the transfers will 437B as compare to 401B.

• Provinces are combining their drug procurement process to reduce costs: http://www.cbc.ca/news/politics/provinces-reach-deal-to-save-on-6-generic-drugs-1.1331370• Provinces have added levels of management: http://www.thespec.com/news-story/2155849-if-lhins-are-disbanded-what-then-/• Provinces need to cap executive salaries:

http://news.nationalpost.com/2014/10/29/ontario-looks-to-cap-executive-salaries-at-scandal-plagued-ornge-ehealth-and-the-broader-public-sector/• Provinces need to look at compensation growth -

http://www.cihi.ca/cihi-ext-portal/internet/en/document/spending+and+health+workforce/workforce/physicians/release_22jan13• Healthcare needs to undertake value for money:

http://www.fraserinstitute.org/uploadedFiles/fraser-ca/Content/research-news/research/articles/value-for-money-in-health-care.pdf

• I am all for debate, but it is like you want me to do the work for you on different aspect of funding, delivery, etc. If there was detail report then I can do more analysis. There are assumptions built into their models that I am not privy to the details!

• Source:• http://www.fin.gc.ca/fedprov/mtp-eng.asp• http://www.fin.gc.ca/fedprov/mtp-eng.asp• http://www.fraserinstitute.org/uploadedFiles/fraser-ca/Content/research-news/research/articles/value-for-money-in-health-care.pdf• http://www.slideshare.net/paulyoungcga/provincial-transfers-and-program-spending•  

NDP AND HEALTHCARE• http://www.thestar.com/news/federal-election/2015/09/14/ndp-prescribes-500m-for-health-care-system.html  • NDP needs to take a deep look at the issues driving the cuts and stop throwing money at the symptoms. NDP seems to

think the whole issue is money when there are issues with delivery including bloated levels of administration. I cannot believe people buy the comments from the NDP as they do nothing but throw money at the symptoms and that never fixes the root causes to a policy

• https://www.youtube.com/watch?v=p0ijr_Gp2os• http://www.slideshare.net/paulyoungcga/provincial-transfers-and-program-spending• http://www.lfpress.com/2014/04/25/only-paltry-sum-was-used-for-retraining • I am all for solutions, but unless accountability/transparency are part of the solution including tying the following to

funding them nothing will be done for healthcare• Access to family physician or specialist• Wait Times – Reduction• Access to homecare spaces• CEO salaries/Compensation• Other productivity/efficiency improvements• *** NDP has never been known to fix healthcare at the provincial level -

http://www.cbc.ca/news/canada/manitoba/manitoba-gets-poor-grade-in-canadian-health-report-1.2954500•  

COUNCIL FOR CANADIANS – 36B HEALTHCARE FUNDING GAP• PBO - http://cupe.ca/canadas-health-care-system-about-lose-36-billion.

Yet nothing is said on the waste with healthcare, why? http://www.nugget.ca/2015/03/31/workers-rally-for-new-health-accord. It seems like unions are complaining at funding from the Feds, but say nothing on the LHINs or CCAC - http://blogs.windsorstar.com/opinion/the-stars-view-time-to-audit-ccacs-and-the-lhins or revenue like Ontario Health Premium that does not go to healthcare - http://www.fin.gov.on.ca/en/budget/paccts/2014/14_cfs.html#operations

ONTARIO HEALTHCARE FORCED CUTS• Quote “The Ontario Nurses' Association is sounding the alarm about layoffs of Registered

Nurses by cash-strapped hospitals, and warns patients will pay the price.• The union, which represents 60,000 registered nurses, says there were 770 RN positions cut

across Ontario last year, and hospitals in Windsor and Kitchener have already announced more RN layoffs this month.• The hospitals decided to "risk the health outcomes of patients by cutting RNs to balance the

budget," said ONA president Linda Haslam-Stroud.”

Source - http://toronto.ctvnews.ca/patients-will-pay-the-price-for-ont-nurse-layoffs-association-warns-1.2737697

GOVERNMENT WASTE• Harris spent more government % on healthcare than Wynne/McGuinty. Harris was slowly putting money back into

healthcare due to new health accord. Harris was not adding management, but front line workers.• Transfers http://www.slideshare.net/paulyoungcga/provincial-transfers-and-program-spending• Ontario Spending - http://www.slideshare.net/paulyoungcga/ontario-government-spending?related=1• Ontario spending - http://www.slideshare.net/paulyoungcga/ontario-tax-and-spend-analysis• Moodys - http://www.thestar.com/business/economy/2015/02/23/moodys-says-ontario-has-a-spending-problem.html• Hydro Rates - http://www.slideshare.net/paulyoungcga/power-generation-canada• Education, Healthcare and Infrastructure -

http://www.slideshare.net/paulyoungcga/provincial-transfers-and-program-spending• 2015 Planned audit - http://www.auditor.on.ca/en/plannedaudits_en.htm• LHINs -

http://www.procurementoffice.ca/2015/02/12/post-ehealth-audit-uncovered-more-health-sector-spending-abuses/• Nursing - http://www.ona.org/presidents_message/RN_Cuts_devastate_Patient_Care_20150324.html• Homecare -

http://www.thestar.com/opinion/commentary/2015/03/14/a-golden-chance-to-fix-home-care-mess-hepburn.html•  

GOVERNMENT WASTE• Here are examples of waste:• P3 Costs $8B (source: http://

www.thestar.com/news/queenspark/2014/12/09/publicprivate_financing_cost_ontario_taxpayers_8_billion_auditor_says.html)• Equalization $10B (http://www.fin.gc.ca/fedprov/mtp-eng.asp#Ontario)• Gas Plant Cancellation $1.1B (http://www.thestar.com/news/canada/2013/10/08/liberals_power_plant_cancellations_cost_11b_auditor_general.html)• eHealth $1B (http://www.cbc.ca/news/canada/toronto/ehealth-scandal-a-1b-waste-auditor-1.808640)• Selling excess power $1B/year http://kitchener.ctvnews.ca/ontario-paid-1-billion-to-export-surplus-power-in-2013-ndp-say-1.1647299 - 2013

amount only)• Wind Subsidies $1B/year (http://www.netnewsledger.com/2014/03/05/ontario-wind-energy-plans-costing-1-billion-annually/)• Ontario capital Expenditures $11.8B (http://www.fin.gov.on.ca/en/budget/paccts/2014/)• Ontario shares of gas tax $750M (http://www.infrastructure.gc.ca/alt-format/pdf/GTF-FTE-20140905-eng.pdf)• Municipalities Capital spending $6B (

http://www.amo.on.ca/Advocacy.aspx?searchtext=capital&searchmode=exactphrase&date=0;&issue=0;&category=0;)• Wynne’s AIT Issues -

http://www.cbc.ca/news/canada/saskatchewan/saskatchewan-premier-brad-wall-concerned-about-ontario-quebec-position-on-energy-east-1.2848930

•  • The government of Ontario as at least wasted $30B via failed projects. Ontario also has spent about $11B/year on capital with the municipalities

spending about $6B. So, why does Wynne not mention that in her speech?