March 11, 2004
Smitherman tackles health care spending
By CHRISTINA BLIZZARD -- Queen's Park Bureau
Health is at a crossroads in this province and a number of critical negotiations are happening right now that will affect how you will be cared for in future - whether it's in a hospital or by your doctor.
Proposed legislation that's causing a big buzz around here is known as Bill 8, aimed at bringing accountability to the system. And fair enough, as you can understand the uphill battle Health Minister George Smitherman is facing, trying to get health costs under control.
A couple of weeks ago, he took on hospitals, pledging to crack the whip on those that continue to run deficits.
Now that the Ontario Hospital Association has seen his proposed law, they're warning that Smitherman's hardline approach will take communities out of decision-making in local hospitals.
"The OHA is in support of moving in the direction of performance agreements, but we believe they should be negotiated," said OHA president Hilary Short.
"The bill fundamentally undermines hospital governance because it gives the minister the ability to impose an accountability agreement on a hospital," she said.
If there is a disagreement between the hospital and the minister about the kind of service that is being provided, there is a 60-day period of discussion to resolve it.
"At the end of the day, he or she can impose that agreement on the hospital. We believe that diminishes the community voice in health care," Short said.
The minister can bypass the board and deal directly with the hospital CEO. And, in the event the hospital doesn't meet the performance guidelines, the ministry can claw back 10% of the CEO's salary and fine the hospital $25,000.
"We understand the need for performance agreements and accountability," Short said, but added that there needs to be a fundamental change in the way hospitals are funded.
Then there are are the doctors.
The Ontario Medical Association (OMA) is locked in contract talks with the government.
One of the most sensitive areas is that of primary care reform. The Coalition of Family Physicians, a large splinter group of family doctors, is worried that the new family health groups the government is proposing will hurt patient care.
Scarborough family physician Dr. Doug Marks, who heads the group, likens what is going on now to what happened to Britain when that country moved to a National Health Service, that forced patients onto rosters.
"They don't have any proof to say that kind of practice is going to provide better care or better access to care. I am part of a group of seven and we provide more service in our group that what they offer on these new contracts," he said.
Meanwhile, a source within the OMA acknowledges the minister has made some major concessions to Bill 8 to meet its concerns. Two sticking points remain, however. First, the bill gives the general manager of OHIP the unilateral right to take back money from a doctor if wrongdoing is suspected.
The OMA says this could be done on a summary basis, with the doctor having no recourse. The OMA considers that as a basic infringement on the right to be presumed innocent. It's also concerned the government wants to restrict "block billing," for uninsured services. Right now, services such as camp medicals or examinations that are required by employers are not covered by OHIP. Some doctors are offering families a voluntary flat rate for such fees.
The OMA says it was unaware there were complaints about the practice and points out that such issues are regulated by the College of Physicians and Surgeons of Ontario (CPSO) anyway.
"We hadn't heard from the government before they introduced this bill that there was a problem," the source said.
"Certainly, if there was a problem we would have addressed it at the table, with the regulators - the CPSO.
"That said, the minister and the ministry definitely went to great lengths to change this bill, and we acknowledge that."
Ontarians universally agree that we have some of the best doctors in the world. Our nurses are saints. Most patients say that when they really need them, our hospitals are better than they expect. Health care takes almost half the provincial budget. If Smitherman doesn't act soon, it will gobble up the other half. That's the fine line he is walking.
No wonder the health ministry is often called the graveyard of political careers. It's no win and no one gets out alive.
Christina can be reached by e-mail at
christina.blizzard@tor.sunpub.com. Or visit her home page.
Letters to the editor should be sent to
editor@tor.sunpub.com.
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