The definition of perpetual might be revised to include attempts to reform the funding formula for Ontario's hospitals. An advantage to being retired is that I can comment publicly on proposals, often with the advantage of hind-sight to when that model was tried 25 years ago.
The Globe and Mail reports the government is considering giving population-based funding another go.
"Ontario is preparing a radical change to hospital funding, tackling health costs by tailoring hospital budgets to match the size and age of their communities."
link: Ontario proposes radical overhaul of hospital funding - The Globe and Mail
I wish the health ministry mandarins well, but have some objections. The principle one is that people often do not access health care where they live. The idea of funding hospitals so that patients can receive care closer to where they live, i.e. in their home communities, sounds nice but can be ill-advised. Populist solutions often do not withstand scrutiny.
It's one thing to go to a local community hospital to have a simple wound sutured, a broken bone set or for minor, uncomplicated surgery. But if I need a cardiac procedure (catheterization, implant, surgery) I want to go to the teaching hospital with the best and more experienced heart specialists available. If I have cancer, I want the most to go to a hospital where the physicians see hundreds of cases a year, not a few dozen.
It has been demonstrated repeatedly, especially in surgery, that the more procedures a hospital performs, the better the results. It is, in my opinion, a mistake to bleed resources from the academic health centres to support start-up tertiary services in relatively small hospitals within an hour or two of the teaching centre. This is exactly the intent of population-based funding.
I live in Markham so, under a population-based funding formula, my health care dollars would go to a York Region hospital. However, those hospitals are further from home than a couple of the best cardiac care centres in Canada. If I am having a heart attack, I want to be taken to be best and closest facility and that would not be Markham or York Region. My hospitals of choice are the Toronto teaching facilities population-based funding would hurt.
A funding formula that compensates hospitals based on the volume and complexity of the cases treated is more responsive to patient choice and fairer to the hospitals. Not coincidentally, it is the one that was in effect for most of my tenure with the Ontario health ministry. "Fine-tuning" the existing formula should be approached with great caution.
