Ford Government Tables First Fiscal Budget Amidst Period of Health Care Transformation
Highlights of the Budget include:
“Balancing the Budget Responsibly”: The government outlines a path back to balanced budgets by “balancing the budget responsibly”, charting a path back to balance by 2023-2024. They also promise to create jobs and “protect what matters most – hospitals, schools and other vital public services” – and provide much-needed relief to individuals, families and businesses.
Child Care: The government is proposing a new Ontario Childcare Access and Relief from Expenses (CARE) tax credit, which they claim is “one of the most flexible child care initiatives ever introduced in Ontario”.
Open for Business: In this budget the government reminds Ontarians of the actions taken to support business including cancellation of the cap-and-trade carbon tax and keeping the minimum wage at $14. In addition, they will deliver on their commitment to reduce corporate income tax earlier than planned and reduce red tape on business by 25%.
Health care: This budget invests an additional $384 Million in hospitals and $267 Million in home and community care, as well as $3.8 Billion for mental health, a commitment to a low-income dental program, and new and upgraded long term care beds.
“Putting People First”: This section touches on many initiatives across government, including long-term care beds, elimination of Estate Administration tax, fixing Ontario’s broken auto insurance system, getting back to basics in education, and addressing transportation across the province including subways in the GTA.
Major Health Care Commitments
The Government’s vision for health is stated in this budget as “creating a truly patient-centered health care system”. They commit that “Every part of the government’s plan to end hallway health care and build a modern, sustainable, and integrated health care system, starts with the patient”.
Budget 2019 projects that health care spending will grow from $62.158 billion in 2018/19 to $63.510 billion in 2019/20. This $1.3 billion increase in spending represents a 2.2% annual growth in spending. Major investment commitments include:
Budget 2019 accounts for a $384 million investment in Ontario hospitals, an annual growth of 2.05%. Under the previous government, hospitals saw an annual increase of 3% in 2017 and 4.6% in 2018. The province will also provide approximately $17 Billion in capital grants over the next 10 years to modernize and increase capacity at hospitals and address urgent issues.
The government is committing an additional $267 Million in 2019/20 for additional home and community care.
The budget reaffirms the government’s commitment to add 15,000 beds to the long-term care system over the next five years. The government also notes that it plans to upgrade 15,000 older long-term care beds to modern design standards. This compares to a commitment to redevelop 30,000 older beds announced by the previous Liberal government. In total, the budget commits $1.75 Billion in additional funding for LTC development and redevelopment over 5 years. The budget is silent on additional operating funding for the sector.
Mental Health and Addictions
As part of the government’s commitment to invest $3.8 Billion in mental health and addictions over 10 years, Budget 2019 provides $174 Million to support community mental health and addictions services, mental health and justice services, supportive housing, and acute mental health inpatient beds. Additionally, the government commits to build a system focused on “core services embedded in a stepped-care model, and a robust data and measurement framework.”
As anticipated, low-income Ontarians ages 65 and older who lack benefits will qualify for free dental care. Individual seniors with incomes of $19,300 or less, or senior couples with combined annual incomes of $32,300 or less, will be able to receive dental services in public health units, community health centres and Aboriginal Health Centres.
The Budget also includes a number of policy commitments, including:
The government will “create a centralized procurement system to better manage the purchasing of products and devices for hospitals, home and community care, and long-term care.” Budget 2019 commits that the model will “build on current, successful models” and be aligned under Ontario Health.
Local Health Integration Networks
The government will continue the process of consolidating 6 existing provincial health agencies and the LHINs into a new, single agency, Ontario Health. The predicated annualized savings of this change is $350 Million, at maturity.
Public Sector Labour Relations Trasition Act (PSLRTA)
If passed, the Budget legislation would amend PSLRTA with the expressed goal of providing “labour relations certainty to workers and employers” during the health transformation. The amendments are purportedly designed will assist MOHLTC in providing efficient delivery of health services.
Public Health Units
Currently Ontario has 35 public health units, funding of which is shared between the province and municipalities. The government will establish 10 regional public health entities and 10 new regional boards of health with one common governance model, providing front-line care efficiencies and removing back office duplication.
Laboratory System (Public Health labs)
The government will “modernize Ontario’s public health laboratory system by developing a regional strategy to create greater efficiencies across the system and reduce the number of laboratories”.
Reviewing Ontario’s Drug Benefit Program
The government will redesign the program and make it more efficient by providing timely access to new clinically proven medicines, modernizing and strengthening oversight of payments to pharmacies, reducing the administrative burden for clinicians, and reducing red tape for the industry.
Protecting Against OHIP Misuse
The government commits to ensuring: OHIP only pays for appropriate, delivered services; making it easier for the government to recover funds when there are incorrect billings; making it clearer to taxpayers what OHIP is paying for; and ensuring all remaining “red and white” health cards are converted to more secure photo cards.
The government will implement a “digital first for health” strategy that will increase the use of virtual care and give the people of Ontario the digital tools to access their own personal health information.
Scope of Practice
The government commits to expand “the scope of practices for certain regulated health professionals, such as pharmacists, nurse practitioners, dental specialists, and optometrists.”
The government commits to create a cross-Ministry seniors’ strategy.
Savings / Efficiencies
Budget 2019 outlines a number of savings initiatives:
- $350 Million in annual savings from agency consolidation (Ontario Health)
- $250 Million in annual savings by “optimizing workforce productivity through improving scheduling, attendance management and reduction in overtime
- $100 Million in savings by 2021/22 by “streamlining transfer payment agreements and consolidating multiple service contracts”
- $140 Million in savings by changing the way pharmacy fees are paid, including a tiered framework for drug mark-up fees, fees for prescriptions for LTC residents and focusing the MedsCheck program on transferring patients
- $200 Million in annual savings by modernizing public health units
- Up to $1 Billion in annual savings by creating an integrated health care supply chain