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February 4, 2003

Save Public Medicare! Information: Eves guilty of hidden money, misspending:
Ontario Health Coalition

 Toronto - In anticipation of the First Ministers' meetings in Ottawa
this week, the Ontario Health Coalition is releasing a briefing note on
provincial transparency and accountability in health spending.  The
coalition takes issue with the Eves government's attempts to win more
health spending without accountability.  The briefing outlines the
enormous difficulty in accessing spending data in Ontario, the total
lack of  public consultation on critical health reforms, the use of
directed funds for other purposes, and unreported profit-taking that
characterize Ontario's health system.

Among the key findings:
. The province mis-spent its portion of the 2001 agreement of a $1
billion federal equipment fund meant for diagnostics and high tech
needs. In Ontario $60 million - enough to fund all of the planned
private MRI/CT scanners - was spent on grants to for-profit long term
care homes and for-profit radiology clinics. It also used the money for
medical equipment that was bought long before the federal funding became
available.

. Homecare in Ontario is explicitly exempted from access to information
legislation.  When community agencies charged with the governance of
homecare publicly complained about cuts in 2001, the province passed
legislation giving itself the power to fire all the CEOs, disband
elected community Boards, replace them with appointees and terminate all
community memberships.  Secrecy in homecare spending is now almost
total.

. A look at hospital staffing trends in Ontario makes it clear that
Ontarians are paying more for less. Details of hospital spending are not
publicly accessible.

. Despite a provincial audit showing that for-profit cancer treatment is
costing Ontarians more than public treatment, the province has
repeatedly renewed the contract for a for-profit cancer treatment centre
at Sunnybrook Hospital.

"The province has proved itself to be an untrustworthy guardian of
public Medicare", noted Bea Levis, coalition Board member.  "In the last
decade we have seen a disturbing trend towards increased secrecy and
lack of access to information about the use of health funding."

Last week, Premier Ernie Eves suggested that the province may use new
funding that will be announced this week to pay for the current year's
health budget rather than focussing on target national priorities.

"The issues that confront the people of Canada this week are fundamental
to the future of Medicare.  Ernie Eves' attempts to win a deal that will
allow his government to continue on the path towards a shrunken public
system must not be allowed to prevail. We expect that our health care
dollars will go to enhanced care, not to profit or tax cuts," added
Derek Chadwick, coalition Board member. "Eves is showing blatant
disregard for Canadians' call to strengthen our public health system."


Ontario Health Spending, Transparency and Accountability
Briefing Note
February 4, 2003

Since its election in 1994, the Ontario Conservatives have pursued a
radical new policy direction in healthcare.  Ultimately, it has amounted
to an overwhelming trend towards for-profit delivery of health services
and a shrinking of the public health system, reductions in regulations
protecting patients and residents, and untold spending on advertising,
consultants, lay-offs, restructuring and profit-taking. All of these
have occurred with little or no public consultation.  Ontarians have
suffered the announced closure of dozens of hospitals and approximately
9,000 hospital beds.  Homecare and long term care, meant to fill in for
the patients who were formerly in hospital, have been largely privatized
and moved out of the public realm.  In long term and homecare, more of
the burden for payment of care has been downloaded onto patients and
residents, and more of the burden of caregiving has been downloaded onto
families.  In the last 8 years, a reported $100,000,000 in OHIP services
have been delisted in backroom negotiations. Tracking money in the
hospital, long term and homecare systems is a full-time exercise in
frustration.  Tracking OHIP delisting is a tough task requiring
dedicated staff time and extraordinary resourcefulness.

Where's the Money? Health Care Spending in Ontario

Federal Medical Equipment Fund
In 2001, the provinces and the federal government came to an agreement
on a $1 billion medical equipment fund.  Public announcements at the
time stated that the fund would be used to improve access to diagnostic
tests and to upgrade high-tech healthcare needs.  A report from the
Canadian Medical Association released in July 2002 shows that in
Ontario, as in provinces across the country, the actual spending of this
fund is very difficult to ascertain.  What is clear is that in Ontario
the fund did not purchase new diagnostic equipment.  Instead the CMA
reports that more than $60 million in Ontario was spent on bathtubs,
beds and mattresses in for-profit long term care homes,  and on grants
to privately owned radiology clinics.  According to Normande Lebarge,
CEO of the CMA, Ontario also used part of its funding to pay for medical
equipment that had been purchased long before the federal funding became
available. $60 million would have been enough to purchase all of the MRI
and CT scanners the province now wants to privatize.

Homecare
In 1997, the provincial Conservatives created the Community Care Access
Centres to govern the delivery of homecare in the province. The
Conservatives  forced these CCACs to privatize homecare services leading
to the closure of the VON and Red Cross offices in many communities.
The government explicitly exempted the entire system from access to
information legislation.  In a report released in 2001, the Ontario
Health Coalition found evidence that contracts in the sector are secured
with gag-orders.  In at least one case, the Ottawa CCAC Board reported
that the forced privatization of rehabilitation therapy would cost
approximately $ million more per year.  The province insisted that they
proceed with the privatization anyway.  In the fall of 2000, when the
community Boards of Directors for the CCACs complained about the impact
of health spending cuts on their clients and information about the flaws
in the system began to leak out, the provincial government stepped in
and passed legislation giving itself the power to fire all CEOs, disband
community Boards of Directors and replace them with
provincially-appointed Boards and all community memberships were
eliminated. There is no public accountability for the CCAC system, no
public control, no community input, no access to information, no
disclosure of contracts, no measure of profit-taking.

Long Term Care
Last summer, the province announced plans for a fee hike for long term
care facility residents.  In response to seniors' and caregivers'
outrage, the provincial government agreed that new funds would go to
patient care and staffing.  Anecdotal reports from facilities around the
province show that facilities have simply moved costs into the resident
care envelope, freeing up money in the funding envelopes that are
allowed to go to profit and other items.  There is no tracking of this,
no public reporting on enhancement of care levels, no tracking of
profit-taking.  Much of the information is impossible to get from
private companies that are not required to disclose details about their
spending.

OHIP Delisting
Announcements about OHIP delisting occur after the province negotiates
with the Ontario Medical Association. Despite public calls for a more
representative transparent process, these negotiations happen behind
closed doors with no patient representation and little public
accountability.  Tracking of OHIP delisting requires one to compare the
entire OHIP list pre-negotiation (thousands of items) against the entire
OHIP list post-negotiation.  The list is coded and coding must be
cross-referenced to determine what items are missing from the new list.

Hospitals
In an Alternative Federal Budget Technical Paper in April 2001,
economist Bill Murnighan looked at hospital funding.  He found that
while spending had increased by nearly 10%, staffing levels had
decreased by 10%.  At fiscal year end in 1995, there were 26 hospital
and long term care staff for each 1,000 Ontarians. By 2001 this number
had dropped to just over 22 staff per 1,000 people (Stats Can figures).
Although the government was in the middle of a massive advertising
campaign to convince Ontarians it was spending more than ever on
healthcare, what it did not disclose was the hundreds of millions spent
on laying off staff and closing down hospitals.  Murnighan notes that
the reasons that Ontarians are paying more for less are hidden because
about of the total health budget is handed over to hospitals and long
term care facilities "where the spending details never become
accessible."  In the recently announced for-profit (P3) hospitals,
secrecy is the code of conduct.  The province has refused to disclose
even the names of the for-profit corporations who are bidding on the
Brampton hospital. Similar refusal to disclose for-profit bidders is
occurring in the newly tendered for-profit MRI/CT clinics.


Cancer Care
Cancer Care Ontario, a public body charged with overseeing Ontario's
cancer treatment centres, created the first for-profit after-hours
treatment centre at Sunnybrook Hospital in Toronto in January 2001.  An
audit by the Provincial Auditor found that treatment at this clinic
costs more than treatment at public facilities.  Nonetheless, the
province has repeatedly renewed the contract with for-profit corporation
Canadian Radiation Oncology Services headed by Dr. Tom McGowan who
served as a VP at Cancer Care Ontario until his company won the contract
to create the for-profit cancer centre.

Ontario Health Coalition
15 Gervais Drive, Suite 305   Toronto, Ontario   M3C 1Y8
phone: 416-441-2502    fax: 416-441-4073