TORONTO - Ontario can no longer afford to pay for all prescription drugs for everyone aged 65 and older, economist Don Drummond told the government Wednesday in a special report on reducing costs to rein in a $16-billion deficit.
"Ontario needs to start having an open, honest discussion about public coverage of health-care costs," Drummond concludes in his 500-page report.
"A minimal step would be to make the portion of pharmaceutical costs paid for by seniors rise more sharply as income increases."
Ontario spent $44.77 billion on health care last year, or 40.3 per cent of all government program spending.
Recommendations to reform health care make up the bulk of Drummond's report, which says the increase in health spending should be reduced to 2.5 per cent a year from roughly 6.5 per cent annually in each of the past eight years.
Education would be allowed a one-per-cent increase and post-secondary education would get 1.5 per cent each year, but overall government spending must be held to 0.8 per cent until 2017-18, said Drummond.
Limiting the increase in health spending will not be easy, he cautioned.
"If that looks like it's relatively rich compared with everything else, just keep in mind there isn't a single jurisdiction in the world that has sustained (just) 2.5-per-cent increase in health in a six-year period over any time in the last 30 years," said Drummond.
"So that might be relatively unprecedented, (but) doable in our view."
Drummond is recommending much more importance be placed on community-based care to keep people out of expensive hospital settings whenever possible.
"Do not apply the same degree of fiscal restraint to all parts of health care. Some areas, including community care and mental health, will need to grow more rapidly than the average," he said.
"On the other hand, with a shift away from a hospital focus, hospital budgets could grow less rapidly than the average."
Ontario physicians should not be looking for a pay hike from the cash-strapped government, said Drummond.
"Since Ontario's doctors are now the best paid in the country, it is reasonable to set a goal of allowing no increase in total compensation," he wrote.
The Ontario Medical Association disputed Drummond's claim that the province's doctors are the highest paid in Canada, citing figures from the Canadian Institute for Health Information.
"CIHI states the average gross payment for a family doctor in Ontario ranks eighth out of ten provinces and is below the national average," OMA president Dr. Stewart Kennedy said in an email.
"Ontario's doctors will continue to work with government to develop a comprehensive system that will improve patients' access to quality health care and will also result in the best outcomes for patients."
The government should also stop negotiating what services and procedures are covered by the Ontario Health Insurance Plan with doctors through the OMA. It should instead give Health Quality Ontario expanded powers to determine what is and is not publicly covered, said Drummond.
"As in other jurisdictions, doctors should be consulted on such questions, but no more," concludes the report.
Drummond suggests Ontario's 14 Local Health Integration Networks be given much more power to oversee health care in each region, incorporating primary care into their mandate, something Premier Dalton McGuinty has already indicated the Liberal government wants to do. He even recommended the LHINs be merged with Community Care Access Centres to better co-ordinate care, and said the local health agencies could use funding "restrictions" to force hospitals to make necessary changes.
The Progressive Conservatives used to call the LHINs a needless layer of bureaucracy that take money out of front-line health care and wanted them shut down completely, but said Wednesday that Drummond was proposing a whole new type of agency.
"We have said from Day 1 that there's way too much duplication in the system, so he's calling for further amalgamation to reduce the duplication," said Opposition Leader Tim Hudak.
"It looks to me like he's blowing up the LHINs and creating an entirely different animal."
The New Democrats were highly critical of Drummond's report because it wasn't allowed to look at tax increases, but said they were pleased he recommended focusing more on home care so seniors are not stuck in hospital beds.
"So there are things in this report that I think are quite useful," said NDP Leader Andrea Horwath.
The government also needs to train more nurses, said Drummond, and let nurse practitioners perform more work currently done by doctors, including annual physical exams.
The former TD Bank economist also recommended the province consider fully uploading public health from municipalities, and said Ontario should follow Nova Scotia's lead and have emergency medical technicians provide home care when they are not on emergency calls.
The aging population will continue to put additional pressures on health care, noted Drummond, who said one per cent of the population accounts for 34 per cent of the province's health-care costs.
Finance Minister Dwight Duncan welcomed the report, but said the Drummond Commission did not have to consider the consequences of its recommendations, so the government will decide which to adopt and which to ignore.
"The commission advises and we decide, and that is what we will do in this year's budget," Duncan told reporters.
