Ontario Budget 2008: Chapter I:

SECTION E : A HEALTHIER ONTARIO: STRENGTHENING HEALTH CARE FOR THE FUTURE

Achieving Better Health

The government’s plan for achieving better health is about keeping Ontarians healthy, providing high quality care if they become sick, and sustaining the public health care system for generations to come.

Investments in public health care contribute to Ontario’s advantages as a place to invest by lowering costs to business, enhancing the productivity of the province’s workforce and supporting a high quality of life that is attractive to skilled workers.

Since 2003, the government has taken significant steps to strengthen health care. In 2008–09, the government is investing $11.1 billion more than in 2003–04.

The 2008 Budget builds on these investments through four key strategies:

• improving access to health care
• shortening wait times
• promoting health and preventing illness
• modernizing health infrastructure

Spending in the health sector is proposed to be $40.4 billion in 2008–09, rising to $42.4 billion in 2009–10 and $44.7 billion in 2010–11. The government spends 46 cents of every program dollar on health.

Improving Access to Health Care

The government is committed to improving access to the care upon which families depend. Improving access is not only about investing more dollars. It is about creating a patient-centred approach in which care is provided by a team of health care professionals when and where needed. With this Budget, the government would improve access to health care by investing:

• $53 million over the next three years to add 50 more Family Health Teams by 2011–12, targeting rural and underserviced communities, in addition to the ongoing implementation of 150 Family Health Teams
• $38 million over the next three years to create 25 nurse-practitioner-led clinics by 2011–12
• in addition to other investments, more than $500 million over the next three years towards hiring 9,000 nurses by 2011–12
  • From this investment, 2,000 nurses will be hired in long-term care homes over the next four years, building on the 1,200 registered practical nurse positions announced in 2007
• $90 million in 2008–09 for the extension, as announced in March 2008, of the Nursing Graduate Guarantee to provide every new Ontario nursing graduate with an opportunity for full-time employment.

These investments will build on existing initiatives to improve access and to support other health professionals, including:

• opening the Northern Ontario School of Medicine (NOSM) in September 2005 — the first new medical school in Canada in more than 30 years. First-year medical school enrolment in Ontario is being increased by 23 per cent between 2003–04 and 2008–09 as a result of NOSM and other new medical school enrolment expansions including four satellite campuses — Kitchener-Waterloo, Windsor, St. Catharines and Mississauga
• increasing the number of undergraduate enrolment spaces for midwives, from 60 to 90 spaces from 2007–08 to 2008–09
• $13 million in 2008–09 for enhancements to the Northern Health Travel Grant to help northerners access health care services
• expanding the total number of enrolment spaces from 150 to 200 over the next four years for nurse practitioners specializing in primary health care.

Improving Access to Health Care for Seniors

This Budget would also improve access for seniors by investing:

• $107 million over the next three years to move towards 2,500 more personal support workers for long-term care homes. These workers, and the additional nurses referenced above, will significantly improve the amount and quality of care provided to long-term care residents
• $278 million over the next three years to address various program needs in long-term care homes, in addition to the investments for nurses and personal support workers and the commitment to redevelop 35,000 older long-term care beds
• as announced in August 2007, more than $700 million over the next three years to implement the Aging at Home Strategy to provide additional community services such as home care, supportive housing and other community supports. Seniors and others who are eligible will receive care at home or move to assisted living as required, keeping them independent and healthier longer
• more than $100 million over the next three years to treat Ontario Drug Benefit program recipients for neovascular (wet) age-related macular degeneration (AMD) with Lucentis, a prescription medication.

Shortening Wait Times

With this Budget, the government is moving forward on expanding the scope of Ontario’s Wait Time Strategy to include wait times in emergency departments and general surgeries. Since 2004, through the Wait Time Strategy, significant investments have been made to provide more medical procedures and reduce wait times. The strategy began by targeting five key areas: cancer surgery, selected cardiac procedures, cataract surgery, hip and knee replacements, and magnetic resonance imaging and computed tomography (MRI/CT) scans. In last year’s Budget, the strategy was expanded to include pediatric surgeries.

The emergency department is a vitally important component of the broader health care system. It is the place we depend on in our most vulnerable moments. From a system perspective, it is also a key indicator of how the system as a whole is functioning. Waiting in an emergency department is an issue that requires a system-wide solution. With this Budget, the government would provide system improvements that would address the issue of emergency-department wait times as well as continue to improve the other elements of the strategy, through the following investments:

• $180 million over the next three years to provide incentives to make continuous improvements in emergency-department wait times and patient satisfaction
• $64 million over the next three years to provide approximately 12,400 additional general surgeries starting in 2008–09, growing to approximately 30,000 additional surgeries in 2010–11
• $120 million over the next three years to help hospitals in areas experiencing high population growth to meet anticipated demand
• $190 million over the next three years to implement a Chronic Disease Prevention and Management Strategy, starting with diabetes. Prevention of chronic disease and improved patient care should help reduce emergency-department wait times
• $80 million over the next three years to improve mental health and addiction services, including funding to increase treatment for eating disorder services and early intervention for psychosis. The government will be developing a comprehensive mental health and addictions strategy
• $20 million to support children with complex special needs, bringing total Provincial spending on children’s mental health to over $440 million annually
• $17 million over the next three years to fund the operation of an additional five MRI machines. This investment will result in approximately 21,900 additional MRI scans, improving access and reducing wait times for diagnostic services in areas of high demand.

Promoting Health and Preventing Illness

The government continues to focus on active and healthy living, health promotion and illness prevention. Over the long term, these investments should help manage health care costs. With this Budget, the government is planning to invest:

• $154 million over the next three years to build on the Province’s cancer screening program to increase early detection and treatment of breast, cervical and colorectal cancers. This will also cover the cost of the Prostate-Specific Antigen (PSA) test used to diagnose and monitor treatment of prostate cancer, and extend the human papillomavirus (HPV) vaccination program
• $10 million annually in a childhood obesity strategy to encourage children to eat healthy and be physically active
• $135 million over three years to provide better dental care to low-income families. For details, see Section C: A Better Future for Families: Improving Quality of Life
• $32 million over three years in the Student Nutrition Program. The new investment will more than double annual funding for this program.

The government is also:

• proposing legislation to ban smoking in cars carrying children
• implementing a complete ban on the display of tobacco products by May 31, 2008, as originally set out in the Smoke-Free Ontario Act
• proposing a permanent Retail Sales Tax exemption for qualifying non-prescription nicotine replacement therapies to help Ontario smokers to quit
• proposing an extension of the temporary Retail Sales Tax exemption to December 31, 2010, for bicycles and related safety equipment to encourage Ontarians to stay healthy and be active in their daily lives
• making Ontario schools healthier by introducing Bill 8, the Healthy Food For Healthy Schools Act, 2007, that would, if passed, ban processed trans fats from food and beverages sold in school cafeterias and remove unhealthy foods and beverages from school vending machines
• naming the new office for the Ontario Agency for Health Protection and Promotion the Sheela Basrur Centre after the former Ontario Chief Medical Officer of Health and Medical Officer of Health for the City of Toronto during the SARS outbreak. Dr. Vivek Goel will head the agency.

Modernizing Health Infrastructure

As part of the ReNew Ontario plan, the Province has committed to funding more than 100 major hospital projects to expand and upgrade facilities across the province and to invest more than $5 billion in health infrastructure with its partners by 2010. These projects will help renew Ontario’s public infrastructure, and will modernize hospitals, improve access to health care and reduce wait times.

Several major hospital projects are scheduled to start construction in 2008–09, representing a substantial investment once complete. In addition, the Province would:

• invest $14 million in 2007–08 for 10 residential hospices across the province to provide end-of-life care in a home-like environment for patients who cannot be cared for at home
• contribute $9 million in 2007–08 to support the development of the new and expanded Toronto’s Ronald McDonald House, which will provide support and accommodation for seriously ill children and their families from across Ontario who must travel to Toronto for specialized medical treatment
• invest $47 million in 2008–09, growing to $239 million in 2010–11, in e-health systems such as diagnostic imaging, drug and lab information, and a Diabetes Registry, which will help people with diabetes to actively manage their disease in conjunction with their health care providers.

Details of Investments in the Health Sector

Since taking office, the government has made strategic investments and achieved tangible results. Investments in the health sector have increased from $29.4 billion in 2003–04 to a planned $40.4 billion in 2008–09. Investments in health care are projected to rise to $42.4 billion in 2009–10 and to $44.7 billion in 2010–11. The introduction of the Ontario Health Premium (OHP) has helped to ensure the government’s ability to improve health services. Every penny of the OHP goes towards improving Ontario’s health care system. In 2008–09, revenue from the OHP is projected to generate $2.8 billion, representing 6.9 per cent of total expenses for the Ministries of Health and Long-Term Care and Health Promotion.

Table 4
Investments in the Health Sector
($ Billions, Change from 2003–04 to 2008–09)

Hospitals — increase in payments for direct hospital activities	3.5
OHIP Services — primarily to fund services provided by physicians and other health care practitioners	2.8
Ontario Drug Programs — to support Ontario drug programs including the Ontario Drug Benefit program	1.2
Long-Term Care Homes — to enhance the quality of care provided to about 76,000 residents of long-term care homes and increase long-term care capacity	1.1
Community Services — to expand home care, community support services and supportive housing	0.8
Public Health including Health Promotion — primarily to increase funding for public health programs including those delivered by public health units and immunizations	0.6
Other — including Cancer Care Ontario, mental health, emergency health services and other programs	1.2
Total Increase in Funding	11.1
Notes: Figures reflect major transfer payments in the Ontario Ministries of Health and Long-Term Care and Health Promotion; these figures do not reflect the structure published in the Estimates. Figures may not add due to rounding. Sources: Ontario Ministries of Health and Long-Term Care and Finance.