2016 Ontario Budget
Chapter I: Building Prosperity and Creating Jobs

Section D: Transforming Health Care

Focusing Health Care on the Patient — Meeting Current and Emerging Challenges

Ontario faces increasing demands due to an aging and growing population. These demographics, along with advances in pharmaceuticals and technology, are driving demand for more health care services, such as for cancer care, hepatitis C drugs and cardiac care, at higher costs. The “Patients First: Action Plan for Health Care” is a comprehensive plan for addressing the province’s health care challenges.

Through recent actions to transform health care, the Province has increased patients’ access to primary care, provided more care for people at home, and reduced wait times for surgeries, diagnostic procedures and emergency department care. The government has invested almost $2 billion to significantly reduce wait times since 2003–04.

The government has also succeeded in bringing down annual spending growth on health from about seven per cent to about two per cent — while continuing to improve access to care.

Transformation Continues — Patient-Centred Health Care

Ontario has made significant gains by focusing on health care access, quality and efficiency. However, more can be done to integrate health care, particularly primary, home and community care, and to foster a closer collaboration with public health.

To help ensure seamless, consistent, high-quality health care for Ontario patients, in December 2015 the Province released a discussion paper, “Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario.” A central focus of the paper is to improve health equity across the province. This means more integration with other social services to allow for a ”health in all policies” approach.

The government proposes to expand the mandate of Local Health Integration Networks (LHINs) so they are accountable for the planning and performance of primary care and the delivery of home and community care. This proposed change will create an integrated system that works efficiently to support patients and caregivers with better access to the care they need — no matter where they live — and smoother transitions between health services. The paper also proposes a more formal relationship between public health units and LHINs. The government is currently consulting with health care providers, patients and caregivers around the province to address these systemic challenges.

Faster Access to Health Care

Primary Care

To help Ontarians get the right care as quickly as possible, the government has improved patients’ access to primary care. Since 2003, over two million more Ontarians have a primary care provider, and even with population growth, 94 per cent of Ontarians now have a primary care provider. Nearly four million Ontarians receive care through primary health care teams of family physicians, nurse practitioners and other providers.

For patients with multiple conditions and the most complex care needs, the government has expanded its community Health Links — local, interdisciplinary care teams — from 69 to 82 across the province. As of September 2015, nearly 24,000 patients received coordinated care through Health Links. This has provided patients with regular, timely access to a primary care provider, and a coordinated care plan, leading to fewer hospital readmissions and better quality of life.

To further reduce wait times for key health services, the Province has also expanded scopes of practice of some health professionals. Nurse practitioners can now refer patients directly to specialists. The government is also planning to expand the scope of practice of registered nurses to allow them to prescribe some medications directly to patients.

Aiming to give Ontarians more options for care closer to home, while also working to ensure that health care professionals can fully use their skills and knowledge, the government is working towards allowing Ontarians to receive travel vaccines in their local pharmacies. The government will also explore the benefits of further expanding pharmacists’ scope of practice.

Community Health Centres, Nurse Practitioner-Led Clinics, Family Health Teams, Aboriginal Health Access Centres and nursing stations provide Ontarians access to high-quality primary care. Interprofessional primary care teams are an important partner in helping the government achieve its guarantee that every Ontarian has access to a primary care provider. To ensure these clinics can effectively recruit and retain qualified interprofessional staff in primary care settings, Ontario will invest an additional $85 million over three years. These investments will help clinics continue to provide services across the province, including northern, rural and fast-growing communities.

Ontario’s Aboriginal Health Access Centres

Ontario is investing an additional $1.3 million annually in Ontario’s Aboriginal Health Access Centres (AHACs) to support the expansion of information management systems. With this investment, AHACs will better enable access to culturally appropriate primary health care.

Better Access to Specialized Care

To accelerate patient access to medical specialists, the government has streamlined intake for some orthopedic procedures, including hip and knee replacements and treatment for low-back pain.

The Province is also expanding access to treatment for Ontarians with all forms of infertility, making fertility services more equitable and accessible. The government is contributing to the cost of one in vitro fertilization (IVF) cycle per eligible patient, at more than 50 clinics across the province. Funding will help support over 5,000 Ontarians per year who are trying to start or expand their families.

In 2016–17, the government will provide about $1 million to fund support services for those affected by pregnancy and infant loss, including resources to train volunteers and support parents and families who have experienced loss.

New Funding for Shingles Immunization

The government aims to make the shingles vaccine available to Ontario seniors between the ages of 65 and 70, free of charge. The investment will save eligible seniors about $170 in out-of-pocket expenses for the vaccine, and reduce emergency room visits and hospitalizations for vaccinated seniors.

Investments in High-Quality Hospital Care

Ontario hospitals have demonstrated leadership in their efforts to help transform the province’s health system. They have maintained and increased services over the past four years in the absence of an increase to base operating costs. In response to the growing demand for highly specialized and complex services and the need to expand access in growing communities across the province, in 2016–17 the government is increasing its base funding for hospitals by one per cent. This investment will help hospitals expand access to complex hospital clinical services, keep wait times low, maintain access to elective surgery and ensure that important health service programs are maintained.

The province’s hospitals remain leaders in providing highly specialized programs and technologies, including cardiac and neurological services and organ transplantation. Hospital facilities are being renewed, expanded or rebuilt, with approximately 35 major hospital projects planned or underway. For more information on capital investments in hospitals, see Chapter I, Section B: Building Tomorrow’s Infrastructure Now, which also outlines investments in community capital to support health care.

Expanding Services in Cancer Care

Over the next three years, the government is investing an additional $130 million in cancer care services. Demand for cancer care services continues to grow, in part because of better diagnosis and screening. The government’s investment will allow for the delivery of more cancer care services and preventive programs. The new investments continue to support reduced wait times for cancer surgeries. In 2014–15, 87 per cent of cancer surgeries were completed within the targets for priority wait times, up from 79 per cent in 2011–12.

The government is also investing in infrastructure to improve access to highly specialized stem cell transplantation programs in Ontario. Stem cell transplantation is an essential component of treatment for people with lymphoma, leukemia, myeloma and other blood disorders. This investment will create highly specialized rooms to enhance the life-saving services provided at University Health Network, Hamilton Health Sciences Centre and The Ottawa Hospital.

Mental Health and Addictions

To help improve access to services and outcomes for people with mental illness or addictions, and to reduce homelessness, Phase Two of the Province’s 10-year Mental Health and Addictions Strategy includes investing $16 million over three years, commencing in 2014–15, to create 1,000 new housing spaces for people with mental health or addictions issues, including $4 million for 248 supportive housing units in 2016–17.

Ontario is also providing $1.5 million to the Dave Smith Youth Treatment Centre in Ottawa to support the construction of a new 30-bed youth residential treatment facility that will increase capacity, improve efficiency, and ensure client needs are met in a safe and comfortable environment.

Ontario is also providing $2 million to 10 Indigenous organizations to engage with their communities and make recommendations on unique mental health and addictions issues facing Indigenous peoples across the province. A dedicated Indigenous engagement process, launched with First Nation, Métis and urban Indigenous partners, will continue to inform the mental health and addictions strategy.

Sustaining the Ontario Drug Benefit Program

Ontario continues to pursue affordable drug access for patients, in partnership with federal, provincial and territorial governments. This includes a coordinated process for approving new and expensive drugs for people who need life-saving medications. For additional information on the federal government’s decision to join the pan-Canadian Pharmaceutical Alliance, see Chapter IV: Together Towards a Stronger Ontario and a Stronger Canada.

As part of Ontario’s “Patients First: Action Plan for Health Care,” the government will introduce a redesigned public drug program by 2019. The new program will improve long-term sustainability while ensuring access to drugs for people who need them. It will be simpler and easier to use, and increase fairness and equity among beneficiaries. For additional information on the changes to Ontario’s Public Drug Programs, see Chapter II, Section B: Transforming Government and Managing Costs.

Connecting Services and Providing More Coordinated Care in the Community

Investing in Home and Community Care

As Ontario’s population ages, patients prefer to receive care at or close to home, so they can continue to live independently. Ontario has extended its commitment to increase funding by $250 million to expand capacity to deliver high-quality home and community care. Care at home or in the community is often less costly than hospital or long-term care and can be just as effective, particularly when interdisciplinary health care teams ensure patients get the care they need. The government plans to continue to fund growth in community-based care at about five per cent per year to 2017–18, as committed to in previous Budgets.

A Roadmap to Strengthen Home and Community Care

In May 2015, the government released a 10-step, three-year plan entitled “Patients First: A Roadmap to Strengthen Home and Community Care.” Ontario has further invested in home and community care, enabling 80,000 more home nursing hours for the most acute patients. The Province has also initiated six interdisciplinary bundled-care teams in communities across the province, with incentives for efficient, effective care, to help patients transition more smoothly out of hospital and into their home.

Ontario has established a patient and caregiver advisory table on home and community care design and delivery. The government has already begun consulting on a statement of values and a levels-of-care framework. The Province appointed Dr. Gail Donner as the external adviser on the roadmap. Dr. Donner chaired Ontario’s Expert Group on Home and Community Care, whose 2015 report, “Bringing Care Home,” led to the development of the roadmap.

Safeguarding Personal Support Services

To help ensure the Province can meet long-term needs for publicly funded personal support services in the home and community care sector, the government further increased the minimum base wage for eligible personal support workers to $15.50 per hour, rising to $16.50 per hour in April 2016.

More Choice and Supports for Palliative Care

The Province’s “Patients First: A Roadmap to Strengthen Home and Community Care” report committed to provide Ontarians with greater choice, access and equity, and clear accountability with respect to palliative and end-of-life care, along with more supports for caregivers. John Fraser, Parliamentary Assistant to the Minister of Health and Long-Term Care, has been meeting with patients, families and stakeholders across Ontario towards developing a comprehensive provincial palliative and end-of-life care strategy.

New Funding for Hospice Services

Through Budget Talks and pre-Budget consultations, the government heard that it was important to increase funding for hospice care in communities to support those in need and their families.

Over the next three years, the government plans to invest an additional $75 million in community-based residential hospice and palliative care, for a total investment of about $155 million. This will bring the government’s funding of residential hospices to more than $55 million annually at maturity, to help fulfil its commitment to fund 20 more hospices, almost doubling the number of people who will have access to quality end-of-life care, including in rural areas.

Long-Term Care

The Province is continuing to improve the long-term care homes sector to focus on resident-centred care that is responsive to behavioural and ethno-cultural needs. To support this, the government will increase its investment in resident care needs by two per cent a year over the next three years.

Beginning in 2016–17, the government will invest an additional $10 million annually in Behavioural Supports Ontario, for initiatives to help residents with dementia and other complex behaviours and neurological conditions.

Keeping Ontarians Healthy

Healthy Choices

To help Ontarians make more informed decisions about healthier food choices, the Ontario legislature passed the Healthy Menu Choices Act, 2015, which comes into force in January 2017. The Act will require food premises with 20 or more locations to post calorie information for food and beverage items. To further help consumers, the government is proposing to amend the Act to require that the necessary caloric and related information on menus and menu boards appears close to the listing or picture of food items.

Healthy Kids

To further encourage children’s physical activity and healthy eating, Ontario’s Healthy Kids Ministers’ Working Group continues to build on the Healthy Kids Strategy. The government is exploring new initiatives, while continuing to implement existing projects, such as the Healthy Kids Community Challenge in 45 communities across Ontario.

Immunization 2020

Launched in 2015, the Immunization 2020 strategy is a first-of-its-kind plan to modernize Ontario's immunization system. The government is developing amendments to the Immunization of School Pupils Act that, if passed, would protect students and communities by including stronger requirements for school vaccine exemptions.

Building on Immunization 2020, Ontario proposes to authorize pharmacists to administer a wider range of vaccines, such as travel vaccines. This would be in addition to the flu vaccines they can already administer and will increase immunization efficiency and convenience for Ontarians.

Smoke-Free Ontario

The government is committed to a smoke-free Ontario that helps smokers quit, protects people from exposure to secondhand smoke and protects young people from taking up smoking. As of January 2016, new regulations prohibit the smoking and sale of tobacco on certain public properties, ban the sale of flavoured tobacco (which is more appealing to youth), and prohibit the sale of electronic or e-cigarettes to youth under age 19.

In the 10 years since the passing of the Smoke-Free Ontario Act, tobacco use and health risks for Ontarians have been greatly reduced. Smoking rates declined from 24.5 per cent in 2000 to 17.4 per cent in 2014, representing about 408,000 fewer smokers. In 2014, Ontario’s smoking rate was the third lowest among the provinces.

Since its renewal in 2011, the Smoke-Free Ontario Strategy has helped large numbers of Ontarians in their efforts to quit smoking; over 94,600 smokers received direct or telephone cessation support and over 26,900 smokers accessed cessation resources online.

However, despite significant progress in curbing the use of tobacco products, smoking is the number-one cause of death and disease in Ontario; 13,000 Ontarians die each year as a result of tobacco-related diseases. The government will continue to build on the strategy’s progress with further action to achieve the lowest smoking rate in Canada.

This is why the Province is taking immediate action by increasing the tobacco tax rate by $3 per carton of 200 cigarettes. Tobacco taxes are a proven method of supporting smoking cessation and prevention efforts, as reported by experts such as the World Health Organization. To further support the Smoke-Free Ontario Strategy, the Province will use $5 million of increased revenues from the tobacco tax to support a new investment for this year that will enhance priority populations’ access to smoking cessation services, no matter where they live in Ontario.

In addition, by increasing tobacco taxes annually at the rate of inflation, beginning in 2017, the Province will continue to support the objectives of the strategy, while also enabling government efforts to address the underground economy and prevent expansion of the contraband tobacco market.

Protecting Ontario’s Health Care System

To further improve health care quality and transparency, following broad public consultations, the Province is providing patients, long-term care home residents and their caregivers the opportunity to get help with unresolved complaints about home care, and health care in hospitals and long-term care homes. Starting in July 2016, Christine Elliott, Ontario’s first Patient Ombudsman, will be able to investigate issues, make recommendations and report publicly to LHINs and the Minister of Health and Long-Term Care.