Background

Growth Pressures Continue to Mount for Hospitals in the GTA / 905

For the past ten years, the rate of population growth in the GTA / 905 has been two to three times greater than the rest of the province. GTA / 905 hospitals have been expected to provide the same level of service as patient volumes increase dramatically and government funding has not kept pace with these growing demands.

Today more people move into the combined areas of Durham, Halton, Peel, York and surrounding districts than any other location in the province. As a result, over 22% of Ontario residents live in the GTA / 905 but only 14% of health care funding goes to area hospitals.

As more people move into the area – roughly 60,000 people a year – GTA / 905 hospitals are forecasting increased costs based on a growing need for hospital services. Added to this equation is the tremendous growth expected within our senior’s population; residents over the age of 65 are increasing in the GTA / 905 at almost three times the provincial rate and four times the Toronto rate.

Since seniors’ are high consumers of health care services, this increase will place greater pressure on GTA / 905 hospitals over the coming years.

Hospital efficiency efforts and the prudent use of resources have been effective in helping to address some of the pressures experienced by GTA / 905 hospitals. Alliance hospitals have initiated many creative strategies, programs and ideas that add up to millions of dollars in cost efficiencies and patient improvements. Nonetheless, even a well-managed bottom line and better than average length-of-stay data cannot completely address inequitable funding resulting from tremendous population growth.

Although beneficial, and most welcome, provincial government funding allocations have provided only partial relief due to the reality of population growth coupled with increased hospital utilization. Alliance hospitals are striving to get ahead of growth and establish a delivery system that will meet the health service needs of the 2.5 million people residing in the GTA / 905.

Working for Equitable Funding

GTA / 905 Healthcare Alliance hospitals are forecasting a collective funding deficit of $90.4 million for 2002/2003. This figure reflects significant growth pressures as well as some cost pressures experienced in the GTA / 905 region. Alliance hospitals are working to obtain appropriate funding levels to avoid deficit positions and more importantly, service reductions for the current year and beyond.

Overcrowding is common in most of the ten hospitals in the GTA / 905 because of our growing population. Alliance hospitals can expect to see an increase of 115,000 patient days, 52,000 additional emergency visits and 82,000 extra day/night procedures.

As a result, constituents who live in the GTA / 905 are also under-serviced compared to the rest of the province.

And even though GTA / 905 constituents pay the same provincial taxes as everyone else, they receive $453 per person in health care funding compared to the provincial average for health care funding of $804 per person. This funding gap will continue to widen, as more and more people move into the area.

This leaves Alliance hospitals in a “catch 22” situation. Alliance hospitals get deeper into debt as they try to keep up with growing service demands, and GTA / 905 constituents fall further behind in per capita funding.

Working with the Government to Improve GTA / 905 Funding

GTA / 905 hospitals will continue to advocate for equitable funding on behalf of constituents in the GTA / 905 and will work with the government to address the current operating funding deficit.

The GTA / 905 Healthcare Alliance will also work to address historic under-funding of the GTA / 905 area.

Even with an influx of $100 million each year, for the next five years, Alliance hospitals would still remain at 20% below the provincial per capita funding average.

The GTA / 905 Healthcare Alliance will also work towards and advocate for three-year funding cycles that will better enable GTA / 905 hospitals to plan for growth.

Capital Needs Forecast

The GTA / 905 Healthcare Alliance is forecasting the need for 1100 additional beds to keep pace with population growth in the GTA / 905 to 2008.

This dramatic number of beds reflects the ongoing population boom in the GTA / 905; a boom that is expected to continue well beyond the government’s current planning horizon of 2003. Capital needs in the GTA / 905 are estimated to be three to five times greater than the rest of the province due to unprecedented growth and aging.

Magnitude of Capital Needs in GTA / 905 to 2008 and Beyond

Alliance hospitals spearheaded a capital needs forecast to determine the magnitude of health service requirements in the GTA / 905, address concerns about rapid population growth and deal with long-term planning needs.

The report shows that keeping pace with population growth in the GTA / 905 will require an additional 1,100 beds at a cost of $650 million and was based on methodology developed by the Halton-Peel DHC. In addition, outpatient service growth is expected to increase 46% by 2008. This significant need for capital development and planning beyond the current 2003-planning horizon established by the Ministry of Health and Long-Term Care calls for partnership with government, community, and hospitals.

The Alliance’s capital needs forecast report examines capital implications based on population changes and takes into account future clinical efficiencies and changes in programs to provide a realistic look at bed requirements in the future.

The magnitude for additional beds is immense and without government approval, support and funding, GTA / 905 communities will be crippled by a lack of necessary healthcare services and result in limited access to care, increasing waiting lists and essentially creating a critical situation for more than 2.5 million Ontario residents.

Alliance hospitals are already experiencing occupancy rates above 90%. According to a July 1999 study in the British Medical Journal, when occupancy rates are above 85%, risks become discernable.

The Alliance intends the report to be instrumental in helping the Ministry of Health to think long-term and plan at the macro level as well as deal with the operating costs associated with the additional beds.

The Halton-Peel DHC recently released a report that reinforces the need for additional beds in the GTA / 905 and the need to increase hospital capacity to 2008/09 and beyond. Entitled “A Regional Hospital Infrastructure Plan for Halton and Peel,” which calls for a number of recommendations, including a new hospital in northwest Peel, a new replacement hospital in north Oakville and redevelopment at the Milton District Hospital, Trillium Health Centre, Joseph Brant Memorial Hospital, The Credit Valley Hospital and William Osler Hospital. A complete copy of the report can be downloaded from www.hpdhc.com.

Alliance Recommendations to Address Capital Needs

In order to address capital needs in the GTA / 905, the Alliance recommends the following government actions.

The government needs to move forward immediately on redevelopment projects in the GTA / 905 to keep in step with population growth and health service needs; and to prevent the widening of service gaps that currently exist in the GTA / 905. We need a realistic and workable system to redevelop, rebuild and reconstruct our hospitals to meet government mandated (HSRC) recommendations for current and future health needs.

The government needs to move beyond its 2003 planning horizon to enable appropriate, long-term planning for health care services in the GTA / 905 and ensure funding is in place for the future.

The government needs to take a serious look at the bed and ambulatory service needs specified in the GTA / 905 Healthcare Alliance’s Capital needs forecast report and the Halton-Peel DHC report.

Providing Services “Closer to Home” for Constituents

Since its inception, the GTA / 905 Healthcare Alliance has worked to provide health care services “closer to home”.

The GTA / 905 Healthcare Alliance has developed a Tertiary Services Model to identify tertiary services that can and should be provided by hospitals in the future to ensure access to service, “closer to home”. The model outlines three geographic divisions, including the north, east and west areas of the GTA / 905, that recognize realistic patient flow patterns and helps to assess the magnitude of the demand for tertiary services.

A clinical panel of medical experts from GTA / 905 hospitals reviewed the scope of tertiary service provision “closer to home” to determine which tertiary level services “made sense” in the GTA / 905.

The resulting plan includes:
• Expansion of large volume tertiary services currently provided at all GTA / 905 hospitals.
• Provision of new tertiary services within one or more of the GTA / 905 geographic areas.

The report also estimates the demand for tertiary services by residents of the GTA / 905 to 2008 using two distinct models to project hospital’s tertiary volume by program cluster.

Achieving Positive Results by Working Together

The GTA / 905 Healthcare Alliance, together with its MPPs and the provincial government has achieved some positive results over the past seven years. Alliance hospitals have secured growth funding for a number of years and welcome the government’s ongoing recognition of the GTA / 905’s tremendous population growth and increasing health care demands. As Alliance hospitals continue to experience the effects of growth, the group is working with the government towards a number of longer-term strategies. These include:

Working for growth funding increases each year until a permanent solution is established to deal with continuous population growth.

Obtaining funding for program and service expansions to meet rapidly growing health care needs.

Working with the Ministry of Health to establish and implement an equitable population needs-based funding method.

Establish effective working relationships with strategic partners to encourage the integration of community health care services.

Continue a strong working relationship with MPPs and the Ministry of Health to develop and implement funding solutions that address population growth.