Background

Growth Pressures Continue to Mount for Hospitals in the high growth regions

For the past ten years, the rate of population growth in high growth regions has been two to three times greater than the rest of the province. High growth 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 Dufferin County and communities of Kitchener, Waterloo, Guelph, Cambridge, West Ottawa, Fergus and Wellington than any other location in the province. As a result, over 22% of Ontario residents live in high growth regions but only 14% of health care funding goes to area hospitals.

As more people move into the area – roughly 60,000 people a year – High growth 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 high growth regions 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 high growth 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 high growth 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 high growth regions.

Working for Equitable Funding

Growing Communities 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 high growth regions. 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 high growth regions 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 high growth regions are also under-serviced compared to the rest of the province.

And even though high growth 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 high growth constituents fall further behind in per capita funding.

Working with the Government to Improve High Growth Funding

High growth hospitals will continue to advocate for equitable funding on behalf of constituents in high growth regions and will work with the government to address the current operating funding deficit.

The Growing Communities Healthcare Alliance will also work to address historic under-funding of high growth regions.

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 Growing Communities Healthcare Alliance will also work towards and advocate for three-year funding cycles that will better enable high growth hospitals to plan for growth.

Capital Needs Forecast

The Growing Communities Healthcare Alliance is forecasting the need for 1100 additional beds to keep pace with population growth in in high growth regions to 2008.

This dramatic number of beds reflects the ongoing population boom in high growth regions a boom that is expected to continue well beyond the government’s current planning horizon of 2003. Capital needs in high growth regions 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 High Growth Regions to 2008 and Beyond

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

The report shows that keeping pace with population growth in high growth regions 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, high growth 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 high growth regions 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 high growth regions, the Alliance recommends the following government actions.

The government needs to move forward immediately on redevelopment projects in high growth regions to keep in step with population growth and health service needs; and to prevent the widening of service gaps that currently exist in high growth regions. 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 high growth regions 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 Growing Communities Healthcare Alliance’s Capital needs forecast report and the Halton-Peel DHC report.

Providing Services “Closer to Home” for Constituents

Since its inception, the Growing Communities Healthcare Alliance has worked to provide health care services “closer to home”.

The Growing Communities 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 high growth, 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 high growth hospitals reviewed the scope of tertiary service provision “closer to home” to determine which tertiary level services “made sense” in high growth regions.

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

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

Achieving Positive Results by Working Together

The Growing Communities 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 high growth regions 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.