The recent series on Toronto's Mount Sinai Hospital by Globe writer Ian Brown and photographer Kevin Van Paassen highlighted the importance of major teaching hospitals to the welfare of Canadians. It raises again the issues of how hospitals are funded, and why waiting lists are so unconscionably long.
There is a major problem with funding of our hospitals and, perhaps surprisingly, a fairly simple solution. All it takes is courage and clear thinking - apparently too tall an order for our politicians.
Ontario hospitals, and probably most other hospitals in the country, are funded through an arcane and extremely dysfunctional mechanism called the "global budget." The ministry informs hospitals, after their fiscal year has already started, how much money will be provided for the coming year. The amount of funding is fixed, and it doesn't matter how many patients come through the doors, nor how sick they are; it will not go up. Hospitals are instructed to stay within budget; to do so, they have to decide what to cut next. Despite the fiction maintained by the Ministry of Health and Long-Term Care, to the effect that efficiencies are available, hospitals have long been cut past the bone: The last bit of fat went about 1987. (As noted recently, 40 per cent of ambulance calls are outside the accepted time window, because there is no room for the patients in hospitals.)
In London, Ont., only 40 per cent of the patients who come through the doors of the London Health Sciences Centre are from the London area. The rest come from across Southwestern Ontario: from Windsor to Owen Sound, from Sarnia to Niagara Falls (bypassing hospitals in Hamilton), from Kitchener (despite the existence of large hospitals there), and from beyond. We commonly see patients from Sault Ste. Marie, Timmins and South Porcupine. In my clinic in the past year, I have seen about 15 patients from the Toronto area; in the past few years, I have seen one patient from Miami, two from Prague, a few each from Vancouver and Vancouver Island, and some from Ottawa, Winnipeg, Prince Edward Island and Sidney, N.S. The reason? We are very good at what we do. The penalty paid by patients from London is that they have to wait in line with patients from outside the London area. The worst waiting times for MRI scans in Ontario are in Stratford and St. Thomas, because patients from there also have to wait with Londoners.
Our hospital is a designated regional stroke hospital. Even though I am on call for stroke only 25 per cent of the time, I have had to refuse a few patients a year with acute stroke, or send them back to village hospitals in Southwestern Ontario, because we had no empty beds. I have had half a dozen patients who had strokes while on the waiting list for an operation to prevent their stroke by cleaning out their narrow carotid artery (the main artery to the front of the brain). That operation, carotid endarterectomy, reduces by two-thirds the risk of stroke and death over the ensuing two years, but only if it is done in a timely fashion. The provincial benchmark, accepted by the Ontario Stroke Strategy Task Force, is that this operation should be done within a month; our waiting list is commonly three months and, by that time, much of the risk has already occurred. This operation has not even made it onto the list of priorities for reduction of waiting lists, even though it is much more cost-effective, in terms of improved cost per quality-years of life, than coronary bypass, cataract surgery or hip replacements, which occupy most of that list.
