In all the accusatory rhetoric over our Soviet-era health-care system, numbers are conspicuously lacking.
Most everyone agrees that the backlog in emergency rooms has its origins in a shortage of acute-care beds, which are in turn occupied by "bed-blockers" -- patients who really belong in long-term beds that haven't been built.
But how do we know all this? Just how many beds short are we?
Three weeks ago, I asked the Ontario Ministry of Health for some simple figures: the number of acute-care, chronic-care and long-term beds in Ontario in each year of this decade.
Providing such basic statistics, you might think, would be a matter of moments. Such numbers are, after all, the very grist of the health-care planning mill, proof of Health Minister Elizabeth Witmer's claims that her government is slowly but successfully reversing years of mismanagement by other governments. Why, I half expected the media-affairs officer on the other end of the phone to reel them off from memory.
They'll be ready the next day, came the confident promise. Well, in one more day . . . Sorry, this is proving complicated . . . The numbers have arrived, they're just being checked . . . Sorry, we just need to get them approved (enter the Premier's Office) . . . Actually, terribly sorry about this, but the numbers are wrong; we're recalculating. And Merry Christmas! . . . We have the new numbers, and they're just being checked. And Happy New Year! . . . Awfully sorry, still waiting on approval (Premier's Office again).
Yesterday the charts arrived. They have been spun so delicately that statistics favourable to the current government include percentage changes, while unflattering news is only provided in raw numbers. But all the massaging in the world can't hide the dismal record of the past 10 years.
There were 35,194 acute-care hospital beds in Ontario in 1990. Ten years later, there are 21,805, a decline of 38 per cent. (Note to Premier's Office: Many larger newspapers now have calculators.) Chronic-care beds declined by 32 per cent over the decade, from 11,436 to 7,787. During that time, Ontario's population grew by 1.3 million (9 per cent) and its mean age increased by a year and a half, to 36.9 years.
The Conservative government's plan is to direct patients out of acute-care and chronic-care beds and into long-term care. But on Premier Mike Harris's watch the number of long-term beds has remained virtually static, increasing from 56,607 to 58,166 (an increase of 3 per cent). Funding for home care has barely kept pace with inflation and demand, rising 43 per cent as the caseload has risen 38 per cent over the past five years.
When governments -- Bob Rae, David Peterson, Brian Mulroney and Jean Chrétien got us into this mess -- slash the number of acute-care and chronic-care beds, provide no significant increase in long-term beds, and barely hold the line on home care, even as the population both increases and ages, there's going to be trouble. Even the most Stalinist commissar in the Kremlin could see it coming.
The Mike Harris government is desperately attempting to make amends by building thousands of long-term beds to ease pressure on the hospital system. As so often happens in a command economy, the government succeeded in closing beds faster than it created new ones. About 7,000 new long-term-care beds will arrive this year and next year. Another 13,000 are planned for future years.
That will help, but demand will soon outstrip even this increased supply. So the state planners at the Ministry of Health are hoping to save more money by reforming the role of family doctors, encouraging them ("Comrade, we strongly encourage you . . .") to reduce overhead by pooling their practices, and easing emergency-ward strain by offering round-the-clock care.
This makes splendid sense, until you consider these are the same planners who gave us the health-care system we enjoy today.
Acute-care beds, gone. Chronic-care beds, gone. Long-term beds, not here yet. Home-care services, barely up to the job.
You know what this province's health-care system needs? Perestroika.
John Ibbitson