Healthcare and the 2018 Ontario Elections
By: Jonathon Chio
Please note that this article was written in advance of the election results
With the Ontario 2018 election set to occur on June 7th, a change in leadership may take place, as major political parties (Progressive Conservatives led by Doug Ford and the New Democratic Party guided by Andrea Horwath) aim to take over from the Liberals, currently led by Kathleen Wynne. Recently, on behalf of Ms. Wynne, the Lieutenant Governor of Ontario delivered the Throne Speech. In this statement, the Liberal government outlined its next steps to build on the plan for fairness, healthcare, and opportunity within Ontario.1 As most of IMS Magazine readers have at least some healthcare background, many working in affiliated teaching hospitals, we felt it was appropriate to first provide a quick overview of how the Liberal party views the importance of healthcare in their election platform. We also evaluate the rationale supporting their healthcare statements and examine how all the parties, hoping to earn Ontarian’s vote (and trust), have responded.
To open the new session of legislature, the Throne Speech titled, “A Plan for Care and Opportunity” mentioned the word “care” 62 times, specifically referring to healthcare, home care, long-term care, pharmacare, dental care, mental health, and childcare.2,3 Through the Throne Speech, it is clear that the Liberals attempted to claim their stake, during the pre-election period, with an emphasis on improving healthcare quality. This focus is likely in response to results from a recent poll asking Ontarians about their top issues in this election.4 40% of voters identified healthcare as the most pressing issue, while “economy and jobs” and “lower taxes” received 35% and 34% of votes, respectively. It is well-established that our healthcare system and associated universal medical coverage is a major part of our national identity and a source of pride.5 However, the poll results serve to be an alarming and nagging reminder that the Canadian healthcare system is flawed. A central tenet of our imperfect healthcare system is the excessive wait times to see/ consult specialists and undergo diagnostic as well as surgical procedures.6 This was highlighted by the 27th annual waiting time survey conducted by the Fraser Institute. In this study, the academic group surveyed specialist physicians across 12 specialties (oncology, radiation oncology, internal medicine, urology, cardiovascular, orthopaedic surgery, neurosurgery, general surgery, otolaryngology, ophthalmology, gynaecology) and 10 provinces.
Between 2016 and 2017, the average wait times to consult specialists have increased from 9.4 to 10.2 weeks. Similarly, within the same period, the average wait times to undergo procedures have lengthened from 10.2 to 10.9 weeks. Actual wait times also exceeded the clinically-reasonable wait times in 62% of comparisons, with the average expected and real wait times being 6.4 and 8.6 weeks. The national wait times for imaging technology (namely computer tomography (CT) scans, magnetic resonance imaging (MRI), and ultrasound) have generally stayed the same, going from 3.97, 11.1 and 4 weeks in 2016 to 4.1, 10.8 and 3.9 weeks in 2017. Ontario can take some solace, as its wait times to consult specialists and undergo procedures are 6.7 and 8.6 weeks respectively, both of which are below the nation’s average. Ontario wait times for imaging technology have largely remained unchanged; at 3, 6 and 2 weeks for CT, MRI and ultrasound. A summary of these values is given in the table below.
While one can argue that the increases are small, and hence not troubling, prolonged wait times have negative socioeconomic consequences. During their wait times, patients may be unable to work due to their physical conditions. The lack of income and decreased productivity hamper economic growth. Extended wait times may also decrease patient qualityof life, as there is a higher likelihood of poor medical outcomes.6 Consequently, to avoid these negative effects, Ontario patients may seek medical help elsewhere. This can explain why Ontario is the top province where patients travel abroad for treatment. In 2016, there were 26,513 patients who sought medical help outside of Canada, and the Ministry of Health spent $35 million to send patients to the United States for procedures.7 While Ontario tops the list for patients leaving to obtain medical assistance, it is important to remember that wait times in Ontario are below the nation’s average. It is clear that the resentment towards the healthcare system can’t be solely explained by longer wait times. Nevertheless, the existence of this cause-and-effect relationship is undeniable. Interestingly, the Ontario Medical Association (OMA) is in midst of a campaign titled, “Not a second longer”.8 Through this campaign, the OMA calls for the provincial government to improve an underfunded healthcare system that is ill-suited for a growing and aging population. However, an even more troubling statistic is that with the current flaws, Ontario is the largest sub-sovereign debtor in the world, owing an excess of $300 billion and spending $11 billion annually to fund it.9
Understandably, healthcare is a major issue debated by all the political parties. As such, the Throne Speech indicated that the Liberal government (among other priorities) aims to: (1) reduce wait times for healthcare by increasing hospital operating budgets, (2) expand homecare to provide more services to seniors at home, and (3) make historical investments in mental health.1 This translates to a Liberal 2018 budget allocating $300 million to hire registered nurses for Ontario long term care facilities and $19 billion for hospital infrastructure and operations.10 However, these promises will push Ontario further into debt until 2025. Given that healthcare is the primary concern for majority of Ontarians, it will be of interest to observe how other parties will seek to obtain Ontarians’ votes and trust through making financial promises within context of a, hopefully, balanced budget.
Taken together, it is imperative for voters to maintain perspective of how promises made to improve healthcare will influence the amount of debt incurred in the future. Based on the Throne Speech, the Liberals have begun the debate and discussion regarding Ontario healthcare. The responses from other parties to the Liberals’ platform, along with their own plans and promises, will be highly anticipated.
So, who will you vote for on June 7th, 2018?
Table 1: Comparison of wait times between 2016 and 2017 in Canada and Ontario for multiple categories of health care.
|Year||Wait times (weeks) for seek specialist after referral||Wait times (weeks) to get procedure completed||Wait times (weeks) for CT scan||Wait times (weeks) for MRI||Wait times (weeks) for ultrasound|
- Throne Speech Announces Major Investments Guided by a Commitment to Care and Creating Opportunity [Internet]
Office of the premier: Ontario [cited 2018 April 22]; [about 2 screens]. Available from: https://news.ontario.ca/opo/en/2018/03/ throne-speech-announces-major-investments-guided-by-a-commitment-to-care-and-creating-opportunity.html
- Editorial: Ontario throne speech – who cares? Oh, Wynne does. [Internet] Ottawa Citizen Editorial Board [cited 2018 April 22]; [about 2 screens]. Available from: http://ottawacitizen.com/opinion/editorials/editorial-ontario-throne-speech-who-cares-oh-wynne-does
- Care and change: The messages driving Ontario’s 2018 election. [Internet] Behind the numbers. [cited 2018 April 22]; [about 3 screens]. Available from: http://behindthenumbers.ca/2018/03/20/ care-change-messages-driving-ontarios-2018-election/
- Ontarians trust PCs with key election issues: Ipsos poll. [Internet] Global News. [cited 2018 April 22]; [about 1 screen]. Available from: https://globalnews.ca/news/4040177/ontarians-pcs-key-issues-ipsos/
- The ER waiting game. [Internet] Toronto Life. [cited 2018 April 22]; [about 1 screen]. Available from: https://torontolife.com/city/ er-waiting-game/
- Bacchus Barua (2017). Waiting Your Turn: Wait Times for Health Care in Canada, 2017 Report. Fraser Institute.
- 63,000 Canadians left the country for medical treatment last year: Fraser Institute. [Internet] CTV News. [cited 2018 April 22]; [about 1 screen]. Available from: https://www.ctvnews.ca/health/63-000canadians-left-the-country-for-medical-treatment-last-year-fraser-institute-1.3486635
- Not A Second Longer Platform. [Internet] Ontario Medical Association. [cited 2018 April 22]; [about 1 screen]. Available from: http:// notasecondlonger.ca/platform/
- Ontario election will be won or lost on health care. [Internet] The Star. [cited 2018 April 22]; [about 1 screen]. Available from: https:// www.thestar.com/opinion/contributors/2018/03/25/ontario-election-will-be-won-or-lost-on-health-care.html
Ontario Liberals bet big on seniors’ care, drug and dental coverage in 2018 pre-election budget/ [Internet]. CBC News. [cited 2018 April 22]; [about 1 screen]. Available from: http://www.cbc.ca/news/canada/toronto/ontario-liberals-budget-2018-1.4595213