Scarborough Mirror

Big changes are coming to health care in Scarborough and the CEOs of both local hospitals say residents should prepare themselves.

For exactly what, they can’t yet say.

But Rik Ganderton of Rouge Valley Health System and Dr. John Wright of The Scarborough Hospital are making a point of warning that soon, because Ontario has chosen a different way to fund hospitals, people will no longer go to the closest hospital to get every sort of care.

In a June blog posting, Ganderton said the next three years, as the formula is phased in, will see the biggest shift in care delivery since Medicare was introduced to the province in the 1960s.

“It may not be a huge upheaval. On the other hand, it could be quite significant,” he said in an interview last month.

“The scale of the change is yet unclear because we’ve never done this before.”

When Ontario’s Liberal government announced its Health Care Action Plan in January, it said the province had invested 61 per cent more in health care since 2003, but added if quality of care is to improve, “we will have to shift spending within health care to get better value for our health dollars.”

A stricken economy, the need to manage chronic disease and an aging population are all ramping up pressure to change the system, said Debbie Hammond, CEO of the Central East Local Health Integration Network, which funds healthcare providers in Scarborough, Durham, Northumberland and the Kawarthas.

“We are going to have to take money out of the hospitals. It’s not a small amount. We’re talking about millions,” Hammond said.

Wright said he sees a “huge transformation” coming as budgets for hospitals, funded independently until now, is shifted to mainly “patient-based” funding based on the efficiency and volume of services performed.

Hospitals still don’t know how much the province will pay for those services, and some procedures are hard to cost, but Wright predicted amounts the province pays will be “very close to the line” even for services done efficiently.

As of October, cataract surgeries will be funded this way, which doesn’t worry Wright, since TSH has one of Ontario’s largest cataract centres at its Birchmount campus.

But though this year, the formula includes just cataracts, hip and knee joint replacement and chronic renal disease; next year, 15 more services will be added, Then in 2014, it will be 30 more.

The result is hospitals will specialize, focusing on what they do best, Wright said.

“Not all hospitals will do all things. That is coming and that is exactly what the government wants.”

Some services will move out of hospitals into the community, and hospitals will work with each other, “sorting out who does what,” Wright predicted.

Though hospitals will have to subsidize some services, he acknowledged, but those who can’t reduce costs for a service to what the government pays will say, “Why am I doing this, because I can’t afford to?”

Wright was guarded when asked about a possible hospital merger in Scarborough. Earlier this year, when the possibility of a merger of TSH and Toronto East General Hospital was under study, Wright suggested such a move was needed to help area hospitals compete with larger counterparts downtown.

The merger was unpopular with staff of TEGH and at TSH, however, where a significant number still regret the joining of Scarborough Grace Hospital (now the TSH Birchmount campus) to Scarborough General Hospital a decade before.

Last month, Wright said Scarborough’s three hospital campuses - the third being Rouge Valley Health System’s Centenary campus - may not need to merge, but those which refuse to consolidate services will fail.

“There’s no way to say, ‘I want a full-service hospital in my backyard.’ The hospital will go bankrupt and close.”

Ganderton said he recognizes consolidation of services is an emotional issue, around which “the inevitability is for people to be defensive,” but added residents must be made to understand why such changes may be necessary.

“We are organized in an ineffective way, and now we’re looking for a correction,” he said.

Ganderton and Wright both maintained the resulting extra distances residents may travel to receive a service - five kilometres, say - would not be a barrier to providing them with “better” health care.

Because services are “fragmented,” available at different locations, waits may be longer or services aren’t available when patients need them, they say.

“Access isn’t just about physical location,” Ganderton said, expressing hope that rather than seeing a system in decline when they need a procedure, residents may see “a better service but it may be provided at a single site as opposed to multiple sites within Scarborough.”

Hammond said the province’s direction won’t necessarily change the LHIN’s clinical services plan, which was already encouraging hospitals to specialize in some services.

Providers will have to determine if procedures could be done outside the hospital, where they will be less expensive. Patients, however, could save the system money by having procedures when necessary, and not just for convenience, she added.

“We know a lot of people are having caesarean sections when they really shouldn’t have. That’s an extra cost to the health-care system,” Hammond said.

She said the LHIN will work with groups such as the Canadian Association of Retired Persons to help residents understand changes.

“We’re trying not to alarm the public,” Hammond added. “This is all about the patient.”