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Can community care take pressure off hospitals?

The Critical Care Unit at Sunnybrook Hospital.

Moe Doiron/Moe Doiron/The Globe and Mail

Health care experts are pushing for more resources to be diverted from hospitals to community-based services as the provinces grapple with a new funding regime from Ottawa.

The federal government surprised the provinces on Monday with a plan to scale back increases in health transfers by linking them to economic growth beginning in 2017-18. But health care experts are already struggling with the new reality of tighter budgets.

In fact, some worry that retaining the existing funding formula of 6-per-cent annual increases for the next five years could drain some of the energy from the reform process that is under way and even breed complacency.

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"The skeptics might say 6 per cent might actually permit us to do things the way we've always done them," said Kevin Smith, chief executive officer of St. Joseph's Health System in Hamilton. "So, is it enough money not to force radical change? I think that's a debate we have to have."

An enhanced role for community care is considered essential to take the pressure off hospitals, where one in six acute-care beds in Canada is occupied by an elderly patient waiting for a place in long-term care or other community services. So far, federal and provincial governments have provided little direction. As a result, most health administrators are devising their own strategies for coping with budgets that often lag behind growing operating costs.

"The answer to a sustainable health care system is not putting more tax dollars into it," said Bob Bell, chief executive officer of the University Health Network, which operates three of Toronto's largest hospitals. "It's thoroughly thinking about integrating our health care into something that is a system."

Howard Waldner, president and CEO of the Vancouver Island Health Authority, says diverting money from acute to community care is the best way to maintain the future sustainability of the health system.

"Nobody wants to be in hospital, and if we can care for patients at home, in their community, that's what we need to work hard to achieve," Mr. Waldner said, noting that the VIHA is putting increased emphasis on prevention and wellness from cradle to grave.

At the same time, he pointed out that the VIHA's jurisdiction includes Victoria, is already a prime retirement destination for many Canadians.

"If anywhere has to come to grips with developing new models for health care spending, it's right here, right in our own backyard, and we are looking hard at how we can manage the treatment process further upstream [before patients end up in emergency or acute care]" Mr. Waldner said.

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In Ontario, health care officials are calling for reforms to address the fact that just one per cent of residents account for about half of the province's combined hospital and home care costs. Hospitals are experimenting with "virtual" wards that provide follow-up care at home for patients with chronic medical conditions to lessen their chances of being re-admitted.

The Ontario Hospital Association said in a recent report that the government should shift some funding from hospitals to community programs. The only way to prevent the frail elderly from languishing in acute-care beds is to keep them out of hospital, which requires investments in the community, the report said.

The Ontario government is scaling back growth in the amount of its own money that it puts into health care to about 3 per cent a year from historic levels of 7 per cent to help erase its deficit, projected to reach $16-billion this year.

OHA president Tom Closson said a 3 per cent increase will leave hospitals without enough funding to meet their growing operating costs.

"We have a serious financial problem here," he said, noting that the interest on the province's debt will total $16.8-billion by fiscal 2018, slightly less than the entire spending on hospitals.

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About the Author

Karen Howlett is a national reporter based in Toronto. She returned to the newsroom in 2013 after covering Ontario politics at The Globe’s Queen’s Park bureau for seven years. Prior to that, she worked in the paper’s Vancouver bureau and in The Report on Business, where she covered a variety of beats, including financial services and securities regulation. More

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