efficiency

Wednesday March 1, 2023

Editorial Cartoon by Graeme MacKay, The Hamilton Spectator – Wednesday March 1, 2023

Sliding toward a new reality in health care

January 17, 2023

According to an Ipsos opinion poll released in February, more Canadians than ever are open to the idea of private-sector delivery of publicly-funded health-care service. Not only did the poll find 59 per cent of respondents support private delivery, 60 per cent supported the idea of private care for those who can afford it.

But wait — just a couple of months earlier half of the respondents to an Angus Reid Institute poll said more private care options would a negative impact on the system, with only 32 per cent believing private options would improve things.

Vagaries of methodology and ideology aside, what’s going on here. Could both things be true? Neither?

It’s a relevant discussion as Ontario and other provinces look to the private sector to deliver more services, reducing wait times and allowing more people to get needed care. But how much private-sector involvement is too much? When does the Canada Health Act, the blueprint for universal health care, become more of a suggestion than the rule?

It certainly doesn’t help when governments, in particular the Ontario government, are more interested in promoting their preferred ideological and political outcome than in providing straight answers.

August 19, 2022

Consider Premier Doug Ford’s promise that Ontarians will always be able to access care with their “health card not a credit card.” Lovely sentiment, but is it true?

There is a lot of private-sector delivery of health services already in the market, so no one can credibly claim private delivery doesn’t work. But increasingly there are some grey areas that should make us worry.

For example, consider the pediatric practice in Toronto that offers same-day virtual access to registered practical nurse services, but only to people willing to pay a monthly subscription and per visit fee. Yes, sick young patients will be seen regardless, but if you want to be sure of same-day virtual care and in-person consultation within a day or so, you need to pay.

Without casting aspersions, does that really sound like equitable access to care, as described in the Canada Health Act? Or does it sound more like real two-tier care, one tier for those who can afford it, the other for those who cannot?

January 18, 2023

There are other anecdotal examples, including some where people say they’ve been told they can get access to services and procedures, but it might take a year or more, unless they want to pay in which case they can get access in short order.

Some tiered service has existed for years now, such as in cataract surgery, where patients are offered different options for lenses, one covered by OHIP, others not and available if you can afford them or have insurance coverage.

The point here is not to denigrate services, patients or providers dealing with this changing landscape. It is that the system is evolving, in real time, without much reflection, debate or study. We’re sliding toward a different health-care universe, and it’s happening largely by stealth. That’s not the he way it should be, nor is it a prescription for success or public buy-in. (Hamilton Spectator Editorial) 

 

Thursday January 17, 2019

Editorial Cartoon by Graeme MacKay, The Hamilton Spectator – Thursday January 17, 2019

Ontario reviewing regional governments, raising prospect of future amalgamations

Ontario’s Progressive Conservatives have announced a plan Tuesday to comprehensively review the province’s regional governments.

Hamilton Amalgamation Octopus, 1999

The review includes all eight regional municipalities — Halton, York, Durham, Waterloo, Niagara, Peel, Muskoka District, Oxford County, and the County of Simcoe — and their lower-tier municipalities, according to a government news release.

A total of 82 municipalities will be examined, and the province hasn’t ruled out the possibility that some could be amalgamated in the future.

The PCs say the review will focus on three areas: governance, decision-making and service delivery.

“Our government is committed to improving the way regional government works and we will be looking at ways to make better use of taxpayers’ dollars and make it easier for residents and businesses to access important municipal services,” said Minister of Municipal Affairs and Housing Steve Clark in a news release.

Common Sense Revolution, 1995

Under former PC premier Mike Harris, Ontario amalgamated a series of local governments ranging from Kawartha Lakes to Toronto in a similar bid to improve efficiency, though the effectiveness of that strategy has been questioned in the years since.

“There’s always opportunity for two municipalities to come together to talk about that aspect, but we’re not talking about that in this regional government review,” he said during an interview at Queen’s Park.

In Ontario, upper-tier municipalities or regions typically oversee services such as policing and garbage pickup, while lower-tier muncipalities handle local bylaws. The current system was introduced in the 1970s.

Mayors from around the GTHA were meeting with Toronto Mayor John Tory on Tuesday afternoon as details about the review first emerged.

Toronto Megacity, 1996

During a news conference following the meeting, several mayors said they would support the review as long as their communities are made part of the process.

“Consult with us before unilaterally making changes, consult with our community before making changes and allow us to educate you a little bit on what we think needs to be done,” said Burlington Mayor Marianne Meed Ward.

Mississauga Mayor Bonnie Crombie acknowledged that the decades-old system has room for improvement. She noted that the three municipalities that form Peel Region — Mississauga, Brampton and Caledon —are each at different growth stages, with different priorities.

“I think this is a great opportunity to re-evaluate our relationship; this is a relationship that is 44 years old now. It perhaps doesn’t make sense as the way it used to,” she told reporters.

Megacity, 1997

Results of the review are expected in early summer, the PCs said. However, political observers are already questioning if such a sweeping and quick review will be effective, especially given the short timeline.

“There’s a lot of things to cover. Trying to get them all within a single review strikes me as a fairly large task,” said Robert Williams, a professor emeritus at the University of Waterloo who studies municipal governance.

Williams drew comparisons to the amalgamations carried out by the Harris government, and the current government’s decision to slash the size of Toronto city council nearly in half last year. (Source: CBC News)