Ontario hospitals are doing more with less, but at a cost
Among those costs are record waits in emergency departments, a growing number of hospitals facing deficits, and a weakening capacity to deal with surges in demand, according to Anthony Dale, president and CEO of the OHA.
Given rising health system pressures, the current situation is not sustainable, says the OHA.
'Over time, the strain on the sector has left hospitals with little ability to expand to manage surges in demand — be it the increasing needs of the population, or the next pandemic,' the report titled: Ontario Hospitals — Leaders in Efficiency warns.
Ontario ranks the lowest in Canada when it comes to per capita spending on hospitals. The province spends $1,935 per person. The average spent by other provinces is $2,209. It would cost Ontario $4.4 billion a year to fund Ontario hospitals at that rate, according to the report.
Ontario's relatively low per capita spending is often pointed to by critics as a sign that the government is failing to properly support health care, but the Ontario Hospital Association sees some positives in the numbers. Its new report notes that Ontario hospitals have achieved good results for patients while also achieving high levels of efficiency.
While there is room for improvement and a clear need for reinvestment, Ontario's health system overall performs well in comparison to other provinces,' according to the report.
Hospitals in Ontario have accommodated the 'growing and aging population while facing a shortage of beds' by reducing the need for hospitalizations through greater use of less-invasive, same-day procedures and outpatient services, along with other innovations and quality improvements, according to the report.
As a result, the average length of hospital stay in Ontario (in 2023-24) was 6.8 days, the lowest in Canada. The Canadian average was 7.3 days, with Alberta recording an average of 8.0 days and Manitoba recording an average of 10.1 days.
But there are limits to how much and how fast lengths of hospital stays can be reduced, warns the report, noting a shortage of home and community care may contribute to a longer stay for some patients.
By some key measures, Ontario hospitals outperform hospitals in other provinces, despite the per capita funding differences.
Ontario hospitals perform among the best in the country according to a measure that reflects whether hospitals are successful in reducing patient deaths and improving care.
By other measures that track how well hospitals are doing, though, there are signs that some improvements could be slipping.
Ontario had seen improvement in hospital readmission rates (the percentage of patients who return to the hospital for any reason within a specific time — usually 30 days — after being discharged) until 2022-2023, but rates increased in 2023-2024, giving Ontario a below-average performance.
The number of patients who received emergency hip fracture surgery within 48 hours has improved recently in Ontario, but remains below average compared to other provinces. Delaying hip fracture surgery can increase a person's risk of death.
The report notes that it will take an investment in a range of health services to maintain the kind of care required. That includes increased and coordinated home care, rehabilitation, long-term care and primary care.
Dale said hospitals are proud of their efficiency, 'but you can't count on continuing to harvest significant efficiencies from the hospital sector. We need to turn the page.'
Without change, he said, 'the system will find it harder and harder to meet the full needs of the population that expects access to care. Let's stop focusing on a single-minded obsession with efficiency. We have to look at this in a different way'.
That includes more funding for innovation as well as giving hospitals a better long-range picture of how big their budgets will be.
Additional hospital beds and staffing support will help hospitals, the report says.
'However, what will shape the health system to meet future needs is further investment in research and innovation to change the way hospitals work. It's a necessary next step toward adaptability and to ensure the delivery of both efficient and high-quality care to Ontario's growing and aging communities.'
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