Ontario Premier Doug Ford has vowed to pass the 2022 provincial budget, tabled April 28, if the Progressive Conservatives are re-elected June 2. As a government document, it provides a comprehensive and fairly detailed view of where the party would take the province over the next four years.
The budget lays out a clear plan to underfund health care in Ontario in the post-COVID era.
Before the recent surge in inflation, Ontario's base health spending had to increase by 4.4% just to maintain service at current levels given inflation, population growth, and the fact that an aging population needs more health care. With higher inflation rates we are experiencing, it is almost certainly true that health care spending must rise by more than 6% this year to keep services more or less as they are.
But as detailed in the budget, health care funding will rise by less than 6% this year, just over 3% next year, and less than 1% two years from now. Over the three years, base health spending increases will average just 3.3%.
Because of inflation and population changes, these nominal funding increases are actual funding cuts.
Pandemic health spending started low and stayed low
Ontario’s pandemic response was hampered by a system that was underfunded long before COVID-19 came along. Despite repeated vows to spend “whatever it takes” to protect the health of Ontarians during the pandemic, on three crucial measures—health spending per capita, hospital beds per capita, and registered nurses per capita—Ontario was dead last among the provinces.
Ontario per capita health spending is the lowest of all the provinces
The chart below shows that Ontario had the lowest per capita spending on health care of any Canadian province in 2020-21, the first year of the pandemic. That year, Ontario spent $536 less per person than the rest-of-Canada average. Bringing Ontario up to the Canadian average would have required an additional investment of $7.9 billion that year.
Ontario has the fewest hospital beds per capita
In the budget and since the budget, the government has talked a lot about building new hospitals. But capital spending to build hospitals with beds in them does not, on its own, increase access to healthcare. Without proper staffing, hospital beds are just hotel rooms.
Data from the Canadian Institute for Health Information (CIHI) shows that Ontario has the lowest number of hospital beds staffed and in operation per capita of any province. Increasing access to hospital care cannot happen without increasing funding for staffing. Bringing access to hospital care up to the Canadian average will require a substantial multi-year financial commitment from Queen’s Park.
Ontario has the fewest registered nurses per capita
Ontario has the lowest number of working registered nurses per 100,000 population of the nine provinces whose data CIHI has published. Just to be average, Ontario would have to hire an additional 21,000 RNs.
Policies aimed at increasing the number of nurses in Ontario must start with valuing the work of nurses. As the Ontario Nurses’ Association noted earlier this year, many working-age nurses are actually leaving the profession. Among the reasons given: “workload, the lack of work-life balance, wages and benefits, lack of respect and feeling valued, the disrespectful treatment of nurses by government and employers, and concerns about health and safety as well as mental and physical health.”
The Budget’s capital plan: construction over care
For every $1.00 the 2022 budget plans to spend on health care program spending (i.e., care) over the period 2022-23 to 2024-25, the government plans to spend $1.80 on health capital (construction). To truly improve access to care, Ontario needs to rebuild the health care workforce. The first step in that process is repealing Bill 124. In an environment of rising prices, limiting compensation increases to 1% is punishing the health care workers that we have depended on for the last two years, and will continue to depend on. A focus on construction over care is a misplaced focus.
Aftermath: comparing the parties’ plans to reduce the surgical and diagnostic procedures backlog
COVID-19 postponed or cancelled many diagnostic tests and surgical procedures. In 2021, the Financial Accountability Office estimated that clearing the resulting backlog would require $1.3 billion to deal with the backlog up to September 2021. Given the ongoing impact of the pandemic, it would be reasonable to expect that those costs are now significantly higher.
In the 2022 budget, the PC party has promised to spend $300 million in 2022-23 as part of its surgical recovery strategy.
Both NDP and Liberal platforms promise to spend $600 million in 2022-23 and $400 million in 2023-24.
The Green Party proposes to increase hospital funding and increase funding to hire more nurses but does not have a specific budget line for surgical and diagnostic procedure backlogs.
Underfunding has consequences
Provincial underfunding of health care has consequences for all Ontarians. Underfunding leads to longer wait times and more delays in diagnosis and treatment undermining faith in the public health care system. Overworked and underappreciated staff are more likely to resign or retire early, and people thinking of working in health care are more likely to look for other options.
Decades of underfunding, an aging population, backlogs of procedures, and a health care workforce that has been under intense stress and pressures dealing with the pandemic, means that the next government will have to invest wisely to maintain our public health care system. The 2022 Ontario budget shows a government that is unwilling to make the necessary investments to provide quality health care for Ontarians.