TORONTO - Ontario can no longer afford to pay for all prescription drugs for everyone aged 65 and older, economist Don Drummond told the government Wednesday in a special report on reducing costs to rein in a $16-billion deficit.
"Ontario needs to start having an open, honest discussion about public coverage of health care costs, which includes the possibility of broader public coverage of pharmaceutical costs and how it should be financed," Drummond concludes in his 500-page report.
"A minimal step would be to make the portion of pharmaceutical costs paid for by seniors rise more sharply as income increases."
Ontario spent $44.77 billion on health care last year, or 40.3 per cent of all government program spending.
Recommendations to reform the health-care system make up the bulk of Drummond's report, which says the increase in health spending should be reduced to 2.5 per cent a year from roughly 6.5 per cent annually in the past eight years.
Drummond is recommending much more importance be placed on community-based care to keep people out of expensive hospital settings whenever possible.
"Do not apply the same degree of fiscal restraint to all parts of health care. Some areas, including community care and mental health, will need to grow more rapidly than the average," he said.
"On the other hand, with a shift away from a hospital focus, hospital budgets could grow less rapidly than the average."
The government should also stop negotiating what services and procedures are covered by the Ontario Health Insurance Plan with doctors through the Ontario Medical Association. It should instead give the Health Quality Ontario expanded powers to determine what is and is not publicly covered, said Drummond.
"As in other jurisdictions, doctors should be consulted on such questions, but no more," concludes the report.
Ontario doctors should not be looking for a pay hike from the cash-strapped government, said Drummond.
"Since Ontario's doctors are now the best paid in the country, it is reasonable to set a goal of allowing no increase in total compensation," he wrote.
Drummond suggests Ontario's 14 Local Health Integration Networks be given much more power to oversee health care in each region, incorporating primary care into their mandate, something Premier Dalton McGuinty has already indicated the Liberal government wants to do. He even recommended the LHINs be merged with Community Care Access Centres to better co-ordinate care, and said the local health agencies could use funding "restrictions" to force hospitals to make necessary changes.
The Progressive Conservatives, on the other hand, call the LHINs a needless layer of bureaucracy that take money out of front line health care and want them shut down completely.
The government also needs to train more nurses, said Drummond, and let nurse practioners perform more work currently done by doctors, including annual physical exams.
The former TD Bank economist also recommended the province consider fully uploading public health from municipalities, and said Ontario should follow Nova Scotia's lead and have emergency medical technicians provide home care when they are not on emergency calls.
The aging population will continue to put additional pressures on health care, noted Drummond, who said one per cent of the population account for 34 per cent of the province's health care costs.
