Delisting can't be ruled out, says health minister

TORONTO - Delisting can't be ruled out during tough economic times, but there are no plans right now to clamp down on rising health-care costs by removing services currently covered by the province, said Health Minister David Caplan.

Ontario is expected to rack up an $18-billion deficit by next April, and experts say growth in annual government spending will have to slow to only two to three per cent if the province is to balance the books once the economy turns around.

When Ontario was grappling with a $5.6-billion deficit left by the former Conservative government in 2004, the Liberals delivered a budget that introduced a health premium of up to $900 per person and delisted eye exams, chiropractic services and physiotherapy.

Now that the province is in the throes of a major economic slump, there are fears that the government may delist more services to get ballooning health-care costs under control.

Caplan said delisting is "not an area I look to first" but acknowledged that all spending will be reviewed.

"We want to take a look at what we're doing and how we can do it better," Caplan said in a recent interview with The Canadian Press.

"If it doesn't make sense, we're going to stop doing it. If it makes sense, we're going to do more of it. And I think that's a fair kind of mindset to have."

While Caplan said he doesn't know the details of the March 26 budget, he added that he has not asked Finance Minister Dwight Duncan to cut services in order to curb spending.

But critics say the recession is no excuse to stifle health-care spending considering the years of surpluses the government had.

"The government, unfortunately, squandered good times over the last five years when they had time to implement some of these programs, so I don't have much sympathy for them now," said NDP Leader Andrea Horwath.

It's unacceptable that the Liberals have already backed away from last year's promises to hire 9,000 more nurses and deliver $135 million in dental care for the working poor over three years, Horwath said.

"During a recession is probably when people will need health care even more. Stress levels go up, incomes go down, people aren't able to keep their health up in the way that they may have been able to do in the past."

The government must do more for seniors living in nursing homes, help hospitals that are cutting services and staff to avoid illegal deficits, and free up beds occupied by so-called "alternative level of care" patients who should be in long-term care or receiving home care, said Progressive Conservative critic Elizabeth Witmer, a former health minister.

"We continue to see money go out the door for health care and we continue to see Band-Aids put on very serious problems, but we never know if the money is achieving any improvement in the quality of services for Ontarians," she said.

"So this government needs to put out a plan of action first and foremost -- that's what we'd like to see."

Caplan said he hopes to trim costs by improving the quality of health care.

"All of the health-care literature tells us that the best way to be able to manage health-care costs is to have better health care -- to have better quality and better accessibility," he said.

Money the province saved by reforming the way it bought drugs has been funnelled into expanding access to other medicines, such as the cancer drug Avastin, he added.

Last year, health care gobbled up nearly half of Ontario's massive $96-billion budget.

When Caplan's mother, Elinor, held the portfolio in the late 1980s, health care accounted for just 20 per cent of the provincial budget, he noted, and demand for services is expected to ramp up further as the population ages.

Economists predict health-care spending in Ontario will continue to put a big squeeze on provincial coffers, which are already strapped for cash as tax revenues take a nosedive.

Last fall, the Liberals warned that the province's economic troubles meant they'd have to delay some commitments, such as hiring 9,000 more nurses.

But the Ontario Nursing Association says it wants the budget to include a commitment to add at least 3,000 nurses next year.

"Now is not the time, in the world that we're all living in today, to be cutting back and decide that we're not going to have enough health-care providers," said association vice-president Vicki McKenna.

"This isn't where they should be making decisions not to meet their obligations to citizens as a whole."

That decision is up to Duncan, Caplan said, but the government is rolling out 25 nurse practioner-led clinics, which will expand their role in the province's health-care system.

He said his "top three" projects over the next year will be finding ways to move "alternative level of care" patients out of hospital beds more quickly, push more aggressively for the use of electronic health records, and provide better services for those with mental health and addiction problems.