Health care experts hope for long-term reform, 'shift in philosophy' for Ontario's system

Bed shortages. Hallway medicine. Lengthy wait times. Communication breakdowns.

To name a few. 

The long list of problem's facing Ontario's health care system, according to many patients and clinicians. So what can be done to improve a situation that has, at times, been called a "crisis"?

In recent days, provincial party leaders have teased at their respective game plans, including the Ontario NDP's proposal to cover dental care and prescription drugs for all Ontarians, and newly-minted Progressive Conservative Leader Doug Ford's goal to make sure people aren't "stuck" waiting for a doctor.

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Today, there's the latest Liberal promise of a four-year investment of $2.1 billion in mental health care services, which comes on the heels of the party's other recent promises of more spending to reduce hospital wait times and make prescription drugs free to those 65 years old or older. 

But while policy makers have their visions for health care, health experts who spoke to CBC Toronto for our ongoing series Prescription for Change say they're hoping for long-term reform of Ontario's system — from hospitals to home care to disease prevention — that will endure beyond the next election cycle.

Calls for more funding for frontline staff

When one of Dr. Nadia Alam's 90-year-old patients developed a wound in her leg, the Georgetown, Ont.. family physician ordered home care to the woman's retirement residence. But Alam never heard any feedback about her request.

"Turns out, she never got her services," said Alam, president-elect of the Ontario Medical Association. "They never came in."

That communication breakdown is just one example of the "crumbling," resource-strapped health care system in Ontario, Alam said.

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The OMA, which represents more than 40,000 doctors, residents, and medical students across the province, launched a campaign earlier this week to raise awareness of what the group sees as long-standing poor decision-making from the government, and a lack of collaboration with clinicians.

Alam wants to see improvements on both those fronts, and said more health care funding is always welcome to ensure there are enough frontline clinicians to care for a growing and aging population.

Vicki McKenna, president of the Ontario Nurses' Association, agrees. "We need staffing numbers that are appropriate for the volume of patients that we can for... not only is there no room, but there's not enough staff," she said.

'Shift in philosophy' needed

Alongside greater funding, Alam also wants to see a "fundamental shift in philosophy" in how the province spends that cash.

"The focus seems to have been bureaucracy in the health care system," Alam said. And on misspending, she added, citing the province's decade-old, scandal-ridden eHealth venture as one example of billions of health care dollars that could have been spent elsewhere.

"Just throwing money at the system won't fix the inherent problems and pressures," echoed Rosealie Wyonch, a health policy expert at the C.D. Howe Institute.

She said provincial funding may open more hospital beds in the short-term, but a long-term reform of the system is also needed, to focus on decreasing patients' dependency on hospitals and increasing community-based health care.

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That type of care — including mental health treatments, home care, and other community supports — has been an area of focus for the province in recent years, but not to the degree desired by many clinicians and health policy experts. 

More needs to be done, according to the president of the Canadian Association of Emergency Physicians, Dr. Paul Pageau, because the "backlog" in hospitals starts in the community.

As an Ottawa-based emergency department doctor, Pageau said he sees the struggles of paramedics dealing with offload delays and "alternate level of care" — or ALC — patients waiting in hospital for spots in long-term care homes and other non-hospital facilities.

"Solutions that look at the larger picture are needed," he said. "That's where I think the governments come into play, because they are funding the entire system, and they're the ones who can address the issue of ALC patients in the hospital."

Health beyond 'health care'

Some say the province also needs to think outside the box when it comes to reducing strain on the system, particularly as Ontario's population continues to age.

Downtown Toronto family physician Dr. Ritika Goel said the focus should be on broad social issues, including access to housing, mental health supports, and the ongoing opioid crisis — in other words, paying attention to people's health beyond just "health care."

"If someone doesn't have access to safe and affordable housing, they're living in a shelter ... it becomes almost impossible to address their addiction issue, mental health issue, their chronic pain issue," she said.

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And University of Toronto health policy expert Raisa Deber said there's another crucial question the province needs to answer: How do you keep people from getting sick in the first place?

Focusing more on public health and prevention of diseases and chronic illnesses is, in her words, a "win-win." Keeping the population from getting sick is both cheaper for the government, and tied to better health comes for patients, said Deber, author of 'Treating Health Care: How the Canadian System Works and How It Could Work Better.'

Others feel it's time to reduce government involvement. Dr. Douglas Mark, interim president of DoctorsOntario, an advocacy group dissatisfied with the much-larger Ontario Medical Association, said the only way to improve Ontario's "overburdened healthcare system" is by ending the province's monopoly on medical care — in other words, opening the system up to competition from private sector health care providers.

"We deserve zero wait times and not a government bureaucrat or politician dictating what we have now," Mark said.

Pageau, in contrast, said real change will come through a combination of government planning for the future, looking at the system as a whole, and collecting more data to help clinicians and the province understand the areas that need reform. 

The bottom line, he said, is there's no quick-fix to Ontario's health care woes.

"Sustained attention to that is the only way it'll get solved," he said.