Ontario Minister of Health Deb Matthews listens to Premier Dalton McGuinty at a press conference in October, 2009.GEOFF ROBINS
A patient's overall experience in an Ontario hospital would directly influence the salary and bonus of its chief executive officer under proposed pay-for-performance rules, a concept the government would consider expanding to the top executive of every Crown corporation and agency in the province.
Ontario Premier Dalton McGuinty said on Tuesday that the proposals are part of an initiative to ensure taxpayers' dollars are spent wisely. His government will begin by targeting hospital CEOs - 14 of whom made more than $500,000 last year - with legislation this spring that would base their compensation on how effectively the hospital reduces infection rates, as well as how long patients wait for care in an emergency department or for such procedures as hip and knee replacements, Ontario Health Minister Deb Matthews told The Globe and Mail.
The proposed model would also take into account what patients themselves consider good-quality care, a voice Ms. Matthews says has largely not been heard.
"The voice of patients is one that isn't nearly as loud as it should be given that it is their system," she said.
Tom Closson, president of the Ontario Hospital Association, welcomed the proposed legislation. "It's appropriate for the government to say, 'Here is where we would like performance improved.' "
The OHA is starting to collect larger sample sizes to better measure patient satisfaction. What's already apparent, Mr. Closson said, is the high correlation between how long patients wait in emergency and how positive they are about their experience.
The proposed legislation is among a series of changes the government plans this year as part of an initiative aimed at curbing ballooning costs for health care.
The province's 154 hospitals will receive a funding increase of 1.5 per cent for the fiscal year that began on April 1, bringing the total for salaries and other basic operating expenses to $14.92-billion.
The government is also doing away with global hospital budgets that for decades have allocated funding evenly across the board. Hospitals in regions where the population is growing or aging will benefit disproportionately from the funding increase, Ms. Matthews said.
"Every hospital will get something, but they won't all get the same."
This is the first step of a radical change to funding that will begin tailoring hospital budgets to match the size and age of their communities. The Health Based Allocation Model, known as HBAM, will divert more money to hospitals in high-growth regions. The model was first announced in 2007 but has been used only modestly to date. Last year, the funding pot for HBAM totalled just $10-million.
There is additional money over and above the 1.5-per-cent increase; some of that will also be used to address demographic trends, Ms. Matthews said.
Mr. McGuinty stressed on Tuesday that it is imperative for his government to curtail the rate of growth in health-care spending. If things don't change, he said, health care will account for 70 cents of every $1 in program spending in 12 years, up from 46 cents today.
His government has frozen the wages of non-unionized public-sector workers for two years. But Mr. McGuinty suggested on Tuesday that he needs to do more and will introduce measures that go beyond hospital CEOs.
"I think those who enjoy the privilege of serving Ontario in an executive capacity, whether you're heading up a hydro company or a hospital or one of a variety of agencies, boards and commissions… you've got to take into account what happened to the economy in the past year and a half," he said. "At some point in time, we've got to put the service back into public service."
New Democrat MPP Peter Kormos scoffed at the idea that freezing "bloated" salaries amounts to restraint, calling it a "sad joke."