This presentation will look at funding of healthcare along with the issues facing the delivery of healthcare dollars by the provinces and territories as part of improving patient care.

1. HEALTHCARE CRISIS – ONTARIO
AND CANADA – MAY 2019
BY: PAUL YOUNG, CPA, CGA
MAY 1, 2019

2. PAUL YOUNG - BIO
• CPA, CGA
• Financial Solutions
• SME – Risk Management
• SME – Emerging Technology
• SME – Business Process Change
• SME – Close, Consolidate and Reporting
• SME – Public Policy
• SME – Financial Solutions
• SME – Supply Chain Management
Contact information:
Paul_Young_CGA@Hotmail.com

3. OVERVIEW
• Healthcare is a key area for many countries
• Canada spends roughly 10% of GDP on
healthcare or about $200B. Approximately
20% comes from the federal government
through the HST
• The largest expenditures for provinces is
healthcare. Ontario for example spends
around $55B or about 40% of their budget on
healthcare
• There is lots of waste within healthcare as
many provinces have not done a very good job
when it comes to value for money/healthcare
• The delivery model is broken!

4. AGENDA
Who is responsible for Healthcare
Federal Government Funding
Healthcare Dollars Flow
Ontario Healthcare Transfer Analysis
Healthcare Ranking
Letter to local MP
Liberal Supporter Debate / Blog
$36B Shortfall / Council for Canadians
Healthcare forced cuts to frontline services
Digital Hospital
Blog - Healthcare

5. SUMMARY
• This presentation will look at funding of
healthcare along with the issues facing the
delivery of healthcare dollars by the provinces
and territories as part of improving patient
care.

6. PROVINCI
AL
POWERS
• The administration and delivery of health care services is
the responsibility of each province or territory, guided by
the provisions of the Canada Health Act. The provinces
and territories fund these services with assistance from
the federal government in the form of fiscal transfers.
• Health care services include insured primary health care
(such as the services of physicians and other health
professionals) and care in hospitals, which account for
the majority of provincial and territorial health
expenditures.
• The provinces and territories also provide some groups
with supplementary health benefits not covered by the
Act, such as prescription drug coverage. The level and
scope of coverage for supplementary benefits varies
between jurisdictions.
Source - http://healthycanadians.gc.ca/health-system-
systeme-sante/cards-cartes-eng.php

7. FEDERAL GOVERNMENT FUNDING
• he Canada Health Transfer, or CHT, is the largest major transfer to provinces and territories. It provides long-term
predictable funding for health care, and supports the principles of the Canada Health Act which are: universality;
comprehensiveness; portability; accessibility; and, public administration.
• CHT transfer payments are made on an equal per capita basis, and include both cash and tax point transfers. Starting in
2014-15, provincial and territorial CHT transfers will be allocated on an equal per capita cash basis only.
• As announced in December 2011, total CHT cash levels are set in legislation to grow at 6 per cent until 2016-17. Starting
in 2017-18, total CHT cash will grow in line with a three-year moving average of nominal Gross Domestic Product, with
funding guaranteed to increase by at least 3 per cent per year.
• The move to an equal capita cash allocation is part of a long-term plan announced by the Government in Budget 2007 to
provide comparable treatment for all Canadians, regardless of where they live. The Government will ensure that the
transition is fiscally responsible by implementing a by-province and territory protection that will ensure that no province
or territory will receive less than its 2013-14 CHT cash allocation in future years as a result of the move to equal per
capita cash.
Source – Government of Canada -
https://www.fin.gc.ca/fedprov/mtp-eng.asp

8. HEALTHCARE RANKING
https://globalnews.ca/news/3599458/canadas-health-care-system-lower-
performing-compared-to-its-peers-study/
• The document makes it clear Canadians
are not getting value for money, spending
the equivalent of 10 per cent of our GDP
on health care in 2014. Meanwhile, many
higher-ranked countries spent less and
still managed to come out on top.
• It’s certainly not all bad news, However.
Canada performed quite well on many
metrics. The country has some of the
lowest mortality rates for patients who end
up in hospital following a heart attack, for
example, and survival rates for certain
types of cancer are also comparatively
high. Unlike their peers abroad, Canadian
doctors were unlikely to say that they
wasted too much time on administrative
tasks.

9. HEALTHCARE FUNDING FLOW
Federal Government (Canadian Health Transfers)
Provinces (Canadian Health Transfer and taxation from general revenue)
Doctors/Clinics
(OHIP/Provincial Plan Billing)
Hospitals
Transfers of funding
Other Programs
• Homecare
• Mental Health Programs
• Substance Abuse Programs
• Assisting Living

10. HEALTHCARE TRANSFERS
6% growth
year over
year
Federal Transfers to Ontario Ontario
Healthcare
Funding
Hospital Example
/Royal Victoria
Hospital Barrie

11. TWEET – ONTARIO HEALTHCARE
Ontario Liberals continue to mislead about
healthcare spending in Ontario
Transfers were 6% and 3% year over year growth.
Hospitals only seen about 2% growth in transfers
Wait times have soared -
http://www.lfpress.com/2017/10/02/wait-times-for-
knee--and-hip-replacement-surgery-at-
southwestern-ontario-hospitals-are-among-the-
longest-in-the-province
Nurses jobs have been cut -
http://www.chathamdailynews.ca/2017/07/10/nurs
es-union-says-job-cuts-means-worse-care
Soaring hydro costs -
http://www.lfpress.com/2017/03/21/hydro-london-
health-sciences-centre-electricity-use-falls-but-
costs-up-30-per-cent

12. HORWATH VS FORD
• https://toronto.citynews.ca/2019/01/31/leaked-document-
privatization-health-care/
• Where was Horwath when Healthcare cuts were made? No where to be
found! Healthcare must be restructure and that means everything is
fair game in terms of how to better allocate scarce healthcare dollars.
• https://www.slideshare.net/paulyoungcga/government-program-
spending-canada-2007-to-2017
• https://www.slideshare.net/paulyoungcga/canada-healthcare-crisis

13. DRUMMOND REPORT - HEALTHCARE
Source - http://www.carp.ca/2012/02/24/drummond-report-to-province-cut-costs-
improve-healthcare-2/
Coordinating services and integrating all health and patient care services for better access and
more efficient use of resources.
Supporting a shift towards ensuring a continuum of care and care that is community-based.
Funding for community-based care may need to grow at a higher rate in the short to medium
term in order to build capacity to take pressure off acute care facilities; shifting away from a
hospital focus would lead to slower growth in hospital costs.
* Placing more emphasis on chronic than acute care. Chronic issues should be handled in the
home and community to the fullest extent possible.
*Reducing the number of future long-term care facilities and instead, emphasize home- and
community based care.
* Introducing system navigators to help patients navigate through the healthcare system.
CARP has long advocated for changes that would not only enhance access, quality, and delivery of
current healthcare services, but contain costs in the process. We will continue to promote
innovative changes that will help to maximize quality of care and better health outcomes while
reducing costs borne by governments.Where was Horwath on Healthcare Report by Drummond?

14. NDP AND HEALTHCARE
• http://www.thestar.com/news/federal-election/2015/09/14/ndp-prescribes-500m-for-health-care-system.html
• NDP needs to take a deep look at the issues driving the cuts and stop throwing money at the symptoms. NDP seems
to think the whole issue is money when there are issues with delivery including bloated levels of administration. I
cannot believe people buy the comments from the NDP as they do nothing but throw money at the symptoms and
that never fixes the root causes to a policy
• https://www.youtube.com/watch?v=p0ijr_Gp2os
• http://www.slideshare.net/paulyoungcga/provincial-transfers-and-program-spending
• http://www.lfpress.com/2014/04/25/only-paltry-sum-was-used-for-retraining
• I am all for solutions, but unless accountability/transparency are part of the solution including tying the following to
funding them nothing will be done for healthcare
• Access to family physician or specialist
• Wait Times – Reduction
• Access to homecare spaces
• CEO salaries/Compensation
• Other productivity/efficiency improvements
• *** NDP has never been known to fix healthcare at the provincial level -
http://www.cbc.ca/news/canada/manitoba/manitoba-gets-poor-grade-in-canadian-health-report-1.2954500

15. COUNCIL FOR CANADIANS – 36B
HEALTHCARE FUNDING GAP
• PBO - http://cupe.ca/canadas-health-care-system-about-
lose-36-billion. Yet nothing is said on the waste with
healthcare, why? http://www.nugget.ca/2015/03/31/workers-
rally-for-new-health-accord. It seems like unions are
complaining at funding from the Feds, but say nothing on the
LHINs or CCAC - http://blogs.windsorstar.com/opinion/the-
stars-view-time-to-audit-ccacs-and-the-lhins or revenue like
Ontario Health Premium that does not go to healthcare -
http://www.fin.gov.on.ca/en/budget/paccts/2014/14_cfs.html
#operations

16. ONTARIO HEALTHCARE FORCED CUTS
• Quote “The Ontario Nurses' Association is sounding the alarm about layoffs of Registered
Nurses by cash-strapped hospitals, and warns patients will pay the price.
• The union, which represents 60,000 registered nurses, says there were 770 RN positions cut
across Ontario last year, and hospitals in Windsor and Kitchener have already announced
more RN layoffs this month.
• The hospitals decided to "risk the health outcomes of patients by cutting RNs to balance the
budget," said ONA president Linda Haslam-Stroud.”
• LHIN failures - https://www.cbc.ca/news/canada/sudbury/north-east-lhin-gets-failing-
grade-from-auditor-general-1.3350481
Source - http://toronto.ctvnews.ca/patients-will-pay-the-price-for-ont-nurse-layoffs-
association-warns-1.2737697

17. GOVERNMENT WASTE
• Harris spent more government % on healthcare than Wynne/McGuinty. Harris was slowly putting money
back into healthcare due to new health accord. Harris was not adding management, but front line
workers.
• Transfers http://www.slideshare.net/paulyoungcga/provincial-transfers-and-program-spending
• Ontario Spending - http://www.slideshare.net/paulyoungcga/ontario-government-spending?related=1
• Ontario spending - http://www.slideshare.net/paulyoungcga/ontario-tax-and-spend-analysis
• Moodys - http://www.thestar.com/business/economy/2015/02/23/moodys-says-ontario-has-a-
spending-problem.html
• Hydro Rates - http://www.slideshare.net/paulyoungcga/power-generation-canada
• Education, Healthcare and Infrastructure - http://www.slideshare.net/paulyoungcga/provincial-
transfers-and-program-spending
• 2015 Planned audit - http://www.auditor.on.ca/en/plannedaudits_en.htm
• LHINs - http://www.procurementoffice.ca/2015/02/12/post-ehealth-audit-uncovered-more-health-
sector-spending-abuses/
• Nursing - http://www.ona.org/presidents_message/RN_Cuts_devastate_Patient_Care_20150324.html

18. HEALTHCARE / HARRIS
• https://www.fraserinstitute.org/article/radical-
plans-harris-and-klein - What about the so-
called gutting of social services and healthcare?
Well, Premier Harris, between the year he was
elected and last year, increased real healthcare
spending by 25.4 percent and reduced social
services spending by 9.6 percent. However, the
decrease in social services spending had more
to do with the fact that the percentage of the
Ontario population on welfare declined by 43.9
percent during Premier Harris’reign.
• https://quixoteslaststand.com/2014/05/11/wy
nne-liberals-to-close-5-five-hospitals-in-the-
niagara-region-whaatt/
• Wynne -
http://www.ontariohealthcoalition.ca/index.ph
p/when-it-comes-to-hospitals-its-hacksaw-
kathleen-ontario-health-coalition/
NDP issues:
• 2011 Budget -
https://www.thestar.com/news/canada/2011
/03/29/ontario_budget_takes_aim_at_publics
ector_pay.html
• http://www.cbc.ca/news/canada/toronto/hor
wath-says-ndp-will-support-ontario-liberal-
budget-1.1313748 “Earlier this month,
Horwath demanded that a financial
accountability office be created to keep tabs
on government spending. She has continually
referred to Ornge, eHealth Ontario and the
two cancelled gas plants as the type of
scandals that can be avoided with an
accountability office.”
• Horwath not supporting education -
https://www.thestar.com/news/queenspark/
2018/05/22/live-at-noon-ontario-ndp-
leader-andrea-horwath-answers-your-
questions-at-the-toronto-star-editorial-
board.html
• Hydro -
https://www.ontariondp.ca/news/statement-
ndp-finance-critic-john-vanthof-auditor-

19. GOVERNMENT WASTE
• Here are examples of waste:
• P3 Costs $8B (source:
http://www.thestar.com/news/queenspark/2014/12/09/publicprivate_financing_cost_ontario_taxpayers_8_billion_auditor_says.html)
• Equalization $10B (http://www.fin.gc.ca/fedprov/mtp-eng.asp#Ontario)
• Gas Plant Cancellation $1.1B
(http://www.thestar.com/news/canada/2013/10/08/liberals_power_plant_cancellations_cost_11b_auditor_general.html)
• eHealth $1B (http://www.cbc.ca/news/canada/toronto/ehealth-scandal-a-1b-waste-auditor-1.808640)
• Selling excess power $1B/year http://kitchener.ctvnews.ca/ontario-paid-1-billion-to-export-surplus-power-in-2013-ndp-say-
1.1647299 - 2013 amount only)
• Wind Subsidies $1B/year (http://www.netnewsledger.com/2014/03/05/ontario-wind-energy-plans-costing-1-billion-annually/)
• Ontario capital Expenditures $11.8B (http://www.fin.gov.on.ca/en/budget/paccts/2014/)
• Ontario shares of gas tax $750M (http://www.infrastructure.gc.ca/alt-format/pdf/GTF-FTE-20140905-eng.pdf)
• Municipalities Capital spending $6B
(http://www.amo.on.ca/Advocacy.aspx?searchtext=capital&searchmode=exactphrase&date=0;&issue=0;&category=0;)
• Wynne’s AIT Issues - http://www.cbc.ca/news/canada/saskatchewan/saskatchewan-premier-brad-wall-concerned-about-ontario-
quebec-position-on-energy-east-1.2848930
•
• The government of Ontario as at least wasted $30B via failed projects. Ontario also has spent about $11B/year on capital with the

20. DIGITAL HOSPITAL
Source - http://nationalpost.com/health/the-hospital-ceo-who-created-the-continents-
first-digital-hospital-is-now-behind-doug-fords-health-policy

21. BLOG – HEALTHCARE
• https://toronto.ctvnews.ca/video?cid=sm%3Atrueanthem%3Actvtoronto%3Apost&clipId=1671830&utm_campaign=trueAnthem%3A+Trend
ing+Content&utm_content=5cc9009a3730d2000134f964&utm_medium=trueAnthem&utm_source=facebook&fbclid=IwAR3qmj5V81LCf_t
KAc-CYZspfEpKQmReWSMBtj3fHze4Dei_CVVqjpQ9dJU
• I think it is time for me to remind people what has happen to healthcare from 2003 to 2018
• Liberals introduced a new health premium. The health premium went into general revenue -
https://www.fraserinstitute.org/article/ontarios-health-premium-is-not-the-answer
• Waste and Mismanagement – eHealth (https://www.cbc.ca/news/canada/toronto/ehealth-scandal-a-1b-waste-auditor-1.808640 or
Drummond Report https://www.cbc.ca/news/canada/toronto/drummond-report-on-ontario-calls-for-cutbacks-1.1138568
• Cancer delays - https://www.cancer.ca/en/about-us/for-media/media-releases/ontario/2017/auditor-general-report/?region=on
• OHIP delisting - https://toronto.ctvnews.ca/ontario-to-delist-some-health-services-from-ohip-1.758943 or
https://www.theglobeandmail.com/news/national/cuts-to-ohip-will-be-painful-critics-warn/article18282582/
• Liberals were getting higher transfers from the Feds but in many cases were only transferring 2% growth in funding to healthcare -
https://www.slideshare.net/paulyoungcga/healthcare-ontario-analysis-and-commentary-january-2019
• Liberals forced cuts to frontline services – Nursing layoffs - https://www.ctvnews.ca/health/patients-will-pay-the-price-for-ont-nurse-
layoffs-association-warns-1.2737697
• LHIN Failures
• Deb Matthews never read the AG report for ORNGE - https://www.thespec.com/news-story/4555071-ornge-founder-mazza-all-but-
destroyed-air-ambulance-report/
• Doctors have blamed the Liberals for the Healthcare mess - https://globalnews.ca/news/4120816/ontario-doctors-say-government-
mismanagement-to-blame-for-broken-health-care-system/
• Liberals always threw money at the symptoms which do not fixed the root cause when it comes to delivering high quality healthcare -
https://www.theglobeandmail.com/news/national/ontarians-pay-millions-for-ineligible-power-generator-costs-

22. WHAT’S NEXT
• All levels of government will need to focus on the delivery
model which should include both private and public sector
involvement
• More work require to manage the cost and procurement of
drugs
• More work with deploying AI and/or technology advances as
part of gene therapy
• More emphasis on frontline services and not administration