August 2017

Health care consistently ranks as a major concern for Canadians, and in Ontario, it is no exception. People expect to have fair access to high-quality health care. This can only be achieved by a well-planned, efficiently-operated and adequately-funded system. Residents are increasingly looking to their local municipal councils to represent their community interests concerning health care provided by institutions, health care professionals and the Province.

Municipal governments and District Social Service Administrative Boards play important roles in the health-care system: co-funding it, delivering services, and employing professionals of vital services such as public health, land ambulance, and long-term care homes. Municipal governments often step in to fill the gaps when needed, especially services for the most vulnerable in their community. Many municipal governments fund above their required cost-share to address community needs. As such, municipalities need to be treated as funding partners, not as stakeholders, in planning how to deliver services that meet the needs of local communities.
Municipal Contributions to Health Operating Expenses ($ in millions)
  2009 2010 2011 2012 2013 2014
Long-Term Care Services 711 730 763 769 784 823
Land Ambulance Services 447 497 544 555 590 619
Public Health Services 274 294 289 295 322 334
Hospitals 30 50 67 34 29 16
Total Municipal Contribution 1462 1571 1663 1653 1725 1792

In addition to direct services, municipal governments are also expected to fund a portion of capital expenses for hospitals, long-term care, and public health.
Municipal Contributions to Capital  Operating Expenses ($ in millions)
  2009 2010 2011 2012 2013 2014
Long-Term Care Services 28 39 42 25 115 63
Land Ambulance Services 48 50 72 62 60 65
Public Health Services 10 18 14 8 16 27
Total Municipal Contribution 87 107 128 96 191 155

Often provincial programs have an immediate impact on municipal programs that are not accounted for by the Province – either in their delivery, or in the monitoring. This can place an additional cost on municipal governments that are often already stretched financially to cover their core responsibilities.

In 2015, the Province outlined its Patients First: Action Plan for Health Care and a Patients First Strategy. The action plan sets the framework for health-care system changes aimed at putting people and patients first, and improving their health-care experience and outcomes. The Patients First Strategy proposes specific actions to achieve more patient-centred care by shifting resources into the community and reforming funding models.

Access is a key focus of the Patients First Strategy. Ready access to doctors, nurses, mental health professionals, diagnostic equipment and quality health care is not available to everyone. The problem is particularly pronounced in rural and northern regions. Due to the lack of facilities and/or providers in these areas, some families have difficulty getting the care they need when they need it. Ontario, like the rest of Canada, faces a physician shortage and many communities struggle with a lack of local healthcare services. This is a major concern in rural and northern communities but it is also evident in many urban communities.

Bill 210, the Patients First Act, is implementing the Patients First Strategy to transform home, community and primary care and to strengthen public health. AMO was pleased to see that the Bill does not transfer funding and accountability oversight of Public Health Units to Local Health Integration Networks. AMO supports more formal relationships between Public Health Boards and Local Health Integration Networks to plan for population health. However, a discussion on the resources to do this job right is needed.

The government is also modernizing Ontario’s Public Health Standards. This process must be fiscally neutral for municipal governments. The scope of the standards cannot be expanded. Already, it is generally agreed that the current funding envelope is inadequate to meet present-day standards. Any expansion of new provincial public health requirements without accompanying investments would result in even more financial pressure for boards of health and property taxpayers.

AMO looks forward to engaging with the government on recommendations of the Expert Working Group on the future of public health within the context of the changes outlined in the Patients First Strategy. It also looks forward to working with the Province to ensure updated Ontario Public Health Standards do not cause additional fiscal stress on municipalities.

As partners, municipalities and the provincial government can work to achieve fair access to high-quality health care for all Ontarians.