Ministry Plans

Results-based Plan Briefing Book 2012-2013


Ministry of Health and Long-Term Care Overview

Introduction

Since the global financial meltdown in 2008, Ontario's economy has been through a few very turbulent years – and the global situation remains uncertain to this day. Ontario is still closely linked to the U.S. economy, which continues to recover slowly from the recession. Over the next several years, Ontario's economy will grow at a modest pace.

During the years when Ontario's economy was stronger, the government invested heavily in public services, among them health care. Historically, funding for health care grew at an average of 6.1 per cent annually.  Such a rate of growth is not sustainable in the long term.

There are, in fact, two enormous challenges ahead that must be addressed.

The first challenge is fiscal: the province has a $15.3 billion dollar budget shortfall that demands more efficient service delivery. This ministry needs to be a partner in this exercise, since health care represents such a large portion - 42 per cent - of provincial government program spending.

The second challenge is demographic: Ontario has a growing and aging population ‑ and that puts pressure on health care.

If Ontario is to make sure that the province's universal health care system will be there for future generations, steps must be taken today to protect and strengthen the system and make the tough choices that must be made.

It is abundantly clear that the province cannot keep spending health dollars the way it has done in the past in light of the significant challenges, both fiscal and demographic, that it faces.

The government is now spending 61 per cent more on health care than it did in 2003, and health spending will continue to grow. But the fiscal challenge demands that the rate of increase has to slow significantly.

Despite the challenges, the Ontario government is determined to do what is necessary to keep improving the quality of health care, and access to it. However, health care decisions must be based on the best available evidence and they must add value.

That means program spending must be controlled if we are to live within the new fiscal realities – and the entire health care sector will have to play its part to make it happen.

There is strong consensus across the sector that the province needs to put more funding into home and community care to help the growing number of seniors. The demographic pressure demands it. Indeed, by not having adequate resources in the community, the province is spending more than it needs to in other parts of the system.

The ministry needs to build the continuum of care in the community, so that there are more options for seniors to get the care they need, outside of hospitals and long-term care homes.

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Ontario's Action Plan For Health Care

The Ontario government has announced that its goal is to make Ontario the healthiest place in North America to grow up and grow old by making sure that families get the best health care where and when they need it.

The government has developed an Action Plan that will shift spending to where it gets the highest value for investment.

The plan will transform health care to ensure that it is centred on the patient and will invest health dollars where patients need it the most. It will also limit year-over-year expenditure growth.

Keeping Ontarians Healthy

The Action Plan starts by Keeping Ontarians Healthy, because people want better health, not just better health care.  The ministry will be promoting healthy living and supporting better management of chronic conditions like diabetes. And to succeed, people need to participate in their own wellness, in part by taking advantage of cancer screening and vaccination programs.

Childhood obesity rates have skyrocketed. And we know that obesity leads to diabetes and heart disease.  Left unchecked, these chronic diseases can be fatal.  The government will therefore create a Council on Childhood Obesity whose goal will be to reduce the childhood obesity rate by 20 per cent within 5 years. It is an ambitious goal, but it reflects the urgency of this situation.

The Smoke Free Ontario strategy has been renewed and expanded. The province now funds smoking cessation drugs and recently expanded access to nicotine replacement therapy to those in treatment for addictions. The government will increase fines on those who sell tobacco to children and it will continue to build on contraband strategy by doubling enforcement efforts.

Keeping Ontarians healthy is also about detecting disease early. That is why the ministry will step up cancer screening efforts, including online Personalized Cancer Risk Profiles. This tool will use patients' medical and family history to measure their risk of cancer and then match people to screening programs and prevention supports including genetic testing for people at high-risk.

Faster Access to Stronger Family Health Care

The second priority in the Action Plan is providing patients with Faster Access to Stronger Family Health Care. 

The government believes that family health care should be the hub of patient centred care. That means doctors should play an even stronger role in the health care system.

The government plans to improve transitions in health care by bringing planning for primary care under the umbrella of the province's 14 Local Health Integration Networks (LHINs).

When LHINs can plan primary care in a community, they will help improve access to care and save money. It will make it easier for family doctors to play the coordinating role between different health care providers, both inside and outside of hospitals and long-term care. Family doctors know very well what needs to be done to further improve the health care system. Soon, their voices will be heard, so they can be part of finding local solutions. It will also bring more accountability for delivering better care for better value.

The government feels strongly that everyone who wants a family care provider should have one. But just having one is not enough. Patients should be able to access their family health provider when they need them. That means more after-hours care and same-day or next-day appointments.

The ministry will support the efforts of family doctors to improve patient care by giving them quality improvement tools similar to those now in hospitals. And primary care will be improved with evidence-based advice from Health Quality Ontario (HQO).

To provide the best care for an elderly person with complex needs, we need to organize care at home with house calls from their family doctor, along with other providers and community supports. This will reduce their likelihood of admission to hospital, and delay or even prevent a move into long-term care. That is much better care, and at a lower cost.

Access to the Right Care, at the Right Time, in the Right Place

The third priority is making sure patients have Access to the Right Care, at the Right Time, in the Right Place. 

Access to the Right Care means ensuring that patients get the care they need, based on the best available evidence. The ministry is going to accelerate the evidence-based approach to patient care by strengthening HQO so that funding is increasingly shifted toward services that are known to get the best results for patients.

In 2011-12, evidence-based changes have allowed a re-investment of $125 million towards more effective patient care. For example, the best available clinical evidence shows that Vitamin D testing in otherwise healthy people doesn't improve outcomes.

By deciding not to fund Vitamin D tests for the general population, the ministry was able to re-invest savings in care that does improve outcomes.

Likewise, the government will continue to fund drugs only when the best clinical evidence indicates that they benefit patients.

More access to the right care will also require health care providers to work to their full scope of practice. It means a bigger role for nurses, nurse practitioners, dieticians, pharmacists, and midwives, to name just a few.

Patients will get Access to Care at the Right Time with early interventions that are clinically shown to improve health and save health dollars in the long run.

Nowhere is early intervention more important than in mental health. Seventy per cent of mental health problems first appear in childhood and adolescence. That is why there will be a new focus to children's mental health.

The ministry is also stepping up management of chronic diseases like diabetes. By acting earlier to manage chronic conditions, we can often prevent the worst effects of the disease.

We will continue to drive our wait time strategy, so that patients can be assured of medically appropriate waits for their procedures. Less time waiting means fewer complications and more time for being healthy.

And finally, Ontario families need Access to Care in the Right Place. For our seniors, the right place to receive care, whenever possible, is at home, in their community.

The ministry will launch a new Seniors Strategy to keep seniors healthy and to provide better quality care at home, where our seniors want to be, with their neighbours and family. As part of this strategy, we will create new care co-ordinators to respond to the needs of our seniors with the most complex conditions, particularly in the transition from hospital to home. They will help to co-ordinate the care between specialists and family doctors, hospitals and their community, and ultimately cut down on readmissions while, at the same time, improving care.

The ministry will increase investments in home care and community services by an average of four per cent annually for the next three years or $526 million per year by 2014–15, to better support those seniors and other Ontarians who could benefit from care provided in the community

The ministry will also propose reforms to enable LHINs to promote a seamless coordination of the treatment patients need across various health care providers and to provide more flexibility to shift resources to where the need is greatest; and

The ministry is introducing Heath System Funding Reform (HSFR) to drive quality, efficiency and effectiveness in the health care system.

HSFR will move Ontario's health care system away from the current global funding system towards what is known as Patient-Based Funding (PBF).

Under PBF, health care organizations will be compensated based on how many patients they look after, the services they deliver, the evidence-based quality of those services, and the specific needs of the population they serve. 

PBF will be phased in over three years, starting in 2012/13 in order to minimize disruption to services and impact on health human resources.  Global funding will be reduced in proportion as PBF increases. The phasing-in of PBF will allow health service providers to anticipate changes and plan for impacts.

PBF will facilitate the standardization of care thus minimizing practice variation, and will allow patients to receive the best practice care at the right time and at the right place. PBF encourages hospitals to invest in quality improvement and patient safety activities to provide appropriate care. Global budgets will continue to be used for activities that cannot be modeled or that are otherwise unique, such as outpatient service costs.

PBF is a shift from paying for select services to paying for the care of the patient's entire journey across all providers, including pre- and post-operative activities, where appropriate and feasible. As the full patient journey is integrated into local planning, funding will follow the patient through the system - from primary care, into hospitals, into specialized clinics, into long term care, and into home care. This will create the right incentives for better care at every stage of the health care system – and deliver better value for every health dollar.

Pressure will be taken off hospitals by moving more routine procedures into specialized not-for-profit clinics - but only if they can provide better care at a lower cost.  This move will free up hospital operating rooms to do more procedures that do need to be done in a hospital.

By focusing on a select few procedures, these clinics can serve more patients more quickly with excellent patient outcomes.  An outstanding example is the Kensington Eye Institute, which has become renowned for providing high-quality cataract procedures, funded through OHIP.

Conclusion

Having made substantial progress over the past nine years in improving the province's health care system, the government must now adjust its approach and strike a new balance, all the while continuing to work collaboratively with its health system partners.

The government is determined to make Ontario's health care system better for patients today so that it is there for patients tomorrow.

To achieve that will involve major health system transformation.

New investments must focus on promoting healthier living, on reducing the time patients wait to see their doctor and on enhancing home and community care. This approach will allow the province to build on efforts to boost access to quality health care for Ontarians while ensuring that new dollars are directed toward the highest priorities.

This is the time to seize the opportunity for transformation to give better care for patients and better value for taxpayers.

The ideal health system the province wants to achieve with the Action Plan is person‑centred, sustainable and promotes quality, providing the care people need today and in the future.

The Action Plan, supported by the 2012-13 RbP, will transform that vision into reality.

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Ministry of Health and Long-Term Care Organization Chart  [PDF]

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Legislation

Acts administered by the Ministry of Health and Long-Term Care

Legislation Description

Alcoholism and Drug Addiction Research Foundation Act

Established the Alcoholism and Drug Addiction Research Foundation with a mandate to conduct and promote programs for the treatment of persons with alcohol and drug addictions. The Foundation amalgamated with the Clarke Institute and the Donwood Institute to form what is now the Centre for Addiction and Mental Health.

Ambulance Act

Purpose is to ensure the existence of a balanced and integrated system of land and air ambulance services, communication (dispatch) services and base hospital programs (quality control for paramedics) in Ontario.

Brain Tumour Awareness Month Act, 2001

Designates October as Brain Tumour Awareness Month.

Broader Public Sector Accountability Act, 2010 except in respect of sections 1-4, 7, 9-13, 16, 19 and 21-23.

Sets out accountability requirements for certain public sector and BPS entities, and provides the Minister of Health and Long-Term Care with the power to issue directives requiring reporting by LHINs and hospitals.

Cancer Act

Continues the Ontario Cancer Treatment and Research Foundation (now known as Cancer Care Ontario) and sets out its objects and powers.

Chase McEachern Act (Heart Defibrillator Civil Liability), 2007

Provides limited liability protection to certain persons who use defibrillators in emergencies, and to owners and occupiers of premises where defibrillators are made available.

Commitment to the Future of Medicare Act, 2004

Establishes the Ontario Health Quality Council, contains prohibitions against two-tier medicine, extra billing and user fees, and provides a framework for accountability agreements and the issuance of compliance directives.

Community Care Access Corporations Act, 2001

Governs the designation, objects, powers and duties of community care access corporations, and sets out the powers of the Minister of Health and Long-term Care with respect to these corporations.

Drug and Pharmacies Regulation Act

Governs the licensing and operation of pharmacies.

Drug Interchangeability and Dispensing Fee Act

Sets out a scheme for the declaration of drugs as interchangeable with one another (for example where generic drugs may be declared to be interchangeable with brand name products).

Drugless Practitioners Act

Regulates naturopaths and drugless practitioners.

Elderly Persons' Centres Act

Governs the establishment and funding of elderly persons centres.

Excellent Care For All Act, 2010

Requires health care organizations (defined as public hospitals and other organizations that may be provided for in the regulations) to: establish quality committees; develop a quality improvement plan; conduct surveys to collect information concerning satisfaction with the services they provide; and have a patient relations process and a patient declaration of values. The Ontario Health Quality Council, established under the Commitment to the Future of Medicare Act, 2004, is continued under the Act.

Fluoridation Act

Provides a legislative framework for municipalities or local boards to establish, maintain and operate, or discontinue a fluoridation system through by-laws or by submitting questions to their electors for a vote.

Healing Arts Radiation Protection Act

Promotes the safe use of x-rays in the healing arts and establishes the HARP Commission that advises the Minister on matters relating to the health and safety of x-rays.

Health Care Consent Act, 1996

Governs determinations of incapacity to make decisions about treatment, admission to care facilities and personal assistance services.

Health Facilities Special Orders Act

Permits the Minister to suspend and revoke the licence of, and take over the operation of, ambulance services, nursing homes, private hospitals, laboratories and specimen collection centres where the Minister has significant health and safety concerns.

Health Insurance Act

Establishes a scheme for the payment, of publicly funded health care services (the Ontario Health Insurance Plan - “OHIP”) for all Ontario residents, most of which are required to be covered under the Canada Health Act. Also sets out a system for the review and recovery of payments made under the Act.

Health Protection and Promotion Act, except section 7.

Provides a framework for the organization and delivery of public health programs and services, the prevention of the spread of disease and the promotion and protection of the health of the people of Ontario. Establishes and sets out the powers and duties of local boards of health and medical officers of health, and the Chief Medical Officer of Health.

Home Care and Community Services Act, 1994

Governs the provision of community services (professional services, personal support services, homemaking services and community support services) by approved agencies, including community care access centres.

This Act was previously named the Long-Term Care Act, 1994.

Homemakers and Nurses Services Act

Authorizes the establishment of a homemaking and nursing service program which includes a provincial cost-sharing arrangement with municipalities and Indian bands.

Homes for Special Care Act

Provides a framework for the Minister to approve a licence and fund an operator of a home that provides residential care to seriously mentally ill persons.

Immunization of School Pupils Act

Requires parents to ensure that school-aged children receive certain immunizations, subject to medical and religious/ethical exceptions, and permits medical officers of health to order suspensions for students who do not receive immunizations.

Independent Health Facilities Act

Establishes a system for licensing facilities to provide quality services that support insured services in areas of need at a fair price to the Ministry (e.g. diagnostic testing).

Katelyn Bedard Bone Marrow Awareness Month Act, 2010

Designates the month of November in each year Bone Marrow Awareness Month.

Laboratory and Specimen Collection Centre Licensing Act

Governs the licensing, inspection and operation of hospital laboratories and specimen collection centres in Ontario

Local Health System Integration Act, 2006

Purpose of the Act is to improve access to health care services, coordinated health care and effective management of the health system at the local level. The Act establishes 14 local health integration networks, whose objects include planning, funding and integrating the local health system through health service providers.

Long-Term Care Homes Act, 2007

This Act came into force on July 1, 2010 and governs all long-term care homes, not just municipal and First Nations homes.  The Charitable Institutions Act, Homes for the Aged and Rest Homes Act and Nursing Homes Act were repealed when this Act came into force.

Mental Health Act

Primarily deals with the involuntary examination, assessment and admission of mentally disordered persons in psychiatric facilities.

Ministry of Community and Social Services Act (Sections 11.1 and 12 re: Long Term Care Programs and Services only)

Relevant provisions in this Act enable the Minister of Health and Long-Term Care to provide direct funding to persons sixteen years of age and older who have a disability, so that they may purchase goods and services, and to enter into agreements respecting the provision of social and community services.

Ministry of Health and Long-Term Care Act

Sets out the duties, functions and powers of the Minister of Health and Long-Term Care.

Ministry of Health and Long-Term Care Appeal & Review Boards Act, 1998

Establishes both the Health Professions Appeal and Review Board and the Health Services Appeal and Review board, each of which hears matters under various MOHLTC statutes.

Narcotics Safety and Awareness Act, 2010

Permits the Minister and/or the executive officer under the Ontario Drug Benefit Act to monitor, analyze, collect and disclose information, including personal information, related to the prescribing and dispensing of monitored drugs.

Ontario Agency for Health Protection and Promotion Act, 2007

Establishes the Ontario Agency for Health Protection and Promotion, and sets out its objects and powers.

Ontario Drug Benefit Act

Provides rules for the amounts the Minister must pay to pharmacists when providing drug benefits to eligible persons, rules for listing drugs and drug products on the Ontario Drug Benefit Formulary, and for pricing those drugs, and rules for defining eligible persons and eligible drug products.

Ontario Medical Association Dues Act, 1991

Requires physicians who are Ontario Medical Association (OMA) members to pay dues to the OMA, and requires physicians who are not OMA members to pay amounts equal to OMA dues to the OMA.

Ontario Mental Health Foundation Act

Creates the Ontario Mental Health Foundation and sets out its objects. This Act also establishes the former Clarke Institute of Psychiatry (now part of the Centre for Addiction and Mental Health).

Patient Restraints Minimization Act, 2001

Prohibits hospitals and other prescribed institutions from restraining patients except where it is necessary to prevent serious bodily harm and the prescribed requirements are met.

Personal Health Information Protection Act, 2004 (Schedule A to the Health Information Protection Act, 2004)

Establishes rules governing the collection, use and disclosure of personal health information by health information custodians and certain other persons.

Private Hospitals Act

Governs the operation of private hospitals in Ontario and provides that no person may use a house or other premises as a private hospital except under the authority of a licence issued under the Act prior to October 29, 1973.

Public Hospitals Act

Governs and regulates matters related to the operation and corporate governance of public hospitals.

Quality of Care Information Protection Act, 2004 (Schedule B to the Health Information Protection Act, 2004)

Protects the confidentiality of information discussed by a duly appointed quality of care committee.

Regulated Health Professions Act, 1991
Audiology and Speech Language Pathology Act, 1991
Chiropody Act, 1991
Chiropractic Act, 1991
Dental Hygiene Act, 1991
Dental Technology Act, 1991
Dentistry Act, 1991
Denturism Act, 1991
Dietetics Act, 1991
Homeopathy Act, 2007
Kinesiology Act, 2007
Massage Therapy Act, 1991
Medical Laboratory Technology Act, 1991
Medical Radiation Technology Act, 1991
Medicine Act, 1991
Midwifery Act, 1991
Naturopathy Act, 2007
Nursing Act, 1991
Occupational Therapy Act, 1991
Opticianry Act, 1991
Optometry Act, 1991
Pharmacy Act, 1991
Physiotherapy Act, 1991
Psychology Act, 1991
Psychotherapy Act, 2007
Respiratory Therapy Act, 1991
Traditional Chinese Medicine Act, 2006

Deals with matters relating to the regulation of health professionals. Each health profession is regulated by a college that is established by one of the profession-specific Acts listed below.

Smoke-Free Ontario Act

Prohibits smoking in workplaces, enclosed public spaces and also in motor vehicles when children under 16 are present. It also bans the public display of tobacco products prior to purchase and prohibits youth-targeted tobacco products such as flavoured cigarillos.

Trillium Gift of Life Network Act

Governs the donation of human tissue for transplant and for educational or research purposes. The Act establishes the Trillium Gift of Life Network to coordinate activities relating to tissue donation.

University Health Network Act, 1997

Continues The Toronto Hospital (TTH) as a corporation without share capital under the name of University Health Network (UHN) and provides for the handling of TTH's assets and liabilities. The Act also sets out UHN's objects.

University of Ottawa Heart Institute Act, 1999

Provides the University of Ottawa Heart Institute with authority to provide cardiac services to the patients of the Ottawa Hospital, and governs the Minister's funding of the Institute.

All laws can be accessed by browsing www.e-laws.gov.on.ca

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Agencies Boards and Commissions

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Financial Information

Table 1: Ministry Planned Expenditures 2012-13 ($)

Operating 47,090,612,560
Capital 1,278,389,600
Total Ministry 48,369,002,160

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Ministry of Health and Long-Term Care

Table 2: Operating and Capital Summary by Vote

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Appendix I: Annual Report 2011-12

Ministry of Health and Long-Term Care Overview

Since 2003, the government has made great progress in building a strong foundation for an improved health care system. There are nearly 3,400 more doctors practicing in the province than eight years ago. Ninety-three per cent of patients have a regular doctor, including more than 2.1 million people who didn't have a physician in 2003, according to the Ontario Medical Association. There are new primary care models which have improved overall access. Wait times - including in emergency rooms - are on the decline.

But while Ontario's health care system is stronger, it faces unprecedented challenges.

The province's population is aging rapidly. A radical demographic shift will see twice as many seniors living in Ontario in 2030, compared with today. It costs more to tend to the needs of seniors coping with complex health problems – an estimated three times more than for the overall population of the province. Combined with this demographic shift is the advancing cost of medical technology, the cost of drugs and the rising expectations of what Ontarians want from their health care system.

Health care spending is on a collision course with Ontario's need to reduce its deficit as the government continues to tackle an economic downturn on a global scale. Health care spending currently consumes 42 cents of every program dollar the government spends and if left unchecked, this could rise to 70 per cent of the provincial budget within 12 years – greatly impairing the ability to fund other important priorities. Transformation of the health care system is essential to provide the quality care Ontarians deserve today and in the future.

In 2011-12, the government took tangible steps to strengthen the quality of care while at the same time enhancing the future sustainability of the system. 

Going forward, the government plans to build on the improvements that have been achieved over the past eight years and accelerate the quality agenda, which gained momentum in 2011-12 through the continued implementation of the Excellent Care for All (ECFA) Strategy.

Better Access To Family Health Care

In 2011-12, the government continued to expand innovative family health care models. Ontarians need to have access to family health care when they need it.   Enhancing family health care is key to building and supporting a sustainable health care system.

Family Health Teams

Since 2005, 200 Family Health Teams (FHTs) have been created throughout Ontario to improve and expand access to comprehensive family health care delivered by an interdisciplinary team of health professionals working together to best serve the needs of patients. The last 50 new FHTs were all operational by fiscal 2011-12.

More than 2.8 million Ontarians have enrolled with physicians at FHTs, including 619,000 people who previously didn't have a family health care provider. There are over 2,350 doctors working as part of FHTs and 1,600 interdisciplinary health professionals, such as nurse practitioners, social workers and dietitians. By working as a broad-based team, FHTs can see more patients and physicians are freed up to spend more time with patients with complex health needs.

The integrated programs and services FHTs offer their patients support a range of government priorities, including better management of chronic disease, mental health and addictions, care for seniors and emergency department avoidance. FHTs are very community-centred and their programs and services are geared to the population groups they serve.

Nurse Practitioner-Led Clinics

Nurse Practitioner-Led Clinics (NPLCs) are another innovative family health care model, which continued to be implemented in 2011-12. Twenty-six are funded by the government. As of February 2012, 21 of the clinics were open and seeing patients. By Spring 2012, all 26 NPLCs will be operational. Over 20,000 patients are receiving primary health care at NPLCs, often in previously under-served communities. Once all 26 clinics are fully operational, they will serve the needs of over 40,000 patients who previously didn't have a family health care provider. NPLCs operate similarly to FHTs, working in interdisciplinary teams to improve access to care.

Regulations were amended to allow nurse practitioners, beginning July 1, 2011, to take on a number of additional clinical responsibilities including:

  • Discharging hospital in-patients
  • Diagnose, prescribe or treat hospital in-patients
  • Order diagnostic procedures in hospital
  • Admit patients to hospital starting in July 2012.

Since 2003, Ontario has more than doubled the number of education spaces for primary care nurse practitioners from 75 to 200.

Community Health Centres

As of 2011-12, there are over 100 Community Health Centres (CHCs) in Ontario, compared to 54 in 2003. CHCs are currently caring for more than 358,600 Ontarians and this figure is expected to increase to about 494,000 once all of the new CHCs, satellites and their sister Aboriginal Health Access Centres (AHACs) are fully operational.

CHCs and AHACs address health equity issues by reaching underserved populations and groups with unique needs, like new immigrants. This primary care model focuses on the social determinants of health by delivering a broad range of primary care, as well as health promotion and community development services. Healthy eating, active living and community gardens are among the programs that can be found in CHCs in Ontario. They often serve Ontarians who face social and economic barriers to accessing programs and services. 

Health Care Connect

Since 2009, the Health Care Connect (HCC) program has been helping people in Ontario who do not have a family doctor or Nurse Practitioner to find one. Ontarians can call 1-800-445-1822 to register with HCC or register at the website (www.ontario.ca/healthcareconnect). People who have the greatest health needs are referred first. Over 95,000 Ontarians have been referred using this service.

Local Health Integration Networks

LHINs support people in navigating the health care system and continued their work to create a seamless transition for patients as they move from primary care, to hospital and back into the community or long-term care. 

LHINs are responsible for over 2,000 service accountability agreements with health service providers, including: 

  • Public and Private Hospitals
  • Community Care Access Centres
  • Long-term Care Homes
  • Community Health Centres
  • Community Mental Health and Addiction Agencies
  • Community Support Services.

LHINs have made gains in better integrating and funding local services by engaging their communities and local service providers.

Physicians 

Ontario has significantly increased the number of doctors working in the province in the last eight years to improve access to care. There were at least 3,400 more doctors practicing in the province in 2010, compared with 2003. Over that time the number of family physicians has increased by 13 per cent and the number of specialists by 18.4 per cent.

Training More Doctors

The government continues to train more doctors to better serve Ontarians. By 2011-12, the province had added 260 more first-year undergraduate medical school spaces since 2004-05 – a 38 per cent increase. In 2011, there were 3,435 undergraduates in all levels of medical school training in the province – compared to 2,482 in 2003.

The four new medical education campuses that the province opened in St. Catharines, Kitchener-Waterloo, Windsor and Mississauga are successfully operating and training doctors.

The Northern Ontario School of Medicine, which was established in 2005, has graduated 107 new doctors since the spring of 2009. As of November 2011, it had a total of 113 postgraduate residents in training.

The government is also in the process of increasing the number of family medicine first‑year postgraduate positions by 160 per cent to 326 new training positions by 2013‑14. As of November 2011, there were a total of 1,015 family medicine residents in all levels of training in Ontario.

Through HealthForceOntario – the province's health human resources strategy – the government created the Northern and Rural Recruitment and Retention Initiative to help attract more physicians, including new graduates, to rural and northern communities through the use of financial incentives. 

International Medical Graduates

The government continued to improve access to care by expanding opportunities for International Medical Graduates (IMGs) to practice in the province. Ontario currently offers more training positions and assessments for IMGs than all other provinces combined. In 2004-05, the government more than doubled the number of spaces for IMGs, from 90 to 200 each year.  For the past six years, Ontario has exceeded this annual target. In 2011-12 the government offered 236 IMG training positions and assessments.

Funding to support retraining IMGs has increased to an estimated $88 million from $16 million in 2003. As of 2010, more than 6,264 IMGs were practicing in Ontario, representing about 25 per cent of Ontario's physician workforce.

As a result of expanding the capacity of medical schools  and training positions for IMGs, the number of doctors graduating and ready to enter practice each year in Ontario will have doubled between 2003 and 2013.

Agreement with the Ontario Medical Association

In 2011, the government and the Ontario Medical Association (OMA) approved the final year of the four-year Physician Services Agreement – originally negotiated in 2008 – by making changes that will deliver better health care outcomes for families, reduce the use of unnecessary medical procedures and allow for health dollars to be redirected into other frontline services.

These changes represent the next phase of the government's plan to work with medical professionals to ensure that publicly-funded medical services are based on the best possible medical evidence. The changes include:

  • A new payment model for methadone that reduces unnecessary tests and increases access to doctors
  • Reduced ophthalmology fees, including those for cataract surgery
  • Reduced payment for screening endoscopy services.

Every dollar saved through these evidence-based changes will be redirected into other frontline health care services.

In February 2012, the government and the OMA entered negotiations to secure a new Physician Services Agreement. These negotiations are taking place during a pivotal time in Ontario's health care history. The government views this as a key opportunity to partner with doctors to address the twin goals of improving the quality of health services and the returns on the province's health care investment.

Nurses

More than 12,600 nursing positions have been created in Ontario since 2003, including more than 1,000 in 2011/12. Ontario continues to be one of the few jurisdictions in the world to guarantee a full-time job opportunity to new nursing graduates. Since 2007, over 11,700 new nursing graduates have received a full-time job opportunity through the Nursing Graduate Guarantee.

Overall, the percentage of nurses working full-time in Ontario was 64.4 per cent in 2011 – a 16.9 per cent increase from 2003.

Under the Late Career Nurse Initiative, Ontario continued its commitment to retain the expertise of experienced nurses in the workplace by providing them the opportunity to spend more time in less physically demanding roles. More than 16,700 experienced nurses have benefited from this initiative since 2004.

The government has supported a number of programs to improve the work conditions and work environments of nurses. This included investing about $20 million in the Quality Nursing Environments-Quality Patient Care Fund in 2011 to enhance nursing practice environments and increase the amount of time frontline nurses spend delivering direct patient care.

Other Health Care Professionals

Midwives

In 2011-12, Ontario expanded access to a midwife for thousands of women by supporting the services of up to 81 more midwives. Funding for the Ontario Midwifery Program increased to $107 million in 2011-12, from $23.7 million in 2002-03. As of November 30, 2011, there were 574 registered midwives in the province. Ontario has over half of Canada's midwives. Midwives in Ontario will provide services to more than 18,100 women and their newborns this year.

The province also amended the Midwifery Act, effective September 1, 2011, to expand the scope of practice of midwives working in Ontario.

Physician Assistants

As of February 2012, there were over 110 physician assistants (PAs) working in over 60 demonstration sites in the province. In 2006, the government launched the PA initiative as part of the HealthForceOntario strategy. 

PAs are currently working as part of inter-professional teams in emergency departments, other hospital departments, community health centres, family health teams, and in diabetes and long-term care patient management settings.  Evaluation results from all demonstration projects will inform decisions on the future role of PAs within the health system.

McMaster University launched the first civilian PA education program in Ontario in September 2008. Forty of the 41 PAs, who graduated from the program in 2011, secured positions in Ontario. The government provided financial supports to facilitate the employment of these graduates in areas of high priority.

The ‘Consortium of PA Education' - a collaboration between the University of Toronto, the Northern Ontario School of Medicine and the Michener Institute for Applied Health Sciences – launched a second PA education program in January 2010.

Clinical Specialist Radiation Therapists

Clinical Specialist Radiation Therapists (CSRTs) are registered with the College of Medical Radiation Technologists of Ontario in the specialty of radiation therapy. They have obtained additional knowledge, skills and judgment that will allow them to perform their full scope of practice, including specific activities that are managed through either medical directives or delegation.

In 2007, the CSRT demonstration project began with the implementation of five CSRT positions at the Ontario Regional Cancer Centres in Sunnybrook Hospital and Princess Margaret Hospital.

Cancer Care Ontario is funded to support the integration and evaluation of up to 20 CSRTs over the period from April 2010 to March 2013. As of November 2011, seven therapists are working full time in CSRT positions at three cancer centres in Ontario. CSRTs have had an overall positive impact on the delivery of high quality radiation therapy and patient care. Their addition has improved access to care and patient satisfaction. Ontario is in the process of fully integrating CSRT positions into the Ontario cancer care system.

HealthForceOntario

HealthForceOntario (HFO) continues to play a leading role in ensuring Ontarians have access to the right number and mix of qualified health care providers, now and in the future. Through HealthForceOntario - the government's health human resources strategy - the province's health human resources needs continue to be identified and anticipated.

HFO has successfully engaged partners in education and health care to develop skilled, knowledgeable providers and create health care delivery teams that will make the most of their abilities. HFO has introduced new and expanded provider roles to increase the number and mix of health care professionals working in the system and building on the skills of those already there.

HFO continues to be actively involved in marketing Ontario as an employer of choice in health care and manages one of the most comprehensive health job recruitment websites in North America.

Quality Agenda

Excellent Care For All Strategy

The overarching goals of the Excellent Care for All (ECFA) strategy are to improve quality care by consistently applying an evidence-based approach that enhances patient outcomes, as it delivers the best value. On June 8, 2010, the Excellent Care for All Act, 2010, (ECFAA), received Royal Assent. Starting with the hospital sector, ECFAA was a starting point of the government's commitment to drive quality and value throughout the health system by ensuring that future health investments get results and improve patient outcomes.

By 2011-12, the following had been achieved within the hospital sector regarding the implementation of ECFAA:

  • All hospitals in Ontario had established and publicly posted annual Quality Improvement Plans (QIPs) by the deadline of April 1, 2011, as required by the act. The QIPs detail the organization's commitment to high quality health care, create a positive patient experience and ensure the hospital is responsive to the public and its executive team is accountable for its achievements.
  • Hospitals are currently working on developing their QIPs for 2012-13 to continue their quality improvement journey.
  • Hospitals are required to conduct patient/client/caregiver surveys to assess satisfaction with services.
  • Hospitals must conduct employee surveys to assess satisfaction with employment experience and views about the quality of care provided.
  • Declarations of values were developed through public consultation.
  • A Patient relations process to address patient experience issues and reflect the organization's declaration of values.

Results from the hospital implementation are being assessed to drive recommendations for how to expand quality improvement to other sectors.

Health Quality Ontario

To help support and focus quality improvement work across the health system, on April 1, 2011, the government announced the consolidation of a range of initiatives under an expanded entity called Health Quality Ontario (HQO). HQO is a key government partner in supporting the ECFA strategy to build capacity for quality improvement within the health care system.

HQO's expanded mandate includes :

  • Designing and developing a provincial resource of practical tools to be made available to health care professionals and organizations to support quality improvement and uptake of evidence-based practice.
  • Developing education and training modules and materials for health care providers to support the implementation of new care standards across multiple settings and to improve quality and patient experience across the care continuum.
  • Promoting health care that is supported by the best available scientific evidence by making recommendations on standards of care in the health system based on best clinical practice guidelines and protocols.
  • Making funding recommendations to the government concerning health care services and medical devices based on the best clinical evidence.

Ontario will continue to make evidence-based changes to various diagnostic tests and interventions that are shown to be ineffective, inappropriate and that add no value to patients. For example, this has included restricting the routine use of Vitamin D testing for otherwise healthy people, limiting the frequency of diagnostic sleep studies to once a year instead of twice a year, and requiring prior government approval for ECGs and chest x-rays for pre-operative cataract surgery patients. Evidence-based change initiatives are expected to save $125 million this year.

Health System Funding Reform Strategy

Funding reform is a key component of creating a health system focus on continuous quality improvement and value. Funding reform will move Ontario's health care system away from the current global funding system towards what is known as Patient-Based Funding (PBF)

Under PBF, health care organizations will be compensated based on how many patients they look after, the services they deliver, the evidence-based quality of those services, and the specific needs of the population they serve.

PBF will be phased in over three years, starting April 1, 2012, allowing the sector to anticipate changes and plan for impacts.

PBF will shift from paying for select services to paying for the care of the patient's entire journey across all providers in the episode, including pre- and post-operative activities, where appropriate and feasible.

Drug System Reform

The government will continue to make reforms to the drug system to maximize the value Ontarians and the province reaps from its investment. The province will examine other potential steps to ensure that the drug program gets better value and that patients get better access to the medications they need. But Ontario will only continue to fund specific drugs when the best clinical evidence indicates that they benefit patients.

The 2010 drug reforms included lowering the cost of generic drugs by at least 50 per cent to 25 per cent of the brand name drug by eliminating professional allowances. This is saving the province $500 million annually.

Ontario continued to leverage the $4.4 billion it allocated to drug expenditures in 2011‑12 to get better value. This resulted in an additional savings of $100 million which was reinvested in the health care system.

These savings are the result of :

  • reducing the cost of generic drugs and changing the way Ontario pays for them;
  • better listing agreements with drug manufacturers; and
  • allowing more substitution of brand name drugs with generic drugs that are equally effective.

The government continued to support access to pharmacy services in rural communities and underserviced areas with new dedicated funding. The government also ensured that pharmacists in Ontario were being fairly compensated, including increasing funding to them for providing expanded services to support people with diabetes, long-term care home residents and home-bound seniors through MedsCheck.

Ontario also took steps to reduce and prevent the inappropriate use, abuse and diversion of prescription narcotics and controlled substances, through the development of a comprehensive Ontario Narcotics Strategy. In February 2012, the government made changes to the Ontario Drug Benefit (ODB) Formulary, delisting Oxycontin to help ensure it is being used appropriately while still maintaining access to treatments that manage pain. 

Since October 2006, 66 new cancer drugs/indications have been listed (new drugs and expanded indications) under the Ontario Drug Benefit, Exceptional Access Program and New Drug Funding Program. As of January 19, 2012, the province has added 214 new drugs, representing 1,543 individual products and strengths to the formulary (including new drugs funded under the Exceptional Access Program) since the Transparent Drug System for Patients Act came into effect in October 2006.

Additionally, expenditures for cancer drugs through the New Drug Funding Program have increased from $72 million in 2003-04 to a forecasted $227.1 million in 2011-12. The government has invested $1.4 billion in the New Drug Funding Program since 2003.

Hospitals

The government has substantially increased funding to the province's hospitals from $10.9 billion in 2003-04 to $16.9 billion in 2011-12. In addition, 23 new replacement hospitals have been built or underway since 2004.

In a gradual shift from a global budget model based on historic funding levels, hospitals will increasingly be funded using a Patient-Based Funding methodology - Health Based Allocation Model (HBAM) as well as targeted Quality Based Procedures. Under Patient-Based Funding, hospitals will be funded based on the mix and volumes of their patient population and the specific health care services they deliver.
 
This funding approach will create an incentive for hospitals to adopt best-practices in delivering care as they will be reimbursed a single payment for a patient diagnosed with a specific condition. The evidence-based rates will be informed by clinical guidelines and clinical expert advisors. Both HBAM and Quality Based Procedures will comprise a greater proportion of hospital base funding over time. Global funding will be reduced in relative proportion as Patient Focused Funding increases. At the end of three years, HBAM is expected to comprise 40 per cent of the previous global budget and Quality Based Procedures will make up 30 per cent, for a total of 70 per cent of previous global funding.
 
In this way, funding will become increasingly more patient-centred, rather than focusing on the health service provider or health care organization. 

Supporting Alternatives to the Emergency Room

The government has invested in a number of coordinated initiatives to expand alternatives of emergency room (ER) services, improve ER performance and support timely discharge to appropriate care in the community.

In too many instances in the past, patients inappropriately relied on ERs as a default entry into the health system when their needs could have been better served elsewhere in the health system. This contributed to longer waits in ERs and an over-reliance on more costly acute care services. The future sustainability of the health system depends on the most appropriate use of the province's health resources.

So, the government launched a coordinated strategy to tackle ER wait times with a $109 million investment  in 2008-09, including targeting the poorest performing emergency rooms and delivering new initiatives outside of hospitals.

On February 19, 2009, the government announced a one-of-a-kind North American initiative setting clear targets for reducing the total amount of time patients spend in emergency rooms - and publicly posting data about local ERs wait times online.

In 2011-12, a number of key initiatives continued to be implemented :

  • The government announced $100 million for the continuation of the Pay-for-Results Program. The program was expanded to include 74 of Ontario ERs that face the most serious challenges in reducing the time patients spend in the ER.  An essential change made to the 2011-12 program is the inclusion of dedicated funds to selected sites to expedite the flow of ER patients through the use of short-stay units.
  • In addition, in 2011-12, the government provided up to $11.8 million to 18 municipalities for the Dedicated Nurses to Receive Ambulance Patients initiative to enhance ER services available to patients in need of critical care.  A total of 93 newly committed positions have been created through the ambulance offload nurse initiative.
  • Funding was also provided to LHINs to standardize the processes across the province for how patients waiting to be discharged from hospital are referred to alternative levels of care (ALC) within the community.

Health Care Options

A Health Care Options (HCO) website was created in 2009 to provide information on the range of health service options that exist in Ontario communities. The HCO website, which has since been expanded, allows Ontarians to search for health care services in their community by postal code to find options close to home. The more you know, the better HCO provides Ontarians with information that allows them to make the most appropriate choice regarding their health care needs and also ease the burden on acute care services.

The government will continue its commitment to provide Ontarians with up-to-date information and tools to support and empower them in making more informed decisions to get the health care services they need, when and where they need them.

Reducing Wait Times

Reducing wait times for key services continues to be an important component of the government's broader strategy to transform Ontario's health system.  In 2004, Ontario's Wait Times Strategy (WTS) was launched to improve wait times for patients requiring critical diagnostic and surgical services. 

Since 2003-04, Ontario has invested approximately $1.7 billion in new funding overall to reduce wait times in Ontario for 2.9 million additional procedures in five key areas of disease and disability: cancer and cataract surgery, cardiac procedures, hip and knee replacements and MRI/CT scans.

In 2011-12, a total of $173.4 million was invested under the Wait Times Strategy to fund an additional 45,000 surgical procedures and an additional 216,000 hours for MRI/CT scans.

Ontario's Wait Times Strategy is committed to :

  • Increasing the number of procedures for each of these services
  • Investing in new, more efficient technology such as MRI machines
  • Standardizing best practices
  • Collecting and reporting wait times data to allow better decision-making and increase accountability.

Ontario's WTS has resulted in shorter wait times for surgical and diagnostic imaging procedures in the province.  As of December 2011, the percentage of services completed within the Priority Level 4 target includes: 97 per cent of cataract surgeries; 89 per cent of hip replacements; 83 per cent of knee replacements; 46 per cent of MRIs; 88 per cent of CT scans; 97 per cent of general surgeries; and 100 per cent of bypass surgeries.

The Canadian Institute for Health Information (CIHI) reported in 2010 that Ontario is one of two provinces (the other is British Columbia) that was able to perform at least 75 per cent of all priority procedures within benchmarks.

In October 2005, the government launched a website that provides current waiting times for hospitals across the Ontario for the five key health services at www.ontario.ca/waittimes. As of June 2010, Ontario began publicly reporting wait times information for all adult and paediatric surgical areas.

Home Care

The government has substantially increased its investments in home care in the past eight years, expanding services to 193,071 more Ontarians.

Funding for Community Care Access Centres, which coordinate home care services, has increased from $1.2 billion in 2003-04 to $2.1 billion in 2011-12 - a difference of 69.3 per cent.

As part of the government's efforts to reduce ER wait times, the maximum amount of service a client can receive for personal support and homemaking hours was increased by 50 per cent and the caps on these services were removed altogether for clients waiting for a long-term care home or receiving palliative care at home.

Community Support Services

Funding for all community support services, including Acquired Brain Injury and Assisted Living In Supportive Housing, has increased from $418.7 million in 2003-04 to $857.4 million in 2011-12. This is a difference of 104.8 per cent.
About 1.03 million Ontarians were receiving community support services in 2010-11. Community support services are available to seniors and people with disabilities to support them in remaining independent in their homes longer. Services include meals on wheels, transportation services, caregiver respite and home maintenance and repair.

Long-Term Care

Funding for long-term care has increased from $2.10 billion in 2003-04 to $3.61 billion in 2011-12, which represents a 72 per cent growth.

Residents also continue to benefit from changes and regulations implemented under the Long-Term Care Homes Act, 2007 (LTCHA) that was proclaimed on July 2010. The comprehensive act safeguards resident rights, improving the quality of care and improving the accountability of LTC homes for the care, treatment and well-being of residents. The newly designed Long-Term Care Home Quality Inspection Program (LQIP) is designed to safeguard residents' rights, safety and security and improve quality of care while creating a culture that is focused on resident outcomes.  The key features of the LTCHA include:

  • A policy to promote a zero-tolerance approach to prevent abuse and neglect of residents.
  • Enhanced reporting obligations for anyone aware of abuse, neglect or other mistreatment of residents.
  • Enhanced whistle blowing protections for individuals who report to an inspector or the director.
  • An enhanced and more clearly enforceable Residents' Bill of Rights.
  • Strengthened and consistent reporting requirements for homes on critical incidents, including: abuse, neglect, and injuries resulting in transfers to hospitals.

The government has committed to a range of other initiatives, which has improved the quality of life for residents in long-term care homes who are increasingly frailer and coping with a range of complex conditions. Effective July 1, 2011, the government increased the raw food allowance to seniors living in LTC homes to $7.46 per day, to ensure that residents are provided with an improved range of nutritional menu options. The government also increased the average paid hours of care per resident day in LTC homes to 3.5 hours by 2011-12, including nursing and personal care and programming and support services. A 1-800 Action Line was introduced in January 2004 and continues to offer a province-wide toll free information and complaint line for LTC residents and their families.

Residents also continue to benefit from the Resident Assessment Instrument Minimum Data Set 2.0 (RAI-MDS 2.0) tool that was introduced to collect clinical data in all long‑term care homes across Ontario. The RAI-MDS 2.0 is a standardized, automated common assessment tool that provides comprehensive information on residents that helps to facilitate individualized care planning and enhances the quality of care to residents by benchmarking within and across all long-term care homes.

Residents First is one of the most comprehensive and innovative quality improvement initiatives in Canada. This provincial initiative supports long-term care homes in Ontario in providing an environment for their residents that enhances their quality of life. Residents First also facilitates comprehensive and lasting change by strengthening the long-term care sector's capacity for quality improvement.

Residents First is partnership driven and supported by the Ontario Ministry of Health and Long-Term Care. Ontario's Local Health Integration Networks (LHINs) are leading implementation at the local level. Training is being delivered by experts in quality improvement through Health Quality Ontario (HQO).

End of Life and Palliative Care

In 2006, the government introduced the End of Life Care Strategy making the province a leader in end-of-life care. The strategy provides Ontarians who have life-threatening illnesses the option of receiving care in their own homes, or in the home-like environment of a residential hospice. The province became the first province to make a significant multi-year investment in end-of-life care, with a $115.5 million three-year strategy between 2004-05 (planning year) and 2007-08. The funding expanded in-home end-of-life care services to 6,000 more Ontarians.

The province committed nursing and personal support services for more than 30 residential hospices across the province. In April 2011, the government provided an additional $7 million base increase to Residential Hospices for providing nursing and personal support services. The priority is to ensure that Ontarians are receiving the highest quality palliative care possible.

Community Mental Health and Addictions

Seventy per cent of mental health problems first appear in childhood and adolescence. This is why the government has placed a renewed focus on children's mental health. The government has invested in eight new pediatric inpatient beds, day treatment and outpatient services for children and adolescents. Funding was also made available in 2011-12 for 21 registered nurses for early psychosis intervention teams across the province, to increase capacity for those in need to access early psychosis intervention services.

In 2011-12, the province also invested in specialized treatment programs for people with eating disorders – including improving access to primary care treatment – to enhance existing services and create new ones.

In addition, funding was made available for four additional adult in-patient beds, as well as day treatment with residential support and outpatient services. The province also made significant new investments in services to help keep people with mental illness out of our criminal justice and corrections system, including:

  • Crisis response and outreach
  • Short-term residential crisis support beds
  • Supportive housing
  • Court support services and intensive case management services.

The province also funded 2,250 mental health supportive housing units and 760 addictions supportive housing units.

Public Health

The government provided $636 million in 2011 to support local public health units to provide a range of mandatory programs in their communities.

Over the last eight years, Ontario has made some of the most comprehensive changes to strengthen the province's health system since the 1980s. The government has:

  • Established the first stand-alone public health agency – Public Health Ontario (PHO) ‑ to provide scientific and technical advice to the support the government and the health system.
  • Funded 180 new Infectious Diseases Control staff in public health units to monitor and control infectious diseases and enhance the capacity of outbreak management.
  • Developed 14 Regional Infection Control Networks (RICNs) to better integrate infection prevention and control activities across our health system, which have now been transitioned to PHO.
  • Improved patient/resident and health care provider/staff safety with the development of a multifaceted hand hygiene program for hospitals called Just Clean Your Hands (JCYH). JCYH was launched in the acute care sector in March 2008 and was expanded to the long-term care homes sector in December 2009. The initiative was transitioned to PHO in 2011.
  • Launched the Integrated Public Health Information System (iPHIS), in 2005, a web-based information system that is used by public health units and the province for infectious disease case and contact management, outbreak management and reporting to better detect and manage threats to public health. This is the first step towards an integrated pan-Canadian surveillance and outbreak management system.
  • Developed and released the Ontario Public Health Organizational Standards, 2011. The Organizational Standards reflect existing literature and best practices and provide a baseline of expectations allowing for an assessment of the governance and administrative functioning of both boards of health and public health units.
  • Worked with the health system stakeholders to update the provincial pandemic plan (Ontario Health Plan for an Influenza Pandemic) and the Ministry of Health and Long-Term Care's all-hazards emergency response plan.
  • Implemented Panorama – a comprehensive and integrated information system for Ontario that is designed to improve public health surveillance and support public health professionals to efficiently manage cases and outbreaks of infectious diseases; immunizations; and vaccine inventories. Important steps have been taken to allow the further development and implementation of this project.

On April 12, 2011, the legislature passed the Health Protection and Promotion Amendment Act, 2011 (Bill 141) which contains amendments that will strengthen the planning, management and response to future pandemics, or other provincial, national or international public health events. The amendments expand the legislative powers of the Chief Medical Officer of Health. The amendments will assist with promoting consistency and standardization across the province with respect to emergency response measures.

The province has a stockpile to ensure that health providers / organizations have access to essential personal protective equipment, infection prevention and control supplies and mass immunization supplies during an emergency. The province also has a stockpile of antivirals to treat Ontarians during a pandemic.

Cancer Screening and Prevention

The government expanded the provincial breast cancer screening program by funding an additional 357,615 screens in 2011-12, compared to 2003-04 and adding 56 new breast cancer screening sites in Ontario during the last eight years for a total of 156 screening sites as of December 2011.

On March 29, 2011, Ontario announced the investment of additional $15 million over the next three years to provide about 90,000 more breast cancer screening exams to expand the Ontario Breast Screening Program to reach women between the ages of 30 and 49 who are at high risk for breast cancer and support additional exams for women aged 50 to 69, who are currently covered under the program.

As of October 2011, Ontarians had completed about 1.8 million screenings through ColonCancerCheck's Fecal Occult Blood Tests since Ontario launched Canada's first organized province-wide colorectal cancer screening program in April 1, 2008. A total of $193.5 million was invested over 5 years ending in 2011-12. The province continues to promote colorectal screening because Ontario has one of the highest rates in the world and more than 3,000 people die from it each year, although it is 90 per cent curable if detected early. The government has also funded about 134,000 colonoscopies in Ontario over the past five years for people at higher risk of the disease.

Every year Ontario offers free vaccines to about 77,000 Grade 8 girls to protect them from the human papillomavirus (HPV) – a leading cause of cervical cancer. Estimates indicated that uptake was 52 per cent during the second year of the program. Analysis of year three of the HPV vaccination program was ongoing in 2011-12.

Childhood and Adult Immunizations

Immunization strengthens the health of individuals and creates a more resilient population less likely to get sick and in need of acute health care services. Ontario maintains an accessible publicly funded immunization program that provides the opportunity to protect children, adolescents and adults from various potentially life threatening vaccine preventable diseases.

In 2011, Ontario expanded the province's publicly funded immunization program to better protect and make it more accessible to families. Two vaccines were added to the immunization schedule. One protects against the rotavirus infection, which is the leading cause of severe, dehydrating diarrhea in infants and young children. Ontario was the first jurisdiction in Canada to make the rotavirus vaccine publicly funded after the National Advisory Committee on Immunization (NACI) recommended its use for infants in July 2010. The second vaccine, MMR adds varicella (V) – which protects against the virus that causes chicken pox – to the combined measles-mumps-rubella (MMR) vaccine. The province also expanded the varicella and pertussis (whooping cough) vaccine programs. 

Ontario currently funds the cost of 14 vaccines, compared to nine in 2003-2004. Vaccines have measurable outcomes that contribute tangible savings to the health system.

Encouraging uptake of vaccines is essential and not just for children. Adults in Ontario are eligible to receive, at no cost, a booster dose of vaccine every 10 years that protects against tetanus and diphtheria, for instance.

Since 2000, the province has offered an annual seasonal influenza vaccine free of charge to everyone six months of age and older, who lives, works or attends school in Ontario. The Universal Influenza Immunization Program (UIIP) has had a significant impact on the rate of illness and the burden caused by influenza. This is especially true for those at higher risk of influenza related complications include the elderly, young children, pregnant women and people with pre-existing health conditions.

Ontario purchased approximately 4.3 million doses of influenza vaccine for the 2011-12 Universal Influenza Immunization Program (UIIP).

Dental Care

Preventing tooth decay and other oral health problems is critical to the health of Ontario's children and youth.  The Ministry of Health and Long-Term Care currently operates two programs to increase access to dental services for children and youth of low-income families – Children in Need of Treatment Program (CINOT) and Healthy Smiles Ontario (HSO) administered jointly by the Public Health and Health Promotion Programs.

Healthy Smiles Ontario

The Healthy Smiles Ontario (HSO) Program was launched on October 1, 2010. This program provides preventive and early treatment services for children and youth in low-income families, who are 17 years of age and under, and who do not have access to dental care. The initiative is part of Ontario's Poverty Reduction Strategy to support the development of healthier communities.

As of October 2011, about 12,000 children and youth had received services through the HSO program. Once the program is at full capacity, it is estimated that it will be able to reach up to 130,000 low-income children and youth.

Through HSO public health units are providing oral health services in new and innovative ways to serve the needs of their local communities, including northern and remote populations. The HSO program has increased oral health services across the province through partnerships with various local organizations, including organizations that serve Aboriginal and Francophone communities, CHCs and through the development of community-based clinics. Several public health units also have mobile dental units, allowing them to treat children and youth who may otherwise not have access to dental care.

Health Promotion 

Certain programs of the former Ministry of Health Promotion and Sport were transferred to the Ministry of Health and Long-Term Care in late 2011-12. 

Children in Need of Treatment Program

CINOT provides a basic level of dental care to children who have identified dental conditions requiring urgent care. Children are eligible for this program if they have no dental insurance and the parent/guardian has signed a written declaration that the cost of the necessary dental treatment would result in financial hardship.

On January 1, 2009, CINOT was expanded to include children up to their 18th birthday (up from the old cut-off of Grade 8 or the 14th birthday, whichever was later).  General anaesthesia coverage was also added for children aged 5 years of age and older.

In 2011, CINOT paid for basic dental care for 40,360 children and youth with serious oral health problems who may have otherwise gone untreated. This total reflected 5,468 teens who received care through the program's expansion.

Renewing the Smoke-Free Ontario Strategy

Since 2006, through the groundbreaking Smoke-Free Ontario (SFO) Strategy, the province has supported people in kicking the habit, discouraged youth from starting to smoke and banned smoking in public places to protect Ontarians from the dangers of second-hand smoke. In the past 10 years, the number of Ontarians who smoke has dropped from 24.5 per cent of the population to 19.3 per cent. Despite achieving significant gains under SFO, smoking-related illnesses remain the number one cause of preventable death in Ontario – killing 13,000 annually. Smoking costs Ontario's economy $1.93 billion in direct health care costs and $5.8 billion in productivity losses.

In the past six years the government has increasingly stepped up its war against tobacco including banning the display of products, prohibiting the smoking in vehicles when children under 16 are present and limiting the sale of flavoured tobacco products aimed at attracting young smokers.

But the government has committed to do more by making more resources available for cessation programs in more settings such as FHTs and pharmacies. The province is providing specific help for smokers in hospitals with chronic diseases and is targeting contraband cigarettes. The government is also working with educators and students to help keep schools smoke-free and develop youth-led programs focused on prevention. The province is committed to working towards Ontario having the lowest smoking rate in Canada.

Healthy Lifestyles

Ontario's Healthy Communities Fund (HCF) Grant Program provides non-capital support for health promotion projects in communities across the province. To date, over $32 million in grants have been awarded to over 500 organizations to deliver these integrated projects, which are expected to benefit 1.5 million of Ontario's most marginalized and under-served populations.

Ontario's After-School Initiative funds 110 organizations delivering after-school programs in over 330 sites, reaching approximately 18,000 children and youth. The province's investments in Aboriginal communities are helping these Ontario families lead healthier, more active lives. In 2011-12, the government invested more than $10 million in health promotion programming reaching Aboriginal populations.

Chronic Disease Management

Nearly four million Ontarians over age 45 – the entire population of Toronto – are living with a chronic disease or condition. Approximately 70 per cent of these people are living with two or more chronic diseases. This reality will only become more pronounced as the province's population ages.Chronic diseases have a significant impact on the quality of life of individuals and the cost to the health system.

The government will continue to target the prevention of chronic diseases and supporting Ontarians in better managing these conditions. The Ontario Diabetes Strategy (ODS) continued to expand diabetes programs and services to improve health care and the health outcomes of people living with and at risk of developing diabetes.

The key accomplishments of the ODS include :

  • Increased the number of Diabetes Education Teams (DETs) from 220 to 321 across the province to help people better manage their diabetes and prevent or minimize the impact of diabetes related complications.
  • Created Diabetes Regional Co-ordination Centres in each of the 14 LHIN regions to co-ordinate diabetes services and care, and foster adoption of clinical best practices.
  • In 2010-11 the province had provided self-management education and skills training to an additional 4,000 individuals with diabetes and 4,000 health care providers.
  • By the end of fiscal 2011-12 Ontario will have six Centres for Complex Diabetes Care (CCDCs) which provide specialized, patient-centred care and treatment for people with complex diabetes and associated health needs.
  • The third iteration of the Baseline Diabetes Dataset Initiative (BDDI) was launched in fall of 2011. As of January 2012, there were over 6,200 primary care providers participating in BDDI, representing over 615,000 Ontarians with diabetes, aged 18 and older.
  • As of 2010-11, the government had more than tripled funding for diabetes programs in Ontario to $93.5 million, compared to $19 million in 2003-04.

The government has committed in recent years to support the early identification and intervention of Chronic Kidney Disease (CKD) Management. Clinic services have been implemented aimed at slowing the progression of the disease and the need for dialysis treatment. The goal is to decrease the annual growth in dialysis patients from 5 per cent to 3.8 per cent by 2013-14.

In addition, new innovative sites offering CKD services were opened, including a co-location with a long-term care facility, a community health centre serving an aboriginal population and a community wellness centre. Increased services have also been developed to offer more patients the opportunity to receive dialysis treatment in their homes.

Newborn Screening

As of 2011-12 Ontario screens newborns for 28 rare genetic disorders, including sickle cell disease and cystic fibrosis. Over the past eight years the government has developed the most comprehensive newborn screening program in Canada. Back in 2003, screening was only done for two diseases and disorders.

eHealth

The government is committed to harnessing the full benefit of technology to enhance the delivery of patient-centred quality care. Electronic Health Records (EHR) will enable better sharing of health information, working to improve patient care and creating a more effective and cost-efficient health care system. eHealth Ontario is tasked with the implementation of the provincial eHealth strategy leading to the creation of an EHR for Ontarians by 2015.

Ontario is focusing its efforts in establishing an EHR, on two specific initiatives :

  • Diabetes Registry: This will help people with diabetes and their health care providers to monitor and manage diabetes more effectively and reduce associated complications and costs.
  • Medication Management System : This will allow for online management of prescription medications to reduce preventable adverse drug reactions.

eHealth accomplishments to-date include :

  • Over 144,400 remote medical consultations took place through telemedicine in 2010-11;
  • Since 2009, 80,000 Ontarians have been participating in a pilot project for e-prescribing, which will help save lives;
  • Since 2005, physicians representing 9 million Ontarians have been participating in provincially-funded electronic medical record adoption programs;
  • All Ontario hospitals are now using digital diagnostic imaging and the majority are connected to regional repositories that enable them to electronically share these images with other connected hospitals;
  • The Drug Profile Viewer provides authorized health care providers in 245 hospital sites, and a selected number of Community Health Centres with electronic prescription drug information and medication histories for 2.6 million recipients of the Ontario Drug Benefit, 24 hours a day, 7 days a week;
  • More than 2 million children have an electronic patient record via the electronic Child Health Network;
  • Completed in March 2011, the use of Emergency Neurosurgery Image Transfer System (which allows neurosurgeons to provide remote consults in urgent situations) has resulted in the avoidance of several hundred patient transfers, resulting in savings of approximately $50M since its inception in January 2009.

 

ISSN # 1718-6730
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