Commission on the Reform of Ontario's Public Services

Executive Summary
The aging of Ontario’s population underlines the need for reforms to community care, home
care and long-term care. We need to match seniors to the services they need from the earliest
available care provider, reduce the number of days people spend in hospitals when another
form of care is more appropriate, and improve the management of referrals for long-term care,
home care and community services. The government should implement the recommendations
made by Dr. David Walker, in his 2011 report, “Caring for Our Aging Population and
Addressing Alternate Level of Care.” There is also a need for more — and more varied —
palliative care.
The province should do more in the area of disease prevention and health promotion. Much
public health work is done outside the primary health care sector. Funding for public health is
strongly linked to municipal budgets. Municipalities now put up 25 cents of every public health
dollar; many are now considering spending cuts that put public health units at risk of losing
provincial support. The province should consider fully uploading public health to the provincial
level. Better co-ordination of the public health system is needed to include hospitals,
community care providers and primary care physicians. Ontario should copy British
Columbia’s Act Now initiative, which has been cited as a best-practice example for health
promotion and chronic disease prevention. Doctors could do their part by addressing diet and
exercise before reaching for the prescription pad. Patients should heed their doctor’s advice
and make lifestyle changes when requested. The province should do more to reverse the
trend in childhood obesity and explore regulatory options for the food industry.
Medical schools should educate students on “system issues” so that they better understand
where physicians fit in the whole health care system. The schools should also flag current or
potential shortages and carry out the task of labour supply planning.
Pharmaceuticals are a major issue. Ontario needs an open, honest discussion of whether
there should be more public coverage of pharmaceutical costs. At the same time, we should
ask if payments under the Ontario Drug Benefit (ODB) program, which covers almost all of the
cost of prescription drugs for seniors and recipients of social assistance, should be linked
more directly to income. One option is to make the portion of pharmaceutical costs paid for by
seniors rise more sharply as income increases. A better option is to link the benefit not to age,
but to income only. This option would greatly strengthen the equity of the program and remove
a large brick in the “welfare wall” by covering low-income non-seniors who do not receive
social assistance. Savings would obviously be greater under the first option. The <strong>Commission</strong>
regrets that there was no modelling of these options that would have clarified the net fiscal
impact; it should be done. In 2003, British Columbia changed its age-dependent program into
one that links solely to income.
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