The Ford government's proposed changes for public health modernization has raised concerns for the province's health units and municipalities.
Marilyn Herbacz, CEO of the Northwestern Health Unit (NWHU), highlighted the potential impacts of centralizing healthcare services and moving from 35 local public health units to 10 regional ones, during the regular council meeting here Monday.
“Such a large change in Northwestern Ontario towards a regional public health entity has little cost savings for the province,” Herbacz said.
"It increases financial burdens for municipalities while decreasing municipal representation on boards of health.
“This would be overwhelmingly disruptive to the system and the resulting system may be less effective and may reduce services for smaller communities,” she added.
There's a different cost sharing arrangement under the new system that is 70 percent provincial and 30 percent municipal.
This will create an estimated cost increase of $1.1 million for the NWHU's obligated municipalities, which equates to a 46 percent increase to the municipal levy.
“The Northwestern Health Unit has not increased its municipal levy for seven years and we understand this impact is significant and will be difficult for all of municipalities to achieve,” Herbacz noted.
Currently the municipal levy is just over $377,000 and with the proposed increase, the levy will move to about $550,000, resulting in a $172,000 increase.
“We hope the number will be a lot less than what we're estimating based on the information that we're getting from the ministry but until we actually have the approvals and the legislation there's no way for us to know that,” Herbacz remarked.
The town's treasurer Dawn Galusha said the estimated tax increase to the NWHU levy would be approximately 1.7 percent, creating a large burden for municipal taxpayers before even starting the budget process.
“It concerns me also that we hear the premier suggesting that municipalities reduce their expenses by four percent on a voluntary basis in the near future and yet here we see an increase of this type being thrust upon us,” Coun. John McTaggart pointed out.
The new cost sharing model will also now include programs that were funded through the Ministry of Health and Long-Term Care (MOHLTC) previously, equating to $2.347 million in the Northwest Region.
“This seems to be the time we live in right now, where the premier and the provincial government seems to think the only that they can save money is by making municipalities pay more,” Mayor June Caul remarked.
Premier Ford announced Monday he would cancel the planned cuts to municipalities for this year, due to widespread opposition and backlash from the public and municipal governments.
“So there will be no impact to our municipality this year that was proposed previously,” Herbacz explained.
“We don't know what the timelines on that will be, but I expect it would now be Jan. 1, 2020.”
So time has been bought but the proposal hasn't shifted, Coun. Douglas Judson noted.
“All of this is taking shape against a backdrop that these changes could give rise to increased public health risk as a result of local accountability and responsiveness if this implements in its current form,” he added.
Herbacz said that Northwestern Ontarians face many unique risks associated with the structural changes that shift to an increased centralization of public health services.
“This could result in less services provided in communities, especially our smaller communities, reduction in local partnerships, potential closure of local offices, and a decline in public health jobs,” Herbacz remarked.
She said this will mean an increased travel time and cost as a consequence for having one regional agency covering the Northwest region which is about 171,000 sq. kilometres in size.
With the new regional agency there will also be less municipal representation on their boards despite an increased financial contribution from municipalities, Herbacz explained.
She also said to council that these health care changes will likely not result in substantial cost savings as the NWHU is already fiscally lean.
“There is also a cost with changing to a regional public health entity, including potential costs from wage harmonization, collective agreements and change management,” Herbacz remarked.
The priority for the NWHU through the province's changes is providing local services, programming needs, and maintaining local jobs.
The NWHU provides a tremendous service in reducing pressure and costs on an already strained healthcare system, Herbacz said.
Every dollar invested in car and booster seats saves $40 in healthcare costs and every dollar spent on tobacco prevention saves $20.
Another example is the clinical services in public health such as immunizations and sexual health clinics.
“If those clinics are not available anymore we would have more pressure on our local physicians,” Herbacz stressed.
“We would have more people going to the doctors and we would have increased wait times.”
Considering the district already has a shortage of physicians, this could have an exponentially negative effect.
Meanwhile, the services the NWHU provide include infectious diseases control, managing outbreaks, testing safe drinking water, restaurant inspections, family support, dental services for financially challenged children, and harm reduction.
The NWHU has 140 staff over 13 offices in 19 municipalities and had a $18 million budget in 2018.
Coun. Wendy Brunetta said healthcare modernization was discussed at the Northwestern Ontario Municipalities Association (NOMA) conference in April and the message was given very clearly to the Minister of Health that in Northwestern Ontario, the health units were not broken.
“We encouraged the minister to come to our area to see how our programs are delivered and see our huge geography,” she explained.
Herbacz said the ministry has been understanding of the unique challenges faced by northwestern Ontario in the past and may make accommodations before the changes are made official.
“We will not know until all of this legislation is passed, but it doesn't mean that because we have one [regional] entity, we still can't operate under separate units,” she noted.
“So we don't know what that looks like and that's what this consultation process is about.”
“As we move forward we'll get more clarity and more understanding on what our positions are and that will help us to move forward through the change,” Herbacz added.
She said the NWHU will continue to work with the town's CAO and will keep the municipality informed as developments occur.