On March 28, 2018, the Ontario government tabled its 2018 budget (the "Budget") in advance of the upcoming provincial election on June 7, 2018.
The Budget is a departure from a prior focus on deficit reduction, with promises of significant new spending, particularly in healthcare. If implemented, the health budget is expected to grow by 5% to $61.3 billion. The government is proposing an expansion OHIP+ for seniors, a drug and dental care plan for those without private insurance, and additional funding for mental health, hospitals, home care, long-term care, palliative and end-of-life care and other initiatives discussed in more detail below.
OHIP+ was introduced in the Ontario government's 2017 budget and came into effect January 1, 2018. OHIP+ covers eligible prescriptions for all Ontarians who are 24 or younger.
The Budget now proposes to expand OHIP+ coverage to all seniors (65+) beginning in August 2019. Currently, seniors are eligible for prescription drug coverage under the Ontario Drug Benefit ("ODB") program, but must pay an annual deductible and co-payment. If implemented, the OHIP+ expansion would cover prescription medications currently funded through the ODB program free of charge.
Drug and Dental Coverage
The Budget proposes a new Ontario Drug and Dental Program (starting in the summer of 2019) for individuals and families that do not have an extended health plan. The current proposal for the program is that it would reimburse up to 80% of eligible prescription drug or dental expenses, with an annual cap of $400 for a single individual, $600 for a couple and $50 for each child of a family.
The Budget also promises to make significant additional investments in mental health and addictions services. It contemplates an additional $2.1 billion over four years, directed to a variety of initiatives including new acute-care beds, community-based child and youth mental health services (including in schools), and additional supportive housing units for people with complex mental health and addictions needs.
Hospital Services and Infrastructure
There are also significant additional funds proposed for hospital services. The Budget proposes a further $822 million in funding in 2018-19 alone and allocated as follows:
- $305 million to support growing service demands;
- $187 million for an increase in hospital beds;
- $95 million for clinical services and facility costs for new patient spaces;
- $54 million for specialized services including bariatric surgeries, organ transplantations, neurosurgical services and critical care;
- $48 million for MRI hours and surgical and medical procedures;
- $40 million for increased cancer surgeries, gastrointestinal endoscopy procedures and systemic treatments (chemotherapy);
- $25 million for additional cardiac procedures;
- $5 million for new adult critical care beds; and
- $4 million for expanded advanced stroke care.
The Budget also includes approximately $19 billion over the next 10 years in capital spending for new and renewed hospital infrastructure, including projects at the Hospital for Sick Children, the Centre for Addiction and Mental Health, Ottawa Hospital, Scarborough and Rouge Hospital, North York General Hospital, Lakeridge Health and South Bruce Grey Health Centre.
Home Care and Caregivers
The government plans to spend an additional $650 million on home care over the next three years. This would include $180 million in new funding for 2.8 million more personal support hours, 284,000 more nursing visits and 58,000 more therapy visits.
The Budget allocates $45 million to improve working conditions and contract rates for personal service workers ("PSWs"), registered practical nurses, registered nurses and therapists. It also includes $23 million to add an estimated 5,500 PSWs to the workforce; $38 million in education and training for new and existing PSWs; and $65 million over the next three years for a pilot program to establish a Tax-Free Savings Account on behalf of eligible PSWs.
Other Budget Items
- Long-term care - in February 2018 the Ministry of Health and Long-Term Care invited existing and new providers to apply for new long-term care beds. Successful proponents will be announced in the spring. The Budget contemplates spending of $300 million over three years to hire more registered nurses for long-term care homes, and increase the average number of hours of daily care per resident.
- Palliative and end-of-life care - an additional $15 million is pledged in 2018-19 for community-based palliative and end-of-life care. This added funding (together with prior commitments) is intended to support 20 new residential hospices and various other related initiatives.
- Opioid addiction - $222 million in additional funding is promised to support the implementation of the Strategy to Prevent Opioid Addiction and Overdose. The strategy was originally released in 2016.
- Interprofessional primary care teams - the government is proposing funding of $102 million over three years to support new and expanded interdisciplinary primary care teams, and $330 million over three years to recruit and retain professionals for such teams.
- Autism and disability support services - beginning in 2018, the Ontario government proposes to spend an additional $1.8 billion over three years for services for people living with developmental disabilities. The Budget includes an additional $62 million in 2018-19 for the Ontario Autism Program ("OAP"). The government also plans to implement a qualified service provider list for the OAP, introduce new qualification requirements for clinical supervisors, and implement a new quality assurance review process.
- Dementia strategy - the Budget reiterates the government's proposal (first made in its 2017 budget) to add $100 million over three years in overall spending on the provincial Dementia Strategy, including $34.5 million to expand community dementia programs and respite care services.
- Psychotherapy - the Budget refers to an intent to increase publicly funded access to psychotherapy. A recently proclaimed amendment to the Regulated Health Professions Act, 1991, makes certain forms of psychotherapy a controlled act and by December 31, 2019, only members of six authorized regulatory colleges will be able to perform the controlled act.