Our hospital is never far away from the leading edge of conversation. Now that the Muskoka Algonquin Healthcare Board has voted for two new builds in Huntsville and Bracebridge, it’s worth taking a closer look at how major hospital projects are funded in Ontario.
I’ll save local numbers for another day. For now, let’s keep it philosophical and ask a question: is it fair to treat small towns and big cities the same when it comes time to pay the hospital redevelopment bill?
Communities in Ontario already do yeoman’s work in supporting hospitals through their local Foundations. Foundations exist to raise money for needed equipment and minor capital upgrades, they front high-profile campaigns and make sure that hospitals are equipped the way we expect. The Ministry of Health does not pay for these things.
That CT scanner? Foundation.
New ultrasound machine? Foundation. Computers? Beds? Furniture? You guessed it, Foundation.
In short – Ministry of Health = Operating, Foundation = Capital
However, when it comes to building or majorly renovating hospitals, the formula changes. The Ministry has a long and extensive vetting process to get in the queue for major upgrades and, subject to approval, will pay for 90 per cent of the project (not a Conservative thing, the policy existed during the Liberal days too). That leaves the community at large to pick up the rest. The community already supports the Foundation, so it should be no problem, right?
Not so fast.
What happens when the capacity of the community and Foundation(s) can’t support all of the remaining costs? In cities, this is where the critical mass of people and the commercial/industrial base kicks in, coming to the table to support their hospitals. But in small town Ontario that doesn't happen nearly as much. There isn’t enough commercial and donor support to cover the difference, so municipalities need to consider local tax increases to ensure the project moves forward.
This needs to change.
Small towns that have the least financial capacity are at the greatest disadvantage. Hospitals don’t come cheap regardless of what size community you live in. A modern acute care hospital is a huge undertaking costing hundreds of millions of dollars. They are required infrastructure for towns to stay healthy and thrive and their important services can’t be regionalized to larger centres.
Nevertheless, I believe there is a role for local government to play in supporting major projects that enhance their community. Many municipalities in Muskoka (including my own) and beyond have formally supported the notion of contributing to the new hospital builds in principle.
The Task Force and Hospital Board has made the right call in looking to the future and ensuring the best quality of care for our residents and visitors. Now, the provincial government needs to recognize the inherent inequity in existing policy and create a level playing field so our community and others, big or small, can have the hospitals they deserve.
Graydon Smith is the Mayor of Bracebridge, Chair of Ontario Small Urban Municipalities and Chair of the Association of Municipalities of Ontario’s Health Task Force.