More details about the funding of public health services in Ontario are emerging. The Ontario Ministry of Health and Long-Term Care (MOHLTC) had a teleconference with the 35 health units in the province on Thursday April 18, 2019. It was announced the current 75% provincial/25% municipal cost sharing relationship will be altered immediately. It will begin with a 70/30 provincial/municipal split next year. It will move to 60/40 for municipalities with a greater than one million population. It is stated that “municipalities” with that population threshold will be affected, but I suspect the unit of population determination will be the newly formed 10 health regions. For Toronto, the cost sharing relationship will be 50/50. Further, the MOHLTC will no longer fund the 100% provincially funded programs fully, and these provincial programs will be included in the regular cost-shared budget. These measures are expected to achieve the $200 million in savings the provincial government is hoping to realize. Important to note that the savings are from the province’s bottom line, and not that of the public health system, or the taxpayer.
This method of cost savings was attempted between 1998 and 2004. The provincial government downloaded the cost of public health services to municipalities in full beginning in January 1998 as aprt of their Local Services Realignment initiative. Municipalities which are obligated to fund public health services under the Ontario Health Protection and Promotion Act began to highlight the inequity of this arrangement as solely beneficial to the provincial government. The province has the legislation and sets the standards of delivery, while the municipalities pay what the board of health sets as its budget. That amounted to taxation without representation. In March 1999, the provincial government reversed this decision and began funding public health services at a 50/50 split. This lasted until 2004 before the province experienced the Walkerton Water Outbreak, the emergence of West Nile virus, and the SARS outbreak. As a result of those events, many reports and commissions urged the funding relationship be revisited, with some calling for a fully provincially-funded system. The funding relationship was returned to the 75/25 split as it was prior to 1998.
Municipalities have been opposed to covering an increased share of public health costs for several reasons. They have argued municipalities are only given the ability to charge property tax under the Municipal Act to support property. Public health is not property. Further, public health funding should be based on an income redistribution program; that is, communities that can afford public health services are the least likely to need these services, and those that need the services, are those that are least likely to afford them. Therefore, communities with the ability to pay should help those that cannot. Income redistribution can only be done at the provincial level. Increasing the cost burden on municipalities only exacerbates this affordability issue. Lastly, public health activities benefit the province through reduced health care expenditures, yet the cost of these preventative activities are borne by municipalities. There is an inconsistency in those that pay and those that benefit.
An increase in funding should be paired with an increase in control of public health programming at the municipal level. It is hard to envision the changes to the board size, structure, and funding relationship being successful. Municipal input will be more difficult given the span of control of these boards. In response to inquiries about the reduced funding to public health and the impact it may have on community health, the Minister of Health’s spokesperson said “Here’s the truth: our government is strengthening the role of municipalities in the delivery of public health. I assume they interpret strengthening to mean they will be more financially committed.
This decision seems to contravene the commitment of this government to end "hallway medicine". Lessening their resource obligation to health prevention and promotion activities across the province will eventually increase the burden on acute healthcare facilities. Having fewer Ontarians enter the healthcare system would seem like a more appropriate direction.