What's another 12 beds?

That's what St. Michael's Hospital cut this month in anticipation of this week's provincial budget, which is expected to put a lid on hospital funding.

In the face of a $24.7 billion deficit and "unsustainable" growth in health-care funding, the province has signalled radical reforms are on the way for hospitals.

In response, hospitals across the province are trimming beds, services and staff – cuts that health-care watchdogs and hospital unions warn compromise patient care.

But Ontario Hospital Association president Tom Closson says the cuts to date have been "modest" and have not hurt patients.

Still, he admits it's getting close to that.

Closson will be watching the budget closely, expecting hospitals to get no less than a 2 per cent hike on base funding of about $18 billion.

But equally important, he said, is the need for a significant investment in community services to offset ongoing cuts to hospitals.

As hospitals admit fewer patients and discharge patients faster, they are commonly sent home on intravenous antibiotics, oxygen, dialysis and with open wounds – things that used to keep them in hospital for weeks.

The expectation is that visiting nurses and personal support workers will pick up the slack.

But the community sector has not been adequately funded to manage higher demand, said Margaret Mottershead, chief executive of the Ontario Association of Community Care Access Centres.

And demand is expected to rise significantly as the health system tries to get a handle on what's known as the "ALC problem."

ALC refers to an alternative level of care, required by 5,000 patients in Ontario, mostly frail, elderly people who are in hospital even though they don't need to be.

They are waiting to be sent back to their homes with visiting home-care support, into long-term care homes or into assisted living environments, such as a seniors' apartment complex with nearby personal support workers.

Mottershead says community care access centres have introduced many programs in the last few years to ease pressure on hospitals and help deal with the ALC problem, but have not been fully funded for them.

As a result, the centres are forced to ration scarce resources and can't provide all the services required.

"A number of CCACs are having to ... reduce some of those hours for personal support for some people," she said.

"They will say, `If we have to cut back because we have to balance the budget, then Mrs. Jones who would normally get four hours will now get two hours.'

"But they don't put anybody at risk as a result of that," she added. "We make sure the people who have the highest priority needs get the supports."

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For hospital watchdogs such as the Ontario Health Coalition, another concern is that the province has signalled its intention to make hospitals compete with each other for some procedures.

If one hospital offers to do the work more cheaply than a competitor, it would get the work.

"This system has already been tried in the United Kingdom where it increased administrative costs and touched off a storm of controversy," said Natalie Mehra, director of the Health Coalition, a watchdog agency comprising more than 400 grassroots community organizations.

Closson is concerned about such a competitive model, too, but said he's pleased the province has also signalled plans to bring in more "patient-based funding" that would see hospitals funded according to the volume and mix of patients.

Much of the money given to hospitals now has no strings attached.

"If they are going to balance the budget they have to bend the cost curve," he said

"If we want to make health care affordable, we have to do it differently."

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