Ontario must trim health spending $2.8 billion by 2019 to meet its balanced budget targets, the province’s Financial Accountability Office warns in a new report.

The 59-page analysis released Tuesday also cautions that “cost drivers” in the system — such as aging baby boomers — raise questions as to whether service levels can hold if growth in spending is kept to 2 per cent a year.

“If the province doesn’t meet its targets…it makes it more difficult to balance the budget,” Peter Harrison, chief financial analyst in the Financial Accountability Office, told a news conference.

Citing controls on the province’s $51.8 billion health budget as “critical” to Premier Kathleen Wynne’s promise to balance the books by 2018, the watchdog said pressures on health spending could, in fact, increase to 5.3 per cent a year by 2020.

“Ultimately, the growth rate of health sector expense after 2018-19 will depend on whether program changes made to date have resulted in efficiencies and quality improvements or simply delayed expenses that will need to be incurred to maintain quality and service levels,” said the report.

That prompted opposition parties to warn patients to expect more crowded hospital emergency rooms and longer waits for medical care under the Liberal government.

“They’re playing a dangerous game here with the health-care system. They’re playing a bit of Russian roulette hoping that they make it to the next election,” said New Democrat MPP John Vanthof (Temiskaming-Cochrane).

“There’s one message in this report. The Liberals are on the way to making even deeper cuts.”

Finance Minister Charles Sousa and Wynne have repeatedly said the Liberal government will balance its budget as promised by 2018, when the next provincial election is scheduled.

Commenting on the report, Health Minister Eric Hoskins said Ontario gave an extra $500 million to hospitals this year and repeated the Wynne government’s call for the federal government to boost funding to the provinces.

“Since 2003, we’ve increased our investment in healthcare each and every year,” he said in a statement, noting the Conference Board of Canada has also warned heath-care costs are set to grow above 5 per cent annually.

Hoskins did not address what the government would do about the $2.8 billion gap.

The report suggested the government find “efficiencies” in health programs but did get into specifics or the policy implications of any cuts.

Progressive Conservative MPP Jeff Yurek (Elgin-Middlesex-London) said the Financial Accountability Office has “revealed a $2.8 billion hole” in the government’s books.

“The Wynne Liberal government is attempting to balance the budget on the backs of patients and our health-care providers,” he said. “Patients are already suffering.”

The budget watchdog, however, commended the government for efforts to reduce growth in health care spending in recent years — including pay curbs on doctors and reducing drug costs — from a 12 per cent increase in 2003-04 to about 2 per cent last year.

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Health spending was forecast in last February’s provincial budget to increase 1.4 per cent in the current fiscal year ending March 31, up to 1.9 per cent next year and 1.8 per cent in 2018-19.

The Financial Accountability Office said cuts of $400 million are needed this year, $900 million next year and $1.5 billion the following year.

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