Busting the myth of bloated health care bureaucracy

Eighteen years ago, six Ontarians died from the contaminated water tragedy in Walkerton. This sad episode in our public health history was caused by improper chlorination practices undertaken by employees of the local water utility. Officials in the provincial Ministry of the Environment failed to hold the utility accountable for poor water treatment practices that the ministry had recognized for years prior to the outbreak.

This cautionary tale demonstrates the risk inherent in the urban legend that Ontario suffers from “bloated bureaucracy” in the Ministry of Health and Long Term Care. This impression is being generated by false statements that are repeated frequently enough that they risk being accepted as fact and need to be refuted.

A column published June 25 in the Globe and Mail suggested that the number of senior officials in the ministry had increased from six to 22 in the past 15 years. This article was revised two days later when the paper was presented with irrefutable evidence that the number of senior officials in the ministry is the same today as in 2003.

Similarly, the former health critic for the Progressive Conservatives, Jeff Yurek, wrote in the Toronto Sun that the number of health bureaucrats in Ontario exceeded the number of family doctors. Yurek counted staff in the Ministry of Health, in the Community Care Access Centers, the Ornge air ambulance agency, Public Health Ontario, eHealth Ontario, Cancer Care Ontario, Health Quality Ontario and Local Health Integration Networks (LHINs). Characterizing health-care bureaucrats as staff who “never interact with patients,” Yurek claimed there are “well over 13,000” employees in a “bloated bureaucracy.”

He then compares this estimate to the number of members of the Ontario College of Family Physicians, which represent 10,500 family doctors. Mr. Yurek presumably knows that many family doctors do not belong to the family physicians college.

Let’s use Yurek’s definition that a bureaucrat “never interacts with patients” to evaluate his claims of “bloated bureaucracy.” Of the 3,053 employees of the Ministry of Health and Long Term Care proper, more than 40 per cent (1,250 staff) interact directly with patients and their families by answering 911 calls in ambulance call centres, assisting Ontarians with drug or assistive devices claims or inspecting long-term care homes.

Since Community Care Access Centres, which were formerly responsible for home care, were merged with LHINs a year ago, all of the community care governance and administration cost has been eliminated and reinvested in home-care. This has resulted in 100 per cent of the 6,775 former community care staff referred to by Yurek becoming care co-ordinators (mostly registered nurses). They all have direct interaction with Ontarians assessing their need for home-care and arranging service delivery.

At Ornge, the majority of the 600 staff are pilots and paramedics providing round the clock, 365 day service to critically injured Ontarians requiring air ambulance services. In Public Health Ontario about 60 per cent of staff are laboratory technicians responsible for testing Ontario blood samples for communicable diseases, such as hepatitis and HIV.

Revising Yurek’s math to eliminate staff with “direct interaction with patients” from his “bloated bureaucracy” totals we can estimate that Ontarians are served by 1,800 bureaucrats in the ministry, at most 200 in Ornge and 400 in Public Health Ontario, 763 at eHealth, 800 at Cancer Care Ontario, 200 at Health Quality Ontario and 600 at the LHINs.

By this estimate, there are about 4,800 employees of the Ministry of Health and Long Term Care and its agencies who have no direct interaction with Ontario patients. This number represents about one third of primary care physicians practicing in the province (including non-members of the Ontario College of Family Physicians).

Rather than disputing whether 4,800 bureaucrats is the right number, let’s review some of what these bureaucrats accomplish. 

The 630 staff in the Ministry of Health and the team at eHealth Ontario are responsible for operating and maintaining the claims services that pay all provincially funded health professionals for their services and ensuring that Ontarians get access to publicly funded drugs and devices. 

This team also maintains, and in most cases have built, the provincial information systems that record all narcotic prescriptions in the province, all publicly funded drug prescriptions, all school age immunizations, all lab test results and results of digital imaging tests, as well as hospital clinical records. Overall, the ministry IT/IM team and eHealth Ontario manage more daily transactions than Canadian banks with a total of about 1,400 staff.

The 100 ministry staff working in the Ontario Public Drug Program will save Ontarians more than $1 billion in 2018/19 by negotiating better prices and better access for publicly funded drugs. The wait times teams at Cancer Care Ontario and Health Quality Ontario collect wait time information for Ontarians undergoing surgery, cancer or cardiac care as well as other quality data from the health system. This information is crucial to the performance of an effective system since without accurate measurement management will always fail.

There are always opportunities for enhancing efficiency in any organization and I applaud the decision of the new Ontario government to undertake a line by line review of public service expenditures. 

As the recently resigned Ontario deputy minister of health and a former hospital CEO and cancer surgeon, I know how important it is to ensure that patients get maximal value for every penny spent on health care. However, it is disingenuous and irresponsible to suggest that 4,800 bureaucrats administering the spending of more than $60 billion to care for 13 million Ontarians represents “bloated bureaucracy.” 

We have already learned once in this province what happens when public servants fail to provide appropriate services that protect the public health. Let’s not repeat that tragic mistake.