Hospital Management – Cancer Care Ontario
1. What are the main demand-side and supply side factors leading to the wait time problem?
In 2011, Ontario experienced an unacceptably long waiting list for its breast and prostrate cancer patients in need of treatment. Sometimes, a patient could be on the waiting list for over 2 months. The wait time problems were as a result of several demand-side and supply-side factors. One of the demand side issues was lack of priorities mismatch between Cancer Care Ontario (CCO) and the front-line staff. While radiation oncologists received “fee-for-service for consultants, treatment prescription and supervision, and follow-up visits” (Bernard, Smith & Rasmussen, 2013, p. 4), their fee on radiation planning was however pegged on a salary. No consideration was given to the number of patients they attended to. Consequently, the only financial incentive available to oncologists was to attend to as many patients as possible during follow-up, as opposed to attending to new patients. This culminated in longer waiting lists.
Another contributing factor was the decision by the CCO to distribute budget allocation via envelope funding, with the budget for an individual facility fixed regardless of the volume of patient. Accordingly, Ontario had a very limited capability to utilise equipment and facilities in the treatment of cancer. There was also increased demand for radiation therapy occasioned by an increase in the aged population who constitutes the majority of breast and prostrate cancer cases. Also, advances in knowledge and medical technology meant that radiation was needed in various treatment courses, including the in the treatment of various types of tumors.
On the supply side, there was a shortage of radiation therapists, oncologists, and medical physicists. The phasing out of diploma programs for radiation therapists in favour of a three-year bachelor program meant that there would be a gap in the supply of 50 new qualified radiation therapists every year. For example between 1997 and 2002, there were no graduating radiation therapists in Ontario. The shortage of human resource also meant that existing health care workers often ran into conflicts with CCO for having to work under a highly stressful environment.
2. Which of the options for reducing Ontario’s cancer treatment wait-times is best?
Of the three options of reducing Ontario’s cancer treatment wait-times considered by Dr. Levin and his team, the one involving a public-private partnership is by far the best. The inclusion of a private entity into the equation would help to inject a sense of efficiency and effectiveness. These are the two key ingredients lacking in government institutions such as CCO. The bonus incentive would undoubtedly inspire the private company to meet its target and in the process, save the Ministry a lot of money every year (Bernard et al., 2013).
The private company would be using the existing facilities in Research Cancer Centers (RCCs) across Ontario. Moreover, it would be operating after the regular operating hours of the clinic, meaning that it would not be interfering with the operations of the clinics during the day. By paying its staff nearly double what their colleagues working with the Ministry earn, the company would effectively be providing its employees with an incentive to meet the company’s goal. While the option of scaling up the capacity of the health care system by improving workforce planning and recruitment is also laudable, we must remember that the same system is dogged with a lot of inefficiencies and bureaucracies, and the idea of bringing on board a private company is meant to circumvent such red tape.
Bernard, K., Smith, A., & Rasmussen, H. S. (2013). Cancer Care Ontario: An Innovation
Strategy for Managing Wait Times, Ontario, Canada: Ivey Publishing.