Merger talks should focus on services

Public health was in the spotlight during the COVID-19 crisis, but generally is pushed out of the spotlight in comparison to Ontario’s two main health-care actors — hospitals and doctors.

Public health service focuses on prevention of disease and illness through programs like vaccination and public education. For a fraction of the cost of hospital beds and physicians salaries it has an outsized impact on community well-being.

Peterborough Public Health (PPH), which delivers those programs here, is back in the news as it considers a potential merger with the City of Kawartha Lakes and Haliburton health unit.

Any merger would be a co-operative venture. Both sides have hired consultants to report on the ups and downs of joining together and are discussing how that might work.

But the impetus for merger comes from the provincial government, which covers the bulk of PPH’s annual costs.

The last time this happened, Premier Doug Ford’s government ordered a major revamp of the network, reducing 34 public health units across the province to a total of 16. Peterborough would have been part of a combined service stretching from the east side of Scarborough through Durham Region to Apsley.

That mega-merger died under a storm of public criticism and concern.

Last year, the province announced a new approach. Health units that voluntarily join together would have all merger costs covered.

Provincial officials are saying mergers will make service delivery more efficient, but the goal is not to cut costs. That messaging shows the Ford government learned from its past failed effort.

Quality health care is an easier sell than high-efficiency, big bureaucracy management systems — in part because bigger seldom seems to result in lower costs or better service (see the track record of Local Health Integration Networks, which the previous merger plan was based on).

It will be up to the two health units to decide if they can deliver better service as a single entity. But there is no getting around the fact that money and budgeting plays a role. There should be savings in management costs, particularly staffing. That money would be available for programs.

Local taxpayers have a direct interest in the financial side of a merger. In recent years, municipalities have covered about 30 per cent of health unit budgets. In Peterborough, property taxpayers will contribute $1.78 million this year.

While that represents just one per cent of overall property taxes collected here, the total has been rising dramatically. PPH got double-digit increases from the city in each of the past two budgets, in part because the province froze public health funding and city council agreed to help make up the shortfall.

A potential merger is one of two changes that could help put provincial/municipal costs back in balance. The province, along with its offer to fund merger costs, has committed to bumping up base funding for all health units.

The promise to cover 75 per cent of costs — up from roughly 70 per cent — could mean $500,000 more in base provincial funding for PPH.

However, the province has also said annual increases will be capped at one per cent for the coming three years, well below the likely inflation rate.

Public health funding has been something of a shell game for two decades. A merger is not likely to end the financial complexities, so PPH and its potential partner should focus on whether health-care services will improve. If so, merger is the way to go.

It will be up to the two health units to decide if they can deliver better service as a single entity. But there is no getting around the fact that money and budgeting plays a role