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This article is the fourth in a continuing series of "Questions and Answers" about the Tavistock Health Centre.
Q. I understand that the Tavistock Health Centre lost money again last year and that a loss is projected for this year. What has happened to the almost $1.4 million raised? What's being done to stop the losses? Are we in any danger of the Health Centre closing?
A. Let's start by going back in time. In 2001 the doctors informed the community that there was a real possibility that the medical clinic would have to close due to the financial pressures of running the office in the current manner. This generated much discussion and ultimately led to a fundraising campaign with the goal of keeping the Tavistock Health Centre open for business. The original goal of $750,000 was established to cover the purchase of the facility from the doctors, recruit a new doctor, and fund operating losses for two years. It was foreseen from the outset that operating losses would occur.
By the time the fundraising campaign was over, almost $1.4 million had been raised. Of that figure $495,000 has been used to purchase the facility, make upgrades and renovations to the building, and purchase needed equipment. Professional services (e.g. lawyers, accountants, auditors), management expenses and recruiting costs have totalled $100,000. Operating losses (the costs of the day-to-day running of the Health Centre) were $47,800 in 2002 for a 6-month period end; $153,100 in 2003; $134,800 in 2004 for a total of $335,700. As of year end 2004, $468,000 remained invested in the bank. An operating loss of $186,300 is projected for 2005. Clearly the Health Centre is not financially sustainable in the long term unless changes are made.
Why are operating losses so high? There are several reasons ... the way health care is managed and funded in Ontario; the community-owned business model at the Health Centre; rising costs for supplies and services; a desire to provide quality health care at our local facility. We read and hear almost daily about problems in the health care system in Ontario ... e.g. fewer graduating family physicians, stress and burnout, aging physicians, inadequate funding from the Ministry of Health. Tavistock is not immune from these issues. In order to attract a new doctor (which we did in 2003) it was necessary to establish a business model that would encourage new physicians to consider Tavistock and not a more major centre where they might enjoy better hours and/or more remuneration. This business model results in higher management costs than situations where a doctor is practising on his/her own. As in all businesses, costs for supplies and services increase over time. The Health Centre now keeps longer hours than it did before fundraising. These longer hours are a benefit to the patients but they come with a cost.
What has been and is being done? Expenses have been reviewed in detail and costs have been cut. As well, we have found different ways of doing things that have effected savings. TCHI and the Tavistock Family Health Network have applied for and received monies from various government sources for computer enhancements. The Tavistock Family Health Network, the Perth Area Network Doctors Association (Panda), and the Mitchell Group of Doctors have jointly applied for Family Health Team (FHT) status. Initial approval has been given by the Ministry of Health. More work needs to be done before the full impact of FHT is known.
What more could be done? Health Centers in other locations have found themselves in a similar situation ... i.e. operating in a deficit. They have chosen various methods of trying to alleviate the problem. Some examples of what others have done include reduction of services (e.g. blood work done at a centralized off-site location; laying off the Business Manager; charging for services not paid for by the Ministry of Health (e.g. physical examinations for schools, camp, employer hiring); charging for appointments that are missed with insufficient notice given by the patient; and charging admin or membership fees (i.e. an annual fee for patients to cover operating and administration costs). TCHI has implemented certain of these methods ... e.g. charging for missed appointments. Other items are under consideration.
TCHI seeks to balance the needs of the patients, the community and our doctors as we work through these decisions. Our vision is unchanged ........."Tavistock Community Health is committed to sustaining and enhancing accessible, accountable, high-quality health care services in response to community needs." The issue is how this is best accomplished. Your thoughts and comments are welcome.
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If you have a question you would like answered, please drop it off at the clinic in the "Questions" envelope posted on the bulletin board in Reception at the Tavistock Health Centre. You may wish to include your name or you may wish to be anonymous. Should you want to discuss a Q&A or any related subject, please call the clinic at 655-2322 and ask for Blain McCutchen, the Business Manager.