--- author: TVO Today date: '2026-04-17' guest: '' layout: post.njk source: https://www.youtube.com/watch?v=zbb28a7vvA4 speaker: TVO Today tags: - healthcare-funding - hospital-deficits - staffing-shortages - patient-care - public-healthcare - healthcare-policy title: 安省医院财政危机：预算拨款不足，私有化担忧与系统改革呼声 summary: 本次访谈聚焦安大略省医院面临的严峻财政困境。专家指出，尽管省政府在预算中承诺增加资金，但实际拨款不足以弥补医院的实际需求和结构性赤字。讨论深入探讨了人手短缺、急诊室拥挤、服务延迟等问题，并对私有化趋势及资金分配提出质疑。与会者强调了稳定医疗系统、增加资金投入、加强人员配置以及引入问责制的重要性，呼吁政府制定基于证据和咨询的长期解决方案。 insight: '' draft: true series: '' category: politics-society area: society-thinking project: [] people: - Natalie Mehra - Otto Kapoor companies_orgs: - Ontario Hospital Association - Ontario Health Coalition - Canadian Association of Emergency Physicians - University of Ottawa products_models: [] media_books: [] status: evergreen --- ### 医院面临生存危机 **Host**: 整个安省的医院都感受到了压力。超过100家医院预测今年年底将出现赤字。在本年度省预算出台之前，**安大略省医院协会**就曾表示，该行业面临 **18亿美元** 的营运资金赤字。那么，这次预算是否起到了作用？**安大略省健康联盟**的执行董事 **Natalie Mehra**，以及**渥太华大学**急诊医学兼职教授、**加拿大急诊医师协会**公共事务委员会成员 **Doctor Otto Kapoor**，很高兴 Otto 你在演播室，Natalie 你在连线。Natalie，我们先从你开始，**安省预算**承诺在明年为医院提供 **11亿美元**，以帮助它们维持运营。这笔钱够用吗？
Original English **Host**: Hospitals across the province are feeling the crunch. More than 100 are forecasting year end deficits. And before this year's provincial budget, the **Ontario Hospital Association** said the sector was facing a **$1.8 billion** deficit in working capital. So did the budget move the needle? **Natalie Mehra** is executive director of the **Ontario Health Coalition**, and **Doctor Otto Kapoor** is an adjunct professor of emergency medicine at the **University of Ottawa** and member of the Public Affairs Committee at the **Canadian Association of Emergency Physicians**. Great to have you in studio, Otto. Great to have you on the line. Natalie, we're going to start off first, **$1.1 billion** promised in the **Ontario budget** for this next year for for hospitals to make ends meet. Does it do the job?
**Natalie Mehra**: 嗯，是的。从预算来看，医院的增长幅度最高为4%。也就是说最高4%。这可能意味着很多事情。但即使是4%，也低于医院实际所需。
Original English **Natalie Mehra**: >> Well, yeah. In context, what the budget said was up to 4% increase for hospitals. So up to 4%. That could mean a lot of things. But even at 4%, it's less than what the hospitals actually need.
### 预算拨款杯水车薪 **Host**: 它们需要多少？
Original English **Host**: >> What do they need.
**Natalie Mehra**: 需要6%才能基本维持现有服务，以应对人口增长、通货膨胀和老龄化压力。事实上，我们医院已经存在问题，正如你所知，非常严重的**人员短缺**。床位太少，或者说，许多手术室或病房因无人手而闲置，无法运转。所以，我们的公立医院有大量的容量没有得到利用，因为它们缺乏资金。因此，它们已经严重资金不足。因此，4%的增长额无法让我们摆脱目前的困境，离我们应有的水平更是相去甚远。尽管如此，我们仍拥有世界一流的医院。安省仍有令人惊叹的世界级医院。只是它们承受的压力太大了。
Original English **Natalie Mehra**: >> 6% just to maintain essentially existing services to meet population growth and inflation and ageing pressures. The truth is that we already have a problem in hospitals, as you know, very serious staffing shortages. Too few beds left, staff did an operation or are sitting there unused because they're not staffed to be run the majority of the time. So we have all kinds of capacity that isn't being used in our public hospitals because they don't have the funding. So they're already very severely underfunded. That point that up to 4% doesn't get us out of the situation we're in, and nowhere near to where we should be. That said, we have world class hospitals. We still have amazing world class hospitals in Ontario. It's just that they're stretched too far.
**Host**: 好的。我们来听听你的反应。
Original English **Host**: >> All right. Let's let's get your your reaction.
**Doctor Otto Kapoor**: 嗯，正如 Natalie 所说，医院需要6%的增长才能维持现状。而我们谈论的是最高4%。但这假设我们一开始就处于一个良好状态。而我们知道事实并非如此，就连安大略省医院协会也表示，我们大约有10亿美元的结构性赤字。我们正在看到这种影响体现在**急诊科**，那里是社区和医院问题汇聚的地方。我们已经看到了**医院过度拥挤**的影响，这导致了急诊过度拥挤，从而导致了漫长的等待和护理延误，有时甚至是危险的护理延误。
Original English **Doctor Otto Kapoor**: >> Well, as Natalie said, the hospital needs 6% just to keep up with the status quo. And we're talking up to 4%. But that assumes we're in a good position to start with. And we know we're not even the even the Ontario Hospital Association says we've got about $1 billion structural deficit, and we're seeing the effects of this in the emergency department, which is where, you know, the community and the hospital problems all meet at once. So we're seeing we've already been seeing the effects of hospital overcrowding, which leads to emergency overcrowding, which means leads to long waits and delays in care and sometimes, unfortunately, dangerous delays in care.
### 十年计划的紧迫性 **Host**: Odawa。政府还承诺在十年内提供640亿美元的**医疗保健资金**，部分用于运营预算、医院项目和增加床位。这能缓解医院面临的压力吗？
Original English **Host**: >> Odawa. The government has also promised $64 billion in health care funding over ten years, some allocated towards operating budgets, hospital projects, additional beds. With this begin to ease sort of the crunch that hospitals are facing.
**Doctor Otto Kapoor**: 这将开始缓解压力。但我没有听到足够紧迫感的呼吁。我们多年来一直在进行**削减**，进行**效率提升**，我们一直在“用更少的钱做更多的事”。但我没有看到紧迫感。十年是一个非常、非常长的时间，去等待那些我们几年前，甚至五到十年前就需要开始解决的事情。
Original English **Doctor Otto Kapoor**: >> It would begin to ease the crunch. But what I'm not hearing as much as the urgency we've been doing cutbacks, we've been doing efficiencies, we've been doing more with less for years and years. And I'm not seeing the urgency. Ten years is a very, very long time to wait for stuff that we need to have started years. Five, ten years ago.
**Host**: 我问这个问题时，你摇了摇头。是吗？
Original English **Host**: >> When I asked that question, I saw you shaking your head. Does it not?
**Natalie Mehra**: 这太令人沮丧了。你知道，这种“以后再说，我们会处理医院的问题”。我是说，有些人反复五次从急诊室被送回家，都没有得到诊断。那些在十、二十年前会被收治住院并进行观察的人，你知道，有医疗专业人员看着他们等等。这样他们才能得到诊断并最终获得护理。我们有体弱的老人，在生命的最后几个月被推着出院，这是极其不人道的。我是说，这是规模化的人类苦难。我现在看到的情况，在一个现代国家，在一个现代医疗体系中，是完全不可接受的。这非常令人沮丧，因为我们看到资金正在被投入到**私有化**中。不是说没钱。他们正在投入数百万、数百万用于私有化。他们是故意让我们的公立医院陷入赤字，以迫使进行削减。那就是“削减公共部门，制造危机，强制私有化”。这正是我们所看到的。
Original English **Natalie Mehra**: >> It's so frustrating. You know, this sort of down the road, we'll deal with the hospital problem. I mean, this people literally get sent home five times from the emerg without a diagnosis. People that ten, 20 years ago would have been admitted to hospital and observed, you know, had health professionals watching them and so on. So they get a diagnosis and finally get some care. We've got the frail elderly out the other end being pushed out of hospital in ways that are absolutely inhumane in the last months of their lives. I mean, this is human suffering on a scale. Like what I see now is, is just completely unacceptable in a modern country, in a modern health system. And it's so frustrating because we're literally watching money being poured into privatisation. It's not like there's no money. They are pouring millions upon millions into privatisation. They've just pushed our public hospitals into deficits on purpose to force cuts. It's cut the public, create a crisis, force privatisation. That's exactly what we're seeing.
### 私有化浪潮与资金错配 **Host**: 我可以想象，安大略省政府会说，他们正在通过提供的资金来处理当前的问题。我们也看到了，你知道，Atul 说过，你知道，医院、急诊室通常是很多这些问题的“收容所”。我们已经看到了对**家庭医生**的资助。我们也看到了一些**家庭护理**的资金。这些是否有助于缓解这些问题？
Original English **Host**: >> I would imagine that the Ontario government would say that they are dealing with the current issues, with the funding that they've put. We have seen also, you know, Atul has said, you know, hospitals, emergency rooms, usually a catchall for a lot of these issues. We have seen funding for family doctors. We've seen some money for home care as well. Does that help alleviate sort of those issues as well?
**Doctor Otto Kapoor**: 嗯，我的意思是，安大略省在全国各省和国家的医疗保健支出比例是最低的。所以，再次从宏观角度看，我们看到宣布了资金，有很多公关宣传。但事实上，我们在加拿大的医疗保健总支出比例是最低的。我们的医院支出在加拿大排名垫底。实际上，我认为魁北克省的支出刚刚跌至我们之下，但我们和魁北克省在争夺这个“倒数第一”的位置，而这些后果是由患者承受的。所以，是的，**资金不足**，我们比其他省份落后数十亿美元。并非是我们负担不起。我们省literally 正在花费数十亿美元用于水疗和，你知道，酒精相关的东西，等等，但不是用于医疗保健，而这却是人们的优先事项。但是，如果我们看看医疗保健内部，有各种各样的资金，比如每年现在在医院和长期护理之间有大约10亿美元用于**营利性**人员配备机构，仅去年一年就宣布了3亿美元用于61家新的**私人诊所**。
Original English **Doctor Otto Kapoor**: >> Well, I mean, Ontario funds health care at the lowest rate of all the provinces and countries. So again, in context, we see funding being announced and there's a lot of PR around that. But in context, we fund all of health care at the lowest rate in Canada. We fund our hospitals dead last in Canada. Actually, I think Quebec actually just dropped beneath us, but we vie for the bottom with Quebec, and the consequences are experienced by patients. So no, there isn't enough funding and we're billions of dollars behind the other provinces. And it's not like we can't afford it. Like we're literally our province is spending billions on spas and, you know, alcohol stuff, you know, etc. but not on health care, which is a priority of people. But if we look within healthcare, there's all kinds of money, like one about $1 billion a year now being spent between hospitals and Long-Term care on For-Profit staffing agencies, 300 million just announced in the last year alone for 61 new private clinics.
**Host**: 好的。我想看看更细致的内容，但是，嗯，请说说你的看法。
Original English **Host**: >> All right. I want to look at sort of the finer lines here, but yeah, let's get your thoughts on their.
### 寻找证据驱动的解决方案 **Doctor Otto Kapoor**: 是的，我认为从我们，从我的角度来看，以及从临床医生普遍的角度来看，一个令人沮丧的方面是，存在着好的解决方案。我们知道什么有效。这需要时间。这需要努力，但存在着基于证据的解决方案。而我们所要求的是，将资金投入到我们已经知道会起作用的解决方案中。
Original English **Doctor Otto Kapoor**: >> Yeah, I think part of the frustration from our from my point of view and for clinicians generally is that there are good solutions. We know what works. It's going to take time. It's going to take effort, but there are evidence based solutions. And what we're asking for is for that money to be invested in the solutions that we know already will work.
**Host**: 它们是什么？
Original English **Host**: >> What are they?
**Doctor Otto Kapoor**: 我认为，我们需要改进我们提供护理的方式，这一点需要得到关注。我们有一些方法可以提高医院现有工作的效率和生产力。Natalie 提到了其中的一些，例如我们可以扩大目前医院内未被使用的手术室的使用。在提供老年护理方面也有其他方法。这些都需要做到。到目前为止，我还没有看到一个深思熟虑的计划，能够与医生、其他护理人员、服务提供者进行协商，以确保这些得到落实。Cape can，即急诊医师组织。我们花费了大量时间在一个名为“empower”的项目上，该项目指出我们需要审视我们投资的系统和提供护理的各种方式，而这是一种实现可持续解决方案的方法。
Original English **Doctor Otto Kapoor**: >> And I think that's we need to we do need to do improvements in the way we deliver care that needs to be looked at. There are ways that we can improve the efficiency and productivity of what's being done in hospitals. Natalie mentioned some of them, if that we could expand the use of ORS that are currently in hospitals that aren't being used. There are other ways of looking at how are we providing elder care. Those need to be done. What I haven't seen so far is a thoughtful plan to consult with the physicians, the other caregivers, the providers to make sure that's happening. Cape can, the emergency physician Organization. We've put a lot of time into a project called empower, which says that we need to look at the various ways that we're investing in the system and that we're delivering care, and that is a way to get to a sustainable solution.
### 医院贷款度日：严峻现实 **Host**: 好的。本期节目早些时候，我们听取了一份关于医院财务状况的调查报告的作者的发言，他们为了维持运营、满足运营需求而寻求银行贷款。我需要听听你们的看法。安省居民为什么应该对此感到担忧？
Original English **Host**: >> All right. Earlier in this episode, we heard from authors of an investigative report on hospital finances that they are seeking bank loans to stay afloat, to keep up with operating demands. I need to get your thoughts. Why should Ontarians be concerned about this?
**Natalie Mehra**: 我认为这是耸人听闻的。我是说，这真的是一直在发生的事情。省政府会宣布为医院提供一定数额的资金，他们会一直拖到财政年度的最后，然后宣布一大笔钱，但为时已晚，医院无法用它来聘请员工、避免裁员或削减项目等等。这种情况已经连续发生多年了。现在，军队也不能这样运作，你知道，军事隐喻有点不对，但我们需要医院里的**后备力量**。我们现在就需要。**人员短缺**导致人员短缺。因为当那里没有足够的人手时，受伤的人就越多，生病的人就越多，加班的人就越多，这会扰乱整个系统。而且成本也更高。这就是正在发生的事情。所以，我的意思是，我认为这份报告非常出色。是时候做了。令人震惊的是，安省大多数医院都处于赤字状态，你知道，实际上有70%的医院在寻求贷款。而我们作为公众，正在为我们公立医院的贷款支付利息。省里有钱。你知道，如果我们做出政治选择，我们本可以为医院提供稳定、多年的资金。而现在，我们却要为银行和金融机构的利息支付数百万甚至数百万。在把医院逼入危机之后，这是完全不可接受的。
Original English **Natalie Mehra**: >> I think it's outrageous. I mean, this is really what what's been happening. The provincial government will announce a certain amount of money for the hospitals. They'll hold back till the very end of the financial year, their fiscal year, and then announced a whole bunch of money, too late for the hospitals to be able to use it to hire staff and stave off layoffs or, you know, program curtailments and so on and so forth. This has happened for years running. Now, it's no way to run an army, you know, skews the military metaphor, but we need boots on the ground in the hospitals. We need it now. Staffing shortages beget staffing shortages. And because when you don't have staff there, you don't have enough people get injured. More people call in sick, more people do more overtime, and it destabilises the whole system. It also costs more. And that's what's happening. So I mean, this report, I think it's excellent. It's about time it was done. And it's shocking. So many the majority of Ontario's hospitals in deficit, you know 70% of them actually seeking loans. And we're paying as the public for interest on those loans for our public hospitals. The province has money. You know, we could be actually providing the hospitals with stable, multiyear funding if that was a political choice to do so. And instead, we're paying millions upon millions to banks and financial institutions for interest. After pushing the hospitals into crisis, completely unacceptable.
**Host**: Otto。
Original English **Host**: >> Otto.
**Doctor Otto Kapoor**: 是的，这是一个重要的里程碑。多年来，我们一直在“用更少的钱做更多的事”，并提高效率、精简开支。我们已经看到了其后果：等待名单越来越长，急诊室越来越拥挤，我们无处安置需要入院的病人。我认为，这是一个重要的里程碑，一个人们必须说“等等，我们又跨过了一个门槛”的事件。如果医院依靠银行贷款来维持运营。
Original English **Doctor Otto Kapoor**: >> Yeah, it's a significant milestone. For years and years, we've been doing more with less and more, with less and becoming more efficient and trimming fat. And we've seen the effects of it as growing waiting waitlists and growing crowding in the emergency department with no place for us to send our admitted patients. This is, I think, a significant milestone, an event where people have to say, wait a minute, we've crossed a yet another threshold. If hospitals are relying on bank loans to stay afloat.
### 急诊室内的真实困境 **Host**: Abdul，我不得不问，你知道，Natalie，Natalie 和我一直在谈话，你知道，她做了这项工作很长时间了，我想更深入地了解幕后情况，了解那些急诊室。当资金不足以满足需求时，会对患者造成什么短缺？我们看到了什么？你在那些房间里看到了什么？
Original English **Host**: >> Abdul, I have to ask, you know, Natalie, Natalie and I have been talking, you know, she's been doing this work for quite a long time, and I want to get a better picture behind the scenes inside those emergency rooms. What is the what are the shortfalls do for patients? What are we looking at? What are you seeing in those rooms when the dollars aren't meeting the demand?
**Doctor Otto Kapoor**: 你看到的是，患者们躺在嘈杂、喧闹的地方的担架上，而他们应该在楼上的病床上，接受他们应得的恰当护理。这不仅仅是不舒服。这对病人来说是危险的。我们多年来一直知道，在急诊科多待一天而不是在楼上的病床上，不仅仅意味着你在那里接受的护理质量会下降，而且你的发病率会增加，你的治疗效果会更差，甚至在那次住院期间你的死亡率也会增加。仅仅是因为在急诊担架上多待一天，而不是在楼上。而且这种情况已经持续了多年，不幸的是。而且情况还在不断恶化。这对我们的员工，我们的士气也有影响。我们看到急诊医生和护士，他们当初并不是因为这个原因才进入这个行业的。他们正在倦怠，他们正在离开。这是一个向下的螺旋。不幸的是。
Original English **Doctor Otto Kapoor**: >> Well, what you see is patients lingering in stretchers in loud, noisy places when they should be upstairs in a bed, getting the proper care they deserve. It's not just uncomfortable. It's dangerous for the patient. We know we've known for years that spending an extra day in the emergency department instead of being upstairs doesn't just mean that you get worse care while you're there, but you have increased morbidity, you have worse outcomes, and you even have increased mortality for that hospital stay. Just from an extra day of being in the in a emergency stretcher rather than upstairs. And that's been going on for unfortunately, many, many years. And it's just been continually getting worse. And it also has effects on our staff, our morale. We're seeing emergency doctors and nurses who are who are that's not what they were went into that field to do. And they're burning out and they're leaving. And it's a spiral going downwards. Unfortunately.
### 稳定医护人员：核心诉求 **Host**: 如果你现在能有机会和政府对话，你会问什么？以便在这个省更好地资助医院并取得进展？
Original English **Host**: >> If you had the ear of the government right now, what would you ask? In order to make progress in funding hospitals better in this province?
**Natalie Mehra**: 嗯，我认为在资金层面，安大略省通常是全国的平均水平。我们人口最多，所以我们通常会拉高全国的平均水平。我们现在在资金方面是垫底的。所以他们确实需要认真审视资金问题。他们需要稳定**医护人员**，因为一旦稳定了人员，其他一切都会到位。护理，没有**工作人员**就没有护理。当然，当你的人员不稳定时，你就要花费巨资，每小时最多三倍的费用来支付，你知道，**机构护士**等等。而你却因为更多的缺勤等原因，让你的人员配置状况变得更糟。所以他们必须稳定人员。这也适用于**家庭护理**，适用于**长期护理**，适用于**初级保健**。我们应该，我们真的需要一个实际的计划来稳定整个医疗系统。
Original English **Natalie Mehra**: >> Well, I think on the funding level, Ontario normally is the average of the country. We've got the biggest population, so we usually pull the average of the country. We're dead last in funding. So they do actually have to look seriously at the funding. They need to stabilise the staff because once you stabilise the staffing, everything else kind of falls into place. The care, there's no care without staff. And of course, when you have unstable staff, you're paying a fortune up to three times per hour for, you know, agency nurses and what have you. And you've, you've made your staffing worse by, you know, more absenteeism and so on and so forth. So they've got to stabilise the staff. That applies also to home care. It applies to long term care. It applies to primary care. We should just we need to have an actual plan to stabilise the health system. Now across the system.
### 问责制与系统稳定 **Host**: 我将把最后发言的机会留给你。
Original English **Host**: >> I'm going to give you the last word here.
**Doctor Otto Kapoor**: 我认为，我真正希望看到的是一个基于咨询、基于我们所知道的证据——我们已经知道什么有效的——的深思熟虑的计划。而且，从根本上说，它需要在各个层级都有问责制，不仅仅是在基本的患者-临床医生层面，而且要一直向上追溯到组织，直到政府和卫生部本身。
Original English **Doctor Otto Kapoor**: >> I think what I think, what I'd really like to see is a thoughtful plan based on consultation, based on the evidence that we know of, what we already know works. And fundamentally, it needs levels of accountability at every level, not just at the fundamental patient clinician level, but accountability all the way up to Organization and up into the government and the ministry itself.
**Host**: 好的，我们今天就到这里。Natalie，我非常感谢你的时间和你的见解。非常感谢。
Original English **Host**: >> Well, we are going to have to leave it there. Natalie, I really appreciate your time and your insights. Thank you so much.
**Natalie Mehra**: 谢谢。
Original English **Natalie Mehra**: >> Thank you.