Executive Summary

Introduction

This paper responds to a request for input to the development of the next Integrated Health Services Plan (IHSP2) for the Toronto Central LHIN (TC LHIN).

Situational Observations of the TC LHIN

The report highlights the very special urban characteristic of TC LHIN including high population density and significant but not unusually high immigrant population (in comparison to adjacent LHINs).

A number of broad characteristics are emphasized including:

• Concerning trends in chronic disease
• Significant health infrastructure with a large share of major teaching hospitals
• High relative patient inflows from surrounding areas are an important element of all aspects of health system usage within the LHIN

The positive economic impact of the health services is highlighted but the report raises concerns about increased health and services demands driven by the challenging economic times.  The important role of charity finance is also acknowledged.  The issue of competitive charity finance is raised.

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Strategic Position of TC LHIN

The report highlights that major components of the health service providers in the LHIN serve a much broader catchment area than the LHIN itself.  The challenges are acknowledged of integrating the community focus of LHIN activities with this ex-regional provider focus.  The financial challenges are also highlighted.

Government relationship to LHINs

In the context of the general structure of the LHIN system, the report considers the challenges posed by the back-looking aspects of the Health-Based Allocation Model (HBAM) as a funding tool.  The report notes the implications of place-of-work health usage rather than place-of-residence and the challenges posed by evolving chronic disease and demographic demands.

Budget-Based Planning

The need for capacity planning and analysis of unmet needs are also outlined.  The importance of considering the full services of institutions including the important clinic and outpatient services is emphasized.

Equity in Health Care

The report summarizes the issues of healthcare equity to emphasize the importance of the cost-effective allocation of health care resources to achieve the greatest gains in health.

Indicators and Accountability

Drawing on a productivity study prepared for the Alberta government, the report outlines the importance of a framework for using indicators to report performance using the example of a comprehensive Australian framework for reporting government performance.

Concluding Themes

This report presents a comprehensive set of ideas to influence the strategic planning process for the Toronto Centre LHIN.  The goal should be to maximize the health status of the population. The broad theme of this report can be found in the key LHIN initial: I for Integration.  The report focuses on the integration of systems, services and planning tools.

The Supreme Court’s Chaoulli decision, disallowing prohibition of private health insurance in Quebec, raises questions of efficiency and equity in delivering health care. Paul M. Jacobson suggests that, however the service is delivered, a single-payer system (government) remains the most efficient model. He argues that alternative insurance will create incentives for service providers to move into more remunerative market segments and away from the principle of universality. He also suggests “a fragmented insurance market will lead to increased inefficiencies in the system.”

This report was prepared as part of a larger project on retail labour market issues undertaken in conjunction with the Innovative Research Group.

Executive Summary

This report reviews the labour market situation in the Retail sector using available secondary data from Statistics Canada.  The study utilizes recent data from a number of sources to examine questions related to labour utilization and compensation.  The results can be summarized in a number of simple stylized facts that can be used to characterize the retail labour market situation and its relative position in the broader workplace picture.

Stylized Facts

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• Recent trends have focussed on strong employment growth driven by general economic performance and the different growth in Western Canada.
• Growth in home-related categories such as furniture, electronics, home repair, home furnishings has been particularly marked.
• Retail provides opportunities to a broad spectrum of workers with a share of immigrants similar to that in other sectors.
• The range of occupations is appropriately broad but the bulk of the jobs are concentrated in front-line sales positions including managers and supervisors as well as cashiers.
• Dominance of front-line personnel (sales, clerks/cashiers) particularly noticeable in sectors such as clothing, furnishings, electronics and small-store sectors.  In these sub-sectors, front-line workers are particularly important to the business model.
• As in all sectors, gains in real incomes for workers have been relatively modest.  In relative terms, real wages increase with education and experience.
• Nominal compensation is rising at similar rates to other occupations but only barely keeping pace with inflation.
• Average wages are higher than median wages suggesting a somewhat skewed distribution, particularly for full-time employees
• The range of weekly wages for front-line occupations shows that some persons can earn very significant incomes in such positions.
• However, university-trained workers occupy a below-average share of the available positions in the sector.
• Sales Clerks have done the least well in compensation terms.
• Because of the nature of the production process in retail, with extended and flexible working hours, the sector provides significant opportunities for persons willing to work part time.
• However, full-time employment is the dominant model.
• As would be expected, in part because of student workers, there is rather more turnover among the part-time workers.  Because the sector is growing, worker tenure remains below average but there is a significant share of workers who have been with their employers more than 5 years..
• Retail is not homogenous in its performance – sub-sector growth rates vary significantly in magnitude and direction.
• Retail sector is increasingly dominated by larger chains and store formats with an employment rather than a self-employment model
• Wages are growing faster in the provinces with fastest growth.  Local labour demand obviously has a strong influence.
• Retail tenure, the time spent with a particular employer, is somewhat shorter than the average but not by much.  In part, this reflects the recent faster growth of retail employment with strong hiring rates.
• Shorter tenure is particularly noticeable for part-time where employment is dominated by younger workers, particularly in sectors such as grocery.
• Retail provides more opportunities to females than many other sectors.
• Retail has a rather lower portion of workers with higher education than the labour force in general.
• Sales and cashiers occupations are particularly attractive for young persons  who may find the part-time work model appealing and necessary.
• Sales and cashiers have lower education and income but there is an apparent return to higher education
• Retail turnover rates are highest in provinces with the strongest growth (Ontario and Alberta)
• Roughly half of workers received no training but that is not much different to other sectors.
• Limited training and benefits for many workers in smaller firms but that also is not dissimilar from other sectors
• As would be expected, larger workplaces can support more training.
• More than 1/3 of retail employees receive no non-wage benefits – partially explained by part-time and shorter tenure.
• As with all private sectors dominated by small business, supplementary benefits remain modest in comparison to the traditionally strongly unionized government and heavy manufacturing sectors.
• However, only 40% of full-time workers have supplementary medical benefits.
• Unlike many sectors, Retail delivers its services in every town providing opportunities everywhere in the country.

Broad Conclusions

Broadly speaking, the labour market conditions in Retail are not as dissimilar from broad trends in the general economy as might be expected.  Most of the differences are explained by the greater emphasis on part-time work, smaller workplaces, and the lower education levels. Adjusted for those factors, training, benefits and compensation are not significantly different from other sectors.

Again broadly speaking, the labour conditions for managers, retail supervisors, retail sales and cashiers are relatively similar across the Retail sub-sectors.  However, the relative emphasis on these occupations is very different in specific subsectors.  For example, the grocery sector emphasizes part-time cashiers whereas men’s clothing provides a strong role for front-line sales workers.  These differences mean that subsector compensation perspectives and labour market views may be very different.

However, the general conclusion is that the general perspectives on the Retail labour market are fairly similar to broad views for other sectors.

 

Our health care system faces capacity constraints from a growing population but also from the very real successes of the medical system.  More people are surviving both birth and disease conditions that only a few decades ago would have been fatal.  This increased survival means that people are now living with more complex health conditions than before.  Optimizing their health prospects may require access to rehabilitation and complex care services.  Changing life styles are also adding to the potential disease burdens that can benefit from rehabilitation and complex care.

This report discusses the challenges facing the rehabilitation and complex continuing care (CCC) hospitals in Ontario.  There are four major themes in the report:

1)     Activity Limitations and Major Trends: The trends associated with temporary and permanent disability or restrictions on daily living;

2)     Rehabilitation and CCC Demand Influences: The consequent demands on the requirement for rehabilitation and complex continuing care services;

3)     Usefulness of Rehab for Disability and Capacity Concerns: Major issues affecting the optimal use of our rehab/CCC system

4)     Usage Patterns: The current pattern of usage in the rehab/CCC system;