About a quarter of the 360 recommendations in Ontario's new austerity blueprint are aimed at health-care costs, with economist Don Drummond pushing to move services out of hospitals and toward home-based care.

The Drummond report, which was released Wednesday, zeroed in on health because it eats up about 40 per cent of the province's budget. Ontario spent $44.77 billion on health care last year.

Drummond's health-related recommendations to deal with the $16-billion overall deficit include:

• Cap health-care budget increases at 2.5 per cent annually, down from the 6.5 per cent it has increased each of the last eight years.
• Freeze doctor's wages.
• Expand the roles of nurse practitioners and pharmacists.
• Increase mental-health spending.
• Move services online, including appointment scheduling, prescriptions refills and test results.

Jackie Hickey, a registered nurse working in home care, stands to benefit if Ontario health care shifts more toward community care.

"It makes sense that we move services, we move care, we move support to the home," she said, arguing that it will ultimately save the province money.

"That's where people want to age," she said. " Our senior population, they want to remain in their home."

Hickey said treating an aging population at home means the system can be proactive and prevent long-term problems.

"It's providing the services people need when they need it, the right service in the right place at the right time," she said.

However, some health advocates say getting people out of hospitals isn't as easy as it sounds.

"There's 24,000 Ontarians on wait lists for long-term care," said Natalie Mehra, director of the Ontario Health Coalition. "Those are seniors, and it does cause a lot of suffering for people."

Mehra says focusing on community care means hospitals will suffer.

"The numbers don't add up," Mehra said. "What we will see is an attempt to cut more from hospitals, something that has been done now for 15 years in Ontario."

Call for changes to prescription drug coverage

Drummond also said in the report that Ontario can no longer afford to pay for all prescription drugs for everyone aged 65 and older.

"Ontario needs to start having an open, honest discussion about public coverage of health-care costs," Drummond concludes in his 500-page report.

"A minimal step would be to make the portion of pharmaceutical costs paid for by seniors rise more sharply as income increases."

Limiting the increase in health spending will not be easy, he cautioned.

"If [health care] looks like it's relatively rich compared with everything else, just keep in mind there isn't a single jurisdiction in the world that has sustained [just] 2.5-per-cent increase in health in a six-year period over any time in the last 30 years," said Drummond.

"So that might be relatively unprecedented, [but] doable in our view."

With files from The Canadian Press