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Will Ontario Do The Right Thing On Health Care Reform At Last?


By Randall White

Those who have watched the subject for too long sometimes say that it takes a while for the right thing to get done in the government of Ontario. But then it does finally happen, often enough. 

The vast public bureaucracy known as the Ministry of Health and Long Term Care  — with a budget of more than $50 billion in the 2014-2015 fiscal year — has been pondering the reform concept of “integrated health networks” since the 1990s. 

This is, sheer common sense might tell you, the most sensible way of organizing health care delivery in a place like Ontario in the 21st century.

The ideal is that we all enrol in networks providing access to the medical and health care services we individually require, with collaborating doctors and other trained professionals, close to home. 

These networks become the focus for provincial government funding and administration. And this makes life easier for aging populations, doctors, patients, and public finance.

If you are lucky in Ontario today, the local health care system you use has been moving towards some form of integrated health network structure for a while now.

Yet to succeed seriously the concept requires bigger changes in traditional health care arrangements. 

By the end of the 1990s, for example, all Canadian provinces except Ontario had established regional health care authorities — a kind of pre-requisite for any effective integrated health networks strategy.

Ontario at that point did have 16 District Health Councils, acting as purely advisory health planning organizations.

It also took a cautious step in the right direction in 2005, when the District Health Councils were abandoned, to make way for 14 Local Health Integration Networks (LHINs) established across the province in 2006. 

This at least sounded closer to integrated health network ideals. (But Ontario did not move to the kind of Integrated Health Networks down on the ground that BC established in 2008.) Money was channelled through the LHINs, critics said, but they were not allowed to do much more. 

Traditional alliances among doctor’s offices, hospitals, and the commanding heights of the Ministry of Health at Queen’s Park were still trying to manage the increasingly complex health care system patients confronted directly where they lived.

The situation was further complicated by the 43 Community Care Access Centres (CCACs) across the province, established in 1996. 

These were meant (in the words of the Ministry of Health) “to help the public access government-funded home and community services, and long-term care homes,” working “together, and with physicians, hospital teams and other health care providers.”

In 2007 the 43 CCACs were reorganized into exactly the same 14 regions as the Local Health Integration Networks. Funding for the CCACs went through the LHINs. But the CCACs remained separate regional organizations with their own mandates. 

The apparent lack of a practical role for the LHINs was a controversial issue in the 2011 Ontario provincial election. But their most severe critics did not form a government.   

Now, more than a year after the Liberals won a majority in the 2014 election, health minister Eric Hoskins and others have been hinting that Ontario is finally going to bite the bullet and do the right thing.

Thanks to various more piecemeal actions by the Ministry of Health and Long Term Care, local health care in Ontario has been gradually moving towards integrated health network ideals for some time. 

Yet for these ideals to be properly realized there needs to be some regional co-ordinating structure between local doctor’s offices and hospitals and the Ministry at Queen’s Park. 

Either the LHINs or the CCACs ought to be doing this job. It seems to have been concluded that when both are trying neither succeeds.

The solution, it also seems to have been concluded, is to get rid of one or the other. And if the objective is serious integrated health networks reform at last, the Local Health Integration Networks probably are the logical survivor. 

The point of departure for current official thought is a November 4, 2015 speech by health minister Dr. Eric Hoskins. 

As he explains: “Our LHIN boards across the province ... have shown to be true local managers of our health care system.” They “must continue to evolve. LHINs have the capacity to play a role that better acknowledges the true importance of local decision-making and local management.”

But can the 14 regional LHINs across the province effectively become true local managers of our health care system, without some considerable shakeup in the vast bureaucracy of the Ministry of Health and Long Term Care at Queen’s Park, as well as the CCACs? Or amongst doctors and hospitals?

And just how serious is Premier Wynne’s government about finally moving the required stakeholder mountains?

These remain very interesting questions — for which we ought to get at least closer to answers in the New Year that lies ahead.





About Randall White

Randall White is a former senior policy advisor with the Ontario Ministry of Finance, and a former economist with the Ontario Ministry of Municipal Affairs and Housing. He is the author of Ontario 1610-1985: A Political and Economic History and Ontario Since 1985. He writes frequently about Ontario politics.
Posted date : December 08, 2015

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