Wednesday, 7 March 2012

Healthcare in Ontario; A Call to Action

Call To Action, an article by Nan Brooks published in Longwoods eLetter March 1, 2012

John Ronson, Will Falk and I have been having a public debate about the future role and structure of the healthcare system. While the discussion focused on the role of the Local Health Integrated Networks (LHINs), concerns about the balance of power were also raised.

The debate surrounded the balance of power between players in the system. Options to recalibrate the authority and responsibility within the system to increase sustainability, enhance access, and maximize quality were debated, particularly as it relates to the Ministry of Health and Long Term Care (MOHLTC), the LHINS and the hospitals.

Now the Minister of Health and Long Term Care, The Honorable Deb Matthews, has started to weigh in publicly on the topic. In her recent document “Ontario’s Action Plan for Health Care: Better patient care through better value from our health care dollars” she outlined the plan to transform the health care system. Did she address the issues raised by the essays?

Primary Care

Mr. Ronson’s original essay “LHINS at Five Years – What Now?” indicated that the role of the LHINs is problematic, particularly because primary care is outside their responsibility, resulting in models of care that are failing the patient. With the objective of providing faster access and a stronger link to family health care, The Action Plan:

“….. will integrate family health care into the LHINs. Together, we will identify a model that brings planning and accountability for the full patient journey under the LHINS. However, the Ministry of Health and Long-Term Care will continue to have a funding role with Ontario’s doctors.”
This is a first step, and the degree of impact will be largely dependent on the extent of the LHINs’ funding responsibility. We have seen in the past with the District Health Councils how planning services without the ability to allocate funding created great expectations and limited results. Mr. Ronson stated, “We need to create single points of accountability wherever possible. “ This initiative, absent details about funding accountability, does not reach that goal.

Other than primary care, the Action Plan is fairly silent on the role of the LHIN and the structure of the health care system. I would suggest - and in fact am hopeful – that the outcomes of the LHSIA (Local Health System Integration Act) review due in June will provide greater insight into the future of the LHINs. In the meantime, it is reasonable to postulate that the recently announced role expansion would seem to indicate that the LHINs are here to stay, and the trend would be toward increasing their authority.

What, then, was in the Action Plan? Did it have any substance? There were a few very clear messages in the Action Plan for two major players in our healthcare system: shift of funding from hospitals to community; shift of services from hospital to community; shift of funding from physicians to community.

Shift of Services from Hospital to Community

There is very definitely a greater focus on chronic care management. The MOHLTC finally updated the incorrect statistic we have all been using of 1% of the population being responsible for 49% of the hospital and CCAC funding. They replaced it with two more accurate and equally compelling statistics
  •  1% of the population accounts for nearly 34% of our health care spending, and

  •  10% of the population accounts for nearly 80% of our health care spending.
The plan contends that a continued focus on how to manage the care of the 1% and then the 10% is the key to sustainability. Further, the proposed solution is to keep these people away from the hospital by providing better patient care and additional resources in the community. In the absence of additional revenues, the Minister made it quite clear that funding in the community sector will now grow faster than the hospital sector.

This growth will be accomplished in two ways: through shifting existing services that do not require the high tech high cost infrastructure of a hospital to the community (such as the Kensington Eye Institute); and through directing new funding to the community sector.

Shifting Funding

A clear shot was sent across the bow of the hospitals and physicians with the following statement:
"We’re going to have to make tough trade-offs and shift spending to where we get the best value for the dollar. For example, a one percent increase in compensation to physicians is equivalent to the funds needed to pay for home care for 30,000 seniors. A one per cent increase in funding for hospitals is equivalent to the funds needed to pay for over five million hours of home care.”
This begs three questions in particular:
  1. Are the LHINs ready to reallocate resources amongst hospitals and community?

  2. Is the government going to take a hard line with the Ontario Medical Association in the upcoming negotiations to restrict the increase in fees?

  3. Is the minority government going to have the stamina to stay the course of this Call to Action?
It is clearly time for us all to put aside our immediate organizational interests and think in the long term. What system do we want supporting us as we age and deteriorate? As I get closer to retirement, the need for excellent chronic care, home care, and support for the aging process somehow becomes a higher personal priority. We need to get this right. If we don’t, we will all personally suffer the consequences. As personally vested as this position is, it is also the one that is sustainable and above all true to the values of our health care system.

Link to the article at

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