By: Hasan Hawilo
Since the Progressive-Conservative (PC) Party of Ontario won the majority government in June 2018, Ontario physicians have been surprised with several healthcare developments. The day after assuming power, the new government announced budget cuts to OHIP+. In October 2018, frustrations with the government’s new Physician Services Agreement (PSA) proposal led the Ontario Medical Association (OMA) to engage in a two-phase binding arbitration process (yes, the same process whose updates have flooded our inboxes). The PSA is a contract negotiated by the OMA on behalf of Ontario physicians regarding compensation and funding for professional activities. However, the most recent and substantial healthcare change proposed by Ford’s government pertains to a large-scale reform. By “committing to new models of collaboration and patient care,” Premier Ford has promised to deal with hospital overcrowding and improve healthcare navigation for patients. But what can we expect of the new healthcare plan announced by the Ford Government?
No More LHINs?
A significant transformation proposed by the Ford government is the dissolution of the province’s 14 Local Health Integration Networks (LHINs). Since April 2007, Ontario’s LHINs have been responsible for allocating and monitoring approximately $30 billion from Ontario’s Ministry of Health and Long-Term Care (MOHLTC) to fund the province’s 14 health regions. While the LHINs have promoted a community- and patient-centered approach to healthcare, they have not been without criticism. For instance, the LHINs’s $90 million annual budget has been disapproved as expensive, and their allocation process as overly-bureaucratic. Furthermore, a 2015 provincial auditor general report suggested that on average, the LHINs had successfully reached only 6 of the MOHLTC’s 15 performance targets. Perhaps more concerning is that discrepancy between the various LHINs’ performance standards could be as large as seven-fold. This concern was echoed by OMA president Dr. Nadia Alam, who expressed that the LHINs possess an “unfairness in the level of service.”
In late January, a leaked draft bill of the PC government’s Health System Efficiency Act revealed that the PC government planned to replace the LHINs, The Ontario Health Quality Council, HealthForce Ontario Marketing & Recruitment, Cancer Care Ontario, eHealth Ontario, and Trillium Gift of Life Network with a single “superagency.” Critics of the draft bill, such as former surgical oncologist and University Health Network CEO Dr. Bob Bell, argued that consolidation of these diverse organizations poses a risk to vulnerable patients whose care may no longer be prioritized. Rather than relieve concerns about the LHINs complex processes, the superagency could turn into an even bigger bureaucratic headache. Others similarly, like former Champlain LHIN director Dr. Rob Cushman, were concerned that a superagency could diminish local and regional control over healthcare.
This significant overhaul of existing healthcare systems was confirmed by Health Minister Christine Elliott on February 26th, when she also announced that Health Shared Services Ontario and Health Quality Ontario would be joining the organizations amalgamated into the superagency. Some healthcare members such as Dr. Nadia Alam, Dr. Doris Grispud, CEO of the Registered Nurses Association of Ontario, and Anthony Dale, CEO of the Ontario Health Association, expressed optimism regarding this proposal. However, New Democratic Party (NDP) Leader Andrea Horwath has cautioned that privatization could be next. Furthermore, Ontario Health Coalition (OHC) executive director, Natalie Mehra, is urgently warning that the bill will not defend the public interest in healthcare. The OHC is organizing town halls across the province to protect existing healthcare and is planning a rally at Queen’s Park on April 30th.
Another of Ford’s major campaign promises involved a significant reduction in hallway medicine, a phrase he’s used extensively since election time last year. While this “emerging subspecialty of medicine” has provided a temporary answer to hospital overcrowding, Ontario’s ageing population and healthcare infrastructure shortages are contributing to capacity challenges requiring long-term solutions. Indeed, as of October 2018, alternate level of care (ALC) patients (those that no longer need hospital care, but are awaiting long-term care) accounted for approximately 16% of acute care beds. ALC has been suggested to pose challenges to both patients and hospitals. Moreover, compared to other provinces and most other developed countries, Ontario has the lowest number of acute care beds per capita, with 10% of Ontarians waiting 41 hours to be admitted to the emergency department.
Home Care Ontario (HCO), a group representing for- and non-profit home care provider agencies, looks forward to Ford’s superagency model as a welcomed opportunity to expand home-care funding. They believe homecare aligns nicely with the new budget vision and a recent government report appears to support this claim. However, given that HCO represents many for-profit companies, they also have the opportunity to capitalize on this healthcare alliance. The PC government has already provided an additional $90 million to address hallway medicine; however, critics suggest that increased integration of home care with other medical sectors will do more to improve outcomes than more bed space or increased home care funding. Innovative solutions, such as transitional spaces to address patients waiting for a new home after being discharged, and reactivation care centers to assist with patient recovery following prolonged bed rest, are areas that physicians suggest would serve as a valuable focus.
In theory, a transformation of this magnitude could integrate care delivery, address hallway medicine, and provide sustainable home care solutions to improve patient-centered healthcare experience. Whether the new provincial healthcare plan will live up to its promises and address current healthcare limitations is something that only time will tell.
Author: Hasan Hawilo
Photo Flikr: Creative Commons, Publicly funded Healthcare in Danger