Reorganizing Health in Ontario

As part of the Ontario government’s austerity drive, health minister Deb Matthews recently announced plans to save money by reorganizing health care.  To start with, the province’s family health teams will be placed under the control of Ontario’s Local Health Integration Networks (LHINS) so as to help plan and provide physician resources and care more effectively.  In addition, they want to move more routine procedures out of hospitals and into specialized not-for-profit clinics but with little detail as to what might happen.  All in all, there will be efforts to provide more community care and integration of that care with the main health system in an effort to rein in spending.  The health minister in her remarks to the Toronto Board of Trade earlier this week also remarked that the changes “will not happen overnight”.

Will this work?  Well, it has been tried before.  We only have to go back to the 1990s with hospital restructuring and the implementation of home and community care initiatives that nearly 20 years later are still not very well developed.  Why?  It turns out effective home care was really not that cheap after all.  As for handing over physician resource planning to the LHINs, well that suggests another complicated exercise in planning fraught with transaction and administrative costs especially given that the LHINs when they were created were never given any responsibility over core health spending resource allocations – physicians and hospitals.  For LHINs to be effective resource allocators, health budgets would need to be completely decentralized from the health ministry so that LHINs could tailor their health services to local and regional needs.  However, LHINs have evolved more into “planning” mechanisms rather than service providers.  Moreover, at this point Ontario would be a late comer to the regionalization game as other provinces – for example Alberta – have already tried it and it turns out they have retreated back to a more centralized model.  It turns out centralized budget decision-making is more useful when you are trying to cut costs across an entire health system.

It is difficult not to come to the conclusion given the vagueness of statements and pronouncements to date that the Ontario government is treading water on health care reform.  Health is contentious and the government has a minority.  True integration of the health care system in an effort to eliminate duplication of mandates and services, reorganization of physician services, billing practices and hospital human resources, the delisting of less cost-effective services and the transfer of additional procedures to not-for-profit clinics will be controversial.  Witness what happened after the health minister’s musings that reducing the number of C-section births would ease health-spending costs.  The media storm was immediate.  After several days, there was a statement that the government would not be delisting C-sections ands that the government would be encouraging new birthing centers as a better way. Taken at its word, this means keeping the current practices and introducing new ones – which means even more health spending down the road.  In health care reform, tomorrow is yesterday.