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.
