Lessons from a ‘super’ fail

Centralization foray in Alberta ended messily

Ontario Premier Doug Ford is on the brink of a decision that could be the worst he will make in his four-year term, a decision that will affect all Ontarians. No service the government provides is more important than health care, but Ford is about to throw the whole system into chaos by creating an ill-advised “super agency” to run everything.

Rather than address well-known health care deficiencies with long-known solutions, Ford and his team would have us believe that restructuring the health care bureaucracy is just what the system needs. Wrong diagnosis, wrong cure.

Any reasonable person would ask how centralization worked elsewhere before plunging Ontario over that particular cliff, but there’s no evidence of that in the slim government report that raises the idea of a super agency. There is no review of the experience of other provinces, no analysis, and no argument made to show why centralization is better. And yet, the new agency is said to be set to go.

Ontarians might want to take a look at Alberta’s experience. In 2008, that province’s PC government decided that Alberta’s health care regions and small agencies ought to be folded into one central health organization. Instead of the hoped-for bureaucratic efficiency, Albertans got bureaucratic chaos and worsening health care results. CEOs came and went with great rapidity. There were complaints of government micromanaging and at one point the whole board was fired.

In 2017, after nearly a decade of centralized health care control, Alberta’s wait times for hip replacements, knee replacements, cataract and bypass surgery were all significantly longer than those in Ontario. The same was true for every major type of cancer surgery. Overall, Alberta’s wait times are seventh-best in the country. Ontario’s are second best.

Organ donation is a little-examined area of health care, but it’s interesting to note that Alberta used to be a national leader in the area and that its performance dipped under centralized control. Ontario’s results have risen continuously and it is now the national leader. It is perhaps no coincidence that Ontario’s cancer care, considered the best in Canada, and its organ donation program are both administered by separate agencies — agencies the Ford government now proposes to suck up into its health behemoth.

Alberta also discovered that centralization is no magic path to lowering health care costs. Ontario spends the least per capita on health care of any province. Alberta, with poorer results, spends the second most.

Finally, in 2015, another Alberta PC government decided it was time to go back to more regionalized health control. Then the NDP got elected and decided to keep the centralized system, saying they wanted to avoid the chaos another system change would create.

So now, despite all of that, Ontario is going to do what Alberta did, even though it didn’t produce expected savings or great health care results. The challenge in Ontario is far greater in scope and scale. Instead of merging a dozen agencies, Ontario will merge 20. The province has more than three times the population of Alberta and a vast geography.

Anyone who has been involved in the merger of even two organizations knows that it takes years to bring them together and not much is accomplished while the new organization figures out who does what and the old organizations power down.

All those points aside, centralization of health control is out of sync with the way health care is delivered. Health care is local by its nature. If you live in Windsor, it doesn’t really matter much what is available in Ottawa, and vice versa.

The PC government doesn’t like Ontario’s Local Health Integration Networks, but the reason they have had limited success is not because they are regional. It’s because previous governments didn’t give them much money or scope to act.

The sole virtue of centralizing health care bureaucracy is that it might reduce the amount of money spent on health care management. Unfortunately, solving that problem would not make any rational person’s list of the Top 10 health care problems to fix.

Ontario is short of longterm care and home care, it lacks universally accessible electronic medical records and it hasn’t properly integrated physicians with the rest of the system. These are discrete, fixable problems. Addressing them will take clear direction and some money.

Attempting to build a better bureaucracy is, at best, a distraction that will consume the remainder of Ford’s term. At worst, it will reduce the quality of health care Ontarians have now.

ALBERTANS GOT CHAOS & WORSENING HEALTH CARE RESULTS.