Getting ready for the seniors

Hospital focus must shift to community health system

It’s no secret: Ontario is getting older. The number of seniors in our province has been steadily increasing and, over the next 20 years, will double. Including factors like increased use of health services and evolving technology, this will result in a substantial increase in demand across the health system. Those services will cost money.

In just the continuing care sector (e.g., home care, rehab facilities, long-term care homes) public spending will need to increase by $16 billion. That doesn’t include an increase in private spending of another $10 billion.

Our provincial government’s response to this challenge is the Patients First Act, signed into law, and currently being put into action. Patients First is a structural reorganization of agencies in the community health system, empowering local health authorities with more responsibility for primary and home health care delivery.

How exactly will this help us take care of double the number of seniors by 2037?

It’s not entirely clear — at least not yet. There is a risk that this reorganization with a friendly name will just shuffle activity from one branch of government to another.

But there’s opportunity for a real transformation in the way we deliver services. Taking care of more seniors does not have to be more expensive. That’s the potential of Patients First: to reorganize our health system to treat patients before they become patients and to organize care around cost-effective, community-based care instead of relying on the traditional, expensive, hospital environment.

There are three major ways LHINs can use their new responsibilities to drive change.

First, improve what they’re doing already. We know better community and primary care can avoid expensive hospital admissions. Yet our health system is still largely organized around hospitals, while the illnesses that affect most patients are chronic and can be better managed in the community.

That’s where LHINs should start to shift the focus of care. For example, why not give hospitals the means and funding to organize their own home care and measure their performance on reducing admissions?

The second is by prioritizing populations according to those who can benefit most. We know that our most socio-economically challenged communities have the highest rates of illness and the lowest levels of primary care support. LHINs should wrap focused support around these areas. For example, why not actively direct home care and primary care funding toward these communities?

The third is to improve population health and disease prevention. Our rates of preventable illness are higher than they could be. What if we focused on reducing them? Population health is an approach to health system planning that focuses on services that allow us to lead healthier lives, today, tomorrow and well into the future.

LHINs can use their new responsibilities to cement a population health approach to all services in their communities. For example, LHINs could collaborate with primary care practices to measure and monitor overall health status and give family doctors the financial flexibility to prescribe any kind of support — like housing or income supports — that result in healthier patients and communities.

In shifting the focus of our health system toward prevention and community care, we will need to be very mindful of Canada’s promise of universal care for all. The Canada Health Act (CHA) is what guarantees that all hospital-based services must be publicly funded and accessible to all. But in the community, the CHA only does so for physician services. This shift to preventive and community-based care needs to be undertaken with a promise of universal access if we wish to create a health system that will effectively serve a greying population.

Patients First could be an incredible moment for health sector leaders to dramatically reshape how our health care is delivered in Ontario — to truly realize the provincial government’s vision to make Ontario the “healthiest place in North America to grow up, and to grow old.”

Kapil Khimdas has worked in senior management roles in health systems in Canada and the United Kingdom. He is a graduate of the Kennedy School of Government and Business School at Harvard University. Danyaal Raza is an expert adviser with EvidenceNetwork.ca, family physician at St. Michael’s Hospital and Assistant Professor with the Department of Community & Family Medicine at the University of Toronto.