Strengthen Toronto’s communities to improve health for all
Toronto will soon see major changes to its health-care system. These changes are being decided in the backrooms of the Toronto Central Local Health Integration Network (TCLHIN), a body established in 2005 to manage the health-care system through greater community input, transparency and accountability.
While the TCLHIN has held the feet of health service providers to the fire, it has no public accountability. Its board members are appointed by the provincial government and a review of the operation of the LHINs, which was required by legislation to happen in 2010, has never occurred.
The TCLHIN requires service providers to regularly submit data on a series of biomedical indica- tors. The data does not reflect the totality of the work being done and its accuracy is debatable. Yet this is how health-care providers are being measured. Service providers were never consulted as to what indicators would best reflect their work.
The TCLHIN plans to reduce the number of health service providers by 50 per cent. They claim it’s needed because it’s too much work to manage the contracts. It appears that the rationale for a significant change in our health-care system is based on the dubious rationale of too much work for the LHIN staff. The TCLHIN has greatly expanded the administrative burden on health service providers without any significant additional resources.
The LHIN spin is an exclusive focus on biomedical issues. It elim- inates any organizational or service dissimilarity among the providers.
The LHIN’s recent announcement is to partially fund Community Health Centres based on setting a price for each medical procedure performed. CHC providers are paid a salary. CHC doctors do not bill OHIP for services. This reflects the high needs of the patients they serve. More time is required and many of the health issues CHC patients face are driven by factors such as a lack of affordable housing, groceries or, all too often, domestic abuse. The income these centres will receive under this new model will vary, yet their operational costs are fixed.
What Toronto needs is not what the TCLHIN is proposing. We need a system that recognizes and does its best to respond to the so- cial determinants of health. We need to recognize the unique needs of each citizen and community and seek to level the playing field. We need an approach that recognizes the importance of equity and its connection to race, which greatly affects the health status of residents of our city. We need diversity among our providers, not slavish similarity.
People don’t relate to systems; they relate to communities. Toronto has a vibrant community sector. It is now at risk. Toronto’s richness is its diversity and we need to strengthen our communities. Therein lies the real solution to improving our health care for all.