Ford’s health-care plan has holes
Re Beware health-care ‘super agencies,’ experts say, Feb. 6
Ontario should focus on removing barriers to integrated community-based health care that includes primary care. In its final report, which followed hospital mergers 20 years ago, the Ontario Health Services Restructuring Commission noted it was important to focus on removing barriers to integrated care rather than structure. A study in the U.S. of 300 hospital mergers found they actually increased fragmentation. Canada’s strategy guru, Henry Mintzberg, found no evidence that restructuring improved care. It would be better to make investments in evidence-based practices that provide integrated care.
Ontario has the lowest per capita health-care spending in Canada. The problem is not how much we spend, but how we spend. Ontario has invested the bulk of spending on acute care, rather than retooling our system to better manage chronic disease. Creating better access to more integrated community-based health care will require new spending. The Health Accord between Ontario and Canada will provide an annual investment of $600 million by 2022. If this is matched by the provincial government, the combined $1. 2 billion will approach the $1.5-billion shortfall identified by the McMaster Health Forum. If invested in services such as early psychosis intervention and multidisciplinary stepped care, admissions and readmissions to hospitals will be reduced.
Steve Lurie, Adjunct professor FISW, University of Toronto, executive director CMHA Toronto
Theresa Boyle’s article needs to be applauded. She has drawn our attention to the “managerial fallacy” in health care. Unfortunately, Doug Ford’s government believes that bigger centralized management is the answer to problems such as emergency wait times and hallway medicine in our hospitals. What it does not seem to understand is that the complexities of modern medicine cannot be managed by applying Harvard Business School solutions.
For example, no matter how efficient an emergency room is, one cannot predict when a patient will show up with a dangerous communicable virus and spread it to other patients in the waiting room while waiting to be seen and diagnosed. Although shortening wait times by adding more doctors to the emergency room staff might help, no amount of managerial restructuring will result in better predictions of when such cases may show up. As a result, when faced with this problem, managers usually end up rearranging the chairs in the emergency waiting room because they don’t know what else to do. The trouble is that the government has come to believe that rearranging the chairs is a viable solution and hence directs resources to it. Medical solutions are often much more difficult to come by and take time and medical, as opposed to managerial, expertise. Even then, most doctors will tell you there are medical emergencies that cannot be predicted statistically or otherwise. That is the nature of the beast, which is not understood by the managerial crowd.
J Wagner, Associate professor (Ret.), Brock University