Patients are the losers in health-care ‘reform’
Ontario Health Minister Christine Elliott could not have been more upbeat and excited as she cheerfully unveiled a massive overhaul of Ontario’s troubled health-care system.
As Elliott tells it, the reforms planned by the Ford government will mean Ontarians will soon get better care, fewer patients will be treated in hospital corridors, more seniors will receive care at home and more of it, wait times will be greatly reduced and there will be more beds for long-term care patients.
All this will happen, she insists, because the government is creating a super agency known as Ontario Health to oversee health care across the province. The new body will absorb all 14 Local Health Integration Networks (LHINs) in the province, along with critical agencies such as Cancer Care Ontario and eHealth.
The super agency, which seems eerily similar to a plan considered but ultimately rejected some 20 years ago by the Tory government under Mike Harris to create a Crown corporation-like body to oversee health care, is designed to end “silos” and fix a “disconnected system.”
Like everyone, I hope the new agency is successful.
But I suspect Ontario faces years of chaos and turmoil as the entire healthcare system adjusts to yet another in a long line of bureaucratic transformations that have fallen far short of their lofty promises.
That’s because the plan unveiled by Elliott isn’t a detailed plan at all. Rather, as a longtime Queen’s Park analyst observed, it’s just generalized ideas with no framework for who is really in charge, no timelines for absorbing the various agencies, no reporting lines, no accountability measures and more.
The result will be that patients are the losers — at least in the short-term and maybe over the long term as well. The signs are already evident:
First, there’s no plan to ease “hallway medicine,” which Ford made a cornerstone of his election campaign. In fact, fixing hospital overcrowding doesn’t require a super agency; it requires more money for hospital and long-term care beds.
Second, there’s no move to increase the number of patients receiving home care or increase the number of homecare visits a patient is entitled to receive. The current mess in home care is the result of inadequate funding and the availability of personal support workers and other professionals.
Third, there’s no move to increase access to a family doctor for patients currently without one.
Fourth, there’s no move to increase rehabilitation services for thousands of patients who are now paying out of their own pockets.
Fifth, there’s no evidence there will be any less bureaucracy under the super agency than exists now.
Sixth, there’s no suggestion there will be any money saved by this organizational shuffle that could be put back into direct patient care.
Interestingly, the Ford government has patterned much of the Ontario Health super agency on Alberta Health Services, a similar agency operating in that province. Instead of being a model of efficiency, though, the Alberta health agency is now mired in controversy, with emergency room wait times soaring, infrastructure spending dropping and morale of health workers across the spectrum at stunningly low levels.
Is that the right model to mimic in Ontario?
On the positive side, the Ford government’s plan may well lead to some integration and innovative approaches in delivery of services. In those cases, it will be critical that quality of service and patient experiences and outcomes are tracked and are incorporated into any further refinements.
Still, patients should be asking tough questions. For example, will the Ontario Health teams to be set up to deliver seamless care be similar to the LHINs that are being scrapped? Who will run them? Will hospitals run most of them, giving hospitals huge power and influence over the system?
Clearly, the Ford government wanted to get rid of the LHINs and the Patients First Act brought in by the Liberals, much like Donald Trump wanted to “repeal and replace” Obamacare.
In its haste, though, the government may have created another, bigger mess — with no money saved, no end to “hallway medicine, and no sign of better times for patients. Bob Hepburn is a politics columnist and based in Toronto. Follow him on Twitter: @BobHepburn