TORONTO—Ontario is considering major changes to its $50-billion health-care system, including monitoring the performance of doctors who already are fuming over fee cuts imposed by the Liberal government.
“This is about better co-ordinated care and a more seamless, positive experience by patients and caregivers,” said Health minister Eric Hoskins.
A Ministry of Health discussion paper suggests an expanded role for Liberal-created Local Health Integration Networks (LHINs) and shutting down the Community Care Access Centres (CCACs) created by the previous Conservative government.
The province budgets $90 million a year for the 14 LHINs, which are responsible for doling out $25 billion in spending—or half of Ontario’s health-care budget.
Earlier this month, Auditor General Bonnie Lysyk found none of the LHINs ever had met all of the targets in 15 performance areas, and the Liberal government responded by relaxing the targets for some of them.
“The ministry has not developed ways to measure how effectively LHINs are performing as planners, funders, and integrators of health care,” noted Lysyk.
The new discussion paper says the LHINs would be responsible for “planning and performance management” of family doctors.
The Ontario Medical Association questioned the government’s commitment to the reforms given fee cuts of nearly seven percent imposed on doctors this year.
“Strengthening patient-focused care, which the government has indicated is a key priority of these reforms, cannot be achieved while the government continues to cut funding for physician services,” said OMA president Dr. Mike Toth.
“Given the magnitude of the changes being considered and the lack of details provided, Ontario’s doctors have concerns with the timeline laid out for discussion,” he added.
However, the Registered Nurses’ Association of Ontario praised the Liberal discussion paper as “bold and visionary,” and said shutting down the CCACs and giving LHINs more power was a good idea.
“Having two parallel bodies, each responsible for different aspects of our health system, has hindered the system’s capacity to be fully integrated,” said RNAO president Vanessa Burkoski.
Under the Liberal plan, the LHINs also would “govern and manage the delivery of home and community care” as the government diverts funding away from hospitals to pay for more services at home or in clinics.
The government wants to make it easier for people to get a family doctor, and to be able to see that primary health-care provider quickly when they are sick.
It also wants to better co-ordinate care as patients move from hospitals to get treatment closer to home while also reducing levels of bureaucracy, said Hoskins.
“Our proposal would improve communications and connections between primary health-care providers, hospitals, and home and community care,” he remarked.
The paper suggests home care co-ordinators could be used at community health centres, Family Health Teams, and hospitals.
“We’re moving to a system that will have one point for contact,” noted Hoskins.
“The responsibility for home and community care will transition to our LHINs and into our primary care system.”
Nurses urged the government to move quickly to integrate the 3,500 care co-ordinators currently working at CCACs into the primary care system.
“Strengthening inter-professional primary care, and positioning it to take on the role of care co-ordination, is essential to achieving timely access and a hallmark of a high-performing health system,” said Burkoski.
Hoskins said he hoped to introduce legislation enabling the proposed health reforms early in the new year.