Insights (Essays)

Insights (Essays) June 2011

Report calls for integration of Ontario health services

Keith Leslie

Ontario needs a better planned and more integrated approach to health care if it wants to improve patient services and outcomes while trimming a huge deficit, concludes a special report from hospitals and community care centres.

The Liberal government wants to limit the increase in annual health spending to three per cent — down from an average of 6.5 per cent annually since 2003 — to help eliminate a $16.3 billion deficit. Health eats up over 40 cents of every program dollar the government spends.

A joint report from the Ontario Hospital Association and the Ontario Association of Community Care Access Centres admits spending on health care can’t keep growing at the old rate, but also calls for funding of 3.5 per cent a year plus inflation to beef up community care.

“I run a hospital association, but our view is that the future and the solution is very much in keeping people out of hospitals,” said Tom Closson, president and CEO of the OHA. “If we can build up community (care) by funding it at a higher rate than the rest of the system … we should be able to keep people out of hospitals, and if they do end up in hospital, keep them from being re-admitted at the high rate that’s currently happening.”

Creating more capacity in the community for services such as home care, assisted living, long-term care and day programs, are “critical,” said Margaret Mottershead, CEO of the Ontario Association of Community Care Access Centres.

“We have a strategic alliance with the OHA to try and figure out what those appropriate services ought to be in the community,” said Mottershead. “We really need to have government appreciate that you have to knit all those pieces together.”

Almost 16 per cent of patients in Ontario hospitals should be at home or in an alternate and more appropriate level of care in the community, according to the report.

The two associations note family doctors operate autonomously from Local Health Integration Networks, which are supposed to co-oridinate care in communities. At the same time, public health units are run by local municipalities, and also are not governed by LHINs.

The Progressive Conservatives call the LHINs a bureaucratic waste of money and promise to close them if they win the Oct. 6 election. The Liberals postponed a planned review of the LHINs in 2010 until 2012, but the hospitals and community care association said the work should start as soon as possible after the fall vote.

“Our recommendation is for a legislative review process because health care needs to be integrated, everybody needs to have the same goal, the same vision of what the system should look like and how it’s organized,” said Mottershead. “We would hope the issue of primary care and public health get put into the mix because we want to see a system that is completely integrated from end to end.”

Most people get their health care from their family doctor, not from hospitals, home care or long term care homes, said Closson.

“So part of the system where most people get their care isn’t even under the purview of the LHINs, which are supposed to establish an integrated approach to health care delivery,” he said. “In public health units there’s not a high degree of integration with the rest of the system, and public health is very much at the heart of keeping a population healthy and not needing health care.”

The two associations also want a new agency created to act as the employer bargaining representative with various health-care unions so hospitals, long-term care homes and others aren’t negotiating individual deals. The problem is one small group can reach an agreement that sets a precedent arbitrators will use for other unions, most of whom are not allowed to strike.

“We do believe that to get the best value for money in terms of negotiations with the various unions that it would be best if it was a single agency doing all of them,” said Closson.

The associations said setting clear goals in health care has been successful in the past, pointing to the efforts to reduce wait times for specific surgeries, and believe the same approach should be expanded across the health care system.

The government should produce and circulate five- and 10-year plans that set goals and objectives and spell out exactly how they want to get there, said the report.

“There’s a need to really be well organized after the election to deal with the current financial situation, and to try and drive better outcomes from the system at the same time,” said Closson.

The report is intended as a guide for the government to achieve better health outcomes, better value for taxpayers, and maintain an integrated and sustainable health care system, said Mottershead.

“It’s really important for the whole health care system to understand and to know what that destination is so that everyone can row in the same direction,” she said. “You can’t change everything overnight, so people need to have a clearly articulated plan that provides a real road map.”

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