I sincerely appreciated the author's opinions and recommendations about the LHINs at five years. The theoretical promise of the LHINs was a body that would have a mandate to improve the “poorly managed transition points of care.” Unfortunately for the growing population of Ontario residents with chronic diseases that promise has not been fulfilled. Yet with that said we need an organization like "IHOs" which will build an integrated continuum of care. This does not have to cost more money to deliver needed services.
On a practical level a body with a stronger mandate inclusive of public health, family practice and other care providers could change our current patchwork quilt of advanced care planning so that a patient’s wishes are recorded and durable along each point of care. This would beneficial to outpatient services like dialysis, acute inpatient care or in long term care. We have regional models in Canada in which this is done. This is one small example of where a body like the LHIN or IHO as proposed, could make a practical difference which both improves quality of care and saves money through avoiding an unnecessary admission to an emergency unit and/or a hospital stay. Presently our healthcare system’s episodic responses to acute illnesses and exacerbations of chronic diseases are proving costly, and inefficient relative to appropriate utilization of our resources. Consequently we need to have a reformulated LHINs or IHOs to ensure that we have an integrated system of care that anticipates and responds along a continuum of a person’s and population’s care needs.