I agree with the assessment and recommendations in this essay. The comments echo many of the observations found in a recent article by Professor Gregory Marchildron, titled" The Crisis of Regionalization"..Healthcare Management Forum, Nov 15/2015 Vol.28 No. 6 p236-238...A key passage follows:

"The LHINs offer the opportunity to experiment with performance measurement and payment incentives and disincentives to an extent not offered in other provinces.

By not owning and running any of the healthcare organizations within their boundaries, LHINs have to potential to use, in a dispassionate and objective manner, the power of the purse to shape behavior and encourage better performance. Using an approach developed in the United Kingdom, LHINs could negotiate agreements with healthcare organizations and groups of providers that set clear targets.9 Although controversial as a system of terror and targets using performance measures, the National Health Services has seen outcomes improve in numerous areas and has become the highest performing health system in the world according to a basket of indicators used by the Commonwealth Fund.10"