Hot! Tory plan puts politics ahead of health in Ontario

TheStar.com – news/canada/politics
September 10, 2012.   By Martin Regg Cohn, Queen’s Park Columnist

Nothing matters more to voters than their health. And nothing costs them more as taxpayers.

Health care soaks up 43 per cent of the provincial budget. And generates a similar proportion of electoral headaches for the party in power.

For the official Opposition, it’s an opportunity for endless critiquing but also constructive thinking. As leader of the Progressive Conservatives, Tim Hudak says he has a prescription for Ontario’s medical and fiscal health in his latest policy discussion paper, “Patient-Centred Health Care:”

• First, his diagnosis of an ailing system: LHINs and CCACs are DoA (yes, dead on arrival);

• Second, his Rx for a miracle cure: “Health Hubs” are us.

Few Torontonians have ever heard of LHINs — Local Health Integration Networks. But in the last election campaign, Hudak’s Tories took aim at these obscure organizations that are a source of resentment in the regions.

Hudak berates them as bloated bureaucracies — choking doctors with red tape and siphoning money from front-line care. Set up by the province in 2006 to improve regional co-ordination, LHINs remain controversial because they reallocate resources among rival hospitals and health care groups.

LHINs can be lightning rods, but Hudak’s criticisms never gained much election traction. And they failed to impress many in the health sector — even in his own party.

Wilbert Keon, the Ottawa heart surgeon and Tory senator, has said Hudak’s argument “doesn’t make sense to me at all.” LHINs are still needed to streamline the system and “the big mistake in health care in Canada is there is too much centralization, too many mega-facilities.”

Hudak kept claiming that pulling the plug on LHINs would save $250 million to $300 million in wasteful administration costs. It sounded like a handsome windfall, but the PCs came up with that number by multiplying $70 million in annual LHIN spending by the first few years they’d been in existence — casting that cumulative figure as recurring savings.

It didn’t add up. Whether one likes LHINs or not, someone or something has to allocate resources in a complex $48-billion system — and administering money costs money.

Clearly, LHINs aren’t perfect. They were part of an ambitious experiment that is due for review — overdue, in fact, because the governing Liberals kept delaying a scheduled reassessment last year to deprive Hudak of election ammunition.

Now the Tories are resuming their LHIN attacks and roping in CCACs — Community Care Access Centres set up by a previous PC government in 1996. A recent report by economist Don Drummond recommended that CCACs could be absorbed, but argued for an even more ambitious regional co-ordinating role that goes beyond what LHINs have achieved so far.

Drummond’s conclusion called for more co-ordination, not less administration.

Yet the core Tory belief is that that LHINs (and CCACs) “are administrative bodies that don’t produce value for money.” A Tory corollary is that little or no money need be spent on administration, since co-ordination has no implicit value — only “front-line care” counts.

Following that logic, the Tories would replace LHINs with something simpler and cheaper: “Health Hubs” — low-cost co-ordinating bodies staffed by local volunteers.

These would be staffed, presumably, by salt of the earth locals, not those big bad bureaucrats from LHINs (who, incidentally, come from and live in the regions they serve). The Tories would replace 14 existing LHINs with 30 to 40 Health Hubs, to be headed by big regional hospital boards.

How, precisely, would hospitals sort out the inevitable conflicts among competing players in the system, in an era when tough decisions must be made about reallocating money to long-term care and home care?

“This does not amount to letting hospitals make all the decisions,” the PC paper argues earnestly. “This will be a partnership among equals. It is also about putting the patient first.”

It’s also about putting politics first. And with PCs at the centre of power, get ready for ad hoc Health Hubs.

< http://www.thestar.com/news/canada/politics/article/1254647–cohn-tory-plan-puts-politics-ahead-of-health-in-ontario >

2 Comments

  1. People vote for candidates that they think can lead the nation as well as provide programs and plans that can benefit them especially when it comes to health. Creating health hubs maybe fine but still having healthcare administrator to manage or supervise would still be better. If only proper measures would be done, costs can still be reduced.

  2. Jonathon Isabella

    The local health integrated networks (LHIN) have a social accountability mandate. A mandate of this type does not imply but accordingly mandates the organization to meet the priority needs of the people it serves. If one looks at the geographic region occupied by the Northeast (NE) LHIN it is massive. Such geographic range brings about a sense of impersonality and distance between the LHIN and community it is mandated to serve – seemingly infeasible to direct priority care needs of all communities. Such situations exist.

    For example, look at the health crisis found in Aboriginal communities all over the North Eastern region. Paying attention to the local news alone gives rise to deplorable health conditions on reserves – Kashechewan First Nations for example. Given a general pass through stats Canada also reveals that aboriginal communities and smaller rural communities suffer the most with health. Their determinants of health are far more complex (and least addressed) than that of the urban individual. It would seem that LHIN’s are not the only answer to the problem of poor health in remote and small rural communities.

    It is not only the soul responsibility of the LHIN to facilitate care. It is also a bottom up issue. Educating individuals (future doctors and allied health care workers) to be prepared for remote and rural communities is essential. This type of approach and subsequent collaboration can be seen in the NE LHIN and the Northern Ontario School of Medicine (NOSM). NOSM is the first medical school to have a social accountability mandate. One that in reality is directing its care towards the priority needs of the community – attracting students with a sincere interest in working in remote and rural communities.

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