Why our health ministry is following doctor’s orders

Posted on February 1, 2015 in Health Debates

TheStar.com – News/Queen’s Park – The first physician to helm the health portfolio in decades, Dr. Eric Hoskins is in his comfort zone as he tries to shake up his $52-billion ministry.
Jan 31 2015.   By: Martin Regg Cohn, Provincial Politics

The doctor is in. Now the pressure is on.

As Dr. Eric Hoskins tries to chart a new course as health minister, he’s already offside with his fellow health-care professionals: Physicians walked out of pay negotiations earlier this month, while home-care workers walked off the job this week for higher wages.

Labour strife is par for the course at the $52-billion-a-year Health Ministry, where funding for doctors and nurses consumes most of its budget. But as the new minister is fast learning, reining in salaries to bend the cost curve will only take you so far.

Despite his narrow margin of manoeuvre (or perhaps because of it), Hoskins is determined to make his mark. Taking on the job six months ago, he was fast off the mark — dealing with doctors, laying down the law to medical regulators, and bracing for a possible Ebola outbreak.

Now, he plans to start laying out a broader vision for health-care reform, with a major speech Monday. But the vision thing remains a work in progress.
Interviewed ahead of the speech, Hoskins says his two top priorities — transformation and transparency — are merely a means to an end in a never-ending process.

He has latched onto transparency, which is eminently doable and affordable, as a way to energize the transformation, which is a far more ambitious and elusive goal: shifting health care from a traditional, institutional approach to a more patient-centred model that delivers more care in the home than the hospital.

“There’s a real appetite out there for continuing with the transformation,” he says. “It’s the lens through which I look at everything . . . How is this going to affect the end user, the patient?”

That means a “patient-centred approach to health care, which people have talked about probably since the beginning of time — so it’s not that new — but it’s something we have to constantly strive for.”

Home care is “cheaper, it’s more efficient, it leads to a better quality of life, it’s more respectful.”

Reaching that destination requires integrating health-care delivery to break silos, but it also needs a push. Hoskins believes he can achieve faster results through greater accountability, by putting the accent on transparency, collaboration and innovation across the system.

His impulse toward transparency coincided with Toronto Star stories exposing unprofessional practices at private clinics — which the professional regulators refused to open up about. Hoskins ordered the self-regulating colleges (whose authority is delegated by government) to release their findings and propose fuller disclosure plans by December.

Hoskins stresses the value of “open data and transparency” in helping people identify problems and achieve best practices: “Having it in the public domain builds confidence in the health-care system . . . Our default is we disclose and reveal and share and are transparent.”

In trying to transform the ministry, Hoskins also seems transformed himself as minister. The first physician to helm the health portfolio in decades, he is back in his comfort zone trying to shake things up — more in control than as minister of economic development, where he had limited success nursing Ontario’s ailing economy back to health.

Hoskins concedes that being a doctor helps him “get up to speed faster,” but insists he retains a healthy dose of humility: “I didn’t want to come in here a week after becoming minister and declare, ‘Here’s my vision for the province.’”

That was six months ago. He moved quickly to ban “medical tourism” (wrongly depriving the province of extra revenues, in my view), and is pressing ahead with partial funding of in vitro fertilization (also wrongly, in my opinion, adding extra costs to the system). But he got it right on Ebola and applied the right touch to the ornery Ontario Medical Association.

Now he’s ready to lay out his own direction on transparency, transformation, innovation.

He is also pitching for a national pharmacare program to complete the unfinished business of medicare. The idea is long overdue — pharmaceuticals play a greater role than ever in managing disease — and Hoskins believes with a federal election looming, Ontario can help push it onto the national agenda.

Whether it’s the dream of national pharmacare or the reality of provincial medicare, Hoskins needs willing partners at ground level. A natural loner in the world of wheeling-and-dealing politicians, he is now without allies among his fellow physicians.

An ambitious plan to claw back payments to doctors and reallocate it to community care has alienated the powerful OMA, whose members act as gatekeepers for most health-care spending, which consumes 42 per cent of the provincial budget. Talks to reform an outdated fee-for-service model have been put on hold by the OMA.

Hoskins still belongs to the OMA. And he makes a point of practising family medicine several days a year (pro bono, to avoid any conflict over the minister billing his own ministry).

Seeing patients is a useful reminder that a lone doctor can only help one person at a time, while as minister he can improve the health of an entire province. And as the most visionary physicians quickly learn, you can’t do it on your own.

< http://www.thestar.com/news/queenspark/2015/01/31/why-our-health-ministry-is-following-doctors-orders-cohn.html >

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