Christine Elliott, Ontario’s Minister of Health and Long-term Care, has announced that the government intends to consolidate health care administration with the creation of a “super agency”, dismantling the much-maligned, but often misunderstood, fourteen Local Health Integration Networks (LHINs) that were created by the previous Liberal government in the mid-2000s.
Perhaps not surprisingly, the Ford government has focused on the cost of administration associated with these “bureaucracies”— about $90 million annually of a $50 billion health-care budget, or 1.8 per cent — and that the health system is not much more integrated and navigable from a patient perspective.
Both of these claims are shaky, given that a recent Conference Board of Canada comparative assessment of the provincial health systems ranked Ontario as the second-best performer in the country, behind only B.C.
As is true with the analysis from the Ford government on a host of issues, the real story is more complex than they are letting on, and the fix is missing the bigger set of issues at stake, namely how to create an effective and responsive health care system.
Curiously absent from the announcement of the reforms to LHINs is that they have a dual mandate: to better integrate local health services, which is what the Ford government has identified as underperforming, but also to bring policy planning and decision making down to a more local level. They have been silent on the latter part of the LHINs’ mandate. Why? Because their proposed reforms will necessarily undermine this element.
The core idea behind LHINs — and indeed all regional health authorities across the country — is that the needs of local areas are different, based on a unique mix of demographics, health care institutions, and network of community services, and that decisions on health care investments are better made by those in that area, in particular after close consultation and engagement with the public and patients in that community.
At each of the 14 LHINs across the province, a board of up to 12 locals is appointed by the province, but often with substantial community input into those appointments. The boards are collectively allocated about $26.5 billion to decide how that money should flow into health services in their regions, and they are formally held accountable by the Ministry of Health and Long-term Care and implicitly by the communities they serve.
As part of this work, every LHIN has extensive public engagement with their communities and most have a robust system in place to feed those insights into locally-sensitive policy making. This includes the use of local town halls, public opinion surveys, citizen panels or councils, neighbourhood advisory groups, and other mechanisms to learn about local experiences in the health system to identify the particular needs in various pockets of Ontario.
The government proposal to dismantle the 14 LHINs and create a health care “super agency” will necessarily mean decision making on health snaps back to bureaucrats around Queen’s Park in Toronto. Thus, eliminating LHINs will make health care actually less connected to citizens.
There is no magic number of regional health authorities within a province, as we see quite a bit of variation across the provinces, with some having as many as 17 and others as few as none (meaning decision making resides nearly exclusively at the provincial-level, such as in Alberta).
There is no systematic correlation between governance models and health outcomes in a province, which is not to say governance and administration does not matter, but that it is one piece of a larger debate on how we ought to design and manage a health system that is not only effective, but also responsive to the needs and priorities of citizens.
LHINs have experienced growing pains in the first decade of operations, but generally have arrived at a solid footing in terms of anchoring themselves in their local communities through extensive public engagement and participation in policy planning, and success at tailoring services as such.
LHINs are certainly not perfect, but a serious reform effort aimed at improving health care in the province would grapple with the question of not how many regional health authorities there ought to be, but how they are designed to break down the silos in the health sector to create a more seamless and responsive system of care.
Given the rationale for the reform being focused on the phantom issues of the cost of administration of LHINs — which are in fact below the average of the provinces, according to 2018 CIHI data — this restructuring will cause substantial turmoil in terms of governance without much payoff in terms of health system performance enhancements, all the while undermining what the Ford government professes to care about: the voice of the people.
Carey Doberstein is an assistant professor of political science at UBC and the author of an upcoming book on regional health authorities in Ontario.
https://www.thestar.com/opinion/contributors/2019/02/26/doug-fords-health-care-super-agency-is-a-solution-in-search-of-a-problem.html
Recent Comments