Ontario’s health system needs change. But has Ford got it right?

Posted on April 26, 2019 in Health Delivery System

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NationalPost.com – Opinion – What’s not yet known is how the Ford health-care regime will work in real life and how it will get local health professionals to work together

The public is starting to get a clearer sense of what Doug Ford’s health-care plan looks like. It is a curious combination of centralization and a perhaps optimistic hope that people delivering health care in local communities will find new, better ways to do it.

Try to picture this structure. At the top sit the premier, the health minister and their provincial bureaucrats. Then we have Ontario Health, a new superagency that has swallowed 21 other agencies and taken on responsibility for improving health-care delivery. Next, there are five health regions, but their boundaries are not yet defined. That might not matter much, because these regional entities are supposed to be the eyes and ears of the superagency, not something with which patients interact.

In the next layer, you will find 10 public-health organizations, down from 35, and 10 ambulance organizations, down from 59. One might have thought that these 10 new service areas might have been married up with 10 health regions, but alas, no. Finally, there are the people who actually deliver health care: the doctors, nurses, hospitals, long-term care homes etc.

That sounds like a lot, and it is, but it’s still a simpler structure than what it replaced. What’s not yet known is how the Ford health-care regime will work in real life and how it will get local health professionals to work together.

So far, the centralization part of the plan is attracting all the attention. The most controversial element is a move to cut $200 million from the $750 million the province contributes to the cost of public health. The province pays between 75 and 100 per cent of the public-health bill now, but will cut that number to between 50 and 70 per cent over three years.

Naturally, this had caused municipal politicians to protest, and it’s not difficult to see why. Their budgets for this year are set, and they didn’t anticipate less provincial money for public health. The municipal types claim that the province’s cut will mean big reductions in public-health services. Unfortunately for them, it’s not that simple. Councillors will have to decide how much to spend on public health. If they value those programs as much as they say that will mean spending less on something else.

Reducing the number of public-health units might well produce some efficiency savings, but this is downloading with a veneer of rationality. The province will now pay public-health costs based on a municipality’s population. Small places will get greater support. It’s a fair approach, unless one compares it to what was done before.

Whether it’s public health or ambulances, municipalities will have less control but still pay substantial tax dollars. It’s fair to say that some health units and some ambulance operations are too small to be effective, but there is no guarantee that people in small communities will get better service after the consolidation, and their municipal leaders will have less ability to make change.

So lots of centralization, but if patients are going to benefit, real change will have to come at the local level. The government says health-care providers of all types are keen to work together and find effective new ways to serve patients better.

There is certainly lots of scope for it. For example, optometrists have four or five years of post-graduate specialty training in eye care, but they can’t prescribe something as common as eye drops for glaucoma because they aren’t medical doctors. Similarly, pharmacists, paramedics and nurses all have the training to do more than they have done in the past.

The question is what will motivate busy health-care professionals to spend time coming up with creative changes? Physicians, in particular, rely on a steady flow of patients to cover costs. Spreading some of their work out to other types of professionals might be a good thing for the system, but not for individual doctors.

If the kinds of local changes the government wants don’t take place, what will Ontario Health do about it? That’s one of the many big unknowns.

The PCs follow a government that spent 15 years fiddling with the health-care levers to little avail. Change is needed, but whether it’s the change the PCs are bringing in remains to be seen.

Randall Denley is an Ottawa political commentator and former Ontario PC candidate. Learn about his new book Spiked at randalldenley.com. Contact him at randalldenley1@gmail.com

Randall Denley: Ontario’s health system needs change. But has Ford got it right?

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