So much could go wrong with Ontario Health. The Tory government’s new proposed “super-agency” — to be created once Bill 74, the People’s Health Care Act, receives royal assent this summer — will consolidate the province’s 14 local health-integration networks and six other agencies. This is a big job, and given that Ontario’s health-care system accounted for $61.2 billion worth of spending in 2018-19, it’s not hard to imagine how even small errors could end up as billion-dollar blunders.
Beyond dollars and cents, some of the agencies that will soon cease to exist — among them, Cancer Care Ontario and the Trillium Gift of Life network — have made major improvements in patient health outcomes, so reasonable people are concerned that those agencies’ prospects for further success could be diminished when they’re folded into a much larger organization.
This is the kind of big, ambitious reform that governments love when they’re newly elected but tend to be wary of once a few years in power have dimmed some of their enthusiasm. (The LHINs themselves were a product of the first McGuinty government.) Voters will get to pass judgment on it during the next election, as the Tories say they hope to have completed the transition to the new system by then.
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But while there are plenty of reasons this could all end in tears, there are also a number of reasons to be cautiously optimistic about the government’s plan. That optimism needs to start with an honest assessment of the real problems with the province’s health-care system.
The issue that the Tories are attacking most directly is the province’s high administrative costs. Every conservative government promises to find “efficiencies” in bureaucratic trimmings, but Ontario’s health-care administration costs are substantially higher than the national average of 4.5 per cent, accounting for 5.8 per cent of the province’s health spending. Ontario really is an outlier: no other province spends as much on bureaucracy as we do, according to the Canadian Institute for Health Information. Simply spending closer to the Canadian average (bear in mind that some large provinces, such as British Columbia and Alberta, spend much less than that) could free up nearly $800 million for other uses.
This is exactly the sort of problem that the Tories’ super-agency is intended to fix. The LHINs that are now being dissolved had offices, staff, and appointed (and paid) boards — and the government is betting that one single agency would be able to do most of their work more efficiently. The hospitals, care homes, and other agencies that used to be organized into LHINs will instead be reorganized into a larger number of smaller groups, to be known as Ontario Health Teams. The hope is that these smaller teams will have dramatically lower administration costs, given that they will have fewer staff and offices. (Indeed, they may avoid having dedicated offices altogether.)
There’s vigorous debate in the health-care sector over how much administration is enough (other provinces have gone through the kinds of consolidation that Ontario will soon undertake), but there’s little reason to believe that Ontario is incapable of getting its administrative costs closer to the Canadian mean.
What’s raising alarm bells in Ontario are the experiences that other provinces have had with major consolidations. Alberta is whatever the opposite of a poster child for such reforms is: the province created a health-care super-agency in 2008, and the results weren’t pretty. In 2017, Alberta’s auditor general reported that there were still institutional and financial barriers to high-quality, integrated care. Still, the auditor general also praised Alberta Health Services for having led the way on administrative efficiency and the adoption of electronic medical records — something Ontario is still struggling with.
It’s encouraging, then, that the Tories aren’t charging ahead like bulls in a china shop: staff from the Ministry of Health and Long-Term Care told reporters this week that the plan is to proceed incrementally — there will be a three-year transition period to the new system. Staff also said that the government will try to avoid being overly prescriptive about how the Ontario Health Teams are formed and governed.
Ontario Health is not everything that the province’s health-care system needs: the Financial Accountability Officer reported last month that Ontario spends far less on health than other provinces do, and all the administrative efficiency in the world isn’t going to fix that. And unless we spend more money on hospitals, nurses, and doctors, there will be more and more stories about so-called hallway medicine — but that makes finding efficiencies more important, not less.