Ontario's government and its critics
alike agree that recent healthcare reform — a rejigging
of the Ministry of Health and Long-Term Care's organizational
structure, which came into effect on April 1 —
promises to realign the balance of power in the Ontario
medical community.
But that's where the agreement
ends. On the questions of how that balance of power
will actually change, and who will benefit from the
changes, the two sides could hardly be further apart.
MOVING
TARGETS
According to the government, the restructuring —
a transfer of much of the day-to-day administrative
and funding decision-making from the Ministry of Health
to 14 Local Health Integration Networks (LHINs, commonly
pronounced as one syllable, rhyming with "tins") —
is a "devolution," or decentralization, of authority.
Health minister George Smitherman is touting the plan
as a way to reduce wait times, improve quality of care,
and make the healthcare system more efficient and sustainable.
But the Opposition NDP and public
healthcare advocates like the Ontario Health Coalition
say the advent of the LHIN system is nothing more than
a decoy to catch some of the flak long-aimed at the
Ministry of Health. They also accuse the LHIN legislation,
passed last year, of failing to decentralize authority
and of increasing the likelihood of a rise in the private
delivery of publicly funded services — charges
roundly denied by officials in the LHIN system.
THE
INSIDERS
"This is not a decentralization of anything — except
as a shield for the government when making unpopular
decisions," says Ontario NDP MPP and health critic Shelley
Martel. "LHINs are absolutely agents for the government.
The folks [LHIN CEOs and board members] are selected
by the government," she says. "They are creatures of
the government, and they are administering whatever
money they get from the government to do what the government
was doing before. The way the Minister [Smitherman]
tries to sell it as though this makes decision-making
better in the communities is absolutely false."
"The creation of the LHINs sets
up a system where it is harder to pin anything on the
Minister of Health," says Eduardo Sousa, the Ontario-Quebec-Nunavut
coordinator for the Council of Canadians and a member
of the Ontario Health Coalition. "We are concerned about
transparency and community control. The LHIN boards
are entirely appointed by the government, so we are
concerned about democracy." Mr Sousa draws a parallel
between the LHINs and Ontario's school boards in terms
of their roles in engaging community participation.
"But the difference," he stresses, "is that the school
boards have a certain measure of accountability because
the boards are elected, but that is not the case with
the LHINs."
Paul Huras, CEO of the South East
LHIN, says the Ministry is not attempting to off-load
accountability. "I see nothing in our discussions in
the Ministry or in our 14 organizations that suggests
that," he says. "The Ministry ultimately is held accountable."
The decentralization approach —
Mr Huras prefers "devolution," which he says emphasizes
local decision-making contained within an organized
overall system — will change the Ministry from
a managerial role, doling out huge sums of money, to
a stewardship role supporting regional projects. "It's
a two-way street," says Mr Huras, denying suggestions
that LHINs merely act as arms of the government.
Ontario isn't blazing a new trail
with LIHNs. Other provinces like BC and Alberta have
created similar Regional Health Authorities in recent
years, says Sandra Hanmer, CEO of the Waterloo Wellington
LHIN. "Ontario wanted to take a look at the successes
and challenges of the other systems, to try to learn
what worked well and what did not work well," she says.
Ms Martel rejects the idea of the
LHIN decentralization leading to more community-based
decision-making. "We don't see how they can make decisions
on a community level because they're so big," she says.
Ms Hanmer, whose LHIN includes 685,400 residents, counters,
"It is a geographic area that makes sense. Part of the
challenge is to make sure everyone has input."
PRIVATE
MATTERS
The LHINs are the first step on a "slippery slope to
privatization," alleges Mr Sousa.
Ontario's LHINs have the authority
to enter into contracts with third-party providers;
the legislation does not specify whether the provider
should be publicly owned or privately owned.
LHINs have the authority to transfer
services out of the public system, says Mr Sousa. Ms
Martel fears they will adopt a competitive-bidding marketplace
to attract the bidders for certain services — whether
or not they are private, for-profit companies. "I put
forward a motion [during debate on the LHIN Act in 2006]
that said LHINs could not use competitive bidding,"
says Ms Martel, "and the government shot it down." Introducing
private, for-profit delivery of public healthcare will
cause the same turmoil and disruption seen in the home
care sector after competitive bidding began there in
1996, she says.
Asked if the LHIN system will lead
to increased private delivery of services, Mr Huras
says, "I don't think so... That is not a discussion
at all. There is no intent in growing that sector that
I see. There will be unique situations occurring all
the time, but as far as a trend we are not discussing
this area." Ms Hanmer declined to comment on the question
on increased private delivery, saying only that " LHINs
are designed on improving the health system and making
sure people get the care they need when they need it."
She also declined to give a yes-or-no answer when asked
if she was considering adopting a competitive-bidding
marketplace.
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