In the run-up to October 10's Ontario
election, healthcare largely fell by the wayside as
the religious schools funding issue took centre stage.
Now, after a big win and the promise
of at least four more years in power, the Ontario Liberals'
health policy plans are back under the microscope. Physicians,
policy analysts and patients alike are all wondering:
What will Premier Dalton McGuinty and health minister
George Smitherman get up to in their second term?
Administration During their
first term, the Liberals reorganized Ontario's healthcare
governance structure into 14 Local Health Integration
Networks. But only in May of this year did the LHINs
officially gain the power to make budgetary changes
in their districts, and the first big decisions are
still to come. "A lot of people are wondering what will
happen the first time a LHIN wants to do something that
a major provider doesn't want to do," says physician
and health policy analyst Dr Michael Rachlis. "The first
time the premier or the ministry [of health] caves and
puts pressure on or goes over the heads of LHINs, these
LHINs will lose any authority they have now, without
the executive function they were supposed to have —
they'll just be paper tigers."
As for healthcare funding, the
election result means the contentious health tax —
or health "premium" as Premier McGuinty prefers to call
it — is here to stay, and the healthcare budget
will continue to swell (by 2012 it should have risen
by $8.7 billion).
Primary care reform Despite
the Liberals' efforts and promises, healthcare access
remains a trouble spot. A survey in March found that
50% fewer GPs and FPs were accepting new patients than
in 2003. The solution lies in expanding Ontario's foray
into primary care reform with strategies encouraging
interdisciplinary care and advanced access scheduling,
says Dr Rachlis. "They need a more strategic view of
primary healthcare, particularly to deal with access
to doctors."
A number of the vaunted reforms
introduced by the government in their first term, like
the Family Health Team capitation billing model, haven't
been properly evaluated, says Dr Rachlis. "Primary care
funding is largely politically driven," he says. "Little
attention is paid to important details, as there is
in other jurisdictions."
Other concerns The Liberals'
reluctance to implement a province-wide electronic health
records (EHR) program could catch up with them, predict
analysts and newspaper op/eds from across Ontario. In
addition, the government must renegotiate collective
agreements with physicians, nurses and hospitals —
all in 2008. The Liberals will be hoping that goes smoother
than it did in 2004.
Overall, says Jeremiah Hurley,
co-director of McMaster's Centre for Health Economics
and Policy Analysis, the Liberals didn't propose any
radical health plans. "I don't expect any big surprises,"
he says.
But Dr Rachlis is less confident.
"Next time I think that the election result could be
very different, because if the government's plans from
their first term don't go so smoothly in the second
term, they'll be vulnerable."
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