Dismantling Regional Health Authorities in Alberta
The more things change, the more they stay the same...or something like that.
I read that Alberta is moving ahead in transforming health care by dismantling its nine regional health authorities and in their place is creating a regional superboard-the Alberta Health Services Board (AHSB). Voluntary Community Health Councils will be appointed by the AHSB to give input on local health issues.
Can Ontario be far behind?
The Ontario government has denied that its Local Health Integration Networks are the same as Alberta's Regional Health Authorities but the concept certainly looks eerily similar. Bringing local health issues to the table is no simple matter and it may be that the unwieldy governance structures did not add to the "seamlessness" of care.
But I have to wonder about the whole LHIN transformation which, like so many other transformations, doesn't change much at all....except perhaps to create some severance packages for District Health Council personnel.
If LHINs were to be the Houdinis of Ontario health care, it seems the future may be well seen in Alberta.
Alberta's Minister of Health and Wellness, Ron Liepert, is reported to have said: "Moving to one provincial governance board will ensure a more streamlined system for patients and health professionals across the province."
So no more local divisions to represent local needs but instead, a "streamlined system" with one governance board. I'm surprised the word "seamless" wasn't used as well. Same jargon, different bag of tricks.
Liberal Health Critic, Dave Taylor, said this week in the Alberta legislature that "no evaluation has been done of the impact of 15 years of restructuring on the health system in Alberta. In that time, the system has been completely restructured three separate times".
Sounds like a good make work project and an attempt to show the public something is being done...even if there is no proof, even if there is no "evidence-based" knowledge of the benefits of such transformation.
Yet, in health care transformation in Ontario we are moving to performance indicators and accountability agreements much lower down the health system hierarchy while there appears to be little or no evidence of improved or more efficient or effective delivery.
What is in store for Ontario? I can't say for sure, but I'm highly sceptical that LHINs are going to solve any real problems and its likely that in a few years they will be dissolved too...to make way for another round of "seamless" streamlining....so much so that we'll wind up exactly where we started.
I give the LHINs ten years...max. They've already had one.
Have a great long weekend and enjoy the outdoors wherever you are!
Merrilee Fullerton
105 Comments
Reader Comments (105)
http://www.lhins.on.ca/home.aspx?LangType=4105
This will fit well in the LHIN system being 'built' in Ontario.
...of interest although the Uk's population has risen 17% since 1951, NHS hospital beds have decreased 40% since 1959 to 3,3 beds per thousand as compared to Germany's 6 and Ontario's 2.7 %...even though the population is ageing the budget for caring of the elderly is going to be slashed...perhaps slashing medical school placements in Canada/Ontario was quite deliberate, in full knowledge of the ageing demographics, deliberately causing even more bed blocking by the elderly with nowhere else to go whilst shedding crocodile tears...the slashing of oncology funding is also ominous...the Darzi principle seems to be to cut services and to cut beds and to have the sick left languishing in the community to save money tended by doctor substitutes and shamans...the LHINs will seem to be an excellent method of deflecting responsibility and public anger from the MOHLTC onto the LHIN Potemkin type structures whilst destroying the capacity of the communities to manage the patients by killing off the highly productive and effective comprehensive care FFS /FHG FPs and replacing them with ineffective and less productive, but budgetable, alphabet soups working in teams that care for less patients and hold more committee meetings to discuss the placement of the waste paper baskets...culling the frail and elderly whilst looking as if they were frightfully busy....culling also the older and more experienced generation of doctors who know how things were, how things could and should be...replacing them with a generation who know no better.
Was it not Confucius who told the tale of the frog at the bottom of the well and seeing the small circle of the sky above it believed that that was the full extent of the sky?
Older doctors , who once observed the universe from the top of the well know that the sky is huge and infinite...the younger generation of doctors raised at the bottom of the well are being taught that the tiny circle high above them is it..."that is the full extent of the sky"..."ignore the fantastic tales of those hidebound geezers and their wild tales".
This will be the last greetings since most of us are returning to regular tasks back upstairs. That doesn't mean all the settlements are done, merely that with general agreeement of timeframe amd overall amounts, the need to keep us all on duty isn't needed.
It is interesting how quickly this contract got resolved. We all had some time to discuss it, and generally agree that the system just has completely changed and all those in the know are acknowledging it.
This is a state run health monopoly where all resources flow through the government and there is no opportunity for massive big gains any more. We only have so much money and that's it. Get on with it. The physician group is so fragmented that no ground swell of opposition can be mounted, most of the new ones have accepted this and joined governmnet teams, many of the old leaders are well salaried, so that's it.
With the auto unions now taking 0% increases for 3 years and just manipulating the perks they can, reality of the new econmy is settling in. The parameters of the settled OMA contract will be dealt with taking into consideration what's happening to other unions workers.
Of course, Ontario’s LHINs have been in existence too little time for anyone to make a decision but evidence from St. Elsewhere supports the fact that they don’t. That being said, we will never be able to prove this social experiment. Our health care experience has been on a rollercoaster ride over the past 10 years caused by an ageing and booming population, medical advancements and government short-falls. We’ve gone from 30% of family doctors accepting new patients to 10% (up from 9.4 as was recently trumpeted by our government). LHIN’s are just one small ripple in the cosmic force that’s shaping Ontario health care and to think that we will be able to provide some sort of evidence that they work or don’t work is implausible. Hopefully, someone in government will better connect the front line workers with the purse-strings so that better decisions can be made.
www.waittimes.blogspot.com
Shouldn't that be, "10% of family doctors screening patients in consideration of acceptance?"
I don't think it means 10% are actually acepting new patients.
Ian, I agree with you on all points.
The issue as I see it is that a great deal of funding is going toward creating transformations that don't provide much in the way of cost-savings or significant likelihood of sustainability for our health care system over the long term.
The regionalization was supposed to provide for local needs. I don't see that it is any better than previously organized care.
And I don't see any significant cost effectiveness or "seamless" streamlining of care as patients with autism, end-stage cancers, rare diseases, mental illness etc. who are left without necessary care while others with stubbed toes and slivers are free to use up resources at will.
So I really have to wonder who dreams up these ideas and what they are based on in an era when "evidence-based" decision making seems so popular.
If the evidence isn't there in the first place , and we do like to tout evidence-based care as the way forward, then how was the extra cash to create the LHINs justified?
In Alberta's case, significant transformation has occurred three times within the last two decades.....with what result? Are costs now under control? Are patients getting better care? Are wait lists controlled?
Answer to all these questions is "NO".
So who is the transformation serving?...Answer: the politicians who really want to be seen as doing something...even if it is not effective.
How will the cycle be stopped?
Of course, this mentality isn't exclusive to government positions, but at least in the private sector there is more of a bottom line mentality that will identify a bad change of direction more quickly than once every five years.
We need a more horizontal structure in MOHLTC - certainly we've given this idea lip service, but there has been no real effort to 'make it so'. There are still way too many senior and middle managers that are more concerned about getting the latest BB than anything else.
This is the second year in a row that the OHQC has been critical of this government's inaction on CDM. Nice to see that they are capable of ignoring their own Councils as they are of everyone else.
By the way, LHINs are all over the map on this: some have taken it on as one of their primary roles, others...not so much.
So what happens now? A rushed chronic disease management strategy or the 'sudden retirement' of some OHQC members?
My bets are on the OHQC staff rushing out to buy framed Robert Bateman prints (or similar tokens of appreciation) for outgoing board members.
Thought you might find the following link on LHINs interesting...but perhaps you've seen it before.
http://wellesleyinstitute.com/files/Brief%20on%20Bill%2036%20LHINs%20Jan%2006.pdf
McGuinty Government Creates First Citizens’ Council On Prescription Drug Funding Policy In Canada
http://www.health.gov.on.ca/english/media/news_releases/archives/nr_08/may/nr_20080520.html
Brilliant, eh wot?
"Good governance includes opening up processes to the everyday citizen's point of view,” said George Smitherman, Deputy Premier and Minister of Health and Long-Term Care. “This council reflects our government’s commitment to ensure the public’s opinions and values are heard.”
“Hearing from Ontarians will help inform future decisions in this vital area of public policy,” said Helen Stevenson, Assistant Deputy Minister and Executive Officer of the Ontario Public Drug Programs.
QUICK FACTS
* The Council is modeled after the National Institute for Health and Clinical Excellence (NICE) Citizens Council in the United Kingdom. This council has been highly successful in bringing the views and opinions of the general public forward on national health issues since 2002.
Apologies to all. The pressdisplay link above is a new one for me and I see now that it appears to change on a daily basis.
It did have the outlines of the Alberta Superboard and the details of how it would be structured and the cost...alas...all that info is changed today. I'll remove the link as I agree it is frustrating.
On to a new journal entry.... the Ontario Health Quality Council report.. I have significant respect for Ray Hession irrespective of the fact that he is a close family friend.
That 600 million could have easily financed 2,000 more GP positions I would think. Instead we get 2,000 more bureaucrats.
More financial incentives will be available to address chronic disease management guidelines as part of the perks in the OMA contract. Resources are being made available to financially encourage providers to provide guideline driven health goals of central. When EHR are properly setup, notices of manadted checkups by guidelines policy will be available and chronic disease care will be provided through clinics approved by central with right level trained professionals.
Much more preferable in my opinion is to leave personal medical records in the hands of the individuals. Let them decide what advantages various modalities have for them and let the decisions between physicians and patients drive the process. What do patient want? What to physicians and their assistants find workable?
Rather than having government make big deals with big companies, keep EMRs "local" ...between patient and provider.
The Google Health system unveiled a few days ago makes much more sense.
From an article in the Ottawa Citizen yesterday: "Users can also import medical records if they are available in digital form.
The service includes links to major US pharmacies, doctors' groups and medical testing labs......
Google aims to foster sharing of information between these services, but keep control in patients' hands, allowing them to schedule appointments or refill prescriptions, for example......"
Also Microsoft has introduced "HealthVault" and as mentioned here many moons ago, former AOL chairman Steve Case started "Revolution Health".....all on the notion that individuals should retain control over their data.
Which in the end will probably cost a lot less than having all kinds of government supported groups with associated levels of bureaucracy managing the information system.
Want to see costs balloon in the near future....just watch government run EMR etc....and then figure out how to recycle or dispose of millions of computers and components as they become obsolete in just a few years spewing all kinds of toxins into the environment when they are ditched for upgrades .....not a particularly green concept.
Let patients drive the need. Government is already in way too deep.
Here is the future....and when Generation Y comes along you can bet that going to the doctor's office to review results or to go over symptoms etc. is not going to be tolerated...and how does government fund such communication between patient and provider? It doesn't....because the parameters of the visit will be too vague...one of the reasons doctors have patients come to the office to review reports and results is that they can't be paid any other way.
When a discussion can be had by webcam and results discussed and treatment options and the message sent to the pharmacy regarding medication changes, how will government monitor this free flowing exchange? It can't.
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"Ontario has a backlog of 100 to 200 people waiting for sex-change surgery, says an advocate for transsexuals.
That contradicts the "eight to 10" people Health Minister George Smitherman suggested would apply for sex reassignment surgery annually following his government's decision to relist the procedure."
Seems highly unlikely though, as I would think you'd need the province onside, and there is the ugly specter of the US govt being able to look at anything they want, via the Patriot Act.
Speaking of the EHR though, does anyone know where OLIS is right now? Wasn't that a big deal, the first phase of the EHR, where all lab tests would be centralized?
Still in pilot, I would expect.
Fewer Ontarians Seeking Family Health Care
New Report Provides Clear Indication That The Number Of People Seeking A Family Doctor Is Down To 400,000
May 20, 2008
NEWS
A new report from the Ontario Health Quality Council (OHQC) indicates that the number of adult Ontarians who want a family doctor, but are unable to find one is 400,000. This revelation stands in sharp contrast to the 1.7 million unattached patients previously projected by the Ontario Medical Association.
OHQC’s new report, “2008 Report on Ontario’s Health System,” shows that 400,000 people (four per cent of Ontarians) are actively seeking a doctor.
The Ontario Health Quality Council conducted a thorough investigation into which Ontarians are actively looking for family health care – effectively eliminating those who seek alternative forms of care such as Traditional Chinese Medicine, Homeopathy or are not looking for a doctor.
QUOTES
“We now have a much clearer picture of how many people are actively looking for family health care,” said George Smitherman, Deputy Premier and Minister of Health and Long-Term Care. “With this new information, we will be better able to target the 400,000 Ontarians who are still in need.”
http://healthzone.ca/health/article/428091
http://www.fin.gov.on.ca/english/publications/salarydisclosure/2008/crown08.html
The Ontario government has a miserable record of failure to deliver major new systems development and implementation projects, and is not much better with purchased software.
EHR will follow this record of failure in this province
Without looking at the original report it appears they excluded patients who were visiting naturopaths, acupuncturists, etc. presumably as these alternative providers had supplanted the FP for medical care. We all know that patients have all kinds of alternative care mistresses but when the caca hits the fan they come running back to the trusted and "free" family doctor who they haven't seen between intervals of apparent "wellness". A week doesn't go by where I am not asked to review some hocus pocus from the naturopath which cost the patient many hundreds of dollars out of pocket.
As Canary notes, a very narrowly defined statistic that looks better than simply listing all Ontarians without a family doctor as orphans.
It's the equivalent of counting all adoptees versus those actively seeking their birth parents.
The plan is good.
More financial incentives will be available to address chronic disease management guidelines as part of the perks in the OMA contract."-mfO
Did it ever occur to anyone that diabetics are not meeting the desired target because of something they themselves are doing?
Having dealt with many diabetics, some (I'd say less than half) are very motivated (especially insulin dependent diabetics) to stay within their target for sugar levels...sometimes despite this, brittle diabetics still can't manage.
Non-insulin dependent diabetics often have a myriad of other problems to deal with. They have joint disease or co-morbid conditions such as obesity which makes exercise difficult. They are overweight in the first place in many instances because of very complicated issues surrounding food intake.
What people put in their mouths is very complex including the "why" of eating.
So the idea that EMR's is going to improve hitting the targets for the majority of diabetics isn't likely....of course, maybe we will be sending someone to shop with them and to monitor their eating and exercise level at home........talk about Big Brother!....good for preserving the "system" maybe!
And if we really make gains in keeping people living longer through successful chronic disease management, lets hope the government sees fit to fund more mental illness coverage including respite for Alzheimer's patients' caregivers and more affordable long term care.....
Maybe the problem of overeating and "underexercising" will be solved when the cost of gas continues to add to the price of food and to more walking and bicycling....before EMRs are ever implemented by 2015.
-realist
"More patients have access to care, more surgeries performed, but Ontario still short 2,500 doctors"
"The source of this data is the same as previous -PCAS (primary care access survey). According to the latest PCAS (which surveys people over 16 yrs of age) data there are 737,000 ADULTS without a regular family doctors. However, there are also an additional 120,000 children(under 16 yrs of age) without a doctor.
The PCAS asks respondents whether they want a doctor, if they have looked for a doctor, etc. We have always counted everyone on the basis that all patients should have a family doctor -- it is not surprising that young males (ie. university students) may be unattached and not care about having or looking for a doctor. Just because people have not tried to find a doctor does not mean they don't need one.
According to the PCAS, almost 40 percent of the unattached adults say they have not tried to find a doctor - if you exclude them, which is what they did for this report, you arrive at over 400,000 adults without a doctor. They may not have tried to find a doctor because they don’t' want one, or because they think there are none, maybe just moved recently, etc.
But they are still missing the 120,000 children"
so even if we were to believe the 400,000 number as being the number of patients actively seeking a family doctor (the others may not feel they need one or may not know they are going to need one)....the number is still misleading since it does not include the 120,000 children without a family doctor.
Spin, spin, spin.
My prediction:
wait lists are going to grow in the ER despite more money.....wait times are going to continue to grow long term....nurse practitioner led clinics will mean a faster end to comprehensive care by physicians......and the cost of health care in Canada will continue to rise in an unsustainable way.........and the politicians will continue to spin because their interest is in the short term.........just watch.
wait lists are going to grow in the ER despite more money. Yes but we will adjust the mechanism of counting such that the numbers provided to the public will continue to look good. Personal experience however, on an individual basis, will get worse.
Wait times are going to continue to grow long term. Yes and No - the big 7 (soon to be expanded will plateau at least, thus building into the system the acknowledgement that wait lists are legimate way of ratioining costs.
Nurse practitioner led clinics will mean a faster end to comprehensive care by physicians. Yes. They are budgetable and needed to reorganize around for government mandated care clinics.
and the cost of health care in Canada will continue to rise in an unsustainable way. No - Costs control will be in place to ration the rise in cost to keep it within allowed budget.
and the politicians will continue to spin because their interest are in the short term. Yes
You may be right in the sense that rationing will be an attempt to control costs. But the rationing to date has not controlled costs. Just look at the spending since 2004 both federally and in Ontario. These rates of spending on health care are not sustainable.
So how can you say that "cost control will be in place"....because it certainly isn't now nor later because health care is tightly bound to politics and vote buying. There are lots of votes to be bought you know..Pleasing the majority will be harder and harder as expectations grow....more joint replacements, more diabetic care, more mental health resource requirements, stem cells allowing for the rejuvenation of organs and growing new organs (not tomorrow but certainly possible in the next 20-30 years just when boomers are peaking) more resources needed for long term care and hi tech surgical robots etc. etc.
Cost control?.not likely.
They will be a very expensive way of providing primary care. Budgetable? I suppose....can you say "deficit financing"?
In addition, the pot both federally and provincially has grown.
The plan is good.
QUEEN'S PARK
Who will be Ontario's saviour?
Leaders offer ideas aplenty, but nary a solution for the dwindling economy in sight
MURRAY CAMPBELL
mcampbell@globeandmail.com
May 22, 2008
The Ontario economy is going in the tank, but try finding a saviour at Queen's Park.
The three men leading the major political parties look at the horizon, see a recession looming as the manufacturing sector shrivels, and concoct schemes for immediate and long-term relief. Their plans are as varied as they are limited.
Yesterday, for example, Premier Dalton McGuinty and his chequebook were in Italy to see if he could persuade the giant auto maker, Fiat, to open a plant in Ontario. And, coincidentally, Progressive Conservative Leader John Tory and New Democrat Howard Hampton unveiled their own relief ideas.
Mr. McGuinty's plan is the most complete, which is not surprising considering that he has the resources of a massive civil service at his disposal. It's a five-point offering that mixes business tax reductions, infrastructure improvements, increased education funding and handouts to private investors. The government doesn't like the word "handout" - it prefers to talk about partnerships - but it's a fair comment given that auto makers in Ontario seem to have chopped as many jobs as they created under the $550-million auto industry strategy.
Despite the meeting yesterday in Turin with Fiat CEO Sergio Marchionne, the government spends a good deal of its energy courting investment from companies that specialize in, say, test tubes rather than lug wrenches.
"We're all over this innovation agenda," Mr. McGuinty said recently in Ottawa. He noted that startup firms commercializing Canadian research are given a 10-year tax holiday "whether your profit is $1 or $1-billion."
The Conservatives sniff at this, of course. Mr. Tory characterizes the Premier as a "one-trick pony" who only knows how to write cheques. "He doesn't know how to improve the business environment here to attract all kinds of investment," he said.
Mr. Tory's prescription, remarkably similar to that of federal Finance Minister Jim Flaherty, is for "broad-based tax relief" for businesses. The belief is that an elimination of the capital tax (which Mr. McGuinty is on his way to doing), a reduction in corporate income tax and a pullback from government regulation will create jobs.
Mr. Tory added a new wrinkle yesterday - a sales tax holiday from Victoria Day to Labour Day on hotels and attractions. He said this measure, which would cost the treasury about $130-million, would save a beleaguered family about $100 on a weekend trip (paying $189 a night for a hotel) and would be the deciding factor about whether to go. Of course, it would also knock the 8-per-cent tax off a $354-a-night room at the Millcroft Inn for people who could well afford to pay it. Soak the poor!
A pox on both houses, says the NDP. Mr. Hampton rejects both unspecific tax cuts and McGuinty-style aid packages because they don't guarantee job protection or creation. Instead, he argues for a 10-per-cent tax credit on new machinery, a reduced industrial electricity rate and a Buy Ontario procurement policy.
All three schemes offer some interesting ideas, but none seems complete enough to deal with the era of the high dollar and globalization. The Liberal ideas seem weighted to post industrial matters and, indeed, Mr. McGuinty seems to have almost given up on manufacturing in favour of IT firms. But what if high energy costs curtail global shipping to make it uneconomic to bring goods from China? Where will the dishwashers come from?
Where would the Conservatives get the taxes to maintain and expand the infrastructure and educational system that prospective investors want? What would the NDP do to get a foot in the door of the biotechnology world?
Can a saviour have three heads?
realist:"Wanted to see Steve Paikins' bit on the LHINs....but other obligations....how did the show get hi-jacked Trebor?" No idea, perhaps we should ask Steve P. - anybody else any thoughts on the show (I thought it tried to cover too much ground in 50 minutes, without any particular focus)?
P59 bottom graph. One of many sources confirming good funding base, and the total pot each revenue of revenues has risen.
http://www.ohqc.ca/en/index.php
http://www.tvo.org/cfmx/tvoorg/theagenda/index.cfm?page_id=7&bpn=779216&ts=2008-05-21%2020:00:45.0
One interesting clip is the Alberta health minister doing a 180 degree turnabout and blending all the provinces regional authorities into one.
Could someone explain what the difference is between a unified health authority and the MOH?
Nothing about new technologies or the effect that more prevention will have on demographics....particularly the over 85 year old group which per capita has the largest health expenditure.
At least the report is accurate on one point which is that health care spending is a complex issue.
With nanotechnology, genetic coupling of new medications, more IT creating more knowledge requiring more decision-making and/or intervention, more people living long enough to need multiple joints replaced, the ability to repair cardiac tissue with stem cell treatments, more expensive cancer treatments, more serious mental health issues....and all of this is supposed to be funded with a "growing" economy......interesting....and I'd say a very large assumption and a big leap of faith....sure, it will all work out.......and you've just won the Lottery from Itsascam...just send me your banking info so your prize can be deposited directly.......