Sir Ernest Rutherford is quoted as saying to his physicist colleagues in Cambridge’s Cavendish Laboratory one morning, “we haven’t got the money, so we’ll have to think!” Addressing his Caucus, Cabinet, and Premier’s Council on Improving Health Care and Ending Hallway Medicine, Premier Ford would be well advised to charge them all with the same task – thinking hard how to meet people’s needs for budget-busting health and healthcare services in new and different ways that won’t break Ontario’s deficit/debt-ridden piggy bank.
The publicly-funded program we call Medicare has never had a governance like other enterprises have to provide them with policy direction, financial discipline, and fiduciary oversight. While governments will claim their Cabinets provide such governance, political considerations clearly dominate policy decisions of governments; running things is not their strong suit. After over half a century of Medicare we still don’t have a real system of smoothly connected, coordinated health and healthcare services. What we do have is a bunch of siloes and costs on the high side of the average of other developed countries, costs that threaten the viability of the social determinants of health, education and financial security for example. And what we’re getting are outcomes well below those achieved elsewhere. Many Ontarions are frustrated and unhappy, especially the frail elderly and their caregivers who want and need more and better health and social care in their own homes and communities.
It’s time for some fresh thinking. Successive governments have squandered their opportunities to redefine the range of publicly-funded health and healthcare services needed to optimize the health of the population and to forge those services into a genuine system. Many years on, we are still talking about the need for a standardized, shareable health information system. Some changes have been made, the creation of some primary care groups and teams, for example, but at greater, not lesser cost. The changes constitute tinkering with the status quo rather than new ways of doing things.
So, what to do now? A bold approach would be to give the ball to the players on the field, region by region, challenging them to figure out how best to organize themselves into teams to meet the needs of the people they serve within the limits of what is spent now on health and healthcare services. If they can figure out how to do that and save money, let them keep a generous share of it. An even bolder approach would include in the team’s ‘envelope’ the money spent on some of the key social services in each region. As for governance, one size won’t fit all in Ontario. Within a broad, general policy framework set by the government, charge Ontario’s fourteen LHINs to develop subsidiary policies appropriate for their regions and leave the operational details to the ‘worker bees’, health and healthcare professionals together with community representatives, requiring only that they:
- organize themselves into teams capable of providing the full range of health and healthcare services needed by the populations they serve,
- use an “off the shelf” well tested information system to,
- measure both the health outcomes they produce and the satisfaction of the people they serve and,
- report on the care- and cost effectiveness of their team’s operation.
Such thinking would mean some loss of control by Queen’s Park’s bureaucracies. It would also mean a somewhat different ‘basket’ of health and healthcare services on offer among the regions of Ontario. But it would be more satisfying for our health service providers in all their diversity to be challenged to do what they have been well-trained to do – help the people they serve be healthier and happier. And that, after all, is what it is all about!
Duncan G. Sinclair