Ontario needs a more centralized and integrated health-care system as it copes with growing demographic challenges, a premier’s council charged with ending hallway medicine says in its first report.

The initial report from the council headed by retired hospital CEO Dr. Reuben Devlin was released Thursday.

It doesn’t contain specific recommendations, but sketches a future of health care in Ontario that likely does not include the current regionalized system of LHINs (Local Health Integration Networks), that is leaner and that is centrally controlled.

“Ontario’s current health-care system can be characterized as decentralized, large and siloed, and it can be difficult at times to know who is responsible and accountable for ensuring Ontarians have access to high-value health care,” the report says.

“Stronger lines of accountability would help make the health-care system more efficient and also help ensure Ontario gets a greater value for what it currently spends on health care.”

The report also notes that there are 21 health-related government agencies supporting the design and delivery of health care in Ontario.

“Many of these agencies were created to tackle specific problems, support research, or to establish quality standards and metrics to help the system as it matured. However, these agencies are not always well aligned and there is limited strategic oversight to ensure the efficient and co-ordinated use of resources.”

The council is widely expected to kill the regional LHIN system and to replace it with a super agency in charge of everything from Public Health Ontario and the Trillium Gift of Life Network to Cancer Care Ontario.

Critics, including former deputy minister of health Dr. Bob Bell, have warned that such a super agency could decrease the quality of health care in the province. A similar centralization in British Columbia worsened cancer care in the province, Bell said.

The Ottawa area’s Champlain LHIN gets praise from Bell and others for achievements in co-ordinating and making health care more efficient in the region, but the LHIN system has many critics who call it unnecessarily cumbersome and bureaucratic and who say it was never given the tools to make a real difference.

The interim report spells out many of the well-documented challenges with health care in the province, notably overcrowded hospitals, patients waiting in hospital beds because there is not more suitable care available and the strain on the long-term care system. There are currently 72 long-term care beds per 1,000 people aged 75 or older in the province, a number that is projected to decline to 29 beds per 1,000 people over 75 by 2041 — a decline of 60 per cent or the equivalent of 48,000 bed closures “if nothing is done,” says the report.

It acknowledges that Ontario has the lowest per capital spending on health care compared to other provinces and territories, but adds: “The system could work smarter and use this same amount of money to achieve better health outcomes.” Canada, compared to some other countries, spends more but scores lower on some performance indicators.

The solutions to the issues outlined in the report are what worry observers and critics. Although there are bed shortages, simply adding more beds is not the solution, the report says.

Bell has been vocal about his concerns that rapid and massive changes could degrade Ontario’s many health care successes, including cancer care.

Sudbury MPP France Gélinas, the NDP health critic, fears the changes will open the door to more privatization of health care across the province, and less input from regions — especially northern Ontario.

The province is likely to be divided into five health regions, including one that includes Ottawa and encompasses most of the province east of the GTA. The northern region would include everything north of the French River.

“The people who are the most excited about this are the big private healthcare providers,” said Gélinas. “They will sell a model that is glossy that further opens the door to care based on the ability to pay.”

Ottawa Hospital CEO Dr. Jack Kitts is among 14 members of the Premier’s Council on Improving Health Care and Ending Hallway Medicine.

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