Toronto Analysis

Why privatization is not the biggest issue with Ontario's health reforms

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Ford government is yet to show how 'super agency' would bring shorter waits or fewer patients in hallways

Ontario Premier Doug Ford watches as Health Minister Christine Elliott speaks at an event in Toronto last month. Leaks about the government's ideas for health-care reform have emerged over the past few weeks. (Frank Gunn/Canadian Press)

Much noise is being made about the changes in store for Ontario's health system, so if you're struggling to understand what is actually going to happen, you're forgiven.

The New Democrats say Premier Doug Ford and his government have a secret plan to throw the system wide open to privatization. The Progressive Conservatives accuse the NDP of baseless fear-mongering, and they say nothing has been decided.

The reality is almost certainly somewhere in between.

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Leaks about the government's ideas for reform have emerged over the past few weeks. They clearly show that health-care administration in this province is in for a shakeup. They do not clearly indicate that health-care privatization is on the way, as the NDP claims.

Drip, drip, drip of leaks

The revelations began with sources telling CBC News that the PCs intend to dissolve Ontario's local health integration networks, known as LHINs. The Toronto Star then reported a plan to form a "super agency" that would oversee the whole system, taking over from the LHINs and folding in such agencies as Cancer Care Ontario and eHealth.

Then the NDP obtained a draft bill that would pave the way for those restructuring plans, confirming what CBC and the Star had reported. Finally, this week, leaked ministry documents detailed the nitty-gritty of the plans.

These lengthy documents, along with an officially released report from Ford's special advisory team on ending hallway health care, provide a picture of how Ontario's health system will likely change.

There is no evidence in these many pages that the Ford government is cooking up a plan to make Ontarians pay for health services that are currently insured under the Ontario Health Insurance Plan, the kind of privatization that supporters of medicare fear most.

Complete overhaul of bureaucracy

There remains the possibility that private-sector companies will play a greater role in the delivery of health care in Ontario. In fact, that is happening already. If an Ontarian gets a blood test, home care, or a prescription for his or her child, those services, though funded by public dollars, are often provided by corporations.

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By setting off the privatization alarm with a hair-trigger, the NDP risks distracting Ontarians from the potentially disruptive administrative changes that are on the way and the very necessary questions about whether those changes will improve health care.

The documents suggest the Ford government will completely restructure the administrative bureaucracy that currently manages the flow of funds between the Ministry of Health and health-service providers such as hospitals, long-term care facilities, home-care agencies and community health clinics.

The legislation would pave the way for these providers to form what the government is tentatively calling MyCare Groups. The documents pitch these as teams that would deliver "a co-ordinated continuum of care to a defined geographic population or patient segment."

Reforms will encourage mergers

That would be a significant shift in how health care is organized in Ontario. If done properly, such reform could smooth a patient's journey through the system from family doctor to specialist to lab tests to hospital to home care. If done poorly, it could make that journey even more confusing than it already is.

Princess Margaret Cancer Centre is part of the University Health Network in Toronto. (UHN)

The reforms will also encourage a lot of hospitals to merge, sources in the health-care sector told CBC News. This does not mean hospitals closing, but merging their administrative operations. A well-known Toronto example is the University Health Network: one hospital corporation made up of Toronto General, Princess Margaret, Toronto Western and Toronto Rehab.

Mergers would — in theory — bring costs savings on administration, which could be reinvested in patient care.

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There's no question where the Ford government stands. The premier has suggested there is too much bureaucracy in health care and too many administrators who don't take care of patients.

Big changes raise big questions

There are nearly as many health-care administrators (13,000) in Ontario as there are family physicians (14,700). You'll hardly hear anybody saying that more health-care money needs to be pumped into administration.

This particular revamping of the system would centralize control in the super-agency. Will such a move save administrative costs? Or will the super-agency simply become one super-large health bureaucracy?

In short, will all this restructuring be good for your health care? Not even the experts agree.

This week, former deputy health minister Bob Bell weighed in. Bell, a former surgeon and former CEO of the University Health Network, questioned the wisdom of forming the super-agency.

"We just don't know anything about it at this point," Bell said in an interview on CBC Radio's Metro Morning. "And importantly, we don't know why. What problem are we trying to fix?"

'I think there's more appetite for change'

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The day after Bell made his comments, another highly respected expert, Michael Decter, also a former deputy health minister in Ontario, told the same radio program a different story.

All the concerns being raised now about the possible changes were raised back in the 1990s when Princess Margaret Hospital was taken over by Toronto General to form UHN, said Decter. Today, no one will dispute that the quality of the cancer care at Princess Margaret is world-class.

Michael Decter is chair of Patients Canada and a member of the Premier's Council on Improving Health Care and Ending Hallway Medicine. (Joncarlo Lista)

Decter is currently chair of the group Patients Canada and a member of Ford's advisory council. He says reforming the health-care system is bound to face a "rocky road" because of groups who prefer things just the way they are.

"If you only talk to people that have a vested interest in the status quo, you miss out on patients," he said. "I think there's more appetite for change on the part of patients than there probably is on the part of providers."

'Happy with transformation'

Decter argues that reforms are needed to fix the problems in the system.

"The 1,000 patients that spent last night on a gurney in a hospital hall ... I think they'd be pretty happy about transformation," he said.

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"People who are waiting 16 hours in emergency to get into a hospital bed, waiting 146 days to get into a long-term-care bed, they'd be happy with transformation."

People who work in Ontario's health system feel change has been a constant of late. Under Liberal governments since 2003, decentralization was the mantra. This saw the creation of 14 LHINs and another 80 sub-LHINs, all in the name of localizing health-care planning.

"Once these structural system changes are fully complete, Ontario's health-care system will be more responsive to people's needs," the Health Ministry crowed in 2017. "Patients will benefit from care that is easier to access, easier to navigate, better co-ordinated, and more open and accountable." ​

Expect the Ford government to make similar claims as it swings the pendulum to centralization.

Health Minister Christine Elliott is so far failing to communicate how the super-agency model would actually result in fewer patients in the hallways or shorter waits for long-term care. Those will be among the measures Ontarians use to judge whether Ford's prescription for health reform succeeds.