There’s no simple prescription to improve complex Ontario health system

Just as any complex medical condition isn’t treated in one doctor’s visit, the Ontario government’s much-anticipated prescription for its strained health-care system, announced Tuesday, won’t provide the definitive answer. Often, the wellness comes through a regimen of treatment and of follow up with active care providers.

To many patients and practitioners, it would come as no surprise the system isn’t working at peak efficiency right now. Patients face long waits for some services and, at times, they’re shuffled between different agencies to access services that complement one another in a holistic care plan. Some could require a full-time advocate just to know how to navigate them.

Those working in health-care administration also face difficulties in the duplication of reporting and policy between the Ministry of Health and Long-term Care and the 14 Local Health Integration Networks (LHINs), all with their own bureaucracy and direction. That’s a lot of people involved in the model and many don’t have experience or never step foot in a patient care setting, other than as patients themselves.

It makes sense for the Province to move away from these silos to build an integrated care model that is patient-centric and to look for ways to reduce administration and get the dollars back into hospitals and community agencies where that money is needed the most. The trick in doing so is that the health-care system is so large and complex, there are a lot of pieces to unravel before they can be put back together again — and as quick as this government seems to want to move on policy changes, chaos won’t help matters.

While the government has stated that it plans to introduce a series of local “Ontario Health Teams” that are intended to administer and provide care, Minister Christine Elliott and her advisors should be applauded for not taking too rigid a view on what those should be. Moving away from a top-down approach and relying on those delivering health care services to design programs that will work best for them will drive discussion on best practices to put in place. Hopefully that added responsibility will be seen as an opportunity and not a burden by already-stretched medical professionals.

That freedom and that acknowledgement that local providers should shape integrated care models is exciting, but it also something that will require keen oversight and revision from the ministry and the public. It has been stated the health teams would serve populations of about 300,000 people. Will that mean that smaller, rural areas will have to operate with larger centres? Their needs could be lost in that shuffle. Alternatively, rural areas may band together, but that could have negative impacts when they rely heavily on specialists and acute services in urban areas. And, while some centralized administration is removed with the LHINs disappearing, is there a chance all these Ontario Health Teams contribute to a more disconnected care model where the standard of service is different from one area to the next — not to mention the possibility of more bureaucracy if these entities aren’t heavily regulated.

It’s a complex problem to say the least and the solution — if there ever could be such a thing — will not be simple. Elliott is on the right path by recognizing the need for a more efficient, patient-focused approach.It was the only reasonable diagnosis. That was easy. Now begins the difficult process of consulting, treating, and tweaking. May it lead to better health for those who put their trust in the system.

– Adam Bramburger