These are likely times of great anxiety for the Local Health Integration Networks (LHINs).
The re-election of the McGuinty Liberals may have created a brief sigh of relief given both opposition parties had promised to kill the LHINs. According to the Mowat Centre’s Will Falk, there is “very broad consensus” that the LHINs will still be restructured.
The policy scenarios that are presently being debated are varied. On the extreme end, one would replace the LHINs with about 30 to 40 more local and powerful administrative bodies that would run an integrated cross-section of services, including primary care. These integrated heath organizations (IHOs) would essentially combine the role of hospital boards, Community Care Access Centres, Local Health Integration Networks and some ministry functions into one. These would in turn be overseen by a small handful – from four to eight – of super regions which would do high level planning and enforce accountability among these IHOs. This scenario would also include a substantial cut to the Ministry of Health itself.
The argument against this scenario is that it would be far too disruptive, especially at a time of emerging austerity. Falk estimates in a recent Longwood’s essay that the set up costs alone would be more than $50 million. By blowing up the present system it would also risk projects that are already in the pipeline and set back the government’s efforts to bring down health care costs.
According to Falk, discussions at the Ministry involve maintaining the LHINs, but reducing their number, combining them with the CCACs, and expanding their role to include primary care.
The scenarios range from four to nine LHINs. Seven LHINs would return Ontario to the boundaries of the former regional Ministry of Health offices.
Revisiting the number of regional bodies has been a pattern across the country as other provinces have scaled back the number of regional health authorities. Alberta is now back to one central authority, and New Brunswick is down to two – one in English and one in French.
Prior to embarking on the LHINs, almost every province had gone the route of regionalization despite the absence of any evidence to show its benefits.
Whether the McGuinty government will act in a minority government situation is an open question, given a major redrafting of the LHINs would be an admission of significant failure on the health file.
The government still has an obligation under its original Local Health System Integration Act to conduct a review after five years – something that should have taken place this year.
This may be the way forward and give the opportunity to make the changes in lockstep with public input, whether that means blowing up the LHINs or tweaking them.
Hi, please read The Change Foundation’s new report (November 30/11) with recommendations on the future of LHINs (or their iterations).
Winning Conditions to Improve Patient Experiences: Integrated Healthcare in Ontario — http://www.change.foundation.com
Thanks for quoting my work. Some stuff has changed since my Longwoods article that may be worth noting:
1) Witmer made a very constructive contribution to the debate on November 21 in the Ottawa Citizen when she said “We don’t support the current LHIN model. We don’t believe it’s addressing the needs of patients,” Elizabeth Witmer, the Progressive Conservative health critic, said in an interview. “But I think everybody recognizes that, as we move forward, we’re going to have to review the delivery of health services in order to make sure it’s done in the most efficient and effective manner. – And, yes, there could well be a need for some regional bodies.” As you point out, this sets up the possibility of an adult discussion in the legislative select committee.
2) IHOs as described by John Ronson could actually exist with LHINs and not be a replacement for them (see: http://www.longwoods.com/content/22469). He speaks of how IHOs could develop from the round of organic mergers that are happening now and create the integration across the care continuum and the focus on the patient that we all want to see. I had previously thought of IHOs as a replacement and objected. As a complement there is good reason why we might want to move in that direction.