Wealth, age and geography should be significant factors in “ranking” LHIN performance

According to the Hamilton Spectator, the three wealthiest regions of the province have the best health results despite the lowest per capita health funding, a blatant reminder of the link between income and health.

These three LHINs also happen to be adjacent to Toronto, where many patients cross LHIN boundaries to seek care.

It also tells us that tackling poverty could have a substantial impact on public health care costs.

Does that make these three regions the best run LHINs? Not necessarily.

Unfortunately, the newspaper’s ranking of the 14 Local Health Integration Networks may not be entirely fair given the emphasis on population health in those standings.

A 2007 federal government study notes that Ontario has the second highest level of income disparity in Canada. That’s a ratio measured between the income of the top and bottom 20 per cent.

That creates real differences by region.

The Spectator ranks the performance of the Hamilton Niagara Haldimand Brant LHIN at the bottom of the southern LHINs and only ahead of the two northern LHINs.

Hamilton also has the highest number of seniors per capita, which may ratchet up its degree of difficulty (to use an ice skating analogy). That population is also rapidly growing at a time when funding is facing restraint.

McMaster’s Stephen Birch hits the nail on the head when he tells the reporter: “I think population health would be a big factor here, but also we have to question whether we’re being as well-served with the resources allocated to health. Are the additional needs of the population in the Hamilton LHIN being funded?”

These are all good questions that are not really satisfactorily answered by the Spectator series.

The Spectator notes that the HNHB failed to meet 10 of 11 targets set in their accountability agreement with the province. No LHIN met more than half the targets.

To suggest the LHINs are directly responsible for health outcomes in their region may be a bit of a stretch, especially with the LHINs having real discretionary spending of one to two per cent of the funding that flows through them to hospitals, long-term care homes and community-based agencies.

Nor do they grant licenses to nursing home operators, leaving them with no control over available supply of beds. Yet the Spectator penalizes the HNHB in their rankings because waits for nursing home beds are almost twice as long as the provincial average.

The LHINs also have little input on primary care, one of the reasons the Minister has suggested the Family Health Teams migrate to the LHINs.

The rankings also conveniently let the province off the hook for system problems in the region.

One only needs to look at the comments beneath the Spectator stories. These comments make the usual calls to dissolve the LHINs. None holds the McGuinty government accountable for inequities between regions in the delivery of public health care. This is also one of the biggest political incentives to keep the LHINs.

The HNHB LHIN has certainly been a lightning rod. The Ombudsman was less than flattering over the HNHB LHIN’s lack of interest in public consultation in 2010. As his office stated in “The LHIN Spin,” the reality of community decision-making has fallen far short of the political spin.

The ombudsman noted in the report more than 60 complaints about two controversial decisions at Hamilton Health Sciences and the Niagara Health System.

Since the Niagara Health System was placed under a government-appointed supervisor last August, the ombudsman has received another 70 fresh complaints related to health services.

We took particular note of the LHIN’s early approval of the Niagara Hospital Improvement Plan, a document that any sensible reviewer could see was completely unrealistic and would throw services into turmoil. That included closing the ERs at Port Colborne and Fort Erie. Not surprisingly, some of those changes contained in the HIP are again under review and the NHS is still running a deficit.

It is possible the HNHB could be among the worst LHINs in the province. But what the Spectator should measure is the change in health outcomes since the LHIN began its work and measure it against the progress elsewhere. It should also weight such considerations as age, income and geographic distance in the rankings.

When you fail to perform your quad while your neighbouring LHINs are only skating double axels, you should be cut a little slack in the final score. The Spectator rankings were done by a sports reporter. He should know this.

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