Tom Closson calls it the Goldilocks principle.
What is the point where governance within our health system is “just right?”
Writing in Healthy Debate, the former CEO of the Ontario Hospital Association points out that Ontario and Alberta are at opposite ends of the spectrum when it comes to health care governance. Ontario has many boards that make up the 14 LHINs, 14 CCACs and about 150 hospital corporations. Alberta runs everything centrally – recently the Redford government even dismissed the board of Alberta Health Services and has placed a single individual in charge. Either way, the buck should stop at the desk of the Minister of Health, although a quick survey of comments to this BLOG would indicate responsibility is thought to reside in a great number of quarters.
Closson argues the trend is towards fewer points of governance, but there is no evidence to suggest many decision points are better than one central command and control environment. Alberta, despite having a much younger population, spends much more per capita on health care than other provinces. That situation doesn’t appear to fluctuate despite the changes between regional and central governance.
Dr. Michael Rachlis often makes the case that fears about health care sustainability are unfounded given governments will always spend according available resources. Alberta appears to be proof of that.
What Closson doesn’t discuss is how these various forms of governance are constituted.
It used to be Ontario hospitals were far more democratic in their approach to board appointments. For a few dollars you could purchase a hospital membership and vote for board representation during annual general meetings. In most cases it was merely deciding whether or not to ratify board candidates put forward by the hospital, but at least there was some semblance of community control. That has been quietly eroded, and now most hospital boards are self-appointing and beyond the direct influence of their local communities.
While the province set up the Local Health Integration Networks to bring decision-making closer to the communities, it was never decision-making “by” the communities. All appointments to the LHIN boards are done so centrally through the provincial public appointments secretariat.