Last week, the caucus of the Ontario Progressive Conservative Party (the “PC Party”) released its third white paper in its Paths to Prosperity seriesentitled Patient-Centred Health Care (the “White Paper”).

The intention of the White Paper is to describe how the PC Party would reform the structure of the health care system in Ontario. Another paper on health care is to follow in an upcoming Paths to Prosperity. The White Paper describes the existing health care system as “… complex, inefficient and difficult for patients to navigate." The PC Party proposes to reduce the bureaucracy and the layers of government involved in health care and to funnel the dollars currently devoted to those layers directly into patient care.

Health Hub Model

The White Paper takes direct aim at the Local Health Integration Networks (the “LHINs”) stating that “…the LHINs haven’t improved health system performance” and have “…failed miserably at their most basic task, integrating our system."[1] The White Paper is also critical of the Community Care Access Centres (the “CCACs”) claiming that they have “… failed in their role in preventing readmissions [to hospitals]”.[2]

The White Paper proposes to eliminate both the LHINs and the CCACs and replace them with regional health authorities. The PC Party calls this model the “Health Hub Model”. The White Paper proposes to have 30 to 40 existing hospital corporations restructured to take over the functions of the LHINs and the CCACs, and act as Hubs in their area. The Health Hub Model is described in the White Paper as follows:

The Health Hub is a simple concept. Hubs take over the LHIN’s job of local health care planning, funding and performance. They also take on the CCACs’ job of connecting people with government-funded home and community care and long-term care. Most importantly, they will be required to integrate acute care with primary care, home and community care and long-term care into a seamless partnership.[3]

The White Paper proposes that each Health Hub would be made up of volunteer board members who are chosen based on their professional expertise and knowledge of their own communities. Each Health Hub would have a permanent, physician-led Primary Care Committee that would be responsible for integrating primary care physicians into local health care planning and to scrutinize their ongoing performance. The Hubs would also be responsible for managing public health, ambulance and paramedic services which are currently the responsibilities of municipalities.

Funding

The White Paper proposes to replace the traditional funding for hospitals with a patient-centred funding model. This will, according to the White Paper, ensure that health care dollars follow the patient and that health funding will reflect the health needs of the community. The PC Party’s system of patient-centred funding would mean that hospitals would receive money for every service they perform instead of a lump sum for the entire year. The White Paper claims this will make sure that health care dollars follow the patient and will create the potential for competition between hospitals and independent health facilities.  Hubs too will be funded through the patient-centred model but the funding will be based on a community’s needs. The Hubs would then be responsible for allocating the funds appropriately throughout the community.

New Role for the Ministry of Health and Long-Term Care

If the White Paper recommendations were implemented, the size of the Ministry of Health and Long-term Care (the “Ministry”) would be reduced and its responsibilities limited to provincial health system planning, funding and quality control, eliminating its role as a “micro-manager of the system”. The White Paper states that “under its Health Hub plan, a smaller, streamlined Ministry will shift to a position of strategic advisor with responsibility for provincial health system priorities, regulation, funding and performance measurement through Health Quality Ontario".[4] The Ministry would then be responsible for capacity planning and determining the province’s future health care needs. In order to do so, the Ministry’s responsibility would be to set the policy structure for the Health Hubs but it would be the Hubs’ responsibility to design programming to meet patient needs. The Ministry would also be responsible for ensuring quality, either directly or through Health Quality Ontario.