Part 4: How I Would Bring Healthcare Back to Life

09/21/2012 12:10 EDT | Updated 11/21/2012 05:12 EST

This is the fourth part in a three-part series on health care reform.

Ontario is moving far too slowly in adopting a patient-centred approach to funding health care -- a model that most developed countries have been using for years.

There are two principles behind patient-centred funding.

The first is making sure health care dollars follow patients as they travel through the health system. The second is making sure that health funding reflects a community's health-based needs.

Patient-centred funding doesn't mean less money for hospitals and hubs -- it simply means they'll get the right amount of money.

Here's just one example: historically, Ontario hospitals have received a lump sum of money for the entire year. This had the unfortunate and unintended consequence of turning patients into a drain on hospital budgets. Under this model, every time a patient walked into a hospital for care, the hospital had less money. The province also uses the same funding model for the Community Care Access Centres (CCACs).

When patients are viewed as a drain, the patient-centred approach takes a back seat. Funding needs to follow patients and not the other way around.

We're proposing to reverse this. Under the new system, hospitals would get money for every service they perform. This simple policy change turns patients into valued customers, not drains on hospital budgets. They would be treated like human beings, and get better customer service. It would create the potential for healthy competition between hospitals and independent health facilities, such as Kensington Eye Institute. It would also reduce variations in rates now being paid.

The health hubs I outlined in my previous post would also be funded on a patient-centred basis. Nearly all of the money they get from the province would be based on a hub's community health needs.

Hubs would have total control and responsibility for this funding. For example, a hub might choose to locate a nurse practitioner-led clinic adjacent to a hospital emergency room, so that people with less urgent problems can be seen quickly.

The key idea here is for hubs to have the capacity to pursue more locally-appropriate improvements, based on local conditions -- rather than feel they have to plead with higher authorities for permission, or for resources to pursue these improvements.

What's really exciting about this is that, over time, local initiatives would result in more innovations by frontline staff that can then be circulated throughout the system, to ensure a better use of resources. No matter where someone is in the province they can walk into any hospital for care. Some hubs will chose to offer a particular service regionally, provincially, or even nationally.

So where would all this leave the Ministry of Health?

Under our health hub plan, a smaller, streamlined ministry would shift to a position of strategic advisor with responsibility for provincial health system priorities, regulation, funding, and performance measurement through Health Quality Ontario. This is significant work, but we don't need hundreds of health bureaucrats to do it.

The Ministry would set the policy structure for the hubs, but they would allow these regional health organizations the freedom to design programming to meet patient needs. The Ministry would ensure accountability for quality, either directly or through Health Quality Ontario, and financially through audits.

The main challenge for the Ministry would be capacity planning, and determining the province's future health needs. The last such plan in Ontario was created in 1998.

Without a detailed assessment of our needs and how to meet them, the health care system is on a journey without a map. This broad guidance is the kind of role that is appropriate for government.

The Health Ministry would continue to play an important role in Ontario's revamped health system, but that role would be fact-based planning -- not bureaucratic micromanagement of the system.

This will be my last post on health care in this series tied to our new white paper. We want to make sure to get the health care foundation right and then we can deal with "wiring" of program delivery. We will address other aspects of health care improvement in the near future.

Let me close with some final thoughts on some of the issues I've tried to explore in previous posts.

Health care is the Ontario government's most costly service, and the one most vital to the welfare of all Ontarians.

The problems that patients have in accessing health care today are not due to lack of money in the system, or any shortcomings of our medical professionals or others on the front lines.

No, these problems stem from the way we've organized health care. The system is hard to understand, and the pieces don't interact well enough. For patients' sake, we simply have to do better.

With the bold new ideas we suggest in Patient-Centred Health Care, we will succeed.