Imagine a bicycle wheel that's got all its spokes -- but a loose hub. Wouldn't get you very far, would it? Well, that's a rough analogy for the way Ontario's health care system is currently organized at the regional level. The spokes all fan out across cities and towns, but there's nothing to connect them. No central point allowing you to move from one to another in a way that makes sense. No direct linkage holding the parts of the system together, from home care to primary care to hospital care.

Common sense tells us there ought to be a tight connection among all these entry points, but they're run under separate systems. All you've got is a Local Health Integration Network (LHIN) as the loose glue that tries to hold them all together. It's up to patients to understand how all this works, and try to connect the spokes. That's not right. And it's not fair.

So we propose a stronger central axis. In "Paths to Prosperity: Patient-Centred Care" we propose having 30 to 40 existing hospital corporations take over the functions of the LHINs and Community Care Access Centres (CCACs). Hospitals are already in place, and hubs can emerge from the health care infrastructure in our communities -- more locally focused, with fewer bureaucrats, offering better care.

The health hub is a straightforward concept: they would take over the LHINs' roles of local health care planning, funding and performance. These are jobs the LHINs have measurably failed at doing, despite huge outlays of tax dollars. They would also take on the CCACs' job of connecting people with government-funded home and community care and long-term care.

Most importantly, they would be required to integrate acute care with primary care, home and community care and long-term care -- into a seamless partnership. And all of this happens at the local level.

Health hubs would provide the administrative expertise that this new system requires. They have strong performance and accountability mechanisms already in place. Ontario has the most efficient hospitals in Canada, according to the Canadian Institute for Health Information. They have a long history of success and are a visible centre of care in the community.

Let's be clear: This does not amount to letting hospitals make all the decisions. This will be a partnership among equals. In our proposed model, the people who actually manage and deliver your health care today would run the system, without costly bureaucracies that impede flexibility and innovation.

Local health care shouldn't be run by people appointed by the provincial Cabinet, as is the case with the LHINs. The health hubs would have board members who are up to the task of managing the new system. These people will bring professional expertise and knowledge of their own communities. For physicians, the rise of health hubs will mean an important leadership role in planning primary care, as well as new accountability for results. This will be driven through physician-led Primary Care Committees.

These hubs would have formal authority for integrating primary care physicians into local health care planning and scrutinizing their ongoing performance in quality of care and patient experience.

We see major gains from the integration of primary and acute care with the other two large parts of the health care system, home and long-term care. This would lead to more rational decisions about how money is spent and what volume of services are available.

With a $15 billion deficit, Ontario can't afford to keep throwing money at health care. We need to be smarter about how we spend what we have, and to always put patients' needs first. That's the context in which we offer our ideas for restructuring health care.

But here's the most important thing: The next time a loved one needs some combination of hospital care, home care and the attention of their physician, and you want to help guide them along from one stage to another, you'll both know just where to go, and when. No more run-around.