It’s time to organize care in communities so that patients stay healthier and fewer need expensive hospital treatment
A version of this commentary appeared in the Toronto Star, Ottawa Life and the Waterloo Region Record
It’s no secret: Ontario is getting older. The number of seniors in our province has been steadily increasing and over the next twenty years, will double. Including factors like increased use of health services and evolving technology, this will result in a substantial increase in demand across the health system. Those services will cost money.
In just the continuing care sector (e.g., home care, rehab facilities, long-term care homes) public spending will need to increase by $16 billion. That doesn’t include an increase in private spending of another $10 billion.
Our provincial government’s response to this challenge is the Patient’s First Act, signed into law in December 2016. It’s a promising start, but to meet the challenges that lay ahead, it must lead to a real transformation of the way we deliver services.
For many, Patients First seems like shuffling a deck of cards — except the cards all have acronyms. Instead of the MoH (Ministry of Health) being responsible for your PCP (Primary Care Physician), that responsibility now goes to a Local Health Integration Network (LHIN). Instead of these LHINs being responsible for local CCAC home care agencies, LHINs will deliver home care directly. And instead of there being no formal links between public health units and LHINs, there will now be links.
How exactly does this help us take care of double the number of seniors by 2037?
It’s not entirely clear — at least not yet. There is a risk that this reorganization will just shuffle activity from one branch of government to another.
But there’s opportunity for meaningful change. Taking care of more seniors does not have to be more expensive. That’s the potential of Patients First: to re-organize our health system to treat patients before they become patients and to organize care around cost-effective, community-based care instead of relying on the traditional, expensive, hospital environment.
There are three major ways LHINs can use their new responsibilities to drive change.
First, improve what they’re doing already. We know better community and primary care can avoid expensive hospital admissions. Yet our health system is still largely organized around hospitals, while the illnesses that affect most patients are chronic and can be better managed in the community.
That’s where LHINs should start to shift the focus of care. For example, why not give hospitals the means and funding to organize their own home care and measure their performance on reducing admissions?
The second is by prioritizing populations according to those who can benefit most. We know that our most socio-economically challenged communities have the highest rates of illness and the lowest levels of primary care support. LHINs should wrap focused support around these areas. For example, why not actively direct home care and primary care funding towards these communities?
The third is to improve population health and disease prevention. Our rates of preventable illness are higher than they could be. What if we focused on reducing them? Population health is an approach to health system planning that focuses on services that allow us to lead healthier lives, today, tomorrow and well into the future.
LHINs can use their new responsibilities to cement a population health approach to all services in their communities. For example, LHINs could collaborate with primary care practices to measure and monitor overall health status and give family doctors the financial flexibility to prescribe any kind of support — like housing or income supports — that result in healthier patients and communities.
In shifting the focus of our health system towards prevention and community care, we will need to be very mindful of Canada’s promise of universal care for all. The Canada Health Act (CHA) is what guarantees that all hospital-based services must be publicly funded and accessible to all. But in the community, the CHA only does so for physician services. This shift to preventative and community-based care needs to be undertaken with a promise of universal access if we wish to create a health system that will effectively serve a greying population.
Patients First could be an incredible moment for health sector leaders to dramatically reshape how our health care is delivered in Ontario — to truly realize the provincial government’s vision to make Ontario the “healthiest place in North America to grow up, and to grow old.”
Kapil Khimdas has worked in senior management roles in health systems in Canada and the United Kingdom. He is a graduate of the Kennedy School of Government and Business School at Harvard University.
Danyaal Raza is an expert advisor with EvidenceNetwork.ca, family physician at St. Michael’s Hospital and Assistant Professor with the Department of Community & Family Medicine at the University of Toronto.