Goodbye LHINs; Hello Ontario Health

The Ontario government recently proposed legislation (Bill 74) that, if passed, would fundamentally change the delivery of health services in Ontario.

In its simplest form, our current model is based on a hierarchical structure with Ontario's Ministry of Health and Long-Term Care at the top, not-for-profit entities called Local Health Integration Networks ("LHINs") in the middle, and various health service providers at the bottom. There are 14 LHINs in Ontario, each tied to a designated geographic area in the province. There are also independent provincial agencies providing a range of health-related services.

The LHINs were created in 2007 in response to a fragmented health care system. The intention was to allow localized needs to be addressed and move away from a centralized bureaucracy. Since their creation, the LHINs have played a wide variety of roles, including:

  • working with local health providers and community members to determine the health service priorities for the region
  • funding local health services including public hospitals
  • integrating health services
  • acting as the gatekeepers to long-term care
  • facilitating publicly funded home care
  • providing school health support services
  • overseeing the now-defunct Community Care Access Centres

Many family caregivers interact with LHINs on a regular basis - with mixed experiences. It is no secret that LHINs have come under much scrutiny since their inception.

The recently proposed legislation, if passed, would create a new "super-agency" called Ontario Health. The 14 LHINs, existing provincial health agencies (such as the Trillium Gift of Life Network, Cancer Care Ontario, and others), would transition to become part of the new agency. The disappearance of these renowned agencies is one of the primary criticisms of the Bill, as many of these agencies are unrelated to the core issues of hospital overcrowding and lack of coordinated services.

The proposed legislation would also permit new "Ontario health teams" to offer multiple kinds of health services. A key criticism of these teams is that it appears to open the door to the provision of services by for-profit and even international businesses.

According to Ontario's Minister of Health and Long-Term Care:

The People’s Health Care Act, 2019... would help us build a connected and sustainable public health care system that would ensure patients get the high-quality care they need, now and into the future...In Ontario, we are fortunate to have an excellent health care system, led by some of the world’s most renowned health care providers, yet we can all agree that there is an urgent need to make the health care experience better for everyone. Many patients, families and caregivers feel lost. They don’t know how to access the right services, and they wait far too long for those services... In addition, health care providers don’t always have the tools to connect with each other and often do not know a patient’s health care history. We must have a system that is connected and more responsive to patients, and providers’ needs...our government is proposing a long-term transformational plan that would enable the creation of local Ontario health teams that connect health care providers and services around the needs of patients, families and caregivers

According to the official opposition:

The LHINs aren’t perfect; no one is saying the LHINs are perfect. The LHINs are going to disappear and we’re going to have one mega-agency. Speaking as someone who comes from northern Ontario and rural Ontario, whenever we hear “mega-agencies,” we hear “less service.” Whenever we hear “modernization,” we hear “less service.”...
The Tories seem to think that whenever the private sector is involved, things are more efficient. But as someone who has been involved in the private sector for most of my life, the one big difference between the private sector and the public sector is that the private sector, due to the way it’s set up, focuses on profit. So each time you put more private sector players into the health care system—and with this bill, it could very well be the management of the health care system—the decision is always going to be: “Do we really make this decision on behalf of the patient or profit?” It’s an inherent conflict of interest....

At this time the Bill has not actually passed and is therefore not yet law. However, it appears steps are being taken in preparation for its passing; it was reported that the newly appointed board of directors of Ontario Health already held its first meeting.

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