Why privatization is not the biggest issue with Ontario's health reforms

Much noise is being made about the changes in store for Ontario's health system, so if you're struggling to understand what is actually going to happen, you're forgiven.

The New Democrats say Premier Doug Ford and his government have a secret plan to throw the system wide open toprivatization. The Progressive Conservatives accuse the NDP of baselessfear-mongering, and they say nothing has been decided.

The reality is almost certainly somewhere in between.

Leaks about the government's ideas for reform have emerged over the past few weeks. They clearly showthat health-care administration in this province is in fora shakeup. They donot clearly indicate that health-careprivatizationis on the way, as the NDP claims.

Drip, drip, drip of leaks

The revelations began with sourcestelling CBC News that the PCs intend to dissolve Ontario'slocal health integration networks, known as LHINs.The Toronto Star then reported a plan to form a "super agency" that would oversee the wholesystem, takingover from theLHINsand folding in such agencies as Cancer Care Ontario and eHealth.

Then the NDP obtained a draft bill that would pave the way for those restructuring plans, confirming what CBC and the Star had reported. Finally, this week, leaked ministry documents detailedthe nitty-gritty of the plans.

• Leaked documents show PC health-care plans are 'done deal,' says NDP

These lengthy documents, along with an officially releasedreport from Ford's special advisory team on ending hallway health care, provide a picture of how Ontario's health system will likely change.

There is no evidence in these many pages that the Ford government is cooking up a plan to makeOntarianspay for health services that arecurrentlyinsuredunder the Ontario Health Insurance Plan, the kind ofprivatizationthat supporters of medicare fear most.

Complete overhaul of bureaucracy

There remains the possibility that private-sector companies will play a greater role in the delivery of health care in Ontario. In fact, that is happening already. If an Ontariangets a blood test, home care, or a prescription for his or herchild,those services, thoughfunded by public dollars, areoften provided by corporations.

By setting offtheprivatizationalarm witha hair-trigger, the NDP risks distractingOntariansfrom the potentially disruptive administrative changes that are on the wayand the very necessary questions about whether those changes will improve health care.

• Ford's health advisers issue first report on hallway medicine

The documents suggest the Ford government will completely restructure the administrative bureaucracy that currentlymanages the flow of funds between the Ministry of Healthand health-service providerssuch as hospitals, long-term care facilities, home-care agencies and community health clinics.

The legislation would pave the way for these providers to form what the government is tentatively calling MyCareGroups. The documents pitch these as teamsthat would deliver "a co-ordinated continuum of care to a defined geographic population or patient segment."

Reforms will encourage mergers

That would be a significantshift in how health care is organized in Ontario. If done properly, such reform could smooth a patient's journey through the system from family doctor to specialist to lab tests to hospital to home care. If done poorly, it could make that journey even more confusing than it already is.

The reforms will also encourage a lot of hospitals to merge, sources in the health-care sector told CBC News. This does not mean hospitalsclosing, but merging their administrative operations. A well-known Toronto example is the University Health Network: one hospital corporation made up of Toronto General, Princess Margaret, Toronto Western and Toronto Rehab.

Mergers would in theory bring costs savings on administration, which could be reinvested in patient care.

There's no question where the Ford governmentstands.The premier has suggested there is too much bureaucracy in health care andtoo many administrators who don't take care of patients.

Big changes raisebig questions

There are nearly as many health-care administrators (13,000) in Ontarioas there are family physicians (14,700). You'll hardly hear anybody saying that more health-care money needs to be pumped into administration.

This particular revamping of the system would centralize control in the super-agency.Will such a move save administrative costs? Or will the super-agency simply become one super-large healthbureaucracy?

In short, will all this restructuring be good for your health care?Not even the experts agree.

• Super-agency for Ontario health system could do real harm, says expert

This week, former deputy health minister Bob Bell weighed in. Bell, a former surgeon and former CEO of the University Health Network, questionedthe wisdom of forming the super-agency.

"We just don't know anything about it at this point," Bell said inan interview onCBC Radio's Metro Morning. "And importantly, we don't know why. What problem are we trying to fix?"

'I think there's more appetite for change'

The day after Bell made his comments, another highlyrespected expert, Michael Decter, also a former deputy health minister in Ontario, told the same radio program a different story.

All the concerns being raised now about the possible changes were raised back in the 1990s when Princess Margaret Hospital was taken over by Toronto General to form UHN, saidDecter. Today, no one will dispute that the quality of the cancer care at Princess Margaret is world-class.

Decteris currently chairof the group Patients Canada and a member of Ford's advisory council. He says reforming the health-care system is bound to face a "rocky road" because of groups who prefer things just the way they are.

"If you only talk to people that have a vested interest in the status quo, you miss out onpatients," he said. "I think there's moreappetitefor changeon thepart of patients than there probably is on the part of providers."

'Happy with transformation'

Decter argues that reforms are neededto fixthe problems in the system.

"The 1,000 patients that spent last night on a gurney in a hospital hall ...Ithinkthey'dbe pretty happy about transformation," he said.

"People who arewaiting16 hours in emergencytogetinto ahospitalbed,waiting146 days to get into a long-term-carebed, they'd be happy withtransformation."

People who work in Ontario's health system feel change has been a constant of late. Under Liberal governmentssince 2003, decentralization was the mantra. This saw the creation of14LHINsand another 80 sub-LHINs, all in the name of localizinghealth-care planning.

• Ontario health minister eyes 'system transformation'

"Once these structural system changes are fully complete, Ontario's health-care system will be more responsive to people's needs," the Health Ministry crowed in 2017."Patients will benefit from care that is easier to access, easier to navigate, betterco-ordinated, and more open and accountable."

Expect the Ford government to make similar claims as it swings the pendulum to centralization.

Health Minister Christine Elliott is so far failing to communicate how the super-agency model would actually result in fewer patients in the hallways or shorter waits for long-term care. Those will be among the measures Ontariansuse to judge whether Ford's prescription for health reformsucceeds.