Local Health Integration Networks

82% of the province has never heard of LHINs or don’t know what they are. You would think then that the province would be doing all they could to ensure that all Ontarians have a chance to learn about, and have input into this system. Perhaps even have a chance to vote on whether or not this is the direction they want their health care system to be going.

Unfortunately, the government isn’t interested in public input and is steamrolling ahead with Bill 36 regardless of the fact that few voters know what it is about, that it opens the door to privatization, that workers stand to lose their jobs, or that health care may become decidedly less accessible for many.

During a public meeting in Port Perry the chair of the Central East LHIN, Foster Loucks, said, “The health care system doesn’t belong to the LHIN board or the province, it belongs to the people and this process has to be driven from the bottom up.”[1] He also stated, “We are accessible, we want to hear from you and we need your assistance.”

These are interesting statements given that at the same meeting he mentioned that only 16% of Ontarians had any idea what the LHINs are about.

LHINs have responsibility for:

• Hospitals
• Long-term Care Homes
• Community Care Access Centres
• Community Health Centres
• Community Mental Health and Addiction Agencies
• Community Support Service Organizations (personal assistance and homemaking)

LHINs do not cover:

• Public Health
• Physicians
• Ambulance Services
• Labs

Much of this is being done to “control costs” however the two costliest items in our health care basket are pharmaceuticals and medical equipment. These costs rose from 18% to 24% of our hospital budgets in just six years. The other great factor is “wait times”. It is rare to hear anyone other than bureaucrats and those trying to privatize the system talk about wait times.

In response to what the province feels are the procedures with the greatest wait times it has created a list of five items:

§ Cataracts

§ Hip Replacement

§ Knee Replacement

§ Cancer Surgeries

§ Cardiac Procedures

These procedures will be bid on by hospitals and decisions will be made on which hospital came in with the best bid for the most procedures.

A cataract clinic has already been opened in Toronto. All cataract procedures previously done in the four large teaching hospitals are now being sent to this clinic. In all they will perform 6700 surgeries per year. Surgeries are done on an assembly line basis with 20 minutes per patient allotted.

Ontarians might well wonder why their minister of health feels comfortable sending them into an assembly line to have serious procedures performed.

There are currently three rooms open in this clinic; a fourth one has yet to be used. Is this fourth room waiting to be used by patients who can afford to pay to skip ahead?

Ontario is now offering $740 to those performing cataract surgery, Dr Allan Hudson who has been hired by the government to “study” wait times boasts, “I can tell you, you can get way below $600 on this.”

When they get “well below $600, will the patient be required to pick up the extra cost? Will support staff be cut? Will patients only get 15mins of a doctor’s time? The difference will have to come from somewhere.

Mr. McGuinty and Mr. Smitherman are quite content to allow both non and for profit clinics to take on procedures we are accustomed to having in hospital, however there is evidence that private clinics do not produce cost savings.

“The fact is, there is no evidence private clinics are more efficient or less costly," McNaught says. Recent research (CMAJ 2004;170[12]:1817-24) shows that payments for care in private for-profit hospitals in the US cost on average 19% more than in their non-profit counterparts. And, last May, the BMJ reported that surgical services contracted out to private clinics in the UK in order to reduce waiting lists cost taxpayers, on average, 40% more.[2]

Private clinics have also been shown to have higher negative outcomes and higher rates of mortality.

It is well documented that private clinics cost more and therefore will be a drain on the public health purse, forcing us to first pay through our taxes and then pay again at the source. What has not been as well documented is that this new level of bureaucracy (LHIN) does not serve as a cost cutting measure either as LHINs will drain our health care resources of $55 million dollars. This is money, which is going straight to administrative costs. That is an expensive buffer between the voter and the government, a buffer, which while promoted to serve the interests of the community, is in fact not governed by the community to any degree. LHINs do not follow political boundries neither is there anyone that the voter can hold accountable. When mistakes are made it is very convenient that the government can blame the LHINs and the populace can do nothing.

Mr. Smitherman has been quoted as saying, in regard to the current system, that, “We don’t even actually know exactly what we’re buying.” If they do not know what they are buying how can they decide they are not getting good value for their dollar?

If they do not know what they are buying then surely their system of accounting and accountability should be first to change.

Health service providers are also held hostage to the LHINs as any decisions they make are subject to a 30-day period of appeal and if the appeal is unsuccessful the decision is then final. 30 days hardly seems like a reasonable amount of time to counter such complex situations.

A quick perusal of the LHIN maps shows that they are not in fact local but cover large areas. The Central East LHIN stretches from Algonquin to Scarborough, the South West, North East and North West LHINs also cover vast distances.

You can see your LHIN area by going to this address http://www.health.gov.on.ca/transformation/lhin/lhinmap_mn.html

In a time when headlines warn us of pandemics, SARS, and other highly communicable diseases, does it make sense that we are to be forced to travel such great distances between numerous communities for health care?

Who will be footing the bill for this travel? And what about those with no car?

Does this system truly achieve integration? Experience in Britain has shown that competition among hospitals and against private clinics has led to a focus on contracts and contract performance rather than a focus on patient needs. Integration has also not occurred in regards to support staff. As each facility strives to cut costs support staff are often the first to suffer cuts and as contracts move around so do the jobs, which are offered at lower and lower rates of pay with benefits disappearing.

In the British system rates of infection have skyrocketed and the quality of hospital food has declined so badly that 10% of seriously ill patients where found to be suffering from malnutrition upon release from hospital.

Though 89% of those surveyed are against privatization the British Health Authorities continue to award contracts to private enterprise to the detriment of the health care system and those who try to access it.

HMO’s such as United Healthcare are even making their way into Britain. How long will it be before foreign interests control our health care system? With the introduction of private clinics NAFTA challenges can hardly be far behind.

Public health offices, ambulance services, labs and physicians must be part of any integrated system. How can this government even consider such changes and yet make no provision for these vitals areas to be considered? If a community hospital is turned into a long-term care facility where will people go for emergency care? What measures have been put in place to prevent spread of disease? Who will be staffing the hospitals if doctors leave to staff freestanding clinics?

Far too many questions have yet to be answered. Far too many people are still unaware of this legislation and it’s implications.

This government did not campaign on and has been given no mandate to, completely restructure the way health care is provided in this province. The rush to push this through and fact that they are backed so enthusiastically by those who wish to see two tier health care should be a warning to us all.

---

[1] http://www.axiomnews.ca/NewsArchives/2006/May/May1.htm

[2] http://www.cmaj.ca/cgi/content/full/172/2/167