The Trillium Party believes the World’s finest Healthcare should be available to every citizen of Ontario.
- TheTrillium Party suggests that we create an “equivalency” scale for foreign credentials. Followed by a residency program that is completed IN ONTARIO, rather than outside Ontario/Canada to upgrade to a Canadian equivalent status.
- TheTrillium Party of Ontario has an ardent belief that the vast proportion of citizens of Ontario are responsible and will make better choices given accurate information. To keep track of what could be, instead of hospital visits, clinics or doctor visits, a statement would be offered to show some alternatives that could have been utilized rather than, for example using a hospital for a really bad cold.
- Fundraising is something that Ontarians should be proud of, but fundraising for equipment, facilities, etc., should not be the norm. Many hospitals are now employing full time administrators (and their assistants) to fundraise – this is an added cost to the health-care system. The money, for those wages, could be saved in a future capital fund accruing interest, for purchases of equipment, facilities, etc. Not to mention the Chief Administrative/Financial Officer of each hospital should be competent to engage the province through the application process for grants, etc., without the need for fundraising staff.
Towards Affordable and Efficient Health Care
- The Trillium Party seeks to ensure that all health-care funding is far more directly tied to the services that are provided to individuals who need them.
- This new approach would be implemented through the use of a new “Smart OHIP Card” that would be used by all Healthcare Service Providers to bill the government for all services that are provided to all citizens of the province.
- A Smart Ohip Provider card would be able to allow for comparative service analysis. Therefore allowing for in-depth service-to-fee analysis.
Healthcare accounts for the largest portion of the budget of the Province of Ontario and the demand for healthcare services will continue to grow as the population ages and as more services are required for hospitals and for long-term care.
About 40% of the healthcare budget is directly tied to the services that are provided to individual citizens – and those directly-funded services to doctors and for drugs are largely paid for through the OHIP card.
The remaining 60% of the health care budget is distributed as block funding to the Local Health Integration Networks (LHINs) which fund hospitals, some long-term care facilities and other services to those in need as well as to other institutions that provide common services to the health-care community. Since those funds are not directly linked to the amount of healthcare that is provided to individual citizens, there is little transparency in the use of a very large portion of the provincial healthcare budget.
The Trillium Party seeks to ensure that all health-care funding is far more directly tied to the services that are provided to individuals who need them.
To achieve this, the Trillium Party supports a new model for funding non-OHIP healthcare services – by tying the funding that is provided through the LHINs and the common-service institutions, to the services that are actually provided to individual citizens who receive care.
This would replace the current practices of cost-based annual budgetary allotments to institutions for all non-OHIP healthcare with a more transparent and accountable model that is comparable to what already exists under OHIP for payments made to physicians and for prescription drugs. This new approach would be implemented through the use of a new “Smart OHIP Card” that would be used by all Healthcare Service Providers to bill the government for all services that are provided to all citizens of the province.
The intent of this change in the allocation of provincial healthcare funds is to ensure that expenditures in the largest and fastest growing area of the provincial budget is directly tied to the healthcare services that are actually provided to citizens rather than being tied to the institutions and to their administration.
Support Materials Re: LHINs – Elizabeth Marshall
1 POLICY 2018 2 10
MAKING GOVERNMENT RESPONSIBLE FOR WHAT THEY SHOULD BE RESPONSIBLE FOR!
Local Health Integration Network (LHIN)
Why are Ontarians paying over $90 Million dollars per year for the operational expenditures of all 14 LHINs, when in 2015, 90% of patients who were referred to CCACs [community care access centres] by their family or primary-care physician received their first CCAC in-home service in 28 days (as opposed to being referred by a hospital after a hospital stay)?[i]
LHINs wait time for CCAC in-home services (days) Worst 82days, Best 12 days depending on the LHINs.
The $90 Million that the LHINs spent breaks down as:
- half of their operational expenditures on salaries and benefits;
- one-third on one-time, LHIN-led initiatives for specific projects, such as those on diabetes, emergency departments and critical care;
- and the remainder primarily on administrative expenses such as rent, consulting services, and supplies and equipment.[ii]
In 2015 the expenditures for the Ontario Health System were $50 Billion of which the LHINs administered $25 Billion and the Ministry of Health administered the other $25 Billion.
So how does this break down? Firstly, the LHINs do not provide health services – all health care providers, such as such as hospitals and long-term-care homes, still maintain their own boards of directors [iii] and are still administered under the Ministry.[iv]
In 2015 the break down was:
- Hospitals (156) – $16.9 Billion
- Long-Term-Care Homes (631) – $3.5 Billion
- Community Care Access Centres (14) – $2.5 Billion
- Mental Health and Addiction Centres (400) – $936 Million
- Community Support Service Agencies (584) – $834 Million
- Community Health Centres (76) – $378 Million
And the Ministry’s break down, which the Ministry’s $25 Billion is spent, is:
Working relationships with LHINs managed by the Ministry
- Primary Care
- Family Health Teams
- Independent Health Facilities
Provincial Health Agencies (duplicates of LHINs)
HEALTH QUALITY ONTARIO
Health Quality Ontario[viii] that is a scientifically rigorous group with diverse areas of expertise. It works in partnership with health care providers and organizations across the system, and engage with patients themselves, to help initiate substantial and sustainable change to the province’s complex health system.
It defines the meaning of quality as it pertains to health care, and provides strategic advice so all the parts of the system can improve; analyzes virtually all aspects of Ontario’s health care. This includes:
- looking at the overall health of Ontarians,
- how well different areas of the system are working together,
- and most importantly, patient experience,
- produce comprehensive, objective reports based on data, facts and the voices of patients, caregivers and those who work each day in the health system,
- makes recommendationson how to improve care using the best evidence
- support large-scale quality improvements— by working with our partners to facilitate ways for health care providers to learn from each other and share innovative approaches.
Is this not what the LHINs were to do? So why are Ontarians wasting $90 Million plus per year for 14 entities that aren’t even needed, considering they aren’t even fulfilling their contractual obligations? It’s pretty sad when the Ministry has to lower the standards for the LHINs, in their various contracts/MOU, so they can pass the grade, isn’t it?[ix]
 Across Ontario, 90% of the patients who were referred to CCACs by their family or primary-care physician (as opposed to being referred by a hospital after a hospital stay) received their first CCAC in-home service in 28 days. However, depending on where a person lives in the province, the wait time could be as short as 12 days to as long as 82 days, a difference of more than two months. LHINs—Local Health Integration Networks, Auditor General Report 2015 section 3.08, p. 323 (17 of 56).
 1.1.5 Operational Expenditures of Local Health Integration Networks
In the year ending March 31, 2015, the total operational expenditures of all 14 LHINs combined were $90 million. About 0.4%, or 40 cents on each $100 of the Ministry’s LHIN funding (including payments destined to health service providers such as hospitals and long-term-care homes) were spent on LHIN operational expenditures. In that year, LHINs spent about half of their operational expenditures on salaries and benefits; one-third on one-time, LHIN-led initiatives for specific projects, such as those on diabetes, emergency departments and critical care; and the remainder primarily on administrative expenses such as rent, consulting services, and supplies and equipment. LHINs—Local Health Integration Networks, Auditor General Report 2015 section 3.08, p. 308 (2 of 56).
 In moving toward a regional model, Ontario took a somewhat different path than that of some other provinces. The most significant difference between the LHIN model in Ontario and the regional health systems in other parts of Canada is that, in Ontario, LHINs neither directly govern nor provide health services: all of the health-care providers, such as hospitals and long-term-care homes, still maintain their own boards of directors. In contrast, in Alberta and Manitoba where all or most of the local boards of the individual health-care providers were dissolved, the regional health authorities themselves directly employ health-care workers, and directly provide health services, sometimes including primary care. LHINs—Local Health Integration Networks, Auditor General Report 2015 section 3.08, p. 307-308 (1-2 of 56)
 See attached graph.
 it is Cancer Care Ontario, a provincial government agency, that is primarily responsible for planning and allocating resources for cancer surgery and works with health service providers in every LHIN to improve cancer care for the people they serve. LHINs—Local Health Integration Networks, Auditor General Report 2015 section 3.08, p. 327 (21 of 56).
The Ministry accepts this recommendation and is implementing strategies to manage capacity and demand for community-based services. For example, Access to Care at Cancer Care Ontario is developing an MRI capacity-planning tool designed to advise the Ministry on LHIN capacity and need for MRI services. The tool considers wait time, population growth and existing services and will be used to support MRI services based on provincial need. LHINs—Local Health Integration Networks, Auditor General Report 2015 section 3.08, p. 330 (24 of 56).
 QUALITY MATTERS: REALIZING EXCELLENT CARE FOR ALL
4 Executive Summary
12The Case For System-Wide Quality
24Quality Matters: A Health System Quality Framework
34Delivering Quality Care
48Understanding Quality Health Care
58Fostering A Culture Of Quality
71References and Further Reading
77Appendix 1: Committee Terms of Reference
80Appendix 2: Committee Membership
82Appendix 3: Key Informants
 Public Health Ontario (PHO) keeps Ontarians safe and healthy. With our partners in government, public health and health care, we prevent illness and improve health. We provide the scientific evidence and expert guidance that shapes policies and practices for a healthier Ontario. PHO has locations across Ontario, including 11 laboratory sites.
PHO protects the health of Ontarians. We monitor, prepare for, detect, and respond to infectious disease outbreaks and environmental incidents.
We improve Ontarians’ health by providing evidence to address challenges like smoking, healthy eating, and physical activity.
We transform data into interactive tools and resources to monitor population health.
Our educational program builds the skills, capacity and competencies in Ontario’s health workforce to face tomorrow’s public health issues.
Our experts guide and support health professionals with evidence and case studies on topics like immunization, environmental and occupational health, health promotion, infection prevention and control, and potential health emergencies.
Our research informs health policy, transforms clinical and public health practice, and advances laboratory science.
 The Ministry’s role is to provide overall direction and leadership for the health system, focusing on developing legislation, standards and policies to support its strategic directions, and ensuring that the LHINs fulfil the Ministry’s expectations. Those expectations are outlined in two agreements it established with each of the 14 LHINs: the Ministry–LHIN Memorandum of Understanding, and the Ministry–LHIN Performance Agreement (accountability agreement). The Ministry also manages provincial programs that are not managed by LHINs. LHINs—Local Health Integration Networks, Auditor General Report 2015 section 3.08, p. 311 (5 of 56).
In practice, when LHINs do not perform according to expectations, the Ministry takes a collaborative approach, working with LHINs to identify issues and determine next steps to improve performance. Although there may be valid reasons for this approach, it has often resulted in performance shortfalls continuing year-after-year. One factor contributing to LHINs’ varying performance is that the Ministry has negotiated different targets for each LHIN to achieve in the 15 performance areas. LHINs—Local Health Integration Networks, Auditor General Report 2015 section 3.08, p. 326 (20 of 56).
For 11 of the 15 performance areas, the Ministry has established what it calls “provincial targets” that serve as long-term goals for LHINs to work towards . In most cases, these targets are more stringent than the targets the Ministry has negotiated for individual LHINs to meet. For example, the Ministry’s provincial target for ALC [Alternative Level of Care] days is 9.46%, meaning no more than 9.46% of the total days a patient spent in hospital should have been due to them waiting for care elsewhere or to be discharged. Only two LHINs had this specific target to meet. The other 12 LHINs were held to targets that were less challenging than the provincial target for ALC days. Using the overall provincial performance in the year ending March 31, 2015, only four of the 11 provincial targets were met that year. Further, the Ministry has not set any timelines for when all 14 LHINs are expected to meet the 11 provincial targets. LHINs—Local Health Integration Networks, Auditor General Report 2015 section 3.08, p. 337 (31 of 56).