Urban Planning Queens University Local Health Integration Networks: Ontarios Approach to Devolving H

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Urban PlanningQueens University Local Health
Integration NetworksOntarios Approach to
Devolving Health System Decisions to the Local
Levelby Paul Huras, CEO, SE LHINNovember 6,
2006
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Overview

• The Big Picture
• Ontario Picture
• LHINs role and functions
• SE LHIN
• Local characteristics
• Findings from our Integrated Health Services Plan
• Role of Epidemiology in LHINs

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Canada spends 114,100,000,000 on Health Care
2003 forecast
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Canada Health ActThe Five Principles

• Universality
• Comprehensiveness
• Accessibility
• Portability
• Public Administration
• Accountability ??

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Total Health Expenditures (Public and Private) as
a Percentage of Gross Domestic Product, Canada

Source OECD Health Data 2003.
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Public vs. Private Health Care Expenditures,
Ontario, 1975-2003
Source Canadian Institute for Health
Information, 2002 and 2003 are forecasts
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Canada USA

• Canada US
• Health as GDP 10.0 14.0
• Coverage universal 70m at risk
• Admin of Total 2-5 10-22
• IS poor good
• Effect on industry positive negative
• Public/Private 70/30 45/55
• Research Q Q

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Chrysler Corporation
Cost of health benefits/car produced
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How Canada Compares with Other Countries
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Selected International Comparisons
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Relative Age of Society, 2004
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The Difference Age Makes
Source CIHI
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Total Health Expenditures as a Percent of GDP for
Ontario, 1981-2003
Source Canadian Institute for Health
Information, 2002 and 2003 are forecasts
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Health Expenditures per Capita, Ontario, 1975-2003
640 increase over 28 years
Source Canadian Institute for Health
Information, 2002 and 2003 are forecasts
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Factors Contributing to Canadian Deficits

• Revenues 50
• Debt Servicing 44
• Increasing Expenditures 6

Canadian Institute for Advanced Research
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Ontario Composition of Revenue 2006 - 07
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Ontario Composition of Program Expense 2006 07
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Ontario Composition of Total Expense 2006 07
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The budget is the ultimate ethical document in
any institution (or system), and resource
allocation is the ultimate ethical decision if
your conscience is not in the budget, you dont
have it

• Leland R. Kaiser

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you cant manage a 33 billion operation from
a head office in Toronto
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Governments Vision

• Our vision is of a system where all providers
  speak to one another in the same language, where
  there are no longer impenetrable and artificial
  walls between stakeholders and services a
  system driven by the needs of patients, not
  providers.
• The Hon. George Smitherman, Minister of Health
  and Long-Term Care

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Ontario Response

• A major Transformational Agenda
• with14 areas of focus, including the following
• Primary Health Care
• Access and Wait Times
• Information Management
• Integration
• Creating a System

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Bringing the Elements Together

• One single objective
• Improving access to health care services for the
  people of Ontario
• Common themes
• Engagement, Conversations Collaboration
• Building the Capacity of the Health System
• Better Information, Better Decisions Improve
  Accountability
• Laying the Foundation for Integration

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Response

• 14 Local Health Integration Networks (LHINS) have
  been set up throughout all of Ontario
• Somewhat similar to Regional Health Authorities
  in all other Canadian Provinces, but also very
  different
• Local provider boards will continue to exist and
  provide leadership to their organizations.
• LHINs will be responsible for managing the
  system, not operating services.

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Regionalization in Canada
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LHIN Geographic Boundaries

• LHIN Areas
• Erie St. Clair
• South West
• Waterloo Wellington
• Hamilton Niagara Haldimand Brant
• Central West
• Mississauga Halton
• Toronto Central
• Central
• Central East
• South East
• Champlain
• North Simcoe Muskoka
• North East
• North West

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Local Health Integration Network

• Goal
• To create an integrated health system
• LHIN Legislation
• Bill 36, The Local Health System Integration Act
• Function
• To provide strategic management for the local
  health system

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Stakeholder Roles

• Service provider Boards will continue to govern
  their organizations
• Boards will be asked to take a leadership role in
  enabling integration based on an Integrated
  Health Services Plan (IHSP)
• Boards will be asked to be accountable through
  performance and accountability agreements.

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The Mandates of LHINs

• Community Engagement
• Integrated Health Services Planning
• Integration
• Performance and Accountability Agreements
• Performance Measurement
• Funding (true devolution of decision making)

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Our Mandate Cycles
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Integrated Health Services Plan (IHSP)

• Current mandate, as per new legislation Bill 36,
  Local Health System Integration Act, requires
  LHINs to develop an IHSP by September 2006.
• First IHSP will be transitional
• Focus on some achievable priorities

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South East Local Health Integration Network

• IHSP process
• Local Characteristics
• Findings from our first IHSP

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South East IHSP Process

• Quantitative and Qualitative Analysis
• Quantitative (our Environmental Scan)
• Data analyzed included geographic demographic
  socio-economic health services funding
  population health survey data acute care,
  long-term care primary health care and
  community support data.
• Qualitative (our Community Engagement)
• Established a Project Working Team (PWT)
  nominated from the various health sectors met 1
  day per week for 6 weeks.
• Held 109 meetings in 22 communities, with groups
  ranging from 6 to over 300 people in the various
  communities

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SE Characteristics

• Ruralality
• Demographics
• Population Size
• Age

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LHIN Geographic Boundaries

• LHIN Areas
• Erie St. Clair
• South West
• Waterloo Wellington
• Hamilton Niagara Haldimand Brant
• Central West
• Mississauga Halton
• Toronto Central
• Central
• Central East
• South East
• Champlain
• North Simcoe Muskoka
• North East
• North West

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Map of SE LHIN
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SE LHIN Sub-Areas and 2004 Population
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Comparison of SE LHIN andOntario Percent
Distribution of 2005 Population by Age Cohort
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Ruralality

• According to the Joint Policy and Planning
  Committee (JPPC), a geographic area with fewer
  than 25 people per square kilometre is considered
  to be rural for the purposes of its acute care
  hospital Volumes Model.
• The SE LHIN, with 24.3 people per square
  kilometre, is the only LHIN in southern Ontario
  which fits that criteria.

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2005 Population per Square Kilometre by LHIN
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2004 Population per Square Kilometre for SE LHIN
Sub-Areas
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Some Other Key Findings

• Oldest population of any LHIN
• Most rural population in Southern Ontario
• Limited access to Primary Health Care.
• High risk factors for many chronic diseases
• Transportation for non urgent medial care is a
  major problem in both rural or urban SE
• Below provincial target for hip and knee
  procedures

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SE IHSP Priorities

• Access to Care, including
• Primary Health Care
• Specialty Care
• Mental Health
• Addiction Services
• Rehabilitation Services
• Transportation to and from care

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SE IHSP Priorities

• Availability of Long Term Care Services
• Integration of Services Along the Continuum of
  Care
• Engagement with Aboriginal Communities
• Ensuring French Language Services
• Integration of e-Health

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Summary

• LHINs are Ontarios approach to devolve the
  management of the health system to the local
  level
• LHINs will focus on integration, planning,
  community engagement and accountability
• The SE is very rural overall with a mixture of
  urban and rural sub communities
• There appears to be no consistent pattern between
  rural or urban based residency and health status
  or access to care.

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Types of Funding

• Global Base Funding set, annualized funds to
  provide a general basket of services. Most
  flexibility and accountability for service
  provision. Eg. Hospitals.
• One-time Funding not annualized (although may
  recur over a number of years). Often used to
  respond to short-term, unusual pressures.
  Announcement most often at year end.

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• Priority Programs generally funds specific
  procedures such as cardiac interventions,
  dialysis, and hips and knees.
• Protected Programs part of the global base,
  however, the health service provider may not
  reduce the funds associated with that service.
  Eg. Sexual assault crisis and treatment programs.

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• Targeted Funding associated with current
  Ministry focus areas Eg.Wait Time Strategy.
• Program Funding generally a line-by-line funded
  initiative with limited flexibility in
  programming decisions. Eg. Mental health and
  addiction programs.

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• Per Diem Funding a daily rate has been
  determined as adequate to support programming
  needs. Eg. LTC.
• Subsidy Funding the amount of approved program
  expenditures that is NOT covered through
  fundraising and client fees is provided by the
  Ministry to a set maximum. Eg. Community Support
  Services.

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• Population-based Funding sometimes referred to
  as capitation, where an amount of resources
  necessary to support a given population is
  determined and that full amount is flowed to the
  provider.
• Fee-for-service Funding where a fee is attached
  to every service provided according to a
  pre-determined menu. Eg. OHIP.

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• Direct Funding where funding to purchase a
  health care service flows directly to the
  patient. Eg. Some instances of attendant care
  for people with physical limitations.

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Contact Information

• Paul Huras
• CEO, South East Local Health Integration Network
• 48 Belleville Street W.
• Belleville, ON K8P 1A3
• 613 243-1288 mobile
• 613 967-0196 ext. 245
• 613 967-0196 ext. 220 ask for Jacqui Prospero
• paul.huras_at_lhins.on.ca