Commission on the Reform of Ontario's Public Services

So if we cannot — in short — look to “easy” answers to the problem, we are left with hard
answers and difficult solutions. We are left with the challenge of reforming the health care
system to make it operate more efficiently and give us greater value for money. This is not
easy, especially not when every proposal for fundamental change is greeted in some quarters
by cries that medicare will be destroyed if Proposal X or Recommendation Y or Scenario Z is
adopted. The public debate in Canada has been poisoned in recent decades by a widespread
failure to comprehend the issues or trade-offs that must be made; by knee-jerk reactions to
worthy but complex ideas for change; by politicians (and media outlets) who have been too
willing to pander to fear-mongering; by stakeholders in the health care system who, wishing to
cling to the status quo, resist change; and generally by a lack of open-minded acceptance of
the reality that change is needed now and that money alone will solve nothing.
What we need is a broad revamping of the system that makes the parts work better together,
so that the whole is greater than — or at the very least equal to — the sum of the parts.
Such change is already underway in bits and pieces that address specific pressing needs. It is
being carried forward by health care providers in every corner of the system who recognize far
better than the politicians or the public what needs to be done and — perhaps more
importantly — what no longer needs to be done. Already, they are moving the system
incrementally towards the greater integration that is utterly necessary. What they need now
and in the years ahead is more encouragement from government and financial incentives that
will induce people and organizations to behave in ways that will produce a health care system
that better serves us all.
The vital first step is a long-term view of how the health system should change to meet the
needs of the future. The government must set out a 20-year plan with a vision that all
Ontarians can understand and accept as not only necessary but also desirable; a plan that
will, though it involves tough decisions in the short term, deliver a superior health care system
down the road.
The purpose of reform is not simply to save money, though that is a welcome consequence.
The purpose is to improve the quality of the system for the benefit of all Ontarians by shifting
from a system that was built mainly for acute care — and remains largely in that mode —
to a system built mainly for chronic care, which is where the aging of the population is driving
Ontario’s health care needs. We cannot emphasize strongly enough that quality of care and
efficiency are essential to any reform. Better care delivered smoothly and briskly across a
range of needs will benefit patients and providers alike; it will also save money in the long run.
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