Commission on the Reform of Ontario's Public Services

Service Delivery
Chapter 5: Health
� Mostly public sector � Blend of public and private sector (within public
payer model)
Information Technology
� Little used by physicians and especially across
the system
� Information conveyed in doctors’ offices
Medical Schools
Current System
� No attention to system (cost) issues
� Little attention to labour supply issues
Coverage of Public Payer Model
� Hybrid with almost 100 per cent primary, less than
half of drugs and limited mental health
Transforming to Reformed System
� Extensive use that is key to co-ordination across
system and accountability
� Information more easily available and conveyed
through multiple sources (phone, Internet, etc.)
� Course(s) on system issues
� Role in directing physicians to areas of demand
(by area of medicine and geographically)
� Broader coverage widely recommended but not at
all clear this will be acted upon
The ideal system begins with a general approach to health care and moves through the major
elements of the system — hospitals, long-term care and home care, physicians and other
professionals, pharmaceuticals, services delivery (public or private), information technology,
medical schools and coverage of the public payer model. Before we get to a more detailed set
of recommendations, here is a summary of the kind of changes we seek.
We have already sketched out the general approach — a shift towards health promotion
rather than after-the-problem treatment; a system centred on patients rather than hospitals;
more attention to chronic care rather than a primary focus on acute care; co-ordination across
a broad continuum of care rather than independent silos that allow too many people to fall
between the cracks; and new ways of dealing with the small minority of patients who require
intensive care.
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