Commission on the Reform of Ontario's Public Services

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The public payer model now covers almost all of primary care — physicians and hospitals — but less than half of drugs and relatively few mental health services; psychological services for example, are not covered. Extending medicare to a broader range of services would be difficult and controversial. But an open dialogue on this question is worthwhile and at some point will become necessary. The government should at least launch such a dialogue; Ontarians should be prepared to engage in this debate, especially stakeholders who know the system best. We must stress two things. First, the health care landscape is not nearly as black and white as the chart and this short discussion imply. Many segments of the old system are already moving towards the kind of reformed system we would like to see and are somewhere along the continuum between old and reformed. Second, none of what we have said will surprise anyone who manages part of the health care system today. These proposals are common among health care professionals, who are full of good ideas about how the system can be reformed; many of them are already pushing the system towards needed reforms with some success. Neither are these ideas in any way radical. But too many of them have been stifled in a public debate by politicians, interest groups and stakeholders who regard even the most sensible reform proposals as threats to medicare rather than solutions to medicare’s problems. Among those we talked to, none who manage parts of the system argued that more money alone is the solution to the problems of the health care system, including the ones they face. Indeed, some argued that the system is now well funded and that too much money would simply impede needed reforms. Certainly, the evidence of the recent past is that more money — political rhetoric notwithstanding — did not buy change, only more of the same, at higher cost. Governments have typically recognized that greater co-ordination is required along the continuum of care and that the co-ordination should be on a regional basis. Ontario created 14 LHINs to do this. Despite the title, the LHINs do not integrate key parts of the system. Among the activities excluded are primary care and physicians in general, public health and in some cases, community care. Some LHINs have struck arrangements with the CCACs and public health units in their regions, but this pattern is fragile and does not apply everywhere. It is hit and (mostly) miss. In theory, LHINs have the authority to allocate budgets across the various components of care; in practice, they do not. 172
Chapter 5: Health There is much to be proud of in Ontario’s health care system, but there are also many problems, as anyone who works in the system — and many who deal with it as patients — will tell you. Fortunately, there is an abundance of opportunities for reform that will create a system that can deliver better quality care more efficiently. The challenge is to realize those opportunities. 173
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2012 COMMISSION O N T H E REFORM O
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For electronic copies of this docum
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Chapter 4: Making Transformation Wo
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Chapter 9: Employment and Training
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Chapter 18: Revenue Integrity Incre
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This context lifts the task ahead w
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Action must begin very soon. The de
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xii Dominic Giroux, Commiss
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Photo Credit: Jovan Matic xiv Carol
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First, we assessed the 2011 Budget
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How did we get to this point? For m
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6 TABLE 1. Three Views of the Outlo
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This permits post-secondary educati
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How does our scenario for the perio
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The “don’ts” are proposals th
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Several measures would strengthen t
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Health care is the Ontario governme
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There are inefficiencies in the hea
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20 Service Delivery � Mostly publ
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Our first recommendation is that th
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Evidence should drive policy. Medic
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One potential way to reduce overall
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Elementary and Secondary Education
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Non-Teaching Staff: Since 2002-03,
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Delivering Services More Efficientl
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Simply maintaining the status quo r
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� Mandate agreements should inclu
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Benefit programs are delivered thro
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Child Welfare: In this case, as wit
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With so many services provided by s
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Over the past decade, the Ontario g
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Urban transportation is a particula
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Environment and Natural Resources R
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� Aging infrastructure is deterio
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Labour Relations and Compensation T
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Leaders in the OPS and BPS should b
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In a number of areas, efficiencies
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Revenue Integrity Across a range of
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Contraband tobacco is another issue
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Risks Posed by the Federal Governme
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� Long-term health costs outstrip
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Immigration settlement and integrat
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Chapter 1: The Need for Strong Fisc
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The Budget Scenario Chapter 1: The
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80 60 40 20 0 Rest of Canada Ontari
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Revenue Implications Chapter 1: The
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TABLE 1.1 Three Views of the Outloo
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Conclusion Chapter 1: The Need for
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Chapter 2: The Fiscal Challenge in
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Page 139 and 140: The Challenge Chapter 2: The Fiscal
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Chapter 6: Elementary and Secondary
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Reform of Provincial Schools Chapte
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Chapter 7: Post-Secondary Education
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Need for Clear Objectives Chapter 7
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9,000 8,000 7,000 6,000 5,000 Unive
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Chapter 8: Social Programs Chapter
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The Challenge Chapter 8: Social Pro
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Chapter 8: Social Programs Recommen
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Chapter 8: Social Programs In the a
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Initial Assessment Chapter 8: Socia
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Chapter 8: Social Programs To quali
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Chapter 8: Social Programs While th
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Youth Justice Chapter 8: Social Pro
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General Approach � Transaction fo
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Employment and Training Services Pr
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Chapter 10: Immigration The Economi
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TABLE 10.1 Permanent Residents Admi
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Chapter 10: Immigration Recommendat
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Other Integration Issues Chapter 10
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TABLE 10.4 Integration Program Fund
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Chapter 10: Immigration A new COIA
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Chapter 11: Business Support Chapte
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� Investment in post-secondary ed
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TABLE 11.1 Total Business Tax Relie
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Types of Business Support Chapter 1
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Chapter 11: Business Support Tax ex
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Appendix 11.1 List of Business Supp
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Chapter 12: Infrastructure, Real Es
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Transportation Chapter 12: Infrastr
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Chapter 13: Environment and Natural
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Reform the approvals process Chapte
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Ring of Fire Chapter 13: Environmen
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Chapter 14: Justice Sector 2010-11
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Recent Expenditures Chapter 14: Jus
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Chapter 14: Justice Sector Public E
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Chapter 14: Justice Sector Continuo
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Chapter 14: Justice Sector Building
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Efficiencies Clustering OPS Adjudic
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Chapter 14: Justice Sector Analysis
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Chapter 14: Justice Sector Recommen
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A Balanced, Effective and Transpare
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ServiceOntario Transformation Chapt
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I&IT Transformation Chapter 16: Ope
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Back-Office Consolidation Chapter 1
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Chapter 18: Revenue Integrity Chapt
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Chapter 18: Revenue Integrity Stati
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Uncollected Fines Chapter 18: Reven
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Tax Revenue Chapter 18: Revenue Int
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CHART 18.2 Assessment and Tax Growt
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Chapter 18: Revenue Integrity Appen
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TABLE 19.2 Historical and Projected
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Social Housing Chapter 19: Liabilit
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Chapter 20: Intergovernmental Relat
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CHART 20.1 Ontario’s Share of Fed
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CHART 20.3 Ontario’s Fiscal Gap 1
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Potential Federal Impacts on Ontari
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Long-Term Health Costs Likely Outpa
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TABLE 20.2 Selected Examples of Tra
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CHART 20.7 2011-12 Equalization Ent
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Canada Social Transfer Chapter 20:
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Chart 20.10 Employment Outcomes for
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Green Energy Chapter 20: Intergover
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Environmental Protection and Regula
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CHART 20.11 2009 Municipal Revenues
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Infrastructure, Real Estate and Ele
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Appendix 1: Commission</str
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Appendix: Commission</stron
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Recommendation 8-9: Advocate for fe
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Appendix 2: List of Acronyms ABCs a
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FIT feed-in tariff FSCO Financial S
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MTCU Ministry of Training, Colleges
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REA Renewable Energy Approval RFP r
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Commission on the Reform of Ontario's Public Services

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