Commission on the Reform of Ontario's Public Services

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Service Delivery
� 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
Here is a summary of the kind of changes we seek: a shift towards health promotion rather
than after-the-problem treatment; a system centred on patients rather than hospitals; more
attention to chronic 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.
Rather than draw patients to hospitals, we should direct them to the most appropriate care
setting for their problem — whether it is a doctor’s office, family care centre or clinic,
rehabilitation centre, long-term care centre or back home. Physicians and other professionals
tend to work alone or in small groups where they are not integrated with other sectors of the
health care system. Family Health Teams (FHTs) go some way to meeting this goal, but tend
to be too small, with too few physicians, and cover too narrow a range of services.
Regional health authorities should establish what expectations professionals should meet
and accountability should be strengthened by electronic records.
Medical schools should add at least one course introducing their students to the broader
system in which they will spend their careers, and where physicians fit. The government
should do more to direct physicians to areas of need.