PATHS TO PROSPERITY

A HEALTHI ER ONTARI O
An Ont a r i o PC Ca uc us Whi t e Pa pe r
Fe br ua r y 2013
Of all the services we expect from government, health care is the most personal. Our encounters with health
care can be the most joyful and the most sorrowful of our lives the birth of a child, the death of a parent, a
diagnosis of cancer or the news of a complete recovery.
Health care in Ontario today has tremendous strengths, none greater than the dedicated and highly trained
nurses, doctors, home care workers and other professionals who devote their lives to delivering care. At the
same time, we face important challenges. For many years we have sustained health care by growing spending
at six to eight per cent every year, far in excess of the economic growth that lets us pay for it. With a budget
deep in deficit, we simply cannot afford to continue down this unsustainable path.
And despite all of the spending, and the enormous dedication of frontline health workers, we do not consistently
get the results Ontario families expect and deserve. Far too many seniors wait for the home care or the
long-term care they need. People with chronic diseases like diabetes and kidney disease get a tremendous
amount of health care treatment, but their health results are often poor, even though we spend more than
most countries. Everybody recognizes that it is more effective and less expensive to invest in prevention and
wellness than treatment, yet every incentive in the system conspires to promote the exact opposite. And
no matter how much we spend, or how committed individual nurses and doctors are, the system is often
maddeningly frustrating to navigate.
The current government has approached these challenges with massive spending and good intentions. It says
many of the right things: that we need more integration among hospitals, doctors and home care that we
need to bring care closer to home especially for seniors that we can use evidence to provide better care. But
the money has run out even the government itself admits it can only afford to grow health spending at less
than a third the rate of the last eight years. And the good intentions just havent delivered.
Theres a reason for this. The current government has taken a fundamentally flawed approach of preferring
centralized, bureaucratic solutions, rather than supporting the people who actually deliver care on the ground.
From eHealth to Local Health Integration Networks, this government has lavished billions on administrative
agencies with no role in caring for patients. Nine years later we still dont have doctors and hospitals using the
same electronic health records, and we still dont have integrated local health care.
When we look at the actual results we achieve how healthy we are and at how much we spend to achieve
these results, we cannot say today that our health system is the best in the world. But it can be. We share
many of the goals the current government claims to support. After all, who would disagree with a goal like
helping seniors to remain at home? But we have a fundamentally different, and much more effective, approach
to getting the job done. Our approach is based on putting resources and authority in the hands of people who
actually deliver care, rather than bureaucratic agencies. It is based on transparency and accountability, even
when that has the potential to embarrass ministers and administrators. And it is based on a laser focus on
what will actually improve the health of you, your kids and your parents, while delivering the quality of service
you expect and deserve.
While there are real challenges for health care in Ontario, I believe there are also tremendous opportunities. By
putting our dollars where they will get the greatest value, by taking advantage of breakthroughs from medical
evidence and technology, and by helping all the parts of our health system to work together, we can sustain our
health system, provide better care for you and your family, and build a healthier Ontario.
Tim Hudak
Leader of the Official Opposition
Health care in Ontario is, quite rightly, one of the services we cherish most. Were proud of our universally accessible
system, which ensures our most vulnerable will receive care, and even prouder of the dedicated and talented health
care professionals who provide it.
Despite our pride, most Ontarians know our system is coming under increasing strain and are anxious about how we
can continue to sustain it into the future. Weve heard we cannot continue to spend an additional six to eight per cent
annually on health care, yet we are faced with an aging population that will require increasing amounts of health care
in the next ve to ten years. The boomer tsunami is almost upon us, yet very little has been done to prepare for it.
The truth is we only have a few paths to follow: increase taxes, decrease services or innovate. The Ontario PC
Caucus believes innovation is the answer.
But what does innovation mean? In our view, there are several key themes that should guide us in developing a high-
performing health care system for Ontarians.
First, we are currently operating our health care system on an outdated, reactive model based on acute episodes of
illness. We need to transition to a twenty-rst century model of care that is proactive and based on chronic disease
management, health promotion and prevention.
The paths presented in this white paper suggest ways in which we can transition to this new model.
Secondly, we need to focus our attention on patients and families and ensure our new model of care centres around
their needs and not the needs of health care providers. This will mean, for example, that people will have choice in
home care services, that people will leave the hospital with a coordinated care plan, and that our mental health and
addictions services will be accessible and coordinated.
Many people will suggest all of this will cost more money than we can afford, but the evidence suggests the opposite.
In fact, when the delivery of care is centred around the patient, signicant savings can be achieved.
The paths presented in this white paper suggest proposals to re-align our system, from reform of eHealth to health
system navigators, which will get the best possible value from each health care dollar, while providing excellent care
and high levels of patient satisfaction.
We hope the ideas presented in this white paper can start a meaningful health care discussion in Ontario, and look
forward to hearing from you. You can contact me by email at [email protected] or by phone at
416-325-1331 (Queens Park).
Christine Elliott
Ontario PC Caucus Critic for Health
Christine Elliott, MPP
DE P UT Y L E A DE R OF T HE OF F I CI A L OP P OS I T I ON,
MP P F OR WHI T BY OS HA WA
A Stronger Health System Starts with Telling the Truth
Getting Better Value Means Better Use of Evidence
New Challenges Require New Solutions
The Best Care is Usually Care Closest to Home
Fund the Health System to Work as a System
Make Care Easier to Access and to Understand
Make Mental Health an Integral Part of the Overall Health System
Recognize that Better Health is Not Just About Health Care
Provide Greater Patient Choice
Harness Competition to Get Better Service at Better Cost
Efficiency Today Allows Time to Get Long-Term Reforms Right
Conclusion
CONT E NT S
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Yearly Ontario Health Care Spending
2002 2003 2004 2005 2006 2007 1998 1999 2000 2001 2008 2009 2010 2011 2012
Source: Ontario Ministry of Finance data, 1998-2012
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PATHS TO PROSPERI TY
A STRONGER HEALTH SYSTEM STARTS
WITH TELLING THE TRUTH
We invest more in health care than in any other service, and rightly so. We rely
on our health care system when we are at our most vulnerable, and great health
care can mean the difference between pain and comfort, between anxiety and
relief, and even between life and death.
We need a strong and continually improving health care
system, not just today but in the decades to come.
Ensuring a strong and improving health care system
begins with telling the truth.
The truth is that for many decades, and especially in the
last 30 years, the cost of our health system has been
growing much faster than our ability to pay. Health costs
have been growing by six to eight per cent a year, year
after year, even though the economy has only grown at
a little more than half that rate. Many studies, including
the recent Drummond report, have demonstrated that it
is not sustainable in the long run for our most important
and expensive spending program to grow faster than our
ability to pay every year, but the same conclusion is evident
to anyone who has ever balanced a household budget.
The reason health spending has been growing so fast
is not mainly that inefficiency has been growing. Nor
is it the aging of the population. By far the biggest
driver of rising health cost is that we are providing more
health services to, say, the average 55-year-old man
each year, than we did the year before, or the decade
before that.
Some of this extra health care is helping a lot. For
example, we have hip and knee replacements now
that essentially didnt exist 30 years ago. When people
are relieved of pain and regain mobility, thats a very
good thing.
But overall, all of this extra health care isnt making the
health of the population in Ontario much better. We
sometimes take comfort that Canadas performance
on health outcomes like life expectancy and infant
mortality is better than the performance of the United
States, but the truth is that plenty of countries achieve
better health outcomes than we do, and most of them
spend less.
In September 2012, the Ontario PC Caucus released
a plan to get the foundation of our health system right,
by putting the patient at the centre. That plan would
address the excessive complexity and overlap in our health
system by replacing the alphabet soup of bureaucratic
agencies from Local Health Integration Networks (LHINs)
to Community Care Access Centres (CCACs) with
integrated health hubs run by people who actually
deliver health care, like hospitals, doctors and nurses.
Infant Mortality
(Deaths per 1,000 Live Births)
Source: Conference Board of Canada, data based on year 2009
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Source: Conference Board of Canada, data based on year 2009
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- 7 -
PATHS TO PROSPERI TY
This paper builds on that foundation by proposing
a set of specific steps we can take to build a higher-
performing health system, while ensuring its
sustainability in the years and decades to come. The
proposals range from treating chronic disease as the
leading health challenge of our time and treating a
person with multiple diseases as one patient, rather
than many to providing greater patient choice in
selecting the home care you need.
No health system can provide and pay for every possible
treatment in every possible situation, and no health
system does. Even though our system purports to
provide whatever treatment is medically necessary,
in practice the government and health care providers
restrict that.
Waiting lists are one obvious way: you can get your
surgery, but not for a year, and you have to wait
Main Causes of Health Care Spending Increases
(Average Annual Increase, Canada from 2000 to 2010)
Source: Canadian Institute for Health Information
7% Total Increase
8%
6%
4%
2%
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Utilization
3.1%
Inflation
2.7%
Population
Growth 1.2%
- 8 -
PATHS TO PROSPERI TY
six months for an MRI. There are other ways, like
deliberately taking a long time to approve reimbursement
of new drugs, or just not having new technologies,
even though they have proven benefits.
The system sets priorities for what care is actually
provided, but it does it in the wrong way. Its set up to
minimize transparency and accountability to give as
much cover as possible for the minister of health rather
than to maximize how healthy we can be.
We need to turn that on its head. We need our health
system to invest our dollars in ways that will have the
most impact in making people healthier. That means
maximum transparency to make good decisions, rather
than minimum transparency to protect ministers and
administrators.
It means rigorously assessing what actions what
prevention programs, what tests, what drugs, what
surgeries, what home care services actually do the
most to improve or maintain our health. And it means
acknowledging that cost is tremendously important in
how we set priorities, rather than pretending that we
dont even think about cost and then secretly doing it
behind closed doors. We want to maximize the health
of patients of people which means maximizing the
value of our health spending and getting the greatest
quality of care for each dollar we spend.
- Jean-Marie Berthelot, VP, Canadian Institute of Health Information, October 2010.
The share [of the health budget] spent on Canadian seniors
has not changed significantly over the past decade from
43.6 per cent in 1998 to 43.8 per cent in 2008. While it is true
that care is costlier for people who are 65 and older, we have
not seen a rise in the proportion we spend on seniors.

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PATHS TO PROSPERI TY
GETTING BETTER VALUE MEANS
BETTER USE OF EVIDENCE
Most of the improvements we have achieved in health come from rigorously
collecting and applying evidence. Understanding the germ theory of disease
led to a revolution in public health, infection control and antibiotic treatments.
Evidence on the linkage between obesity and diabetes has allowed doctors
to intervene much earlier to help patients to manage their risk, as well as to
include lifestyle modifications like exercise as a central element of treatment.
There are literally thousands of similar examples, forming the basis for most
health practices today.
Appropriate use of evidence can also help to change
or eliminate treatments that are ineffective or even
dangerous. There is ample evidence that antibiotic
treatments are not effective for cold symptoms, yet
surveys indicate they are sometimes prescribed. Some
surgeries for back pain or arthritis have been shown to
be no more effective than physiotherapy. Early disease
management programs to help people with diabetes
and asthma were supported by the best theories, but
many did not actually produce measurable results.
Recent evidence has called into question some common
medical practices such as the early administration of
beta-blocker drugs for heart attack survivors.
- Drummond Commission, page 170.
Evidence-based guidelines for the care of specific
maladies or conditions are needed to even out the
wide variety of treatments some more effective than
others that are now used for the same problems.
Currently, it is unclear what objectives professionals
are expected to meet and accountability is weak.

Yet experts are virtually unanimous that we do not

collect enough of the evidence that could lead to
better treatments, and we do not always apply what
we learn. One of the most important steps in applying
evidence to care is assembling patient databases or
registries that keep track of thousands of patients with
similar conditions, what treatments they got and how
their health progressed afterward, with the patients
names and personal details deleted to protect privacy.
Researchers and clinicians then examine the results
and change practices based on what is proven to work.
Sweden has done a particularly thorough job of building
patient registries and has been rewarded with significant
improvements in measures ranging from 30-day survival
after heart attacks to the rate of complications in
cataract surgeries. The current Ontario government
has done too little to build the patient registries that can
enable evidence-based care, and recently abandoned
its efforts to build a diabetes registry. This has to change.
To get better value, we need evidence not only on outcomes
which treatments actually lead to better results but
also on cost. Amazingly, when the Ontario government
collects data on the cost of a surgery, it doesnt include the
cost of the surgeon, because the surgeon is paid through
the OHIP budget instead of the hospital budget. If we
want to get the best value for our health dollars, we need
reliable evidence on how much treatments cost, including
follow-up costs like hospital re-admissions.
Finally, we need to apply the evidence we gather. In some
areas, like surgical techniques, the role of the Ontario
government is primarily to get evidence into the hands
of practitioners through a much more effective Health
Quality Ontario.
PATH 1
Focus health care decisions on evidence, to achieve greater quality per dollar
spent. Dramatically enhance patient databases to enable doctors and researchers
to improve treatments and prevention programs based on real-world evidence.
Require drug and medical device manufacturers to provide proof of incremental
value when seeking reimbursement. Move more quickly to make innovative
new drugs and devices available, while requiring better cost effectiveness if
manufacturers cannot prove superior effectiveness or safety.
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PATHS TO PROSPERI TY
In others, like drug reimbursement, the government
needs to make decisions differently. When a new drug
comes onto the market, if the manufacturer wants the
Ontario Drug Benefit program to pay a higher price for
it, that manufacturer should be required to produce
evidence not only that the drug is effective and safe,
but also that it is more effective and safe than other
therapies, at least for some patients. And when post-
market surveillance provides additional insight on the
benefits and risks of drugs, this should be considered
in decisions about whether to continue, enhance or
discontinue reimbursement.
Governments in many countries, like the United
Kingdom and France, have already adopted this
approach, but Ontario has lagged. Instead, Ontario
is slow to cover all new drugs, so those that genuinely
represent breakthroughs, like some new cancer
drugs, arent available to patients. This one-size-
fits-all approach wastes money and denies patients
the best available care.
Patients Have More Complexity as They Age
Age
One Disease
Two Diseases
Three Diseases
Four + Diseases
45-64 65-79 80+
Source: : Healthcare Quarterly, "Population patterns of chronic health conditions,
co-morbidity, and healthcare use in Canada, 2008.
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PATHS TO PROSPERI TY
NEW CHALLENGES
REQUIRE NEW SOLUTIONS
The kind of health care people need is changing, in part because of the past
successes of our health system.
More and more people today are living with two, three,
four or more chronic conditions, like heart disease
and diabetes and chronic kidney disease. Thats not
because our health system has failed. In fact, its
because it has succeeded. Fifty years ago few people
survived a chronic condition long enough to acquire
three or more.
Early in the twentieth century, we achieved the biggest
improvements in outcomes like life expectancy in human
history, mainly by managing infectious disease. Some
of the measures to achieve that didnt involve health
care at all: the most important were clean water and
better sanitation. But even the advances in the health
system were in areas like vaccinations and antibiotics,
which were highly effective and relatively inexpensive.
By the middle of the twentieth century, the biggest
challenges were changing. Once water is clean, you
cant fight disease by making the water even cleaner.
Once smallpox is eradicated, the vaccine cant make
any further improvements in health. As people lived
longer, we needed hospitals and more advanced acute
care to manage the heart attacks, cancer, and other
conditions that became the most important frontiers
of health care once the burden of infectious disease
was significantly reduced.
Now, the biggest challenge for our health system is
changing once again. When our acute care system
works well enough that more people are surviving heart
attacks, more of us live with heart disease. When better
surgeries allow fractured hips to be repaired and joints to
be replaced, people live longer with the consequences
of impaired mobility. Longer life expectancy leads to
more of the diseases that come with age, from diabetes
to emphysema to Alzheimers disease. And just as
we couldnt deal with acute conditions through even
more clean water, we cant manage chronic disease
with even more acute hospital care.
Chronic disease is the most significant challenge our
health system faces, from the perspective of both results
and costs. People with multiple chronic conditions
unfortunately have quite poor health outcomes, even
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PATHS TO PROSPERI TY
The Ontario government has not developed or
implemented directives about the actual delivery of
health care or the way in which that care is organized and
delivered, which includes chronic disease management.
Financial incentives (rather than directives) have been
utilized. The Ontario Chronic Disease Prevention and
Management Framework then remains just that a
framework without an implementation plan or
the resources to support it.

though they use a huge amount of health care. The

170,000 patients with the most complex chronic disease
use $9 billion in health care in Ontario each year; the
500,000 patients who are the next most complex use
another $9 billion.
Our health care system is not set up to provide the best
care for people with serious chronic conditions, and
especially those with multiple chronic conditions. We
rightly rely on family doctors to be the gateway to the
health system, but for the one to two per cent of patients
with the most complex needs, a family doctor without
additional support often doesnt have the resources
to manage all of a patients different specialists, tests,
hospital and clinic visits, and medications.
The medical profession is mainly set up around diseases
one doctor to deal with kidney disease and another to
deal with diabetes but we are just at the beginning of
building expertise in how to manage all of these diseases
in the same patient. Even clinical trials typically screen
out patients with multiple conditions because the extra
conditions make analysis too difficult, but this means
that we often have very little evidence about what works
for the patients who are the most intensive users of
health care. We need a new, integrated, evidence-
based approach to care that is tailored specifically to
the needs of people with multiple chronic diseases.
This offers an encouraging opportunity because
there is considerable evidence already that for people
with chronic health conditions, the best care is often
significantly less expensive than what we provide today.
In particular, the best care is usually provided close
to home through community clinics and home care.
But people with complex chronic conditions frequently
end up in acute care hospitals especially emergency
rooms even when they dont have acute problems.
Waiting in an emergency room is inconvenient and
disruptive for these patients, and expensive for the
Source: McMaster Health Forum, Strengthening
Chronic Disease Management in Ontario, October 2009.
Chronic Disease is the Most Significant Challenge
Our Health System Faces
Patients with Most
Complex Disease
170,000
500,000
=
Patients with Next
Most Complex Disease
$53,000
$9 Billion Total $9 Billion Total $30 Billion Total
=
$18,000
13,000,000
All other Ontarians
=
$2,300
per patient per patient per patient
PATH 2
PATH 3
Build a system that treats chronic disease as the leading health challenge of
our time, not as an afterthought in a system designed around acute care. Build
on the unique assets of Ontarios chronic hospitals, along with family doctors
and community-based care, to pioneer a truly integrated approach to health for
patients with chronic conditions. Focus on providing community and home-
based care options to help these patients to live better at home, and to avoid
unnecessary acute hospital visits. Create one or more centres of excellence to
develop evidence-based approaches to care for these patients, including those
living with two, three or more health conditions.
Ensure that every patient with chronic conditions has a comprehensive care plan,
and provide dedicated care navigators such as nurses for the patients with the
highest needs. Treat a patient with multiple conditions like one patient, not many.
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PATHS TO PROSPERI TY
system, especially when they dont need the specialized
capabilities that only an emergency room can provide.
Moreover, vulnerable patients can be exposed to risks
like hospital-acquired infections.
These patients dont go to the emergency room because
they are being irresponsible. Its often because the
system isnt set up to give them good alternatives.
For example, for people with conditions like mobility
challenges, rehabilitation therapy is often more beneficial
and much less expensive than a visit to an acute
hospital. Yet rehab hospitals today are often not set
up to admit a patient who has not gone to an acute
hospital first, even if that acute visit is completely
unnecessary. This has to change.
Since care is fragmented, patients with complex
conditions often do not have a comprehensive care
plan that covers all of the different specialists and all
of the different sources of care they access. Without
a comprehensive care plan, there is little hope of
coordinating the patients overall care even with an
electronic health record, which is only a record rather
than a plan.
We simply must support health professionals to work
together to develop integrated care plans for patients
that need to see multiple doctors and use multiple
sources of care. And for patients with the highest needs,
we must provide a dedicated care navigator most
often a nurse who can actively coordinate the plan,
ensuring that a patient doesnt get the same test three
times, and that she isnt scheduled for physiotherapy
at home at the same time as she is supposed to be
getting an x-ray across town.
PATH 4
Shift resources and incentives to promote care closer to home, particularly by
expanding home care and long-term care availability, and by promoting more
types of care in the home. Allow pharmacists, paramedics, nurses and nurse
practitioners to provide more types of advice and treatment where these are most
convenient and beneficial for patients, updating scope of practice where required.
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PATHS TO PROSPERI TY
THE BEST CARE IS USUALLY CARE
CLOSEST TO HOME
For people with chronic disease, and even for seniors in relatively good health,
we need to recognize that the best care is often the care provided in the home
or closest to home.
The foundation of a top performing health care system
is ensuring that everyone has access to a great
family doctor or nurse practitioner. Not only is your
family doctor the first person you see for most health
conditions; family medicine plays a critical role in co-
ordinating what all of the other parts of the system do
for you, like keeping track of multiple medications you
may be prescribed by different specialists. We need
to support excellent family health care with tools like
functioning electronic health records, with education
and evidence, and with the flexibility to provide care
in new ways, such as advice over the phone, or home
visits.
Good home care, like personal support, physiotherapy
and home nursing not only allows seniors to stay in their
homes rather than having to move, but it can also keep
them in significantly better health. For example, they
are exposed to considerably lower risk of influenza and
other infections. Over time, we need to restructure our
health system and take advantage of new technology to
allow even more care to be provided in the home, from
home doctor visits to remote advice on medications
and emerging technologies like home dialysis.
When people cannot remain at home, they deserve
access to a long-term care facility designed for people
to live in it for months or longer, not a hospital bed
intended for a short, acute stay.
While we cannot rely on funding more of everything
at a time when we simply do not have the money, we
must deliver more of the services like home care and
long term care that keep people healthier, and away
from unnecessary hospital visits. This in turn allows
hospital beds to be used for people who really need
the full services of a modern hospital for surgery or an
acute condition, reducing wait lists and pressures on
hospital budgets.
Providing care closer to home can also mean taking
advantage of existing resources, like pharmacists and
paramedics, to deliver better access to advice and
appropriate therapies. For example, pharmacists are
often available 24 hours a day and can provide advice on
relevant therapies in areas such as smoking cessation.
Nova Scotia has had great success in expanding
the scope of practice for rural paramedics to allow
them to treat appropriate patients rather than always
transporting them to see doctors. This has significantly
increased the number of patients that can be treated
within long-term care facilities rather than making a
trip to an acute hospital.
PATH 5
Fund the health system to work as a system. Allow health hubs greater exibility to
direct funding to the actions that have the greatest impact on health in the long run,
from prevention programs like smoking cessation, to intensive rehabilitation and home
care to reduce hospital readmissions. In the long term, move towards funding the
health of a population cared for by a hub, rather than funding individual treatments.
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PATHS TO PROSPERI TY
FUND THE HEALTH SYSTEM TO
WORK AS A SYSTEM
Our health care system too often fails to function as a true system, not just for
people with the highest health needs, but for all patients.
Our earlier paper, Paths to Prosperity: Patient-Centred
Health Care proposed a plan to create an integrated
system through health hubs. These would be run by
organizations that actually deliver care and would
replace overlapping layers of administration from LHINs
to CCACs. At the same time they would strengthen
the home care and other services currently delivered
through CCACs. The paper also introduced the idea
of patient-centred funding for hospitals and for health
hubs.
Although the government is moving too slowly, the
version of patient-based funding it is implementing
today represents an important step forward from the
outdated system of the past. Historically, funding for
hospitals was based on lump sum global budgets,
which treated patients only as a cost. Under the new
system, funding will follow patients so that hospitals
that provide more services get more funding.
The governments first step could more accurately
be described as treatment-based funding because
it still focuses on the treatments that each institution
provides for the patient, rather than on the patients
actual health. For example, if a patient appropriately
gets physiotherapy at home instead of a hospital visit,
the hospital loses funding. While we still expect that
hospitals will do the right thing, it is still not helpful
to provide a disincentive to direct patients to more
appropriate care. If a wellness program for a patient
with diabetes can delay or avoid that patient ever having
kidney failure and needing dialysis, surely we would
prefer to direct funding to that wellness program, rather
than penalizing a hospital that runs the dialysis clinic.
One of the most important benefits of creating integrated
health hubs is to bring together the whole system
of care from clinics to hospitals to home care and
rehabilitation. Each hub will be responsible for a defined
population of patients and will look after all of those
patients health needs. In the short term, this will
allow hubs to make better choices about the settings
in which care is provided like an urgent care clinic to
reduce emergency room waits because they will be
responsible for all of the costs and all of the funding.
Once we build the right foundation over the next
decade, we can move to funding hubs based on the
health of the populations they serve, rather than the
treatments they provide. This will allow hubs even
greater flexibility to invest in prevention and wellness
programs, and the health procedures that have the
greatest long-term impact on peoples health, without
fear of being penalized because healthy people need
fewer treatments.
Among Ontarios greatest strengths is its diversity, and
this is reflected in the diversity of our health system.
Our public health care providers include many with
religious and cultural roots. As we integrate our
universal, public health care system into hubs, we
can and should continue to respect the religious and
cultural heritage of those parts of the system.
PATH 6
Make care easier to access and to understand. Rigorously measure satisfaction with
the patient experience and communication, and tie managers incentives to the scores.
Break down the barriers that separate CCACs, LHINs, family doctors and hospitals,
providing a single point of accountability for your care regardless of where it is provided.
- 16 -
PATHS TO PROSPERI TY
MAKE CARE EASIER TO ACCESS
AND TO UNDERSTAND
While the purpose of our health care system should be to help us be as healthy
as possible, it must also be understandable and easy to access. Too often,
patients and families are faced with immense frustration and anxiety when
they try to get the care they need. Thats not acceptable, and even worse, it
sometimes leads to people not getting the right care at all.
For everyone who uses the health system, we need
to make clear communication and excellent service a
core value. That means measuring satisfaction with
the patient experience, holding managers accountable
and rewarding those who deliver great communication
and a great patient experience. It also means giving
patients tools, like access to real-time information
about emergency room wait times online and through
Telehealth Ontario.
The people with the most complicated health needs,
like congestive heart failure and dementia, have the
greatest challenges in accessing the right care at the
right time. We need to provide much more help with
navigating the health care system. As noted earlier,
this requires a dedicated professional such as a nurse,
who talks to the patient or her caregiver directly and is
responsible for ensuring that the patients family doctor,
specialists, tests, physiotherapy and hospital visits all
work together. There is a cost to providing this service
and it is not feasible to do it for every patient, but for
those with the highest health needs often seniors
there is ample evidence that good care navigation not
only improves outcomes, but saves money overall.
Of course, the most fundamental element of accessible
health care is having a family doctor. We will continue
to work to ensure access to family doctors, especially
in northern and rural areas, and will remove barriers
to Ontario residents or others trained in quality global
medical schools who wish to practice in Ontario.
Economic Costs of Mental Health and Addiction
*For example, the costs of hospitalizations, substance abuse programs, law enforcement, supportive housing, etc
Sources: W. Gnam, The Economic Costs of Mental Disorders and Alcohol, Tobacco, and Illicit
Drug Abuse in Ontario, 2000, 2006, Centre for Addiction and Mental Health Fact Sheet; and
Ministry of Health and Long-Term Care, Every Door is the Right Door: Towards a 10-Year Mental Health Strategy, 2009.
Productivity
Loss
74%
Direct
Costs* 26%
$39 Billion
B
i
l
l
i
o
n
s

o
f

D
o
l
l
a
r
s
$50
$30
$40
$10
$20
$0
- 17 -
PATHS TO PROSPERI TY
MAKE MENTAL HEALTH AN INTEGRAL
PART OF THE OVERALL HEALTH SYSTEM
The brain is the most complex organ in the human body, and health conditions
that affect the brain can be among the most debilitating and challenging that
any of us can ever face. Yet mental health has for too long been treated as an
afterthought in our health system. People suffering with mental illness have
too often faced misunderstanding and even blame, rather than compassion
and effective treatment.
Suicide is the second leading cause of death in young
people aged 15 to 24. How can we explain to a
parent whose child is contemplating suicide that care
is available only after a two-year wait? The adults
most in need of care often cannot access mental
health services, especially if they have serious physical
health conditions, because no one in todays system
is equipped to manage their complex needs.
No part of our health system is more in need of change.
Don Drummond estimated in his 2012 report on public
service reform that the economic costs of mental health
and addiction issues in Ontario are $39 billion. Seventy-
four per cent of those costs $29 billion were related
to a loss of productivity in the workplace, and $10
billion were directly related to multiple hospitalizations,
community mental health and addictions programs and
involvement in the criminal justice system, among others.
But the economic case for change if anything obscures
the pain that every day afflicts those living with mental
health conditions, and the frustration and anguish of
families who cannot access the care and support they
so desperately need. We are simply not doing enough
to support our children, youth and adults living with
significant mental health and addictions challenges.
Lack of integration is a critical issue throughout our
health system, and nowhere more so than in mental
health. Ontarios Select Committee on Mental Health
and Addictions noted in its August 2010 report that one
of the main problems in Ontarios mental health and
addictions system is that there is, in fact, no coherent
system. Mental health and addictions services are
funded or provided by at least 10 different ministries.
Community care is delivered by 440 childrens mental
health agencies, 330 community mental health
PATH 7
Treat mental health as equal in importance to physical health. Ensure fragmented
elements of adult and childrens mental health and addictions treatment in Ontario are
integrated into a coherent province-wide plan. Recognize childrens mental health as
part of the health care system. Better integrate the diagnosis and treatment of mental
health conditions from depression to dementia with the physical health conditions that
frequently occur in the same patients, at the same time.
- 18 -
PATHS TO PROSPERI TY
agencies, 150 substance abuse treatment agencies
and approximately 50 problem gambling centres.
Yet no one has the ultimate responsibility for
coordinating these services or for measuring their
results. That, combined with the stigma still surrounding
mental health and addictions, creates barriers to change
beyond those faced by physical health issues.
We have a wealth of knowledge and experience in
the field of mental health and addictions in Ontario,
but we are not taking advantage of it by listening to
experts, building sufficient capacity and organizing
our resources effectively.
For example, many Ontario families with children facing
serious mental health and addictions challenges, such
as severe eating disorders and personality disorders,
are forced to seek residential treatment in the United
States. Families can sometimes receive $75,000 or
more in OHIP funding for these services, yet must strain
their own family budgets to pay tens of thousands of
dollars in additional costs for the services and to send
their children out of the country. We could provide
better services at lower cost in Ontario. Right now the
Ministry of Children and Youth Services is responsible
for childrens mental health in Ontario and the Ministry
of Health pays for the expensive residential programs in
the United States. This means no one is empowered to
fix a patently absurd system that wastes money while
hurting patients and their families.
While we sometimes talk about mental health care
as if it were a single service, in fact it encompasses a
wide variety of needs. These range from the needs of
dual diagnosis patients people with developmental
challenges and mental illness to those of people
managing addictions or specific challenges like eating
disorders. We need the appropriate capacity in our
mental health system to deal with each of these issues
in children, youth and adults.
We must recognize that mental health care is as
important as physical health care. True patient-centred
health care recognizes that the brain is the central
organ in the body, and therefore embraces a mind-
and-body approach. Patient-centred health care
recognizes that the people with serious physical health
conditions like cancer and heart disease are the most
likely to face mental health challenges like depression
at the same time, and that management of the mental
health conditions is deeply related to physical health
recovery.
One of the main problems in Ontarios mental health
and addictions system is that there is, in fact, no coherent
system. Mental health and addictions services are funded
or provided by at least 10 different ministries. Community
care is delivered by 440 childrens mental health agencies,
330 community mental health agencies, 150 substance
abuse treatment agencies and approximately
50 problem gambling centres.

-Ontario Select Committee on Mental Health and Addictions, Final Report, 2010.
PATH 8
Recognize that health care is not the only contributor to health. Through 45 minutes of
mandatory daily physical activity in schools, and smarter use of social and economic
policy, improve prevention and wellness, ultimately reducing unnecessary use of health
care and building a healthier Ontario.
- 19 -
PATHS TO PROSPERI TY
RECOGNIZE THAT BETTER HEALTH IS
NOT JUST ABOUT HEALTH CARE
Although health care is the biggest and most expensive program the Ontario
government funds, the truth is that the health care system is not the most
important or the most cost effective determinant of how healthy we are.
There is overwhelming evidence that education,
economic growth, housing and many other economic
and social factors have a much bigger impact on how
healthy we are than the health care system does. One
implication of this is that good economic and social
policy is good health policy. This is one more reason
why it is so important to accelerate job creation, to raise
family incomes especially among the working poor,
to move people from welfare to work, and to ensure
that our education and training system helps people
get the skills they need to find and keep a good job.
It also means that in some situations, the best
investments to improve health may not be in the health
care budget. For a person with serious mental illness
who becomes homeless and repeatedly goes to the
emergency room, a smart investment in supportive
housing is critical, along with good community-based
mental health services. These can actually save the
health system money, since that patients visits to
the emergency room can be much more costly than
housing and community services.
Ontario families also understand the best approach
to health is to stay healthy in the first place. There are
important wellness and prevention programs that can
and should be managed by family doctors and other
health providers, such as smoking cessation programs.
However, one of the most important contributions we
can make to a healthy Ontario is to ensure our kids get
enough daily physical activity, and the best place to
do that is at school.
Physical education and health classes, led by a qualified
physical education teacher, play a critical role both in
students health and in their education. Yet it is neither
practical nor necessary to replace other subjects during
the school day with more physical education. Instead,
we should require that every child enrolled in school
participate in 45 minutes of mandatory physical activity
each day, in addition to curriculum-based physical
education classes. This would be phased in starting
with students in grade seven and above. Except those
exempted for medical reasons, it would be an obligation
for all students, like attending class and coming to
school on time. Boards would be permitted to recognize
organized physical activity through community sports,
like a local soccer league as long as students participate
in a minimum amount of organized physical activity
every school day.
In many cases, dedicated teachers provide their
time to supervise school sports. Many would be
delighted to see more students take advantage of
these opportunities. But to ensure that all students can
participate in daily physical activity, we will eliminate
the barriers in insurance arrangements and collective
bargaining agreements that prevent appropriately
screened community volunteers from supervising
sports and fitness.
We can also help to give our students the right start by
giving them the knowledge they need to lead a healthy
life. This goes beyond lecturing students on topics like
nutrition to helping them to understand the science
of human health. Health is a valuable and vigorous
area of science. There is a reason why a Nobel Prize
is awarded in medicine. Our students deserve an
introduction to health science just as much as physics
and chemistry. Building on the valuable content already
in the science curriculum on biology, we should offer
a more thorough grounding in human health science,
from physiology to epidemiology.
PATH 9
PATH 10
Give patients more choice in the health services they receive. Allow patients receiving
non-clinical home care services like housekeeping and personal support to choose
whether to have a care provider purchase home care for them, like CCACs do today, or
whether to use the same money to hire their own home care.
Encourage everyone in Ontario to have an end-of-life plan specifying his or her wishes
if incapacitated, from preferences about care, to who should make care decisions, to
organ donation.
- 20 -
PATHS TO PROSPERI TY
PROVIDE GREATER PATIENT CHOICE
We all rely on the expert judgment of doctors, nurses and other professionals
to help us to get the right health care for our needs. At the same time, patients
and their family members make important choices about their own health care
all the time. We choose what emergency room to go to in a city with multiple
hospitals or whether we want heroic measures taken if we are faced with a
terminal illness. Our health system needs to do a much better job of supporting
patients and families in making choices.
In some cases, what is needed is better information.
For example, there is no reason you shouldnt be able to
find out the expected wait times for emergency rooms
or urgent care on the internet or through Telehealth
Ontario before you leave for the hospital or a clinic.
In other situations, we need to recognize that patients
and families really are in the best position to make
decisions about what they need. For example, if a senior
needs more frequent visits from a personal support
worker, but doesnt need help with meal preparation,
she and her family should have the flexibility to make
sure the available home care money is spent in the
best possible way. That includes allowing them to
opt out of the government-provided services currently
organized by CCACs and to use the equivalent money
to choose another qualified home care provider. Where
possible, it also means providing support to family
members who choose to work part time or to take
time off work to provide care for a relative, instead of
relying on government-funded home care workers to
provide that care.
We sometimes need to plan ahead for our health care
choices, and this is particularly true for end-of-life
care. Through better online resources and training
and support for health professionals, we should strive
to meet the goal of everyone in Ontario having an end-
of-life plan. These plans outline what kinds of care you
want to receive in situations like a terminal illness. They
also designate who should make care decisions for
you if you are incapacitated, and your preferences on
matters like organ donation. They do not in any way
restrict the care to which you have access. Instead
they ensure your wishes are respected if you are ever
in a situation where you can no longer communicate
what they are.
PATH 11
For appropriate services, use competitive tendering to ensure the best value for our
health care system. When expanding clinical services that need not be provided in
a hospital, such as MRI scans, dialysis treatment and high-volume, less complex
surgeries, conduct a transparent tendering process and select providers that can offer
the best quality and most cost-effective service.
- 21 -
PATHS TO PROSPERI TY
HARNESS COMPETITION TO GET
BETTER SERVICE AT BETTER COST
Some people talk about competition in health care as if it were a sinister force, at
odds with the public good. Yet appropriate competition plays a very important
and beneficial role in health care today.
Doctors compete for patients, and patients have the
right to seek a different doctor if they are not satisfied
with the service they are getting. Thats a good thing.
When we build a new hospital, it would be a scandal if
we didnt put the building project out to tender to get
the best proposal at the best price.
Certainly there are some areas in health care in which the
wrong kind of competition is not helpful. For example,
while researchers compete for grants, its extremely
important that they ultimately share the results of their
publicly-funded research for everyones benefit.
However, there are opportunities to expand the use of
productive competition within our health care system,
to get better service at better cost. We should take
full advantage of these. Hospitals and other health
institutions frequently tender for non-clinical services
like cafeteria service already. We would build on existing
best practices by requiring them to seek competitive
bids for all relevant non-clinical services like IT, just as
we propose for the rest of the public sector.
For clinical services that can be provided outside a
hospital or physician practice, we can also use well-
established tendering processes to ensure we get
the best service at the best price when expanding
system capacity. These would include services like
MRI tests, dialysis services and high-volume, less
complex surgeries such as cataract surgeries, hernia
repairs and simple joint replacements. Performing
these procedures in a specialized clinic rather than a
hospital is increasingly recognized as a best practice.
It can lead to higher quality service without some of the
unique risks associated with hospital admissions. It can
There should not be... an
ideological bias towards
public- or private-sector service
delivery. Both options should be
fully tested to see which provides
the best service. This should not
be defined simply with respect to
cost, but be quality-adjusted.

-Drummond Commission, page 175.

also be much more convenient for patients, reducing
the length and uncertainty of wait lists. In addition, it
often allows this excellent care to be provided with a
lower cost structure.
Of course, in many cases, the existing providers of
these services may be able to offer the best proposal.
After all, they have the benefit of experience, and in
some cases of scale. But we cannot simply assume
that every existing provider will automatically deliver
the best value, any more than we could make that
assumption about air ambulance service.
For services where tendering is possible, clear proposals
and a transparent process represent the best way to
get the best service and the best value. Initially, the
government will sponsor these competitions, and once
health hubs are fully operational, they will take over
the responsibility.
Yearly Ontario Health Care Spending
(As a proportion of total government expenses)
Source: TD Economics, Charting a path to sustainable health care in Ontario, Special Report, May 27, 2010.
2010 2030
Health Care
Everything Else
54%
Everything Else
20%
46%
Health Care
80%
- 22 -
PATHS TO PROSPERI TY
EFFICIENCY TODAY ALLOWS TIME TO
GET LONG-TERM REFORMS RIGHT
For all of the reasons we have described, we need thoughtful but fundamental
reform to strengthen our health system and to make it financially sustainable
in the long term.
The system needs to focus on value, and we need good
evidence on both quality and costs to achieve that. It
needs to be much more integrated: a true system, with
the patient at the centre. It needs to be more effective
in prioritizing prevention to both to avoid disease in the
rst place, and to prevent it from getting worse. It needs
to recognize that a person with diabetes, early-stage
Alzheimers and heart disease is one patient, not three.
We need to recognize the unique needs and challenges
of northern and rural health systems, from attracting
qualied professionals, to using technology to make
care more available in remote locations. We need much
better information systems including patient records.
And we need the right mix of different types of care,
including more care in the home and in the community.
We cannot make the health system effective and
sustainable in the long term solely through making
it more efficient through ever-lower administrative
costs and ever-lower pay for workers. Thats why we
need real reform to strengthen the system. But getting
that reform right will take time and, in the short term,
we can sustain the system by making one-time gains
in administrative efficiency and by taking a temporary
pause in wage increases.
While administration is not the biggest driver of growth
in the health system, we spend billions on it every year
and any waste is too much. By eliminating LHINs and
the administrative component of CCACs in favour of
health hubs that will actually deliver better care, we
can redirect millions of dollars from administration
to patient care. And more importantly, we can avoid
the waste of literally billions of dollars that the current
government has directed towards failed, out-of-control
agencies like Ornge and eHealth Ontario.
eHealth Ontario has been a failure, spending $2 billion on
administration and consultants without producing results
and, perhaps more tragically, delaying the progress health
providers could have been making in actually implementing
existing electronic health records solutions that would have
benetted patients. Electronic records are tremendously
important because they allow all of a patients health
status and history to be shared with all of the people
involved in delivering care, eliminating duplicate tests,
uncovering potential drug interactions and preserving
vital information about how the patient has repsonded
to therapy in the past. A single electronic health record
also provides a better opportunity for family doctors to
share all of a patients health information with the patient.
PATH 12
PATH 13
Create time to achieve fundamental strengthening of our health system by making one-
time improvements in efciency today, such as eliminating administration in LHINs and
CCACs, while strengthening the home care services currently organized by CCACs, and
by temporarily pausing cost ination through an across-the-board wage freeze.
Deliver on the electronic health records that are mission-critical for better health quality,
by putting control of the eHealth initiative in the hands of the hospitals and doctors who
actually use health records. Conduct a focused value-for-money audit to determine
what eHealth has actually produced with the $1 billion it spent since the Auditor
Generals report in 2009. Give oversight of all future funding to a board of health
providers. Enable them to include off-the-shelf and open-source components while
ensuring an effective province-wide records system and to hold eHealth administrators
accountable for delivering on time.
- 23 -
PATHS TO PROSPERI TY
In 2009, the Auditor General issued a special report on
eHealth, concluding that Ontario taxpayers [did] not
receive value for money for this $1 billion investment.
Since then, the pace of spending has accelerated, but
the pace of results has not. Government figures say
that a further $1.06 billion has been spent on eHealth
since the Auditors report in 2009. Yet we still do not
have province-wide electronic health records, and
critical initiatives like the Diabetes Registry and the
Drug Information System have been either cancelled
or delayed.
This failure was utterly predictable. As with the LHINs,
the government created a layer of administration that
was not accountable to the hospitals, doctors and other
health providers who actually need to use the health
records. And after the government was told in 2009
that this initiative had failed completely, its response
was to double down on the same failed approach.
We will put control of the eHealth initiative in the hands
of the hospitals and doctors who will actually use
electronic health records, rather than allowing eHealth
to continue as a top-down agency accountable to
nobody.
After conducting a focused value-for-money audit
to evaluate what concrete progress eHealth Ontario
has actually made with its second billion in funding,
we will put all further funding in the hands of an
oversight board composed of the health providers
who desperately need the records eHealth Ontario
is supposed to produce. We anticipate that they will
insist on greater flexibility to include off-the-shelf and
open-source solutions, while ensuring that all records
in Ontario are interoperable (meaning that all of the
different parts of the health system family doctors,
specialists, hospitals, pharmacists and so on can
seamlessly share the same information). They will also
be empowered to hold administrators accountable for
delivering on time. As health hubs get up and running,
they will jointly take over this oversight role.
At the same time as we fix out-of-control provincial
agencies, we will encourage and enable hospitals and
other health providers to achieve greater efficiencies
in their own administration through combined
procurement, and through further shared back-office
services like information technology and finance.
Finally, we must recognize the biggest driver of cost
increases besides utilization growth is wage inflation.
Over time, compensation for our capable and dedicated
nurses, physicians and health workers can and should
grow along with other wages in the economy. But at
a time when Ontario faces a deficit of over $10 billion
and private sector wages have stagnated, we simply
cannot afford to go back to six per cent and eight per
cent budget increases every year. While we make the
long-term changes that will make our health system
stronger and more sustainable, we will implement a
temporary wage freeze for health care workers as part
of a comprehensive public sector wage freeze.
- 24 -
PATHS TO PROSPERI TY
CONCLUSION
While Ontario faces important challenges in sustaining and improving our
health care system, we also have an enormous opportunity.
By moving care closer to home, we can shorten wait
lists for home care and long-term care, and fund a
significant part of the shift by reducing unnecessary
hospital visits. By rigorously applying evidence to our
health care choices, we can replace treatments that do
more harm than good, more quickly fund new drugs
that fight cancer better, and make Ontario a global
centre for innovation in higher value care.
By empowering health hubs to put the most important
decisions in the hands of the hospitals, doctors and
community health providers that actually deliver care,
we can direct resources from treatment to prevention
and wellness, and overcome the silos that too often
prevent patients from getting the care they need.
We cannot continue down the path of trying to solve
all of our health care problems by throwing money at
them, hoping that more of the same will produce a
different result. Not only do we not have the money to
pay for it; the truth is that this approach has actually
gotten in the way of needed improvements in care.
Making chronic disease a priority and treating it in the
community doesnt cost any more than the current
approach, but it will improve the lives of people with
diabetes and heart disease much more than additional
hospital beds would. Directing funding to hospitals
and clinics that can demonstrate the best results for
the dollar is the right thing to do, no matter how much
money we have.
All of the proposals in this paper are focused on one
goal: helping you and your family to be as healthy as
possible. Some of the choices to get there are difficult,
while others seem so obvious that its hard to imagine
why they havent happened already.
With the courage to make those choices, and with the
support of the dedicated professionals who make our
health their lifes work, we have complete confidence
that our best, and healthiest, days are ahead.
- 25 -
PATHS TO PROSPERI TY
PATH 1
PATH 2
PATH 3
PATH 4
Focus health care decisions on evidence, to achieve greater quality per
dollar spent. Dramatically enhance patient databases to enable doctors and
researchers to improve treatments and prevention programs based on real-
world evidence. Require drug and medical device manufacturers to provide
proof of incremental value when seeking reimbursement. Move more quickly to
make innovative new drugs and devices available, while requiring better cost
effectiveness if manufacturers cannot prove superior effectiveness or safety.
Build a system that treats chronic disease as the leading health challenge of
our time, not as an afterthought in a system designed around acute care. Build
on the unique assets of Ontarios chronic hospitals, along with family doctors
and community-based care, to pioneer a truly integrated approach to health for
patients with chronic conditions. Focus on providing community and home-
based care options to help these patients to live better at home, and to avoid
unnecessary acute hospital visits. Create one or more centres of excellence to
develop evidence-based approaches to care for these patients, including those
living with two, three or more health conditions.
Ensure that every patient with chronic conditions has a comprehensive care plan,
and provide dedicated care navigators such as nurses for the patients with
the highest needs. Treat a patient with multiple conditions like one patient, not
many.
Shift resources and incentives to promote care closer to home, particularly by
expanding home care and long-term care availability, and by promoting more
types of care in the home. Allow pharmacists, paramedics, nurses and nurse
practitioners to provide more types of advice and treatment where these are most
convenient and beneficial for patients, updating scope of practice where required.
PATHS TO PROSPERITY
A HEALTHI ER ONTARI O
- 26 -
PATHS TO PROSPERI TY
PATH 5
Fund the health system to work as a system. Allow health hubs greater flexibility
to direct funding to the actions that have the greatest impact on health in the long
run, from prevention programs like smoking cessation, to intensive rehabilitation
and home care to reduce hospital readmissions. In the long term, move towards
funding the health of a population cared for by a hub, rather than funding
individual treatments.
PATH 6
Make care easier to access and to understand. Rigorously measure satisfaction
with the patient experience and communication, and tie managers incentives to
the scores. Break down the barriers that separate CCACs, LHINs, family doctors
and hospitals, providing a single point of accountability for your care regardless
of where it is provided.
PATH 7
PATH 8
PATH 10
PATH 9
Treat mental health as equal in importance to physical health. Ensure fragmented
elements of adult and childrens mental health and addictions treatment in Ontario are
integrated into a coherent province-wide plan. Recognize childrens mental health as
part of the health care system. Better integrate the diagnosis and treatment of mental
health conditions from depression to dementia with the physical health conditions that
frequently occur in the same patients, at the same time.
Recognize that health care is not the only contributor to health. Through 45
minutes of mandatory daily physical activity in schools, and smarter use of social
and economic policy, improve prevention and wellness, ultimately reducing
unnecessary use of health care and building a healthier Ontario.
Encourage everyone in Ontario to have an end-of-life plan specifying his or her
wishes if incapacitated, from preferences about care, to who should make care
decisions, to organ donation.
Give patients more choice in the health services they receive. Allow patients
receiving non-clinical home care services like housekeeping and personal support
to choose whether to have a care provider purchase home care for them, like
CCACs do today, or whether to use the same money to hire their own home care.
- 27 -
PATHS TO PROSPERI TY
PATH 12
Create time to achieve fundamental strengthening of our health system by making
one-time improvements in efciency today, such as eliminating administration in
LHINs and CCACs, while strengthening the home care services currently organized by
CCACs, and by temporarily pausing cost ination through an across-the-board wage
freeze.
PATH 13
Deliver on the electronic health records that are mission-critical for better health
quality, by putting control of the eHealth initiative in the hands of the hospitals and
doctors who actually use health records. Conduct a focused value-for-money audit
to determine what eHealth has actually produced with the $1 billion it spent since the
Auditor Generals report in 2009. Give oversight of all future funding to a board of
health providers. Enable them to include off-the-shelf and open-source components
while ensuring an effective province-wide records system and to hold eHealth
administrators accountable for delivering on time.
PATH 11
For appropriate services, use competitive tendering to ensure the best value for our
health care system. When expanding clinical services that need not be provided in
a hospital, such as MRI scans, dialysis treatment and high-volume, less complex
surgeries, conduct a transparent tendering process and select providers that can offer
the best quality and most cost-effective service.
Please let us know what you think by
contacting us at:
[email protected]
416-325-1331
Room 436, Main Legislative Buidling
Toronto, ON, M7A 1A8
email:
phone:
mail: