LHINs

Ontario has been undertaking a wide-ranging and ambitious reform of its health care system. Establishing Local Health Integration Networks to plan and fund health care on a regional basis is one important part of this transformation project.  LHINs were announced in 2004 and the enacting legislation was introduced in the fall of 2005 and passed in March 2006.  The fourteen new LHINs consulted extensively with their communities through the spring and summer of 2006, delivered their first Integrated Health Service Plans in the fall of 2006, and gradually assumed funding and resource allocation responsibility from April 2007 on.  They developed their second IHSPs in late 2009.

Equity Into Action

A pressing immediate challenge is how LHINs can maintain and drive their equity agendas in the context of budget restraints, increasing pressure from providers for limited resources, and a conservative fiscal  climate.  The challenge, of course, is not just managing the LHIN’s relatively limited discretionary expenditures, but ensuring that providers don’t reduce their focus on equity in the face of other competing priorities and bottom-line pressures, or make financial decisions that could worsen health disparities.

LHINs Policy Briefing - Advancing Equity in Tough Times

Health Equity Strategy

LHINs play an indispensable role in creating a more equitable health system and in helping to reduce pervasive and damaging health disparities.

In 2008, Bob Gardner was appointed Special Advisor on Health Equity to the Toronto Central LHIN and seconded for a three-month period to develop a comprehensive equity strategy.  He produced a broad 12-point action plan and 50+ specific recommendations designed to address and reduce inequitable access to healthcare; build equity into service delivery, planning and performance management; effectively target programs and resources to reduce barriers and meet the needs of disadvantaged communities; support cross-sectoral action and collaboration; and encourage system change and innovation to reduce health disparities in Toronto.

While many specific recommendations were geared to Toronto, the overall direction and framework will be relevant to other LHINs.

Health Equity Discussion Paper
Health Equity Discussion Paper – Executive Summary

Ongoing Policy Challenges

The LHINs have great potential. More effective coordination and integration of health care providers, institutions and community agencies could help create a real continuum of care and ensure that resources can be most effectively utilized. The LHINs could tap into community needs and interests to better identify service and investment priorities for particular regions and neighbourhoods, and allocate scarce resources where they will have the most impact. They could also foster innovations within their regions and share these lessons across the system. Finally, by creating more integrated and responsive planning and delivery, the LHINS could make an important contribution to the overall reform of the health care system.

But the LHINs will only be successful if they are driven by community needs and priorities, including the most marginalized and poorly served; build equity onto all aspects of delivery and planning: develop effective, responsive and innovative governance and community engagement mechanisms; build on existing coordination networks and accumulated knowledge; foster innovation and spread the best of what is working well throughout the system;  build service provider, stakeholder and public momentum for change; and coordinate the myriad of hospitals, clinics, health care providers and community agencies into a coherent system.

Among the many policy challenges the LHINs will continue to face are:

• how to address pervasive disparities of access to services and health outcomes;
• how to ensure that the social determinants of health are effectively incorporated into health care planning and delivery, and that the heath care system is linked into other areas of public policy to address the fundamental roots of health inequity;
• how to ensure that LHIN governance, service delivery and health utilization reflect the complex diversity of their populations;
• how to encourage local community engagement, service delivery and organizational innovations;
• how to share the best of these innovations — and the lessons learned from what didn’t work as well – among all the LHINs and throughout the health care system;
• how to create effective and responsive forums and processes where the full range of community and institutional needs and interests can be considered and balanced;
• how to involve all residents and communities – including the most vulnerable and marginalized whose voices are seldom heard in policy debate — in planning and priority setting;
• how to connect LHINs to other reform priorities – such as primary care, chronic disease prevention and management, mental health and timely access to services – and to the drivers of system change – such as effective planning, electronic health records,  defining and ensuring quality care and performance management.

Background

These policy papers were produced in 2007 as the LHINs were first being established.  They provide a detailed background on the LHINs initiative, including: lessons for Ontario the experiences of other provinces with regional planning and delivery; analysis of key challenges and opportunities the initiative will face; policy directions and alternatives that can achieve an integrated and equitable health care system. While inevitably dated, they may provide useful historical background and key issues anlyzed are still relevant.