Ontario has embarked on a wide-ranging and ambitious reform of its health care system. Establishing new Local Health Integration Networks to plan and fund health care on a regional basis is one important part of this transformation project, eventually controlling 2/3 of the provincial health budget. 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.
The policy goal is that more effective coordination and integration of health care providers, institutions and community agencies will create a seamless and responsive continuum of care, provide more equitable access to services, and ensure that resources can be most effectively utilized. This page provides background analysis on how these goals can be achieved.
LHINS: The Ongoing Policy Challenge
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 competing 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 front-line reform efforts – such as primary care and the expansion of Community Health Centres – and in the foundations of system change – such as electronic health records and defining community-driven standards of quality care and performance expectations.
