Ontario introduces changes to healthcare administration

This week the Ontario government announced legislation that will overhaul the administration of healthcare delivery in Ontario.

Bill 74 was introduced in the Ontario legislature on February 26, 2019, and passed first reading. The bill creates the Connecting Care Act (the Act). The province’s 14 existing Local Health Integration Networks (LHINs) and six other agencies such as Cancer Care Ontario and the Trillium Gift of Life Network will be replaced by a single agency known as Ontario Health (the Agency).

The Act provides a framework under which healthcare services will be administered in the province. The Agency’s objects include implementing health service strategies developed by the Ministry of Health and Long-Term Care and managing health service needs according to these strategies.

Under the Act, the Minister of Health (Minister) and the Agency will enter into an accountability agreement that sets out the Agency’s goals and objectives, performance standards, targets and measures, reporting requirements, spending plan, and performance management process. The accountability agreement will be posted on the Agency’s website.

The Minister is also given the power to designate persons or entities, or groups of persons or entities as an “integrated care delivery system” (ICDS). To be designated an ICDS, the person or group must have the ability to deliver, in an integrated and co-ordinated manner, at least three of the following: hospital services, primary care services, mental health or addiction services, home care or community services, long-term care home services, palliative care services, or other prescribed services.

The Agency is tasked with integrating the health system by providing or changing funding to ICDSs and other health service providers and by negotiating and facilitating integration. Integration is defined for the purposes of the Act as including:

• co-ordinating services and interactions between different persons and entities,
• partnering with another person or entity in providing services or in operating,
• transferring, merging or amalgamating services, operations, persons or entities,
• starting or ceasing provision of services, and
• ceasing to operate or to dissolving or winding up the operations of a person or entity.

Other highlights of the Act include:

• The Agency is given the power to support or provide supply chain management. This could result in a single purchasing entity for business to negotiate with.
• The Agency is given inspection powers to inspect any “health service provider,” a defined term that includes operators of various health centers or providers of health services.
• The Minister is given considerable powers. For example, the Minister may appoint a supervisor of an ICDS or health service provider who then has the exclusive right to exercise all of the powers of that ICDS or health service provider (and, if owned or operated by a corporation, the powers of that corporation’s board, officers, members, and shareholders). The Minister can also order integration provided certain requirements are met.
• The Minister can delegate powers under any act to the Agency except for regulation-making powers. 

A clear implementation timeline has not been provided, and the government has indicated implementation will likely take several years.