Russ Ford's Blog

North Simcoe Health Links

When I think about Georgian Bay, I usually think about cottages lined up behind sandy beaches, expensive boats and the odd canoe, paddling upstream.  It is the sort of image that beer commercials desire to create.
A recent report from the North Simcoe Health Link does provide a countervailing picture.
According to its research 74 per cent of the people that use its services live in poverty; 33 percent say they do not have access to fresh food and 20 percent live without any family support.
For those of you not familiar with Health Links, these are recently formed organizations of health providers working collaboratively to improve access to care while at the same time trying to save the system money.  There is no specific direction from Queen’s Park for how these Health Links are to function, which makes Health Links quite unique.
The idea is each Link knows its community and likely has different resources to employ so the structure and function has to be locally based.  Local planning is of course currently on life support. It will likely disappear if the province initiates its plan called Patients First which seeks to reform health care by centralizing decision making at the Ministry and imposing greater accountability measures (aka red tape) on local providers.
Although all the Links are developing their own plans, there are some commonalities.  Most are trying to reduce the costs associated with those who are high users of the system. Five percent of Ontarians use 66 percent of the province’s health care resources. That does not mean however, that high users are using services inappropriately.  If, for example, you are in palliative care, your costs to the system will be higher and appropriately so.
But many show up at emergency rooms, which is a very expensive method of care when their needs could best be served in the community by a provider.  People show up for many reasons but the assumption is that some go to emerge because they do not have a provider or do not know how to access care.  They know if they go to emerge, somehow they will get care.
Our health care system has become an octopus.  So complex that people simply cannot figure it out.
McMaster University did a study many years ago which addressed the concept of managed care. This means having a health professional facilitate access to care rather than leaving people to muck through the system on their own.  They assumed the results would say that those who had their care managed, would have a better experience.
That is not what they found.  The study concluded that both groups were equally satisfied with the service they received but the managed care group cost the system about ten per cent of what it cost when people were left to their own devices.  Left alone, the report concluded, people will chose the most expensive form of care.  They will choose to go to a doctor, for example, when a nurse could address their concerns.
So the notion of “care coordinators” or “system navigators” was created to be an effective way of reducing costs.
The McMaster study had two randomly selected groups from the general population.  But what the North Simcoe Link has found is that those who need its services are not random at all.  What they found is that participation is highly correlated to the social determinants of health.
They have found that not only are their clients poorer, they also have far less support.  Seventy per cent of Ontarians report feeling that they have close ties with their community, whereas only 50 per cent of Health Link clients feel that way. Nine per cent of Ontarians feel they do not have close ties with their family, whereas 20 per cent of the Simcoe Health Link’s clients report not having close family ties.
So while care coordination has been shown to reduced costs, North Simcoe is focussing on providing programs, to reduce isolation, and social workers to provide individual support, food access and housing support.  In other words, they are acting on the root cause of ill health, the social determinants of health.
The results are quite impressive. Not only has the patient experience improved, there has been a significant reduction in hospital use and overall a 42 per cent reduction in health care costs.  More service, a better experience and at a reduced cost.
There is really no surprise here.  Everyone, including the government, I suspect, knows that the real way to health reform goes through the social determinants of health.  Unless you address it, any reform will merely be tinkering.
North Simcoe was able to develop such a program because of the absence of central control from the Ministry.  Yet central control is the cornerstone of the government’s Patients First health care reforms.
They believe that if they had more control and brought in more standards, somehow, care providers would provide better and cheaper service.  It is a notion that has no basis in fact or in theory. If the government actually used best practices in determining health policy we would be more likely to get an increase in welfare payments instead of more bureaucrats at Queen’s Park.
Community Health Centres like LAMP are one of the few organizational forms in health care that are committed to addressing the social determinants of health.  Yet we have been in a funding freeze for almost seven years and are evaluated on, almost exclusively, what could best be described as traditional clinical indicators. 
It just does not make any sense.

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