Health care in Ontario is at a crossroads. Our system is still experiencing the strains placed on it by the pandemic, while at the same time looking ahead to a potential tsunami of demand as the province's population both grows and ages. What these combined pressures make clear is that Ontario needs to transition to funding models that align with an integrated, high-quality, and sustainable system of care, moving away from the ossified rules and ways of doing business that currently define our system. Fortunately, the pandemic taught us that change is possible—given the right conditions—and that proactivity and collaboration are among the most important of those conditions.
With this in mind, and as a key partner in advising on funding methodologies for more than two decades, the Ontario Hospital Association hosted a two-day forum (October 11-12) to launch a dialogue with local and international experts, provincial decision-makers and health care providers to expand the body of evidence on funding and learn from the experience of other jurisdictions. The goal was to generate insights that would help us collectively reimagine elements of funding methodologies that incentivize the creation of the health system Ontario needs for the future.
The forum identified five key challenges we will need to overcome as we move forward: variations in capacity and performance across communities; deficiencies in data and data use; longstanding policies, rules, and ways of operating; geographic variation translating to differential care and funding needs; and the inability of organizations/geographies to change at the same time or at the same pace.
These challenges are not unique to Ontario, and over the course of two days we heard from system leaders and academics from the UK, the US, the Netherlands, Germany, and Australia about how their health systems have faced similar issues—as well as the solutions that worked to address them.
The experiences of the other jurisdictions underscored one of our key lessons from the pandemic—we must not simply rebuild the hospital funding system. Instead, we must focus on the system as a whole, recognizing the interdependency between health care, social care, and public health, and ensuring social and primary care are valued in the same way and receive the same focus as acute care.
Taking these lessons into consideration, the Forum identified the following high-level principles as foundational to a successful funding model:
Funding needs to be anticipatable year-over-year.
To ensure better patient care, the system needs to take a single budget perspective where provider decisions are integrated across the care continuum.
The volume of care needs to be disconnected from the corresponding funding (including physician income) to remove incentives that work against, rather than for, quality.
The focus needs to be on return on investment, recognizing that it will be necessary to spend more in the first years as we build the culture of innovation, relationships, and trust that is required to foster long-term improvement. Taking a long-term view also means a focus on patient engagement and prevention to help offset future demand, while at the same planning for future health human resource needs.
At the end of the Forum there was a sense of optimism about our collective strength—together, we have the data, analytical capacity, and clinical leadership to respond to the challenges in front of us, and recent experience that has demonstrated that we can change. The OHA will be exploring opportunities to host similar collaborative events with various providers and policymakers to continue to build on the outputs of this Forum and inform a roadmap for health care financing approaches for Ontario. This summary of the Forum including key takeaways will serve as guide for future conversation.
Read Summary