Private bias leaves Ontario communities without health care

While 15 communities organize for community health centres, Harris government bets on private group practices - backed by doctors' lobby

By: Pat Daley

  BEACHBURG, ONTARIO: The tilt of Ontario's Harris government toward doctors and private medicine is preventing communities without doctors from getting health care.
  Government cutbacks have combined with an aging population to leave Ontario regions like this rural community in eastern Ontario with insufficient health care. The Harris government promised for years it would reform primary care - the first tier of the health care system, where patients first go for help. There's been no real help for under-serviced communities despite the promises.
  As a result, many communities have seized on an old idea that saves money and delivers health care in places where it's hard to get doctors to settle - community health centres (CHCs).
  When a provincial government review of CHCs is finally over - possibly next month - they could be part of Ontario's plans for primary care reform. But until then, 15 Ontario communities that have submitted funding proposals for new CHCs are just going to have to keep on waiting.
  That's not the news the interim board of directors of the Whitewater-Bromley Community Health Centre wanted to hear. There are about 8,000 people living in this section of Eastern Ontario located between Renfrew and Pembroke. Three part-time physicians - two of them from over the border in Quebec - are trying to meet the area's primary health care needs. Together, they make up 0.9 full-time doctor. None of them has Ontario hospital privileges.
  A CHC looked like the right fit for this community, says interim board chair Dave Shields. Operating in Ontario for 30 years now, CHCs are managed by boards selected from the community. They use an integrated team approach to primary care. Depending on health care needs, a patient could see a family physician, a nurse practitioner, a registered nurse, a social worker, a chiropodist or a dietitian, among others. There are currently more than 80 centres in the province.
 

"When government is talking to the OMA about primary care reform - and they're only talking to the OMA - it only gets OMA solutions"

A health care model that makes sense
  "The CHC model makes sense," says Gary O'Connor, executive director of the Association of Ontario Health Centres (AOHC). "When you have a scarcity of physicians, you have a scarcity of other health professionals too." One of the reasons doctors are in short supply in some communities, he says, is the need for the individual professional to be all and do all.
  "In a health centre, physicians are part of a team so they don't have to be everything to everyone," says O'Connor. "They have guarantees of quality of life."
  Dave Shields thinks that's one of the selling points that will draw doctors to his underserviced community. Not only do doctors have the chance to spend the time they need with patients - because they're on salary - but they don't have the administrative headaches of a private practice.
  Further north and west, the use of a variety of health professionals appeals to Susan Hopkins. She's one of the people involved in the proposed Elliot Lake Community Health Centre/Centre du santé communautaire. A primary care model that promotes wellness and prevention, rather than being disease oriented, is essential in a community where more than 30% of the population are seniors, Hopkins said.
  All in all, there are more than 86 groups from 67 communities looking at the CHC model, says O'Connor. Twenty-four have completed needs assessments and 15 have written funding proposals. Seventy of the groups are from underserviced or rural/northern areas - two of provincial government's key health targets.
  So what's the delay? When Mike Harris took over in 1995, his government announced a freeze on CHC funding. It seemed to be in keeping with a recommendation from the provincial auditor in the previous year. The auditor said funding should be frozen until the government conducted a strategic review of the program. The freeze went on, but there was no review.
  Former Health and Long Term Care Minister Elizabeth Witmer lifted the freeze in 1999 to announce two health centres - one in Grand Bend and one in downtown Kitchener. The freeze was reinstated.
  The review finally started last November.
  In the meantime, Harris has announced his government's intention of having at least 80 per cent of family doctors join new Ontario Family Health Networks by 2004. On the surface they sound a bit like CHCs - group practices in which physicians will be paid based on the number of patients enrolled. But they're still doctor-centred and doctor-controlled, unlike CHCs where the doctor is just another member of the team.

OMA backs private scheme
  This is not surprising, since the family health network model is the one supported by the Ontario Medical Association (OMA). Together, the OMA and the province have seven pilot projects already running.
  "When government is talking to the OMA about primary care reform - and they're only talking to the OMA - it only gets OMA solutions," says Gary O'Connor. "The OMA officially supports CHCs for high-needs communities. Their traditional concern is that physicians are on salary. There are also concerns about lack of decision-making power."
  Family health networks could include other health professionals, such as nurse-practitioner., However, says Jacqueline Choiniere, Director of Policy & Research for the Registered Nurses Association of Ontario (RNAO), the profession is waiting to hear how they're going to be funded. A member of the Coalition for Primary Health Care along with AOHC and other organizations, RNAO believes any new methods of health care delivery should be community controlled and non-profit.
  Still, it's the government's own reform targets that may bring CHCs into its primary care plans.
  "If we want to get 80 per cent of family physicians into family health networks, it may make more sense in some communities to talk about community health centres," said a spokesperson for current Health and Long Term Care Minister Tony Clement. But, he warned, don't expect any answers until the review is completed, possibly in May.

For more information, visit:
Association of Ontario Health Centres

Whitewater-Bromley Community Health Centre

Other articles from the Daley dispatches

Posted: April 30, 2001

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