Care Watch prepared a Backgrounder on Applying Canada Health Act Principles to Home Care and Community Support Services. In a series of posts, we have been presenting sections of this document (which you can find here). Today, we begin to look at the principles: Public Administration; Comprehensiveness; Universality; Portability; and Accessibility.
Public Administration (Section 8)
- Public health insurance must be administered by a public authority on a non-profit basis, accountable to the province or territory, and with records and accounts subject to audits.
Medicare is publicly funded via general and specific taxes administered by each provincial/territorial government and its designated crown agencies, which are publicly accountable for expenditures and performance. Each government determines the extent and amount of services covered. To foster Canada-wide equity, programming, and standards, the federal government also gives some provinces equalization funds.
In Ontario, the Ontario Health Insurance Plan Act (OHIP) and associated regulations outline insured services. The Ontario Medical Association negotiates physician fees and the Ontario Hospital Association negotiates hospital fees; the resulting fees, reflected in OHIP’s Schedule of Benefits and Fees, are deemed regulations.
In 2006, Ontario’s government delegated health service planning and funding to 14 regional health authorities (local health integration networks, or LHINs), which allocated funds and managed provider contracts within geographic regions. In addition to planning and funding institutional services (except for physician services), LHINs were responsible for funding HCC through Community Care Access Centres (CCACs). However, a 2015 Auditor General of Ontario report identified some 1,500 different service agreements with HCC delivery agencies, with a multitude of financial arrangements for the same or similar services. Understandably, the report questioned how, and how effectively, public resources were being used.
Under Ontario’s restructured health system and Bill 175, Ontario Health will assume responsibility for overall system planning and funding home and community care services. Coordination and delivery of these services will become the responsibility of interim service providers called Home and Community Support Services (formerly LHINs) for a transitional period and, eventually, the sole purview of local Ontario Health Teams.
Funding for home and community care will be allocated to and through the health teams. It isn’t yet clear how these health teams will be accountable for their use of public funds or for the performance of services they choose to deliver, and especially how they will plan, allocate, protect, or sustain funding for home care and community support services. It is also not clear how they will negotiate fees and payments.
Accountability for and public reporting of system expenditures currently rest with Ontario’s government, and expenditures are subject to audit by the provincial auditor general. Crown agencies, such as Ontario Health, which deliver and manage insured services, are similarly accountable for their use of public funds. Other providers, such as health teams, health service organizations, and/or contracted service providers, however, have limited public accountability. For example, for-profit home care and community care providers receiving public funding don’t have to provide detailed public financial or service performance reports. The auditor general has had limited authority. The principle of public administration and accountability could be at risk, leaving the question of who is minding the store.