Ontario Premier Doug Ford uses the term “hallway medicine” to describe the overcrowding in hospitals, with patients languishing outside for want of beds. The image creates a potent picture of people needlessly suffering because of an ill-organized and poorly funded non-system in which institutional interests are put before patients. This image has defined the problem to be addressed. The appointment of a thoughtful and respected membership to the Premier’s Council on Improving Heathcare and Ending Hallway Medicine, under the leadership of the distinguished Dr. Rueben Devlin, creates a real opportunity for major change in how we organize and fund our health-care system in Ontario.
Previous approaches tinkered with incremental change while allowing profound problems with funding systems and payment models to linger and, in some cases, worsen. Ontario’s contract dispute with its doctors, ongoing since 2014, is one of the most public examples. Health-system participants know that this dispute is a symptom of the underlying systemic flaws in the funding of care in Ontario.
Fundamentally, Ontario’s payment system is too complex and incoherent. It often creates perverse incentives and makes it difficult for policymakers to achieve desired outcomes. Our current acute-care non-system includes an alphabet soup of HBAM, QBP, PPP, ICC, HQO, CCO, and POC (translation: health-based allocation model, quality-based procedures, public-private partnerships, Integrated Comprehensive Care, Healthy Quality Ontario, Cancer Care Ontario, and Programs of Choice) This problem calls for a radical simplification and a fresh, fundamental idealism about how we pay for value in our health-care system. Enter value-based funding.