Windshield Wiper Approach to Health Programs and Policy

Denis Morrice

Windshield Wiper Approach to Health Programs and Policy

You know – Centralize, Decentralize, Centralize, Decentralize. We have been experiencing it with Regional Health Authorities, Regional Health Councils, Community Care Access Centres, Local Health Integrated Networks, OHIP+, Patented Medicines Prices Review Board.

Windshield wiper or “Centralize/Decentralize” programs and policies have an impact on those that deliver direct patient care. The political decisions seem to be made for political reasons and follow political party philosophies or the immediate need regarding election timing.


Decentralize: recognize local needs, local decision making, closer to the people…

Centralize: efficiency, cost effective, central and administrative control …

These supposed high level decisions are made without serious consultation with those most affected by the decision – namely Doctors and Patients. (A simple philosophy to follow: “those affected by a decision should be involved in making that decision”)There doesn’t seem to be any appreciation of the administrative work required at the direct patient care level when these changes are made – nor the impact on access to care.

OHIP+ is a perfect example. The ORA and OPDP reps spent considerable collaborative time on policy development to ensure an effective integration of OHIP+ for youth 25yr and under. Then with a change in government an overnight change was made to scrap OHIP+. So thousands of hours of volunteer and ministry staff time went down the drain. Plus there was zero consultation with Doctors, Parents or youth. Further, the system will add more administrative work for Doctors and their staff and a bureaucratic system that is difficult for many parents to work through.

PMPRB is another very recent example where an incredible amount of consultation with various stakeholders has taken place for over 2 years regarding pricing policies and reference countries. The whole process was put on hold in Nov 2018 and the CEO could not say what the next steps would be. We will probably soon hear that it is back on track.

National Pharmacare is another!

Good luck Dr. Hoskins. Apparently a form of National Pharmacare has been tried 9 times since 1945.

Our ‘Decentralized’ system now has 10 Provincial, 3 Territorial and a number of Federal drug programs with varying degrees of policies and criteria relating to drug access. Plus 100,000 private insurance plans with policies and criteria that are a moving target – especially with specialty drugs e.g. Biologics involving special authorization, co-pays, deductibles, caps, etc.

One thing for sure: the ORA will stay at these policy tables to try and influence the changes in the best interest of Rheumatologists and their patients.