Monday, October 10, 2016

Who's Afraid of the Big, Bad LHIN, Take II

Ontario's health bureaucracy is a sheep in wolf's clothing.

Someone sent me an e-mail noting that when I broached this subject back in June, before the Ontario doctors' "Civil War", I used pictures of Wile E. Coyote while alluding to a wolf in the title of the post. As a Looney Tunes purist, I don't take such charges lightly. So to set the record straight, it's time to revisit Patients First and its ill-fated plans for primary care in Ontario, this time with the proper cartoon, Ralph Wolf.

Yes, Ralph Wolf, he of the darker fur and red nose, is a pretty good metaphor for the beefed-up LHINs, stalking the sheep doctors and people of Ontario with threats of grotesque bureaucratic meddling and unfettered access to confidential patient records, in particular records of marginalized peoples such as Community Health Centre clients and Aboriginal Canadians. For now, private doctors' offices are spared from the prying eyes of bureaucrats.

Exactly what the LHIN and their Ministry pals might want with said records is anybody's guess, especially since the government is looking to sell its beleaguered eHealth infrastructure.

Though many might disagree with me, I find the fretting over privacy to be misguided, even setting aside the fact that everything in our lives could be hacked in a heartbeat, but for the cyber-terrorists' preoccupation with the U.S. election. First, anyone who's ever sat through a dinner with adults, or taken a ride on a bus or subway, or stood in line at the grocery store, knows that Canadians will merrily broadcast their health history to anybody, especially if they feel they've been slighted by their health care provider.

Second, despite seeming in cahoots with one another, the LHINs are there to be whipping boys for the Ministry, where the real power lies. The Ministry has no qualms about micromanaging, nor letting the LHINs know who's in charge. Since they have little real authority, LHIN bureaucrats will think long and hard before perusing confidential patient records, lest they risk the ire of their overlords.

Third, there's really no evidence that bureaucrats would have any clue about what to do with someone's health information, outside perhaps the setting of an audit to make sure that enough services are being provided to justify the money. It's a pretty tall order to find nefarious types among the drones in Ontario's bureaucracy. You need a dreadfully milquetoast personality to thrive in that environment, where constipation, not innovation, is the hallmark of the institutional mindset. Somebody hell-bent on selling your health information (never mind to whom and for what) would run out of patience long before they devised a villainous scheme to profit from the result of your last Chalmydia swab.

So as unsettling as it is that the Patients First legislation will theoretically give invasive authority to non-health-professional pencil-pushers, in reality the bureaucrats are as hapless as they ever were. It's going to be years before they've ironed out the kinks of their more immediate mandates, namely rebuilding the home care system with the same corrupt, incompetent people that made the mess in the first place. To think that they're going to be auditing patient records out of the gate? With a possible change in government right around the corner?

I think the sheep are still safe for the time being.

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