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Provincial Governments/Regional Authorities/Hospitals

Provincial Governments and Public Health

Hospitals Internal Accountability

Cancercare Ontario and Hospitals

Regional Health Authorities and Community

Provincial Government and Nursing Homes

Local Governments and Homes for the Aged

Provincial Governments and Lab Services

Provincial Governments/Regional Authorities and Primary Care

Professional Regulatory Bodies

Provincial Government and Nursing Homes

Research Team:
Walter Wodchis
Whitney Berta
Audrey Laporte

Ontario Association of Non-Profit Homes and Services for Seniors
Ontario Long Term Care Association

In this discussion, we ascertain the factors affecting the strengths and weaknesses of various approaches to accountability in Long Term Care Homes (LTCH, nursing homes) in Ontario. We classify potential approaches to accountability in terms of policy/governing instruments.24–27 Among the four central approaches to accountability, 1) Financial incentives in LTC are primarily focused on cost-containment and risk-adjusted standardized payment for all LTC residents, 2) Regulations are enacted by the Ministry of Health and Long Term Care (MOHLTC) with considerable stringency and with a lesser role for regional Local Health Integration Networks (LHINs), 3) Information directed towards patients and providers is developing and becoming more available online, facilitated by public reporting by Health Quality Ontario, while 4) the role of Professionalism is far less emphasized compared to regulatory authority.

The policy goals pursued, identified by the outcomes identified in the LTC Act in Ontario appear to be relatively broad with more focused objectives included in Accountability Agreements between the LTCH and the LHINs. There is some though not entire complementarity in the outcomes measured by the different stakeholders who are trying to influence the cost and particularly the quality of Long Term Care in Ontario. The production characteristics of LTC services appear to be not contestible (market entry is highly restricted), but are sufficiently measureable while complexity is difficult to assess. With low contestability, high measurability and uncertain complexity the emphasis on a highly regulated market (with requirements for high transparency) may be more valuable than a professional emphasis. The largest of these issues is contestability, with greater allowance for market entry and exit, a less regulatory approach might be successful. The governance of LTC is highly varied and includes a large proportion of for-profit enterprises and corporations and may require strengthening to enable a less regulatory approach to be successful. The appearance of low trust in the LTC sector is potentially affected by the high vulnerability of the population as well as media reports of poor quality in LTCHs. Our assessment of accountability mechanisms in LTCH suggest that improving quality and accountability in LTC is likely more responsive to regulatory approaches but could be enabled through well-regulated market-based approaches.
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