Summary#

Bill 74, The People’s Health Care Act, 2019, was enacted as Chapter 5 of Ontario’s 2019 statutes. It creates the Connecting Care Act, 2019, continues the existing Health Program Initiatives corporation as Ontario Health, and amends or repeals other laws, including the Local Health System Integration Act, 2006. Its stated goal is to create a more connected, coordinated health-care system.

• Ontario Health is a Crown agency (an organization acting for the provincial government). It must have a board, a chief executive officer and staff, and it must work under a multi-year accountability agreement with the Minister.
• The Minister may designate integrated care delivery systems made up of people or organizations able to deliver at least three listed types of service. Ontario Health may fund health services and supporting non-health services, on terms it sets.
• The Minister may order funded health service providers and integrated care delivery systems to change services, move or transfer them, partner or amalgamate, or stop operating. Orders can also require related actions, including property transfers. Limits apply, including protections for some charitable property and organizations.
• The Minister may order transfers of assets, debts, rights, duties and employees from named organizations—including local health integration networks—to Ontario Health, a health service provider or an integrated care delivery system. The Minister may also dissolve those organizations.
• The Act creates Indigenous health councils and a French language health services advisory council to advise the Minister. Ontario Health must engage specified Indigenous and French-language health planning entities as part of its duties.

What it means for you#

• Patients: The Act bars Ontario Health and funded providers from agreements that restrict services based on where a person lives in Ontario. Integration decisions cannot require patients to pay for services unless another law permits it. This does not guarantee that every service will be available everywhere.
• Health service providers and care organizations: If Ontario Health proposes funding a delivery organization, the organization and Ontario Health must negotiate a service accountability agreement. If they cannot agree, Ontario Health may offer terms that become binding after set time limits, unless the parties agree to another process. Funded organizations may also face audits or reviews and have to provide information.
• Providers and employees: Some organizations and their employees could be transferred by ministerial order; employee service is treated as continuous. The Act does not itself transfer every named organization. The Minister may also order major service changes or, in some cases, closure or amalgamation. Special limits apply to municipalities, some long-term-care operators, and mergers or transfers involving for-profit and not-for-profit organizations.
• Indigenous and francophone communities: The Minister must establish the advisory councils. The Act requires engagement with Indigenous communities before Indigenous council members are appointed and before Indigenous health planning entities are specified. It does not set out detailed rules for council membership or how advice must be used.
• Taxpayers: Ontario Health is subject to annual audits by the Auditor General. The Act does not promise that integration will produce savings or better care.

Money#

No cost estimate is available in the supplied material.

• The Minister may fund Ontario Health, which may in turn fund providers and other organizations. The Act gives no amount or guarantee of funding.
• Ontario Health must employ a chief executive officer and may hire staff it considers necessary. No staffing or cost estimate is given.
• The Act allows some compensation when property is transferred under an integration decision, based on rules to be set by regulation. It also says there is generally no compensation for losses caused by actions under the Act.

What is unclear#

• The supplied material does not include the former laws in full, so I could not verify every change against the law that applied before Bill 74.
• The Act leaves many operating details to regulations, including some designation rules, engagement requirements and compensation rules.
• The text does not give the funding, staffing or implementation costs, or explain how those costs would be divided.
• The exact timing depends on commencement provisions and, for some changes, proclamations. Dates are not given in the supplied material.
• The Act provides some notice and submission steps for integration decisions, but does not set out a general appeal process for them.

Case for#

• The bill appears intended to help health providers coordinate care across service types and locations through one provincial agency.
• A single agency with funding, planning and coordination powers could make it easier to align services and share standards across Ontario.
• The Act requires written integration decisions to state their purpose, actions and timing, and provides for public notice and submissions on some proposed orders.
• The patient-mobility rule and limits on charging patients for services affected by integration could help guard against certain access barriers.

Case against#

• The Minister’s integration powers are broad: orders can require providers to change or stop services, transfer operations or property, or amalgamate. The Act does not provide a general appeal process for these decisions.
• The bill does not specify the funding, staffing or oversight details needed to judge how the new structure will work in practice.
• Some information-gathering powers reach personal information, and investigators can access personal health information when it is needed for an investigation, subject to limits in the Act.
• The Act generally bars compensation for losses caused by actions under it, though it provides a limited compensation route for some property transfers.