The Independence of Ontario's Public Health Units: Does Governing Structure Matter?

Lyons, Joseph

During a period of increasing provincial funding, the City of Hamilton was able to exert greater control over the cost-shared program funding increases of HPHS -an integrated health unit -than the City of London was able to exert over the cost-shared funding increases of the MLHU -an autonomous health unit. The City of Hamilton quickly moved to reduce its contributions to HPHS once provincial increases were implemented, thereby freeing up money to spend on other municipal priorities. The MLHU, on the other hand, seized this opportunity by convincing its municipal funders to maintain their contributions, thereby capturing the provincial increase more fully. The City of London asked to have its contribution reduced beginning in 2009, but the MLHU refused. This stalemate continued until 2012, when the MLHU cut the City' s levy by $100,000. By then, however, provincial spending caps had really started to take their effect and annual cost-shared expenditure increases were nowhere near the level they were during the early part of the study period. These findings are consistent with the study' s hypothesis. The more autonomous health unit, the MLHU, did behave more in accordance with provincial expectations than HPHS, which is integrated into the City of Hamilton' s municipal structure. Despite the consistency with the hypothesis, the limited scope of this study means that it is unable to account for all of the different variables in a complicated policy field. At least one of these, the issue of per capita funding, should be addressed, though. The purpose of this study was to compare the spending growth of two similar health units with different governing structures during a period of increasing provincial funding.