Introduced in 1996-97 by the Mike Harris government
Every 3 to 4 years CCAC put out a “request for proposal” asking agencies to bid for a share of the home care market. The winning agencies are told they have a “market share” of services for the period of the contract. The CCAC does not commit to particular service volumes. More details on the way in which agencies are picked is described below.
Managed competition was widely protested by the nonprofit sector as a system that destabilizes relationships with clients and turns nursing into a commodity and would lead to reduced wages, benefits and job security for nurses. These early concerns have proven to be correct. This is the only part of the health care sector where professional workers must submit to this kind of competitive process as if they were pencils.
The CCACs, statutory agencies accountable to the Ministry of Health and Long-term Care, run the local bidding process and then manage the relationship with independent service providers (both nonprofit like VON and SJHC and for-profit like Bayshore) who provide the services. The CCAC provides no direct service but it does do case management, which means their case managers decide who is eligible for services and what services they should receive. As of April 1 2008 CCACs will be accountable to the Local Health Integration Network for the way in which they spend money and the service they supervise.
The costs of home care have gone up quite significantly under this system.
Bidding for contracts
You would think that it is fairly simply to run a fair competitive process but this is not the case when it comes to a complex service. It is very difficult to measure quality in home care: clients usually have a number of problems, many have chronic diseases or at times they are dying. Quality of care in those cases becomes about quality of life and so is subjective. Traditionally we relied on nursing standards, agencies’ culture of...