Table 1 Guiding principles of LHINs

1. Equitable access based on patient need

Equitable access based on patient need is defined in MOHLTC documents as "access to appropriate quality care when (patients) need it." [25] Equitable or fair access requires sufficient resources to offer these services and to eliminate social barriers that may keep patients from accessing those services. Because patient need is often best defined by the actual patients, community members, including those with chronic conditions and disabilities, must participate in setting goals and organizing community health programs.

2. Preserving patient choice

Preserving patient choice is discussed in the MOHLTC documents as permitting persons to seek treatment outside of their LHIN [25]. We read this important principle more broadly and suggest that it ought to mean that patients or their substitute decision makers (SDMs) are offered a meaningful range of options to consider when making decisions about health services along the continuum of care. This includes, but is not limited to, accessing services outside of the patient's regional health district.

3. Responsiveness to Local Population Health Needs

To be responsive to the health needs of a local population means being attuned to the specific health problems within the community and being able to address those needs with effective targeted programs and services. Because communities are unique, complex, and dynamic, there must be broad community representation in the organisation of services.

4. Shared accountability

The concept of shared accountability, as advanced by the MOHLTC, is a bilateral initiative between the province and health care delivery agencies to increase responsibility and transparency with respect to priority setting and measuring. Shared accountability requires a shared commitment to, and responsibility for, improving health care delivery between governments, LHINs and health care providers. This includes clear delineations of responsibility and the alignment of authority and accountability. Specifically, "the government will do its job of leading and managing the health care system instead of micro-managing, and regional structures will likewise be accountable for planning and coordinating care, cutting across the current silos of both programs and funding, and be responsible for the day-to-day delivery of care on behalf of the individual patients and populations they serve." [26]

5. Patient-centred care

Patient-centred care embraces a philosophy of respect for and partnership with people receiving services by building processes into the health system that recognize patients' perspectives in identifying care needs and ensuring that services are accessible and fit for the context in which persons live [27,28].