Reforming Ontario's primary health care system: one step forward, two steps back?

In Ontario, one-third of the provincial budget is spent on treatment-oriented, institutionally based medical care. Urgently needed, some critics say, is a shift toward less costly, prevention-oriented, community-based care informed by a nonreductionist approach to health planning. In this regard, Community Health Centres (CHCs) have long been advocated as the most effective way to reform the province's primary health care system. At present, however, Ontario has only 56 CHCs. This article examines factors that gave rise to the implementation of CHCs during the 1970s, their slow growth across the province during the 1980s, and their relatively rapid expansion during the early 1990s. In 1995, the newly elected Progressive Conservative government decided to freeze funding for this innovative program. The author argues that the state's latest plan for "reforming" the province's primary health care system is destined to repeat the mistakes of the past.