title: Just regionalisation: rehabilitating care for people with disabilities and chronic illnesses.
abstract: BACKGROUND
  Regionalised models of health care delivery have important implications for people with disabilities and chronic illnesses yet the ethical issues surrounding disability and regionalisation have not yet been explored. Although there is ethics-related research into disability and chronic illness, studies of regionalisation experiences, and research directed at improving health systems for these patient populations, to our knowledge these streams of research have not been brought together. Using the Canadian province of Ontario as a case study, we address this gap by examining the ethics of regionalisation and the implications for people with disabilities and chronic illnesses. The critical success factors we provide have broad applicability for guiding and/or evaluating new and existing regionalised health care strategies.
  
  
  CONCLUSIONS
  Ontario is in the process of implementing fourteen Local Health Integration Networks (LHINs). The implementation of the LHINs provides a rare opportunity to address systematically the unmet diverse care needs of people with disabilities and chronic illnesses. The core of this paper provides a series of composite case vignettes illustrating integration opportunities relevant to these populations, namely: (i) rehabilitation and services for people with disabilities; (ii) chronic illness and cancer care; (iii) senior's health; (iv) community support services; (v) children's health; (vi) health promotion; and (vii) mental health and addiction services. For each vignette, we interpret the governing principles developed by the LHINs - equitable access based on patient need, preserving patient choice, responsiveness to local population health needs, shared accountability and patient-centred care - and describe how they apply. We then offer critical success factors to guide the LHINs in upholding these principles in response to the needs of people with disabilities and chronic illnesses.
  
  
  CONCLUSIONS
  This paper aims to bridge an important gap in the literature by examining the ethics of a new regionalisation strategy with a focus on the implications for people with disabilities and chronic illnesses across multiple sites of care. While Ontario is used as a case study to contextualize our discussion, the issues we identify, the ethical principles we apply, and the critical success factors we provide have broader applicability for guiding and evaluating the development of - or revisions to - a regionalised health care strategy.
authors.affiliation: Joint Centre for Bioethics, University of Toronto, 88 College Street, Toronto, Ontario, Canada. barbara.secker@utoronto.ca.
authors.forename: Barbara
authors.initials: B
authors.lastname: Secker
authors.forename: Maya J
authors.initials: MJ
authors.lastname: Goldenberg
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Gibson
authors.forename: Frank
authors.initials: F
authors.lastname: Wagner
authors.forename: Bob
authors.initials: B
authors.lastname: Parke
authors.forename: Jonathan
authors.initials: J
authors.lastname: Breslin
authors.forename: Alison
authors.initials: A
authors.lastname: Thompson
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Lear
authors.forename: Peter A
authors.initials: PA
authors.lastname: Singer
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D002908:Chronic Disease / Q000534:rehabilitation / Q000628:therapy; D003695:Delivery of Health Care / Q000941:ethics* / Q000458:organization & administration*; D006233:Persons with Disabilities / Q000534:rehabilitation; D006292:Health Priorities; D006293:Health Promotion / Q000941:ethics; D006297:Health Services Accessibility / Q000191:economics / Q000941:ethics; D006801:Humans; D017146:Models, Organizational; D009864:Ontario; D010353:Patient Education as Topic; D018802:Patient-Centered Care; D011050:Policy Making; D012041:Regional Medical Programs / Q000941:ethics* / Q000458:organization & administration*; D012046:Rehabilitation / Q000191:economics; D012935:Social Justice; D012946:Social Welfare