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Govind Rao

Lancaster House | Headlines | Arbitrator upholds mandatory flu shot policy for health... - 0 views

lancasterhouse.com/...92xc48jz

infectious disease lancaster house arbitrator flu shot

shared by Govind Rao on 07 Feb 14 - No Cached
  • February 7, 2014
  • Dismissing a union policy grievance, a British Columbia arbitrator held that a provincial government policy requiring health care workers to get a flu shot or wear a mask while caring for patients during flu season was a reasonable and valid exercise of the employer's management rights.
  • Arbitrator upholds mandatory flu shot policy for health care workers
  • ...10 more annotations...
  • The Facts: In 2012, the Health Employers' Association of British Columbia introduced an Influenza Control Program Policy requiring health care workers to get a flu shot or wear a mask while caring for patients during flu season, which the union grieved. The employer, representing six Health Authorities in B.C., implemented the policy in response to low vaccine coverage rates of health care workers and an inability to achieve target rates of vaccination through campaigns promoting voluntary vaccination commencing in 2000. Acting on the advice of Dr. Perry Kendall, B.C.'s Provincial Health Officer, and relying on evidence suggesting that health care worker vaccination and masking reduce transmission of influenza to patients, the employer moved towards a mandatory policy. Asserting that members had the right to make personal health care decisions, the B.C. Health Sciences Association filed a policy grievance, contending that the policy violated the collective agreement, the Human Rights Code of British Columbia, privacy legislation, and the Canadian Charter of Rights and Freedoms. Extensive expert medical evidence during the hearing indicated that immunization was beneficial for the health care workers themselves, but was divided as to whether immunization of health care workers reduced transmission to patients. The evidence was similarly divided as to the utility of masking.
  • Comment:
  • Having determined that the policy was reasonable under the KVP test, Diebolt turned to the Irving test applicable to policies that affect privacy interests, which he characterized as requiring an arbitrator to balance the employer's interest in the policy as a patient safety measure against the harm to the privacy interest of the health care workers with respect to their vaccination status. Determining that the medical privacy right at stake in the annual disclosure of one's immunization status did not rise to the level of the right considered in Irving, which involved "highly intrusive" seizures of bodily samples, Diebolt further held that the employer's interest in patient safety related to a "real and serious patient safety issue" and that "the policy [was] a helpful program to reduce patient risk." Diebolt also considered that the employer had chosen the least intrusive means to advance its interest in light of the unsuccessful voluntary programs and in providing the alternative of masking. To quote the arbitrator: "[W]eighing the employer's interest in the policy as a patient safety measure against the harm to the privacy interest of the health care workers and applying a proportionality test respecting intrusion, based on the considerations set out above I am unable to conclude that the policy is unreasonable."
  • Diebolt also upheld the masking component of the policy as reasonable, finding on the evidence that masking had a "patient safety purpose and effect" by inhibiting the transmission of the influenza virus, and an "accommodative purpose" for health care workers who conscientiously objected to immunization. Observing that mandatory programs have been accepted in New Brunswick and the United States, Diebolt also considered that regard should be paid to the precautionary principle in health care settings that "it can be prudent to do a thing even though there may be scientific uncertainty." Moreover, he held that the absence of a reference to accommodation did not make the policy unreasonable, noting that this duty was a free-standing legal obligation that was not required explicitly to be incorporated into the policy and that any such issue should be addressed in an individual grievance if made necessary by the policy's application. He also rejected the union's submission that the policy could potentially harm health care workers' mental and physical health, considering the evidence to fall short of "establishing a significant risk of harm, such that the policy should be considered unreasonable."
  • Turning first to the KVP test, specifically whether the policy was consistent with the collective agreement and was a reasonable exercise of the employer's management rights, Diebolt noted that the only possible inconsistency with the collective agreement would be with the non-discrimination clause, given his ruling regarding the scope of Article 6.01, and that he would address this issue in his reasons with respect to the Human Rights Code. Diebolt then turned to the reasonableness of the policy and found, after an extensive review of the conflicting medical evidence that: (1) the influenza virus is a serious, even fatal disease; (2) immunization reduces the probability of contracting the disease; and (3) immunization of health care workers reduces the transmission of influenza to patients. Accordingly, Diebolt reasoned that the facts militated "strongly in favour of a conclusion that an immunization program that increases the rate of health care immunization is a reasonable policy."
  • Diebolt instead regarded the policy as a unilaterally imposed set of rules, making it necessary to establish that they were a legitimate exercise of the employer's residual management rights under the collective agreement and met the test of reasonableness set out in Lumber & Sawmill Workers' Union, Local 2537 v. KVP Co., [1965] O.L.A.A. No. 2 (QL) (Robinson). In addition, given that the policy contained elements that touched on privacy rights, Diebolt held that the policy must also meet the test articulated in CEP, Local 30 v. Irving Pulp & Paper, Ltd., 2013 SCC 34 (CanLII) (reviewed in Lancaster's Disability & Accommodation, August 9, 2013, eAlert No. 182), in which the Supreme Court of Canada held that an employer cannot unilaterally subject employees to a policy of random alcohol testing without evidence of a general problem with alcohol abuse in the workplace, based on an approach of balancing the employer's interest in the safety of its operations against employees' privacy.
  • In a 115-page decision, Arbitrator Robert Diebolt denied the grievance and upheld the policy as lawful and a reasonable exercise of the employer's management rights.
  • The Decision:
  • As noted by the arbitrator, no Canadian decision has addressed a seasonal immunization policy similar to the policy in this case. However, a number of decisions have addressed, and generally upheld, outbreak policies mandating vaccination or exclusion on unpaid leave. B.C. Health Sciences Association President Val Avery expressed his disappointment in the arbitrator's ruling, stating: "Our members believed they had a right to make personal health care decisions, but this policy says that's not the case." Avery said the Association is studying the ruling and could appeal. On the other hand, Dr. Perry Kendall, B.C.'s chief medical officer of health, applauded the decision, calling it a "win for patients and residents of long-term care facilities."
  • In 2012, Public Health Ontario changed its guidelines to call for mandatory flu shots because not enough health care workers were getting them voluntarily. Other municipal public health units – led by Toronto Public Health – also called for mandatory shots. Ontario's chief medical officer of health, Dr. Arlene King, stated in November 2013 that, while the government wants to see a dramatic increase in the number of health care workers who get a flu shot, it is stopping short of making vaccinations compulsory, but has instead implemented a three-year strategy to "strongly encourage health care workers to be immunized every year." She acknowledged, however, that the number of health care workers getting inoculated remains at 51 percent for those employed in hospitals and 75 percent for those in long-term care homes. For further discussion of the validity of employer rules, see section 14.1 in Mitchnick & Etherington's Leading Cases on Labour Arbitration Online.
Irene Jansen

Senate Social Affairs Committee review of the health accord, Evidence, September 29, 2011 - 0 views

www.parl.gc.ca/...49055-e.htm

accord waits senate

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Christine Power, Chair, Board of Directors, Association of Canadian Academic Healthcare Organizations
  • eight policy challenges that can be grouped across the headers of community-based and primary health care, health system capacity building and research and applied health system innovation
  • Given that we are seven plus years into the 2004 health accord, we believe it is time to open a dialogue on what a 2014 health accord might look like. Noting the recent comments by the Prime Minister and Minister of Health, how can we improve accountability in overall system performance in terms of value for money?
  • ...97 more annotations...
  • While the access agenda has been the central focal point of the 2004 health accord, it is time to have the 2014 health accord focus on quality, of which access is one important dimension, with the others being effectiveness, safety, efficiency, appropriateness, provider competence and acceptability.
  • we also propose three specific funds that are strategically focused in areas that can contribute to improved access and wait time
  • Can the 2014 health accord act as a catalyst to ensure appropriate post-hospital supportive and preventive care strategies, facilitate integration of primary health care with the rest of the health care system and enable innovative approaches to health care delivery? Is there an opportunity to move forward with new models of primary health care that focus on personal accountability for health, encouraging citizens to work in partnership with their primary care providers and thereby alleviating some of the stress on emergency departments?
  • one in five hospital beds are being occupied by those who do not require hospital care — these are known as alternative level of care patients, or ALC patients
  • the creation of an issue-specific strategically targeted fund designed to move beyond pilot projects and accelerate the creation of primary health care teams — for example, team-based primary health care funds could be established — and the creation of an infrastructure fund, which we call a community-based health infrastructure fund to assist in the development of post-hospital care capacity, coupled with tax policies designed to defray expenses associated with home care
  • consider establishing a national health innovation fund, of which one of its stated objectives would be to promote the sharing of applied health system innovations across the country with the goal of improving the delivery of quality health services. This concept would be closely aligned with the work of the Canadian Institutes of Health Research in developing a strategy on patient oriented research.
  • focus the discussion on what is needed to ensure that Canada is a high performing system with an unshakable focus on quality
  • of the Wait Time Alliance
  • Dr. Simpson
  • the commitment of governments to improve timely access to care is far from being fulfilled. Canadians are still waiting too long to access necessary medical care.
  • Table 1 of our 2011 report card shows how provinces have performed in addressing wait times in the 10-year plan's five priority areas. Of note is the fact that we found no overall change in letter grades this year over last.
  • We believe that addressing the gap in long-term care is the single more important action that could be taken to improve timely access to specialty care for Canadians.
  • The WTA has developed benchmarks and targets for an additional seven specialties and uses them to grade progress.
  • the lack of attention given to timely access to care beyond the initial five priority areas
  • all indications are that wait times for most specialty areas beyond the five priority areas are well beyond the WTA benchmarks
  • we are somewhat encouraged by the progress towards standardized measuring and public reporting on wait times
  • how the wait times agenda could be supported by a new health accord
  • governments must improve timely access to care beyond the initial five priority areas, as a start, by adopting benchmarks for all areas of specialty care
  • look at the total wait time experience
  • The measurements we use now do not include the time it takes to see a family physician
  • a patient charter with access commitments
  • Efficiency strategies, such as the use of referral guidelines and computerized clinical support systems, can contribute significantly to improving access
  • In Ontario, for example, ALC patients occupy one in six hospital beds
  • Our biggest fear is government complacency in the mistaken belief that wait times in Canada largely have been addressed. It is time for our country to catch up to the other OECD countries with universal, publicly funded health care systems that have much timelier access to medical care than we do.
  • The progress that has been made varies by province and by region within provinces.
  • Dr. Michael Schull, Senior Scientist, Institute for Clinical Evaluative Sciences
  • Many provinces in Canada, and Ontario in particular, have made progress since the 2004 health accord following large investments in health system performance that targeted the following: linking more people with family doctors; organizational changes in primary care, such as the creation of inter-professional teams and important changes to remuneration models for physicians, for example, having a roster of patients; access to select key procedures like total hip replacement and better access to diagnostic tests like computer tomography. As well, we have seen progress in reducing waiting times in emergency departments in some jurisdictions in Canada and improving access to community-based alternatives like home care for seniors in place of long-term care. These have been achieved through new investments such as pay for performance incentives and policy change. They have had some important successes, but the work is incomplete.
  • Examples of the ongoing challenges that we face include substantial proportions of the population who do not have easy access to a family doctor when needed, even if they have a family doctor; little progress on improving rates of eligible patients receiving important preventive care measures such as pap smears and mammograms; continued high utilization of emergency departments and walk-in clinics compared to other countries; long waits, which remain a problem for many types of care. For example, in emergency departments, long waits have been shown to result in poor patient experience and increased risk of adverse outcomes, including deaths.
  • Another example is unclear accountability and antiquated mechanisms to ensure smooth transitions in care between providers and provider organizations. An example of a care transition problem is the frequent lack of adequate follow-up with a family doctor or a specialist after an emergency department visit because of exacerbation of a chronic disease.
  • A similar problem exists following discharge from hospital.
  • Poorly integrated and coordinated care leads to readmission to hospital
  • This happens despite having tools to predict which patients are at higher risk and could benefit from more intensive follow-up.
  • Perverse incentives and disincentives exist, such as no adjustment in primary care remuneration to care for the sickest patients, thereby disincenting doctors to roster patients with chronic illnesses.
  • Critical reforms needed to achieve health system integration include governance, information enablers and incentives.
  • we need an engaged federal government investing in the development and implementation of a national health system integration agenda
  • complete absence of any mention of Canada as a place where innovative health system reform was happening
  • Dr. Brian Postl, Dean of Medicine, University of Manitoba, as an individual
  • the five key areas of interest were hips and knees, radiology, cancer care, cataracts and cardiac
  • no one is quite sure where those five areas came from
  • There was no scientific base or evidence to support any of the benchmarks that were put in place.
  • I think there is much less than meets the eye when we talk about what appropriate benchmarks are.
  • The one issue that was added was hip fractures in the process, not just hip and knee replacement.
  • in some areas, when wait-lists were centralized and grasped systematically, the list was reduced by 30 per cent by the act of going through it with any rigour
  • When we started, wait-lists were used by most physicians as evidence that they were best of breed
  • That continues, not in all areas, but in many areas, to be a key issue.
  • The capacity of physicians to give up waiting lists into more of a pool was difficult because they saw it very much, understandably, as their future income.
  • There were almost no efforts in the country at the time to use basic queuing theory
  • We made a series of recommendations, including much more work on the research about benchmarks. Can we actually define a legitimate benchmark where, if missed, the evidence would be that morbidity or mortality is increasing? There remains very little work done in that area, and that becomes a major problem in moving forward into other benchmarks.
  • the whole process needed to be much more multidisciplinary in its focus and nature, much more team-based
  • the issue of appropriateness
  • Some research suggests the number of cataracts being performed in some jurisdictions is way beyond what would be expected to be needed
  • the accord did a very good job with what we do, but a much poorer job around how we do it
  • Most importantly, the use of single lists is needed. This is still not in place in most jurisdictions.
  • the accord has bought a large amount of volume and a little bit of change. I think any future accords need to lever any purchase of volume or anything else with some capacity to purchase change.
  • We have seen volumes increase substantially across all provinces, without major detriment to other surgical or health care areas. I think it is a mediocre performance. Volume has increased, but we have not changed how we do business very much. I think that has to be the focus of any future change.
  • with the last accord. Monies have gone into provinces and there has not really been accountability. Has it made a difference? We have not always been able to tell that.
  • There is no doubt that the 2004-14 health accord has had a positive influence on health care delivery across the country. It has not been an unqualified success, but nonetheless a positive force.
  • It is at these transition points, between the emergency room and being admitted to hospital or back to the family physician, where the efficiencies are lost and where the expectations are not met. That is where medical errors are generated. The target for improvement is at these transitions of care.
  • I am not saying to turn off the tap.
  • the government has announced, for example, a 6 per cent increase over the next two or three years. Is that a sufficient financial framework to deal with?
  • Canada currently spends about the same amount as OECD countries
  • All of those countries are increasing their spending annually above inflation, and Canada will have to continue to do that.
  • Many of our physicians are saying these five are not the most important anymore.
  • they are not our top five priority areas anymore and frankly never were
  • this group of surgeons became wealthy in a short period of time because of the $5.5 billion being spent, and the envy that caused in every other surgical group escalated the costs of paying physicians because they all went back to the market saying, "You have left us out," and that became the focus of negotiation and the next fee settlements across the country. It was an unintended consequence but a very real one.
  • if the focus were to shift more towards system integration and accountability, I believe we are not going to lose the focus on wait times. We have seen in some jurisdictions, like Ontario, that the attention to wait times has gone beyond those top five.
  • people in hospital beds who do not need to be there, because a hospital bed is so expensive compared to the alternatives
  • There has been a huge infusion of funds and nursing home beds in Ontario, Nova Scotia and many places.
  • Ontario is leading the way here with their home first program
  • There is a need for some nursing home beds, but I think our attention needs to switch to the community resources
  • they wind up coming to the emergency room for lack of anywhere else to go. We then admit them to hospital to get the test faster. The weekend goes by, and they are in bed. No one is getting them up because the physiotherapists are not working on the weekend. Before you know it, this person who is just functioning on the edge is now institutionalized. We have done this to them. Then they get C. difficile and, before you know, it is a one-way trip and they become ALC.
  • I was on the Kirby committee when we studied the health care system, and Canadians were not nearly as open to changes at that time as I think they are in 2011.
  • there is no accountability in terms of the long-term care home to take those patients in with any sort of performance metric
  • We are not all working on the same team
  • One thing I heard on the Aging Committee was that we should really have in place something like the Veterans Independence Program
  • some people just need someone to make a meal or, as someone mentioned earlier, shovel the driveway or mow the lawn, housekeeping types of things
  • I think the risks of trying to tie every change into innovation, if we know the change needs to happen — and there is lots of evidence to support it — it stops being an innovation at that point and it really is a change. The more we pretend everything is an innovation, the more we start pilot projects we test in one or two places and they stay as pilot projects.
  • the PATH program. It is meant to be palliative and therapeutic harmonization
  • has been wildly successful and has cut down incredibly on lengths of stay and inappropriate care
  • Where you see patient safety issues come to bear is often in transition points
  • When you are not patient focused, you are moving patients as entities, not as patients, between units, between activities or between functions. If we focus on the patient in that movement, in that journey they have through the health system, patient safety starts improving very dramatically.
  • If you require a lot of home care that is where the gap is
  • in terms of emergency room wait times, Quebec is certainly among the worst
  • Ontario has been quite successful over the past few years in terms of emergency wait times. Ontario’s target is that, on average, 90 per cent of patients with serious problems spend a maximum of eight hours in the emergency room.
  • One of the real opportunities, building up to the accord, are for governments to define the six or ten or twelve questions they want answered, and then ensure that research is done so that when we head into an accord, there is evidence to support potential change, that we actually have some ideas of what will work in moving forward future changes.
  • We are all trained in silos and then expected to work together after we are done training. We are now starting to train them together too.
  • The physician does not work for you. The physician does not work for the health system. The physician is a private practitioner who bills directly to the health care system. He does not work for the CEO of the hospital or for the local health region. Therefore, your control and the levers you have with that individual are limited.
  • the customer is always right, the person who is getting the health care
  • It is refreshing to hear something other than the usual "we need more money, we absolutely need more money for that". Without denying the fact that, since the population and the demographics are going to require it, we have to continue making significant investments in health, I think we have to be realistic and come up with new ways of doing things.
  • The cuts in the 1990s certainly had something to do with the decision to cut support staff because they were not a priority and cuts had to be made. I think we now know it was a mistake and we are starting to reinvest in those basic services.
  • How do you help patients navigate a system that is so complex? How do you coordinate appointments, ensure the appointments are necessary and make sure that the consultants are communicating with each other so one is not taking care of the renal problem and the other the cardiac problem, but they are not communicating about the patient? That is frankly a frequent issue in the health system.
  • There may be a patient who requires Test Y, X, and Z, and most patients require that package. It is possible to create a one-stop shop kind of model for patient convenience and to shorten overall wait times for a lot of patients that we do not see. There are some who are very complicated and who have to be navigated through the system. This is where patient navigators can perhaps assist.
  • There have been some good studies that have looked at CT and MRI utilization in Ontario and have found there are substantial portions where at least the decision to initiate the test was questionable, if not inappropriate, by virtue of the fact that the results are normal, it was a repeat of prior tests that have already been done or the clinical indication was not there.
  • Designing a system to implement gates, so to speak, so that you only perform tests when appropriate, is a challenge. We know that in some instances those sorts of systems, where you are dealing with limited access to, say, CT, and so someone has to review the requisition and decide on its appropriateness, actually acts as a further obstacle and can delay what are important tests.
  • The simple answer is that we do not have a good approach to determining the appropriateness of the tests that are done. This is a critical issue with respect to not just diagnostic tests but even operative procedures.
  • the federal government has very little information about how the provinces spend money, other than what the provinces report
  • should the money be conditional? I would say absolutely yes.
Govind Rao

Economic inequality is bad for our health - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20150426|219226356

from heather determinants poverty

shared by Govind Rao on 28 Apr 15 - No Cached
  • Toronto Star Sun Apr 26 2015
  • The powerful relationship between poverty and health has been documented for nearly two centuries. We have long known that a person's economic position is the strongest predictor of their health status. Being poor means dying sooner and dying sicker. A Toronto Public Health report released earlier this week concludes that poverty is literally imprinting itself on the lives of Torontonians. The findings presented in the report are grim. Over the past decade, health inequalities between the rich and the poor have persisted. In some cases, they have grown wider. Opportunities to be healthy in Toronto remain as unequally distributed as ever. The report rightfully attributes these inequalities to the social determinants of health - a diverse range of factors including income, education, employment and housing.
  • We live in a divided city and the deepening of economic cleavages has become a defining feature of our civic landscape. Income inequality is on the rise. Housing is becoming less affordable. Neighbourhoods are becoming more polarized. And the cost of living has far outpaced individual earnings. In Toronto, as elsewhere, the social determinants of health have suffered significant decline. As the report makes clear, the poorest among our city's residents have borne the greatest part of this burden. These trends have affected the health of the poor in countless ways. They have constrained access to quality health care. They have increased susceptibility to harmful behaviours, such as smoking. They have compromised the adequacy and stability of housing conditions. They have restricted access to nutritious foods. They have heightened exposures to daily stress and adversity that get under our skin and harm not only our minds but our bodies as well. In fact, research has shown that economic conditions underlie almost every pathway leading to almost every health outcome.
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  • oronto has made little progress in the fight against poverty over the last decade and thus it's to be expected that health inequality remains stark. We find little fault in the actions of Toronto Public Health. Rather, as the science makes clear, the true guardians of our health are the policy-makers that determine whether all Torontonians - and all Canadians, more generally - are able to keep up with the costs of everyday life. What can we do? We can create widespread recognition that when our governments fail to redress inequalities, they undermine the health of our society. We can engage in civic and political action to help pass public policies that reduce the economic distance between the rich and the poor. We can also support organizations that advocate on behalf of these policies, including Toronto Public Health and the labour unions that protect the conditions of low-wage workers.
  • So it shouldn't come as a surprise that, despite a decade of public programs intended to promote health equity, the health status of the poorest Torontonians hasn't improved. In fact, this was entirely predictable. At the heart of the issue are two important insights provided by our best available science. First, public health programs that are designed to encourage people to alter their lifestyles and behaviours simply do not address the myriad other associations between economic position and health status. Attempts to address any one problem do little to fundamentally interrupt the overall correlation. Second, because public health programs do not address the "causes of the causes," they are incapable of stemming the tide of new individuals that develop poor health-related behaviours. No sooner has one cohort been exposed to a health-promotion program than another is ready and waiting.
  • Health inequalities are one of the most formidable public health problems of our time. The science strongly supports Toronto Public Health's insights that public health programs are wholly insufficient to alleviate their burden. The solution lies in tackling the unequal distribution of resources that has become a defining feature of our city and our society at large. Arjumand Siddiqi is assistant professor and Faraz Vahid Shahidi is a doctoral student at the Dalla Lana School of Public Health, University of Toronto. Correspondence should be sent to Ms. Siddiqi at: aa.siddiqi@utoronto.ca
Irene Jansen

Senate Committee Social Affairs review of the health accord. Evidence, October 5, 2011 - 0 views

www.parl.gc.ca/...49078-e.htm

accord hhr senate

shared by Irene Jansen on 23 Jan 12 - No Cached
  • our theme today is health and human resources
  • Dr. Andrew Padmos, Chief Executive Officer, Royal College of Physicians and Surgeons of Canada
  • The first is to continue and augment investments in patient-centred medical education and training programs that support lifelong learning.
  • ...25 more annotations...
  • we have three recommendations
  • Patient-centred care, inter-professional care and comprehensive care are all things that deserve and require additional investment and attention.
  • We need a pan-Canadian human resources for health observatory function to provide evidence and data on which to plan. Our workforce science in Canada is at a very primitive stage, and we are lurching from one crisis in one locality or one specialty to another.
  • The second recommendation
  • Our third recommendation
  • Canada needs an injury prevention strategy to elevate in the public's attention and bring resources to bear to reduce needless injuries in our life. The reason for this is that injuries cause a lot of loss of life, disability, long-lasting disability and painful disability, and they cost a lot of money.
  • Jean-François LaRue, Director General, Labour Market Integration, Human Resources and Skills Development Canada
  • foreign credential recognition
  • Marc LeBrun, Director General, Canada Student Loans, Human Resources and Skills Development Canada
  • Canada student loan forgiveness for family physicians, nurses and nurse practitioners, as introduced in Budget 2011
  • Robert Shearer, Acting Director General, Health Care Programs and Policy Directorate, Strategic Policy Branch, Health Canada
  • in 2004 the federal government committed to the following: accelerating and expanding the assessment and integration of internationally trained health care graduates across the country; targeting efforts in support of Aboriginal communities and official language minority communities to increase the supply of health care professionals in these communities; implementing measures to reduce the financial burden on students in specific health education programs, in collaboration with our colleagues in other federal departments; and participating in HHR planning with interested jurisdictions
  • Canada does not have a single national health human resources plan
  • Health Canada plays a leadership role in HHR by supporting a range of targeted projects and initiatives of national significance.
  • Pan-Canadian Health Human Resource Strategy
  • Internationally Educated Health Professionals Initiative
  • Health Canada supports collaborative efforts as co-chairs of the federal-provincial-territorial Advisory Committee on Health Delivery and Human Resources known as ACHDHR. This committee was created by the conference of deputy ministers of health back in 2002, to link issues of primary health care, service delivery and HHR.
  • ACHDHR will be providing a written brief
  • The federal government also participates on ACHDHR as a jurisdiction that directly employs health care providers and has responsibility for the funding and delivery of certain health care services for populations under federal responsibility, such as First Nations and Inuit, eligible veterans, refugee protection claimants, inmates of federal penitentiaries, and serving members of the Canadian Forces and the Royal Canadian Mounted Police.
  • Shelagh Jane Woods, Director General, Primary Health Care and Public Health Directorate, First Nations and Inuit Health Branch, Health Canada
  • Dr. Brian Conway, President, Société Santé en français
  • account for over a million Canadians who need access to quality health services in their own language.
  • Acadian and francophone communities outside Quebec
  • Senator Eggleton
  • I am interested in the injury prevention idea. We hear of it from time to time. Do you have some specific thoughts on what an injury prevention program or strategy might look like and how it might fit in with the health accord? One of the things the Health Accord brought about in 2004 was the federal government saying to the provinces, “If you do this and you do that we will give you money here and there.” Maybe we should be doing that here. Maybe we should ask the federal government to provide an incentive for the provinces to be able to do something. It would be interesting if you could come up with a vision of what that strategy might look like.
  • Irene Jansen on 23 Jan 12
     
    Health Human Resources
Heather Farrow

Indigenous health: Time for top-down change? - 0 views

www.cmaj.ca/E247

aboriginal cma

shared by Heather Farrow on 08 Aug 16 - No Cached
  • CMAJ August 9, 2016 vol. 188 no. 11 First published July 4, 2016, doi: 10.1503/cmaj.109-5295
  • Lauren Vogel
  • A year after the Truth and Reconciliation Commission’s call to action, public health experts say indigenous health won’t improve without major system change. Last June, the commission issued a comprehensive treatment plan for healing the trauma inflicted on indigenous communities under Canada’s residential schools system — but not much has happened. Eight of the commission’s 94 recommendations directly addressed health care. So what’s the hold up on high-level change?
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  • That question dominated the recent Public Health 2016 conference in Toronto. Speakers described persistent inequity and inaction across the health system, from research to medical training to hospital care. “The common response is to deny that the problem lies in the structures,” said Charlotte Loppie, director of the Centre for Indigenous Research and Community-led Engagement at the University of Victoria in British Columbia.
  • She argued that it’s a mistake to see “colonization” as something that happened in the past. “It’s about the control that some people have over other people, which obviously continues today in the health policies and programs that are developed and expanded on indigenous communities, rather than with those communities.”
  • Research Loppie spoke at a panel hosted by the Canadian Institutes of Health Research (CIHR), which faced criticism in February for awarding less than 1% of funding to Aboriginal health projects in its first major competition since restructuring. “We know we have to work to get this right and get this better and I think we’re learning as we go,” said Nancy Edwards, scientific director of the Institute of Population and Public Health at CIHR.
  • According to Edwards, Aboriginal health is now a “standing item” at science council meetings, which bring together CIHR top brass every four to six weeks. There has also been “a lot of consultation” with indigenous researchers and communities. There isn’t a single barrier standing in the way. “It’s not that simple,” she said.
  • Speakers at the Canadian Public Health Association’s annual conference urged structural change to improve indigenous health.
  • Loppie said she considers Edwards an ally, but noted that CIHR has “a long way to go” to correct the disadvantage to Aboriginal health research under the new funding structure. “Change is a difficult point,” particularly at the most senior levels of administration, she said.
  • Medical education Australia’s experience integrating indi genous health education into medical training shows how change at that level can help transform a system. Australia’s version of a Truth and Reconciliation Commission recommended compulsory courses for all health professionals in 1989. But this didn’t become reality for doctors until 2006, when the Australian Medical Council set standards that the indigenous health training schools must provide.
  • With accreditation on the line, change was rapid and meaningful, said Janie Smith, a professor of innovations in medical education at Bond University in Australia. “If you don’t meet the standards, you can’t run your program, so it’s very powerful.” Bond’s medical program overhauled its case-based curriculum to include indigenous examples to teach core concepts. Students also complete a two-day cultural immersion workshop in first year and a remote clinical placement in fifth year.
  • “It’s a really important principle that this is the normal program and it’s funded out of the normal budget,” Smith said. Integration in core curriculum teaches students that cultural sensitivity is fundamental to being a good doctor, like understanding anatomy. It also protects indigenous health education from “toe cutters” when budgets are tight. Although Canadian medical schools are expanding their indigenous health content, some educators noted that it’s still peripheral to core training.
  • Lloy Wylie teaches medical students as an assistant professor of public health at Western University in London, Ontario. She recalled one indigenous health session that only a third of students attended. “When it’s voluntary, only the people who don’t need the training show up.”
  • Hospital care Wylie said she encountered the same indifference among some medical colleagues at Victoria Hospital in London, Ont., where she is appointed to the psychiatry department. “There are still some very unsettling things that I see going on in our hospital system.” She shared stories of “huge jurisdictional gaps” between the hospital and reserve, of patients with cancer denied adequate pain medication because of assumptions about addiction, and of health workers “woefully unaware” of indigenous culture and services.
  • People in the hospital weren’t even aware of the Aboriginal patient liaison that was in the hospital,” Wylie said. There are some recent bright spots; for example, British Columbia and Ontario are boosting cultural sensitivity training for health workers. But Wylie noted that the same workers “go back to institutions that are very culturally unsafe, so we need to look at changing those institutions as a whole.”
  • Brock Pitawanakwat, an assistant professor of indigenous studies at the University of Sudbury in Ontario, cited the importance of creating space for traditional healing alongside clinical care. In some cases, it’s a physical space: Health Sciences North in Sudbury has an on-site medicine lodge that provides traditional ceremonies and medicines.
  • These services are as much about healing mistrust as any physical remedy, Pitawanakwat said. “Going into a hospital after attending a residential school, there’s still that negative emotion,” he explained. “If you look at these buildings in archival photos, they’re almost identical.”
  • Wylie suggested that the fee-for-service model could also be changed to support physicians building better relationships with patients. “Anything we do to make our hospitals more welcoming places for Aboriginal people will be good for everybody,” she said. “Right now, they’re really alienating for everybody.”
Irene Jansen

Healthy Workplaces for Health Workers in Canada: Knowledge Transfer and Uptake in Polic... - 0 views

www.longwoods.com/18668

safety health and safety hhr

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Abstract The World Health Report launched the Health Workforce Decade (2006-2015), with high priority given for countries to develop effective workforce strategies including healthy workplaces for health workers. Evidence shows that healthy workplaces improve recruitment and retention, workers' health and well-being, quality of care and patient safety, organizational performance and societal outcomes. Over the past few years, healthy workplace issues in Canada have been on the agenda of many governments and employers. The purpose of this paper is to provide a progress update, using different data-collection approaches, on knowledge transfer and uptake of research evidence in policy and practice, including the next steps for the healthy workplace agenda in Canada. The objectives of this paper are (1) to summarize the current healthy workplace initiatives that are currently under way in Canada; (2) to synthesize what has been done in reality to determine how far the healthy workplace agenda has progressed from the perspectives of research, policy and practice; and (3) to outline the next steps for moving forward with the healthy workplace agenda to achieve its ultimate objectives. Some of the key questions discussed in this paper are as follows: Has the existing evidence on the benefits of healthy workplaces resulted in policy change? If so, how and to what extent? Have the existing policy initiatives resulted in healthier workplaces for healthcare workers? Are there indications that healthcare workers, particularly at the front line, are experiencing better working conditions? While there has been significant progress in bringing policy changes as a result of research evidence, our synthesis suggests that more work is needed to ensure that existing policy initiatives bring effective changes to the workplace. In this paper, we outline the next steps for research, policy and practice that are required to help the healthy workplace agenda achieve its ultimate objectives. The early decades of the 21st century belong to health human resources (HHR). The World Health Report (World Health Organization [WHO] 2006) launched the Health Workforce Decade (2006-2015), with high priority given for countries to develop effective workforce strategies that include three core elements: improving recruitment, helping the existing workforce to perform better and slowing the rate at which workers leave the health workforce. In this recent report, retaining high-quality healthcare workers is discussed as a major strategic issue for healthcare systems and employers, and improving workplaces as a key strategy for achieving this goal. The workplace can act as either a push or pull factor for HHR. Heavy workloads, excessive overtime, inflexible scheduling, safety hazards, poor management and few opportunities for leadership and professional development are among the push factors that result in poor recruitment and retention of HHR. Evidence shows that healthy workplaces improve recruitment and retention, workers' health and well-being, quality of care and patient safety, organizational performance and societal outcomes. What are healthy workplaces? Based on existing definitions, there is not yet a standardized and comprehensive definition of healthy workplaces. In this paper, we define healthy workplaces as mechanisms, programs, policies, initiatives, actions and practices that are in place to provide the health workforce with physical, mental, psychosocial and organizational conditions that, in return, contribute to improved workers' health and well-being, quality of care and patient safety, organizational performance and societal outcomes (Griffin et al. 2006). Over the past few years, healthy workplace issues in Canada have been on the agenda of many governments and stakeholder organizations. Nationally and internationally, robust evidence has been accumulated on the impact of healthy workplaces on workers' health and well-being, quality of care, patient safety, organizational performance and societal outcomes. This evidence has provided guidance for governments and employers in terms of what should be done to make the workplace healthier for healthcare workers. Across Canada, many initiatives to improve the working conditions for HHR are currently under way, but the continuing concerns suggest that barriers remain. An assessment of the progress to date is necessary in order to inform the next steps for research, policy and practice.
  • Irene Jansen on 23 Jan 12
     
    Healthcare Papers 7(Sp) 2007: 6-25 Judith Shamian and Fadi El-Jardali
Govind Rao

Photo project gives human face to health care; Initiative aims to use portraits, storie... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20150718|225121478

from heather research support services

shared by Govind Rao on 21 Jul 15 - No Cached
  • Toronto Star Sat Jul 18 2015
  • Andreas Laupacis is the first to admit he is a policy wonk. The doctor, who co-directs a 500-employee research institute and chairs a provincial agency that strives to improve health quality, is also the first to admit there are gaping schisms between health policy-makers like himself and those working and being cared for on the front lines. So he has conceived of a novel way to bridge the gaps: a photojournalism project that tells it like it is from within each of those silos. Faces of Health Care, unveiled Thursday, is modelled after Humans of New York, the wildly popular blog by photographer Brandon Stanton, which documents images and stories of regular folk in the Big Apple. Laupacis' project features portraits and short narratives, collected from the bedside, front lines and back offices.
  • "I am increasingly convinced that patient and health-care worker stories about the good, bad and the complex in health care are important, especially for those of us making policy. We can become a bit distant from the impact of our policies on the people we serve," he says. One profile features Kieran Quinn, an internal-medicine resident at the University of Toronto. Quinn describes how one of his most challenging cases involved caring for a young woman with advanced cancer.
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  • Her husband refused to accept that she was close to death and battled with hospital staff to keep her alive with a breathing machine and feeding tube. "Looking back, I don't like the fact that we were treating the woman this way, but I also don't like that we were battling her husband," Quinn related to Faces of Health Care. "He'll probably remember her death as a battle with the health-care system to provide care. In some ways I feel like we failed him - he's the one who is living; he'll carry that with him the rest of his life," Quinn adds. Laupacis has held some of the most senior positions in Ontario's health system.
  • He is currently executive director of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, board chair of Health Quality Ontario and a board member of Cancer Care Ontario. He holds a Canada Research Chair in Health Policy and Citizen Engagement and formerly served as president of the Institute for Clinical Evaluative Sciences.
  • Trained as a medical internist, he continues to see patients as a palliative care specialist. The photojournalism project has grown from his belief that the health system would be better if there was more informed public input. "I think these stories are great learning tools for those of us who practise health care, and many of them are just darn interesting to almost anyone," he says.
  • "Our hope is that it will bring a human face to the articles about health care that we write on the site," he adds. Faces of Health Care is put together by a team of writers and photographers and is part of the online health policy magazine HealthyDebate.ca, another Laupacis creation. Because it is not a typical health-care project, there are no typical health-care grants to fund it. So Laupacis is also launching a crowd-funding campaign in hopes of raising $50,000 to see the project through its first year.
Govind Rao

Liberals' silence on health funding shows they can't be trusted with our cherished publ... - 0 views

cupe.ca/shed-public-health-care-system

from heather cupe federal election accord

shared by Govind Rao on 06 Oct 15 - No Cached
  • The release of the Liberal platform last weekend makes it clear that they have no plan for one of Canadians’ top issues: public health care. The words ‘health care’ do not appear in the plan. There is no mention of a national prescription drug program. There is nothing on the expansion of federal funding for public home care and long-term care.
  • But two the two most disturbing elements of the plan for Canadians should be its total silence on restoring the $36 billion in cuts Harper has made to federal health care transfers over 10 years; and the Liberals’ stated intention to find $6.5 billion of ‘efficiencies’ in years three and four of their first mandate to bring their deficit-spending plan back to balance.
  • This is particularly worrisome when we think back to the Liberals’ actions the last time they set their sights on balancing the budget, during the 1990s. Paul Martin’s cuts to health care federal transfers by nearly 50 per cent in the five years starting in 1993-94 were devastating. This meant federal health care transfers relative to provincial-territorial spending fell below 10 per cent.
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  • The health care system was in crisis. It took nearly 15 years of incremental increases to bring the federal portion of health funding back to the level is was at before Paul Martin took his axe to it. Going through an exercise like that again would be devastating for the health services that Canadians depend on each and every day.
  • Adding fuel to the speculation that the Liberals are planning massive cuts to health funding is Trudeau’s September 2nd letter to the Council of the Federation that makes no firm commitments to health care or federal transfers. The only firm commitment was to improve the federal-provincial relationship. That’s pretty thin gruel considering the state of that relationship after 10 years of Stephen Harper!
  • All Canadians who are concerned with the future of health care in this country need to scratch below Trudeau’s soothing words and take a look at his hard numbers. When you break down their plan, 77 per cent of the value of their “new investments” are tax shifts and benefits (including others not listed under that category), 12 per cent is the catch-all of ‘infrastructure’ spending (though most Canadians don’t think of early learning and cultural facilities as ‘infrastructure’), and five per cent is EI (paid for through EI premiums).
  • That leaves only six per cent, or a little over two billion a year for everything else. How much of that available funding will go to public home care and long-term care? How much will go to the provinces for new hospital beds after years of cuts? On reading the Liberal plan, we have to conclude: not a penny.
  • Their plan also targets $6.5 billion in spending reductions from an expenditure review. Will health care be on the table for cuts, if they can’t meet that ambitious target? John McCallum said on Saturday that in the effort to balance their books before the next election, ‘everything was on the table.’ Contrast this with Tom Mulcair’s plan for health care under a federal NDP government, and the stark choice is brought in to focus. 
  • Mulcair has committed to reversing Harper’s $36 billion in health care transfer cuts to the provinces.  He has committed to investing $5.4 billion into new public health care programs, including a prescription drugs, a plan for 41,000 home care and 5,000 long-term care spots. Over five million more Canadians will have access to primary health care through his plan to build 200 Community Health Clinics. And there are practical policy initiatives on mental health for youth, Alzheimer’s and dementia care.
  • Canadians cherish their universal Medicare system as one of the things that makes Canada great. They want a federal government that will commit the necessary funding and leadership to build the public health care system of our collective futures, to meet the challenges of an aging population and increasing drug costs. The next party to lead the federal government should be judged by the real dollars and focused policy it has committed to meet Canadians’ health care needs.
  • On that measure, the Liberal plan is dead on arrival. Paul Moist is national president of the Canadian Union of Public Employees. Representing over 633,000 members, including over 153,000 working in the health care sector, it is Canada’s largest union.
Govind Rao

We need to talk about poverty and health - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20150416|218563875

from heather determinants poverty

shared by Govind Rao on 16 Apr 15 - No Cached
  • Toronto Star Thu Apr 16 2015 Page: A21
  • With a federal election on the horizon, we're starting to see policy topics creeping, as they so rarely do, into the headlines: the economy, energy prices, jobs, even climate change. But what seems surprisingly absent from the political conversation so far is any discussion of an issue that is traditionally top-of-mind for Canadians: our health, and how we can improve it. Health for many pundits is all about health care. And while health care deserves its place in the political spotlight, it's also essential that voters understand a too-often ignored, inextricably linked issue: the human and economic costs of poverty on health.
  • These costs aren't just personal - affecting those unfortunate many beneath the poverty line - but affect our economy and our communities as a whole. Fail to address poverty, and you fail to address health. Fail to address both and your discussions about the economy or jobs or markets (which rely on healthy Canadians and healthy communities) are incomplete. More than three million Canadians struggle to make ends meet and what may surprise many is the devastating influence poor income, education and occupation can have on our health. Research shows the adage, the "wealthier are healthier," holds true, as the World Health Organization has declared poverty the single largest determinant of health.
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  • We know that income provides the prerequisites for health including housing, food, clothing, education and safety. Low income limits an individual's opportunity to achieve their full health potential (physical, psychological and social) because it limits choices. This includes the ability to access safe housing, choose healthy food options, find inexpensive child care, access social support networks, learn beneficial coping mechanisms and build strong relationships. Here's what everyone needs to know:
  • 1. In Canada, there is no official measure of poverty. The way in which we measure and define poverty has implications for policies developed to reduce poverty and its effect on health. Statistics Canada does not define poverty nor does it estimate the number of families in poverty in Canada. Instead, it publishes statistics on the number of Canadians living in low-income, using a variety of measurements. Following the federal government's cancellation of the mandatory long-form census, long-term comparisons of income trends over time have been made difficult because the voluntary survey is now likely to under-represent those living in low income. 2. There is a direct link between socioeconomic status and health status. Robust evidence shows that people in the lowest socioeconomic group carry the greatest burden of illness. This social gradient in health runs from top to bottom of the socioeconomic spectrum. If you were to look at, for example, cardiovascular disease mortality according to income group in Canada, mortality is highest among those in the poorest income group and, as income increases, mortality rate decreases. The same can be found for conditions such as cancer, diabetes and mental illness.
  • 3. Poverty in childhood is associated with a number of health conditions in adulthood. More than one in seven Canadian children live in poverty. This places Canada 15th out of 17 similar developed countries, and being at the bottom of this list is not where we want to be. Children who live in poverty are more likely to have low birth weights, asthma, Type 2 diabetes, poorer oral health and suffer from malnutrition. But also children who grow up in poverty are, as adults, more likely to experience addictions, mental health difficulties, physical disabilities and premature death. Children who experience poverty are also less likely to graduate from high school and more likely to live in poverty as adults. 4. People living in poverty face more barriers to access and care. It has been found that Canadians with a lower income are more likely to report that they have not received needed health care in the past 12 months. Also, Canadians in the lowest income groups are 50 per cent less likely than those in the highest income group to see a specialist, and 40 per cent more likely to wait more than five days for a doctor's appointment. They are also twice as likely as higher-income Canadians to visit the emergency department for treatment. Researchers have reported that Canadians in the lowest income groups are three times less likely to fill prescriptions and 60 per cent less able to get needed tests because of costs.
  • 5. There is a profound two-way relationship between poverty and health. People with limited access to income are often more socially isolated, experience more stress, have poorer mental and physical health and fewer opportunities for early childhood development and post-secondary education. In the reverse, it has been found that chronic conditions, especially those that limit a person's ability to maintain viable stable employment, can contribute to a downwards spiral into poverty. Studies show the former people living in poverty experiencing poor health occurs more frequently than poor health causing poverty.
  • As we approach the October election, Canadians ought to remember that poverty, health and the economy are inextricably linked issues. We ignore those links at our peril. Carolyn Shimmin is a Knowledge Translation Coordinator with EvidenceNetwork.ca and the George and Fay Yee Centre for Healthcare Innovation in Winnipeg.
Govind Rao

Moving Canada toward a true health care accord - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|trtm|20160121|238400785

from heather accord campaign ally

shared by Govind Rao on 21 Jan 16 - No Cached
  • Trail Daily Times Thu Jan 21 2016
  • This week Canada's Minister of Health, Dr. Jane Philpott, will meet with her provincial and territorial counterparts in Vancouver. This is no ordinary get-together. In his mandate letter to the Minister, Prime Minister Trudeau tasked Philpott with "engaging provinces and territories in the development of a new, multi-year Health Accord with long-term funding agreement." This is a distinct change in tone from the previous federal government, which refused to meet with provinces to negotiate a new agreement after the accord ran out in 2014.
  • The top-down approach by the Harper government was greeted with two distinct reactions. There were those that saw the cancellation of the Health Accord as a step backward that would further reduce the federal portion of funding for health care, offloading costs to the provinces. Others criticized the past accord, billed as "a fix for a generation," because it didn't buy the intended change. While progress was made on wait times for certain services, other innovations in home care, primary care, prevention and health promotion, and the development of a national pharmaceutical strategy were not achieved in any meaningful way, with most of the increased funding getting absorbed into regular health budgets. Both of these perspectives hold merit.
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  • There is a strong case to be made for a return to the original 50/50 funding arrangement, which is one of the key reasons the provinces signed on to Medicare in the first place but which has steadily been eroded in the decades since. There is also a fair criticism that increased funding - from $124 billion in 2003 to $207 billion in 2012 - should have been used more deliberately to attempt to achieve the intended change in system performance or health outcomes for Canadians. So as the health ministers meet in Vancouver, how can they bend the curve toward a less costly and more effective health care system? How can they ensure the funds invested this time around will buy real improvements in health?
  • Some of the directions for this can be found in the Prime Minister's mandate letter to the Minister of Health, which included an exhortation to "support the delivery of more and better home care services." Investment in quality home care has been shown to improve patient experience while easing pressure on acute and long-term facilities.
  • The letter also encouraged Minister Philpott to "encourage the adoption of new digital health technology." If done right, electronic medical and health records can greatly expand our ability to effectively treat individuals and the population. A third major element described in the mandate letter was a call to "improve access to necessary prescription medications" by "joining with provincial and territorial governments to buy drugs in bulk," and "exploring the need for a national formulary." This falls short of a national pharmacare program, but does not close the door to the possibility.
  • Canada is the only nation with a universal health care system that doesn't include drug coverage; one in five Canadians reports being unable to afford to take necessary medications as prescribed. A national pharmacare program would eliminate that problem while saving Canadians approximately $6 billion per year in excess costs. Half measures in this area will not achieve the desired savings or accessibility. The directives from Trudeau to Philpott are helpful, but there are two key ingredients missing. The first is that the flow of health care funds needs to be connected to clearly articulated goals. Indiscriminately increasing fund transfers with no accountability for how they will be used is a recipe for continually increasing costs without improving the quality and accessibility of care. The second is that all levels of government need to move toward a Health in All Policies approach that understands all areas of government - policies affecting income, education, housing, food security, for example - impact health outcomes. Health care is the greatest cost driver in provincial governments, but it isn't the area in which spending has the greatest impact on health - and it's not where those costs can best be controlled.
  • The decisions emerging from this upcoming summit could change the landscape of health care policy in Canada. Ryan Meili is a family physician in Saskatoon, vicechair of Canadian Doctors for Medicare, an expert with EvidenceNetwork.ca and founder of Upstream: Institute for A Healthy Society.
Govind Rao

Closing hospital cafeterias won't accomplish much - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|frdg|20151127|234591166

from heather NB hospital food cuts

shared by Govind Rao on 27 Nov 15 - No Cached
  • The Daily Gleaner (Fredericton) Fri Nov 27 2015
  • Last week, the Horizon Health Network announced that it was closing some hospital cafeterias and substantially reducing the hours of others. This change is meant to save the health network some of the money that it currently spends on the cafeterias, but it will only save the health network a tiny amount of money, while imposing a real cost on vulnerable New Brunswickers, most notably those who are ill in hospital and their families, as well as the staff that makes hospitals run efficiently and provides the public services that are delivered in hospitals. In the greater scheme of things, this decision will have no real impact on New Brunswick's fiscal health but it will hurt those New Brunswickers who need the service in a very tangible way.
  • If Horizon Health is going to treat food service as a commercial operation and not treat it as a public service, then it should go all the way and privatize food service operations in New Brunswick's hospitals. In doing so, though, the health network needs to realize that food service in hospitals has to be accessible for a wide range of hours; it should be a requirement of any contracts signed with private food service providers that the privatized cafeterias remain open and serve food, at a minimum, from 8 a.m. to 8 p.m., or maybe even require them to remain open 24 hours a day. As well, privatizing the food service operations in our hospitals risks having our workforce lose good, unionized jobs, at a time when good jobs are hard to find in New Brunswick; doing so should thus only happen after a serious public debate
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  • The reality is that, when a loved one is in hospital, you cannot schedule your meals at normal hours. You need access to nutritious food, not to mention to the relief from the stress of sitting by the bedside of a loved one who is ill, whenever it is convenient, for example when your ill loved one is being looked after by the medical staff or when they drift off to sleep. It is therefore an important public service to provide the members of the public who have to make use of the hospital with access to good, nutritious food beyond the normal hours when the rest of us have breakfast, lunch, and dinner. These cafeterias are not really "commercial operations" but part of the public service of a hospital; as CUPE local President Norma Robinson pointed out, nutritious food is a necessary part of a patient's recovery. It is also a necessary part of a patient's family members' continuing health.
  • Alternatively, maybe the smart thing for Horizon Health to do is to accept that food service is part of the public service that our hospitals provide and therefore get on with providing food services to those who use our hospitals as a public service, not as "commercial operations." This means that the health network needs to accept that providing adequate food services, including by investing in new equipment and putting the cafeterias in better locations to increase visitorship, will cost the health network money. The harsh truth is that trying to balance Horizon Health's and the provincial government's books by reducing the hours of cafeterias that, in total, are losing $350,000 a year is the public finance equivalent of trying to get rich by looking for loose change behind your couch cushions.
  • If the government of New Brunswick wants to have the health care system contribute to reduced government expenditures and a balanced provincial budget, reducing the hours of hospital cafeterias is simply a side-show; it will have no meaningful effect on the provincial budget. If the provincial government wants to reduce expenditures on the health care system in a meaningful way, it and the health networks should engage in real health care reform.
  • As part of these reforms, they should either close or downgrade a number of hospitals to basic health care and triage centres and build the health-care system around a few full-service, high-quality regional hospitals. If the evidence of other provinces that had a plethora of small rural hospitals but rationalized their health care service delivery as part of a health care reform agenda is anything to go by, these reforms will also have valuable side-effect of providing New Brunswickers with better health care and making them healthier. As well as not saving any significant amount of public money, closing cafeterias in hospitals or substantially reducing their hours, on the other hand, will not do anything to make people healthier, either. If it cannot make a serious contribution to either public sector cost containment or health reform and will harm people in the process, why do it?
  • an Peach has worked in senior positions in federal, provincial, and territorial governments and at universities across Canada; he also served as vice-president, Policy for the New Brunswick NDP between 2012-15. His expertise is in constitutional law, federalism and intergovernmental relations, Aboriginal law and policy, and the policy-making process.
Govind Rao

Growing gap a health risk - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246200|ntnp|20150311|216151379

from heather determinants

shared by Govind Rao on 11 Mar 15 - No Cached
  • National Post Wed Mar 11 2015
  • In his article "Death by one-percenter" (March 3), Peter Shawn Taylor makes a very strange argument. He suggests that physicians and public health experts, charged with caring for the health of Canadians, should not concern themselves with the root causes of illness and stick to a narrow range of health interventions. Fortunately, Canadian health experts have a broader and more complete understanding of how and why people get sick. They aren't satisfied with simply pulling drowning kids out of the river; though this is obviously important, they also look upstream to ask why kids are falling in the river in the first place. Decades of studies have shown conclusively that income and its distribution, education, employment, housing, food security and the wider environment have far greater impact on health outcomes than health care. I see this borne out daily in the lives of patients whose life circumstances have limited their ability to enjoy full health.
  • Taylor belittles this well-established and supported concept of the social determinants of health as "impossibly broad." It's true that these upstream factors touch on all aspects of public policy. Our health is determined by political choices. If we want the best for Canadians, shouldn't our political choices be determined by health? There is a growing international movement, supported by the World Health Organization, toward "Health in all Policies," an approach that has been adopted by governments around the world. Here in Canada, Quebec has such a policy, and Newfoundland and Labrador is currently exploring this model. Taylor takes particular umbrage with an idea that has been expressed most clearly in the British Medical Journal: "The more equally wealth is distributed, the better the health of that society." There are three key ways in which wealth inequality can lead to worse health outcomes. The first, and most obvious, is poverty. In a less equal society, more people live in relative disadvantage, and are less able to afford safe housing and nutritious food or to access educational and economic opportunities. Their health suffers as a result, with people living in poverty often having life expectancies 20 or more years shorter than wealthier citizens. In my inner-city neighbourhood of Saskatoon, that manifests in rates of diabetes, heart disease, STIs, infant and overall mortality many times greater than the rest of the city.
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  • With Canadians increasingly waking up to the need for an upstream approach to health and politics, those who actively oppose social investment and greater equality are sure to take aim at the notion of health as a guiding principle in public policy. This is beyond unfortunate, as addressing the upstream determinants of health can both improve the economy and the ability of that economy to provide for the well-being of Canadians. That's a hopeful and compelling idea, and, to some, a dangerous one. The fact that it's receiving so much press attention suggests it's an idea whose time has come. Ryan Meili is a family physician in Saskatoon and founder of Upstream: Institute for A Healthy Society.
Govind Rao

Canada needs 'coalition of the willing' to fix health care - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20151118|233921243

from heather privatization medicare

shared by Govind Rao on 18 Nov 15 - No Cached
  • The Globe and Mail Wed Nov 18 2015
  • apicard@globeandmail.com What country has the world's best health system? That is one of those unanswerable questions that health-policy geeks like to ponder and debate. There have even been serious attempts at measuring and ranking. In 2000, the World Health Organization (in)famously produced a report that concluded that France had the world's best health system, followed by those of Italy, San Marino, Andorra and Malta.
  • The business publication Bloomberg produces an annual ranking that emphasizes value for money from health spending; the 2014 ranking places Singapore on top, followed by Hong Kong, Italy, Japan and South Korea. The Economist Intelligence Unit compares 166 countries, and ranks Japan as No. 1, followed by Singapore, Switzerland, Iceland and Australia. The Commonwealth Fund ranks health care in 11 Western countries and gives the nod to the U.K., followed by Switzerland, Sweden, Australia and Germany. The problem with these exercises is that no one can really agree on what should be measured and, even when they do settle on measures, data are not always reliable and comparable.
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  • "Of course, there is no such thing as a perfect health system and it certainly doesn't reside in any one country," Mark Britnell, global chairman for health at the consulting giant KPMG, writes in his new book, In Search of the Perfect Health System. "But there are fantastic examples of great health and health care from around the world which can offer inspiration."
  • As a consultant who has worked in 60 countries - and who receives in-depth briefings on the health systems of each before meeting clients - Mr. Britnell has a unique perspective and, in the book, offers up a subjective and insightful list of the traits that are important to creating good health systems. If the world had a perfect health system, he writes, it would have the following qualities: the values and universal access of the U.K.; the primary care of Israel; the community services of Brazil; the mentalhealth system of Australia; the health promotion philosophy of the Nordic countries; the patient and community empowerment in parts of Africa; the research and development infrastructure of the United States; the innovation, flair and speed of India; the information, communications and technology of Singapore; the choice offered to patients in France; the funding model of Switzerland; and the care for the aged of Japan.
  • In the book, Mr. Britnell elaborates on each of these examples of excellence and, in addition, provides a great precis of the strengths and weaknesses of health systems in 25 countries. The chapter on Canada is appropriately damning, noting that this country's outmoded health system has long been ripe for revolution, but the "revolution has not happened."
  • Why? Because this country has a penchant for doing high-level, in-depth reviews of the health system's problems, but puts all its effort into producing recommendations and none into implementing them. Ouch. "Canada stands at a crossroads," Mr. Britnell writes, "and needs to find the political will and managerial and clinical skills to establish a progressive coalition of the willing."
  • The book's strength is that it does not offer up simplistic solutions. Rather, it stresses that there is no single best approach because all health systems are the products of their societies, norms and cultures. One of the best parts of the book - and quite relevant to Canada - is the analysis of funding models. "The debate about universal health care is frequently confused with the ability to pay," Mr. Britnell writes. He notes that the high co-payments in the highly praised health systems of Asia would simply not be tolerated in the West.
  • But ultimately what matters is finding an approach that works, not a perfect one: "This is the fundamental point. There is no such thing as free health care; it is only a matter of who pays for it. Politics is the imperfect art of deciding 'who gets what, how and when.' " The book stresses that the challenges are the same everywhere: providing high-quality care to all at an affordable price, finding the work force to deliver that care and empowering patients. To do so effectively, you need vision and you need systems. Above all, you need the political will to learn from others and put in place a system that works.
Govind Rao

Make universal dental care an election priority - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|vitc|20150719|225173880

from heather dental health medicare research

shared by Govind Rao on 21 Jul 15 - No Cached
  • Times Colonist (Victoria) Sun Jul 19 2015
  • As Canadians, we are justifiably proud of our universal publicly funded medicalcare system where nobody has to lose their home to get an operation. But is it truly universal? The Canada Health Act that enshrines our accessible health-care system states: "It is hereby declared that the primary objective of Canadian health-care policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers."
  • But dental care is not covered under the Canada Health Act. Surely proper medical care of our teeth and gums is an essential health service. It is time for us to resurrect the fighting spirit of Tommy Douglas and demand that our leaders bring in universal dental care. The need for universal dental care pivots around one important fact: Everything that happens in our mouths affects every other area of our bodies. When it comes to human health and care, they cannot be separated. The oral cavity, teeth and the rest of the body are all fed by the same blood and oxygen and controlled by the same nervous system. Any infection or harmful bacteria in our teeth and gums gets distributed to many corners of our bodies. Since what happens in our teeth and gums is intimately involved in all aspects of our overall health, it makes no logical or scientific sense to have national health care that provides universal access to medical treatment for every tissue and organ in our bodies - but just not for the teeth or gums.
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  • New research points to a close relationship between our oral and overall health. In Oral Health in America: A Report of the Surgeon General published by the U.S. National Institute of Dental and Craniofacial Research, the authors conclude that "the oral cavity is a portal of entry as well as the site of disease for microbial infections that affect general health status." And: "Animal and population-based studies have demonstrated an association between periodontal diseases and diabetes, cardiovascular disease, stroke and adverse pregnancy outcomes." My own experience getting total knee-replacement surgery offers indisputable proof of that all-important connection between mouth and body. And the inherent risk to my overall health from the lack of dental medicare proved undeniable. An abscess under my crown went untreated because I could not afford to properly replace the tooth once it was extracted.
  • Due to the infection, my kneereplacement surgery was postponed because the bacteria from the gum and tooth infection could have wreaked havoc on the surgery site, destroying any chance of a new knee now or in the future. So I had the tooth and infection removed and my surgery was rescheduled. I chose a better life and being able to walk again over worrying about an unsightly hole in my mouth. But why should I have to choose?
  • I am immensely grateful that the medical costs of replacing both my knees are covered. But when an infection in my tooth and gums adversely impacts this lifechanging surgery, it seems unbelievably obtuse and ludicrous that there is no universal medical coverage for my mouth. That is like trying to purify and clean a jug of water while ignoring a small patch of toxic material floating on the top. Brushed Aside: Poverty and Dental Care in Victoria, A Report
  • from the Vancouver Island Public Interest Research Group by University of Victoria researcher Bruce B. Wallace raises important questions: Are Canadians - regardless of income - entitled to basic health care, including basic oral health care? Why do we disconnect the jaw from the body? A person's dental health affects their whole health status, and yet we refuse to treat it. In Canada, while we pride ourselves on our provision of universal health care, we exclude oral health. As a society we are agreeing to not provide basic health care to a significant part of our population." Let's show the world that we know how to take care of each other. Universal dental care should get top billing in the fall federal election campaign. Doreen Marion Gee is a Victoria writer and activist.
Govind Rao

CIHR spurns Aboriginal researchers' call for reconciliation - 0 views

www.cmaj.ca/E75

from heather aboriginal research

shared by Govind Rao on 15 Mar 16 - No Cached
  • CMAJ March 15, 2016 vol. 188 no. 5 First published February 8, 2016, doi: 10.1503/cmaj.109-5232
  • Laura Eggertson
  • Aboriginal health projects received less than 1% of the funding awarded by the Canadian Institutes of Health Research (CIHR) in its first major competition since restructuring — an outcome Aboriginal researchers say illustrates the need to reconcile the new system with the vast inequities in Indigenous health.
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  • CIHR’s decision-making style, which resulted in it going ahead with changes to funding despite objections from Indigenous and non-Indigenous researchers, “is not consistent with the recommendations of the Truth and Reconciliation Commission,” says Rod McCormick, a Mohawk researcher and co-chair of the Aboriginal Health Research Steering Committee.
  • There is no recognition or provision for the fact that systemic policies, when applied across the board, can have damaging impacts for groups that are different,” McCormick told an emotionally charged meeting at the Wabano Centre for Aboriginal Health in Ottawa on Jan. 25.
  • In 2014/15, funding for Aboriginal health research was $31 million, down from $34 million at its annual peak 2004–2008, the Aboriginal Health Research Steering Committee reported.
  • McCormick and co-chair Frederic Wien, the principal investigator for the Atlantic Aboriginal Health Research Program, urged CIHR to revisit its changes and rebuild what Wien called “a respectful relationship with First Nations, Métis and Inuit people.” Given the crisis in the health and well-being of many of these communities, the researchers want CIHR to prioritize Aboriginal health research.
  • We have gone through major changes at CIHR. I do not deny that,” Beaudet said. “But I would deny ... that these changes are affecting particularly the Aboriginal community.”
  • Marlene Brant Castellano, co-director of research for the Royal Commission on Aboriginal Peoples, believes CIHR is out of step with the Truth and Reconciliation Commission’s recommendations.
  • Beaudet made the remarks just three days after the shootings at La Loche, Saskatchewan. The murder of two teenagers, a teacher and a teacher’s aide in the largely Dene community underscored for some attendees the crises in suicide, lack of mental health support and poverty that affect many Aboriginal youth and families.
  • Beaudet said Aboriginal health research is “extremely important” for CIHR, and its strategic investments will reflect that. CIHR has been working with the Aboriginal Health Research Steering Committee for 14 months and, according to the institute’s media specialist David Coulombe, is committed to “co-building research initiatives” that “will improve the health of Canada’s First Nations, Inuit and Métis peoples.”
  • While Beaudet acknowledged both the magnitude of the recent changes and the fact that the Aboriginal health research budget has “flatlined,” he said it has done so parallel to CIHR’s overall budget. CIHR’s billion-dollar annual federal budget has not increased since 2009, meaning that its spending power has declined by roughly 25% since then.
  • CIHR’s president denied any need for the federal agency to engage in reconciliation. “I would like to bring my personal views, not only those of CIHR, about the stormy weather we have been experiencing lately,” Dr. Alain Beaudet told attendees at the January meeting. “But not in the spirit of reconciliation, because I don’t think anything has been broken.”
  • The Aboriginal Health Research Steering Committee contends that CIHR disadvantages researchers working in Aboriginal health through recent changes such as scrapping an Aboriginal-specific peer review process, requiring matching funds for several granting programs, and reallocating almost half the open competition funding for stellar emerging and establishing scholars.
  • But Beaudet said the changes promote more “out-of-the-box” research that will enable Canada to achieve more international success. He also suggested that those critical of the new system are afraid of change, and advised researchers that “looking back doesn’t work.” Learning from the past is a critical Indigenous value. CIHR is starting to analyze the
  • results of its initial investments, but it will take seven years for the new system to take full effect and before “meaningful” figures result, Beaudet said. “We’ll work as quickly as we can, but we need the data. I’m saying ‘Yes, trust us,’ because if you look at CIHR’s record, we’ve done a lot, and we’ve done it in good faith.”
  • Most of the researchers and representatives of Aboriginal political organizations at the meeting did not seem inclined to trust Beaudet’s reassurances.
  • You’re really saying to this group, ‘Trust us.’ And I just want to remind you that there’s very little basis for trust,” said Scott Serson, a former deputy minister of Indian Affairs and Northern Development, now with Canadians for a New Partnership, a group working for a new relationship between Indigenous and other Canadians.
  • The Aboriginal Health Research Steering Committee asked CIHR to set aside half a day at the June meeting of its governing council to address these issues. In an online statement, Beaudet acknowledged the request for an in-depth discussion at “a future meeting” of the governing council. He also urged Indigenous health researchers and community members to apply as members of the new Institutes Advisory Board on Indigenous People’s Health and a new College of Reviewers.
  • Marlene Brant Castellano, co-director of research for the Royal Commission on Aboriginal Peoples and the Mohawk elder who closed the meeting, described Beaudet and CIHR’s response to the committee’s requests as “disconnected” from the prevailing political environment.
  • Castellano, who is revered as the first Aboriginal full professor at a Canadian university, brought many in the audience to tears. Instead of recognizing the need for a new relationship between Canada and its Indigenous peoples, Beaudet’s remarks echoed a too-familiar demand that Aboriginal researchers “get with” CIHR’s program because, eventually, they would discover it was good for them, Castellano said.
  • “We have 400 years as Indigenous people trying to make things work in other people’s agendas, and that is where we’ve gotten to the place now, where we still are, of watching our children dying,” she said, tears streaming down her cheeks.
  • Beaudet had already left the meeting before Castellano went to the podium, and the two CIHR vice-presidents who had stayed for most of the discussion left as she began to speak, citing prior commitments. Only Malcolm King, scientific director of CIHR’s Institute of Aboriginal Peoples’ Health and a member of the Mississaugas of the New Credit First Nation, remained for the duration of the meeting.
  • According to Coulombe, Beaudet had a phone conversation with Castellano on Jan. 29, and “agreed to continue working collaboratively with community representatives and leaders in the future.”
Govind Rao

Pictures of health; Through photographs and words, a website chronicles the human dimen... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150903|228460395

from heather medicare

shared by Govind Rao on 03 Sep 15 - No Cached
  • The Globe and Mail Thu Sep 3 2015
  • Parents of a four-year-old battling a rare form of cancer reflect on how polished their doctor was giving them heartbreaking news. A transgender male explains how he felt stigmatized by the health-care system when looking for help. A daughter brings her ailing mother home to die. And a nurse practitioner with a positive outlook visits inner-city patients.
  • These are some of the personal accounts profiled on the website Faces of Health Care, a recent initiative that seeks to bring the human face back into the health policy picture. Inspired by the work of photographer Brandon Stanton on his popular blog Humans of New York, the photojournalism project uses portraits and quotes of patients and practitioners to tell the stories of Canadians who interact with the health care system.
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  • "Health care is an industry about people," says Andreas Laupacis, the creator of the website, which launched in July. "But there's a strain on the ways patients interact with their health-care providers and the people that create the policies and manage the system are sometimes so removed from the reality of it."
  • Mr. Laupacis is in the health field, as the executive director of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, board chair of Health Quality Ontario and a board member of Cancer Care Ontario. The new site is linked to HealthyDebate.ca, an online health policy magazine and another one of Mr. Laupacis's creations.
  • As technology is further integrated in the system, he says, there are fewer face-to-face interactions, and sometimes patients become a "drop-down menu" rather than a human being. With a group of writers and photojournalists, Mr. Laupacis aims to tell the stories of the people affected by health-care decisions, both positively and negatively, as well as all the murky in-betweens.
  • His collaborators are either in the health-care field or have a strong interest in it, such as Dr. Jeremy Petch, a photographer, and Wendy Glauser, the main writer for HealthyDebate.ca. "Even those of us that work in the health care system, we only work in a certain part of it, so we only have an idea of a certain side," he says. "I think it's really valuable for us to be able to hear and see those faces and stories."
  • Policy makers and managers of health care are often removed from the realities of giving and receiving care, they explain on their website. So they rarely see the human consequences, both good and bad of their decisions. The project is meant to give voice to those impacted by the decisions and spark a different way of thinking. For Cathie Hofstetter, a woman living with rheumatoid arthritis for the past 23 years, who was profiled by the site, it was a great opportunity. "They're doing a wonderful thing," she says.
  • "These voices really need to be heard. How else are you going to know if something is working or failing?" So far, it's been positively received. In a 30-day crowdfunding campaign to help pay for the website's operations, $15,000 was raised. The site has also been met by positive feedback from people reaching out to share their own experiences. The plan, Mr. Laupacis says, is to have two new faces up on the site every week and expand outward from Toronto, where the stories are based now, to other parts of Ontario, and then across Canada. Next month, he is travelling to Quebec to interview people in small towns, hoping to encompass a wider range of health issues.
  • "I'm looking for diversity on the site, different stories from people who haven't had the chance to share them," he says. IN THEIR WORDS When you go into someone's home, it is a different power relationship. I am a guest.
  • You have to win them over. A lot of the folks who are living at home in dire circumstances, or in supported circumstances, are there because they are fiercely independent. So, they don't like this bossy nurse telling them what to do. Lorna, a nurse practitioner I walked into the office of my old family doctor and told her I was trans and that I wanted surgery. She said she would look into it but I could tell she was not very comfortable with it. Within a couple weeks, she called me at my home. 'I'm really sorry but I just don't know what to do with you' were her words.
  • Lucas I just knew that I wanted my mom to be where she could be comfortable and have somebody with her all the time, and that I wouldn't have to hear from somebody 'Oh, your mom's died'. So that I would be there with her. Pat When we were initially told that our four year old had cancer, aside from being in shock, I remember how polished the doctor was in his presentation. I remember thinking how sad it was that a man could be so polished and deliver such devastating news. Kirby, father of Indira (pictured)
Doug Allan

Reforming private drug coverage in Canada: Inefficient drug benefit design and the barr... - 0 views

www.healthpolicyjrnl.com/...fulltext

drugs benefits

shared by Doug Allan on 04 Feb 15 - No Cached
  • Reforming private drug coverage in Canada: Inefficient drug benefit design and the barriers to change in unionized settings
  • The Canadian Life and Health Insurance Association, concerned about the sustainability of private drug coverage in Canada, has asked for government help to reduce costs [11x[11]Canadian Life and Health Insurance Association, Inc. CLHIA report on prescription drug policy; ensuring the accessibility, affordability and sustainability of prescription drugs in Canada. Canadian Life and Health Insurance Association Inc., ; 2013See all References][11]. Growing administrative costs of private health plans continues to put additional financial pressures on the capacity to offer private health benefits [12x[12]Law, M., Kratzer, J., and Dhalla, I.A. The increasing inefficiency of private health insurance in Canada. Canadian Medical Association Journal. 2014; 186See all References][12].
  • Most Canadians are covered through private drug plans offered mostly by employers through supplemental health benefits: 51% of Canadian workers have supplemental medical benefits [2x[2]Morgan, S., Daw, J., and Law, M. Rethinking pharmacare in Canada. CD Howe Institute, ; 2013 (Commentary 384)See all References][2], and since work-related health insurance also covers dependents of employees with coverage, as many as two-thirds of Canadians are covered by health insurance plans.
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  • Prescription drug spending in Canada's private sector has increased nearly fivefold in 20 years, from $3.6 billion in 1993 to $15.9 billion in 2013 [3x[3]Express Script Canada. 2013 Drug trend report. ESI, Mississauga; 2014 (http://www.express-scripts.ca/sites/default/files/uploads/FINAL_executive%20summary_FINAL.pdf [accessed 01.06.14])See all References][3].
  • Private drug plans in Canada are often considered wasteful because they accept paying for higher priced drugs that do not improve health outcomes for users and use costly sub-optimal dispensing intervals for maintenance medications. As a consequence, it is estimated that private drug plans in Canada wasted $5.1 billion in 2012, which is money spent without receiving therapeutic benefits in return [4x[4]Express Scripts Canada. Poor patient decisions waste up to $5.1 billion annually, according to express script Canada. (June)Press release, ; 2013 (http://www.express-scripts.ca/about/canadian-press/poor-patient-decisions-waste-51-billion-annually-according-express-scripts [accessed 01.06.14])See all References][4]. This amount represented 52% of the total expenditures of $9.8 billion by private insurers on prescription drugs for that year [5x[5]Canadian Institute for Health Information. Drug Expenditure in Canada 1985 to 2012. CIHI, Ottawa; 2013See all References][5].
  • Respondents from all categories mentioned that, in contrast to employers, the over-riding objective of unions is to maximize their benefits with minimal co-payments for their employees.
  • The study focused on large unionized workplaces that had Administrative Services Only (ASO) plans, where the employer is responsible for the costs of benefit plans and bears the risks associated with it, while insurers are just hired to manage claims.
  • This study focused on ASO arrangements because they are the most common insurance option chosen by large private-sector firms [16x[16]Sanofi. Sanofi Canada healthcare survey. Rogers Publishing, Laval; 2012See all References][16]. Those organizations whose activities resided solely in the province of Québec, where the regulation of private drug plans differs [17x[17]Commissaire de la santé et du bien être du, Québec., Les médicaments d’ordonnance: État de la situation au Québec. Gouvernement du Québec, Québec; 2014See all References][17], were excluded.
  • Respondents from all categories indicated that consistency of benefits with other market players is of significance to employers.
  • Sean O’BradyxSean O’BradySearch for articles by this authorAffiliationsÉcole de relations industrielles, Université de Montréal, Montreal, Quebec, CanadaInteruniversity Research Centre on Globalization and Work (CRIMT), Montreal, Quebec, Canada, Marc-André GagnonxMarc-André GagnonSearch for articles by this authorAffiliationsSchool of Public Policy and Administration, Carleton University, Ottawa, Ontario, CanadaCorrespondenceCorresponding author at: School of Public Policy and Administration, Carleton University (RB 5224), 1125 Colonel By Drive, Ottawa, Ontario, Canada K1S 5B6. Tel.: +1 613 520 2600.xMarc-André GagnonSearch for articles by this authorAffiliationsSchool of Public Policy and Administration, Carleton University, Ottawa, Ontario, CanadaCorrespondenceCorresponding author at: School of Public Policy and Administration, Carleton University (RB 5224), 1125 Colonel By Drive, Ottawa, Ontario, Canada K1S 5B6. Tel.: +1 613 520 2600., Alan Cassels
  • Finally, employers were most concerned with the government's role in distributing the costs associated with drug coverage among public and private players in the system. In fact, each employer expressed concern over this. Three of the four employers expressed concern over the government's role as a plan sponsor and how governments shift costs to the private sector. As described by one employer, “the government is a very big consumer of drugs” and if the drug companies “start losing money on the government side, they pass it on to private insurance”. Thus, government regulations that help employers contain costs are desired.
  • the employer always has the advantage in this stuff because they have all of the information with respect to the reports and the costs from the insurer or the advisor”
  • According to one consultant, “no one knows the cost of drug benefit plans.” This respondent was arguing that few involved in benefit design, either in private firms, unions, or insurers, are sufficiently competent to undertake proper analyses of claims data so they do not really know how proposed plan changes could affect them. This lack of expertise has ramifications for the education of stakeholders on the outcomes of benefit design.
  • However, when speaking of for-profit insurers, participants from all groups argued that insurers have no financial incentives to cut costs for employers, as indicated by one employer saying: “from my experience on the committees, I don’t get the impression that the insurers are there to save costs for the employers. I haven’t seen it. It's always been the other direction.” This claim was also corroborated by a benefits consultant, who argued that “there has been a fair bit of inertia, you know, amongst the providers out there in actually doing something too radical, too leading edge” because “there's no direct financial incentive for insurance companies or pharmacy benefit managers to actually help employers save money”.
  • Expanding on this, another consultant argued that an insurer's commission structure, which is based on volumes of claims expressed in a dollar value, may in fact discourage insurance companies from proposing plan designs that reduce the volumes of claims, as doing so would adversely affect company profits. Furthermore, another benefits consultant indicated that insurers are experts who calculate risk and thereby have no aptitude for the creation of formularies. According to this respondent, the impact is that insurance companies excel at managing risk, yet fare poorly in designing cost-effective plans that rely on the design and implementation of formularies.
  • An interesting finding from the interview data was that respondents from all interviewed groups declared being in favor of introducing some sort of arrangement for a national drug plan. Some favored having a universal pharmacare program which would apply to all drugs, while others favored programs tailored for catastrophic drug coverage. Two of the insurers that responded to this question explicitly favored some form of universal catastrophic drug coverage while the other favored universal pharmacare.
  • Each of the union representatives and one employer interviewed for this study expressed their support for universal pharmacare. Three out of five consultants argued in favor of a national pharmacare plan while the other two favored some other form of national risk pooling or formulary management to address costs.
  • While a majority of interviewees favored some form of universal coverage, a few respondents from the insurer and employer sides expressed concerns that universal pharmacare is not feasible.
  • The employers indicated that their over-riding strategy is to maintain cost-neutrality in providing drug benefits – in the context of overall compensation – to employees: any increases in the costs of a particular benefits area must be off-set by cost-savings elsewhere. Controlling knowledge was also frequently reported by the union-side respondents (and by one consultant that services employers) as a strategy to achieve greater control over negotiations and plan design by firms. According to one union representative, “
  • Marc-Andre Gagnon has received research funding by the Canadian Federation of Nurses’ Unions for a different research project related to drug coverage in Canada. Alan Cassels is co-director of DECA (Drug Evaluation Consulting and Analysis). The authors would like to acknowledge the financial contribution of the Canadian Health Coalition in order to pay for the transcription of interviews.
Doug Allan

Reining in ballooning medical costs - 0 views

www.thespec.com/...ng-in-ballooning-medical-costs

shared by Doug Allan on 11 Apr 14 - No Cached
  • Retired hospital CEO Murray Martin has suggested that Ontario's health care system is unsustainable in the absence of dramatic cost-saving changes, such as further hospital mergers. However as with many other health care policies, there is a serious disconnect between the problem — sustaining free, universal health care — and his solution.
  • The report found that although the appeal of hospital mergers is powerful, the evidence supporting mergers is weak. It concludes that "the urge to merge is an astounding, runaway phenomenon given the weak research base to support it, and those who champion mergers should be called upon to prove their case."
  • We are getting older/living longer because at each age level, average health is better than it was 10, 20 and 30 years ago. Health care needs per person are falling at each age, which is healthy aging. But the methods governments use to plan health care services, the number and type of health care providers and expenditure on health care are not based on the health care needs of the population. Instead they are based on the assumption each age group will need the level of care it received in the past. We simply increase expenditures to allow for the increased numbers in each group, never realizing the savings from healthy aging.
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  • Failing to link the supply of health care to the needs of the population means the cost of our health care system is determined by the number of providers. Because the number of suppliers has been increasing at a rate far faster than the size of the population, even after allowing for an aging population, we now face a crisis in meeting the costs of keeping the increasing supply of health care providers fully employed.
  • Doug Allan on 11 Apr 14
     
    This piece argues that the evidence does not show that hospital mergers will save money.  Moreover it argues that our improving health reduces costs naturally:  with improving overall health, our health care needs per person are falling.  Instead, cost increases are driven by health care providers.
Irene Jansen

Health Care Law to Allow States to Pick Benefits - NYTimes.com - 0 views

www.nytimes.com/...w-states-to-pick-benefits.html

insurance reforms us

shared by Irene Jansen on 23 Jan 12 - No Cached
  • In a major surprise on the politically charged new health care law, the Obama administration said Friday that it would not define a single uniform set of “essential health benefits” that must be provided by insurers
  • it will allow each state to specify the benefits within broad categories
  • Opponents say that the federal government is forcing a one-size-fits-all standard for health insurance and usurping state authority to regulate the industry.
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  • The new law lists 10 categories of “essential health benefits” that must be provided by insurance offered in the individual and small-group markets, starting in January 2014. These include preventive care, emergency services, maternity care, hospital and doctors’ services, and prescription drugs.
  • The announcement by the administration follows its decision this year to jettison a program created in the law to provide long-term care insurance
  • This criticism has inspired legal challenges to the new law — with the Supreme Court set to decide next year whether the government can require Americans to buy health insurance — and helps explain why public opinion of the law remains deeply divided.
  • Under this approach, each state would designate an existing health insurance plan as a benchmark. The benefits provided by that plan would be deemed essential, and all insurers would have to provide benefits of the same or greater value.
  • Each state would choose one of the following health insurance plans as a benchmark: ¶ One of the three largest small-group plans in the state. ¶ One of the three largest health plans for state employees. ¶ One of the three largest national health insurance options for federal employees. ¶ The largest health maintenance organization operating in the state’s commercial insurance market.
  • the administration’s approach “builds off the experience of today’s marketplace and will minimize disruption to it.”
  • Several states have received temporary waivers from tough new federal standards that require insurers to spend more of each premium dollar for the benefit of consumers. Federal officials have also provided temporary exemptions from some provisions of the law for some employers and labor unions offering bare-bones coverage.
  • The law also says that the definition of essential benefits must not “discriminate against individuals because of their age, disability or expected length of life.” Sara Rosenbaum, a professor of health law and policy at George Washington University, said the new bulletin “does not offer any guidance on this crucial part of the law.”
Govind Rao

Budget czar says provinces won't be able to afford reduced health-care transfers - Info... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150722|225356602

from heather federal accord provinces coalition

shared by Govind Rao on 22 Jul 15 - No Cached
  • The Globe and Mail Wed Jul 22 2015
  • The independent office responsible for assessing the country's finances says limits imposed by the federal Conservative government on increases to health transfers will eventually make it impossible for provinces and territories to handle the costs of an aging population. The fiscal sustainability report released on Tuesday by the Parliamentary Budget Officer (PBO) looks at whether spending policies of the various levels of government will be viable 75 years into the future, given current economic and demographic predictions.
  • While the report says the Canada Pension Plan and the Quebec Pension Plan can absorb what is expected to be a significant increase in the number of retirees over the coming decades, it says the provinces and territories will not be able to afford health care. "Subnational governments cannot meet the challenges of population aging under current policy," the PBO said. The federal government has been increasing health transfers to the provinces and territories by 6 per cent a year since the signing of a health accord in 2004. But Ottawa announced in 2011 that, after 2016-17, future increases would be tied to the growth in the nominal gross domestic product, which is a measure of real GDP plus inflation.
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  • With an aging population requiring medical care, the PBO report says health-care costs will increase significantly as a share of the GDP and the lower levels of government will be forced to foot an increasing share of the bill. "Provinces are responsible for health-care delivery," Melissa Lantsman, a spokeswoman for Finance Minister Joe Oliver, said in an e-mail. "Nevertheless, our government is increasing health funding at a higher rate than provinces are spending it. Record sustainable funding will reach $40-billion annually by the end of the decade."
  • That is about the point when the PBO says the provinces and territories will be in the best financial position, after which increasing health-care expenditures will force a long, steep slide toward deficits and, by 2034, their budgets will be chronically in the red. Premiers who met this month in St. John's called on the federal government to provide more money for health. Newfoundland Premier Paul Davis said the provinces and territories want Ottawa to increase the Canada Health Transfer to cover at least 25 per cent of their health-care spending.
  • British Columbia Health Minister Terry Lake told The Globe and Mail on Tuesday that the current system, in which the federal money is allotted on a per-capita basis, ignores the fact that some provinces have much older populations than others. "When an older province has higher health-care costs because we have older residents, that should be reflected in the Canada Health Transfer as a population-needs based approach," Mr. Lake said. The PBO report said some other recent federal expenditures should have little negative effect on the bottom line in the years to come. The universal child-care benefit, which was increased in this year's budget and resulted in the delivery of $3-billion in cheques to Canadians this week, will have only a minor impact on fiscal room because the cash transfers are not indexed to inflation, the report said. And, while the increase in the amount Canadians can put in a tax-free savings account will reduce government revenues, the PBO says those declines will be offset by increases elsewhere.
  • The report also says the federal government is on track to eliminate its own net debt over the next 35 years. But, for the provinces, healthcare spending will be a problem. Melissa Newitt, the national co-ordinator of the Canadian Health Coalition, an advocacy group for public health care, said the PBO report is more evidence that a new national health accord is needed. That accord, she said, should provide stable funding, set national standards and include a national drug plan and a national seniors plan.
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