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Govind Rao

Public-sector plan goes above and beyond for its pensioners - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|tost|20150305|215759083

from heather pensions Ontario cupe

shared by Govind Rao on 05 Mar 15 - No Cached
  • Toronto Star Thu Mar 5 2015
  • Ontario's nurses, social workers, lab technicians and other hospital staff have a lot of reasons to smile today. At a time when most pension plans are cutting benefits, their Healthcare of Ontario Pension Plan (HOOPP) has just increased inflation protection for its 295,000 members. Instead of covering 75 per cent of the annual increases in the cost of living, HOOPP is raising the bar to 100 per cent. While many plans struggle with underfunding, Ontario's third-largest pension fund has $1.15 on hand for every $1 it must spend. Stocks on the Toronto market returned 7.4 per cent on average in 2014, while HOOPP returned a record 17.71 per cent. The plan's average return in each of the last 10 years is 10.27 per cent.
  • CEO Jim Keohane seemed almost embarrassed Wednesday as he discussed his annual results. He noted sombrely, "We have the highest 10-year return of any global pension plan." Hey, let me in. Where can I get a pension plan like that? Well, in the private sector, nowhere. The surest way to rouse readers from slumber to red hot anger is to suggest that anything in the public sector can be better than the same thing done privately. The profit motive is the only way to breed efficiency, some say. Let the market decide. Government and quasi-government agencies are fat, wasteful and largely corrupt. You can add lazy, unproductive and incompetent.
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  • But when it comes to pensions, that's not true. Ontario's big public-sector funds are the top of their class. While companies want 110 per cent of our effort, they've largely rewarded workers by abandoning the sort of pension plans that provide security and let people sleep easy in retirement. Some 76 per cent of private-sector employees don't have a pension of any kind. Of those who do have a pension, less than half have defined benefit plans. When you do the math, only about one in 10 people working in the private sector has a defined benefit plan. Such plans pay a monthly amount for life, putting the onus on companies to come up with the money. Corporate Canada doesn't like that idea and has been bailing out, moving to defined contribution (DC) plans where they can throw some money in the pot to match workers' contributions (if they're lucky) and then wash their hands. That leaves workers with all the risks and stress of investing and managing the money on retirement. These are skills most people don't have.
  • The public sector still believes that collective effort can give a better outcome. So, 86 per cent of workers for provincial and local governments - people such as firefighters and police, those at universities and colleges and workers in health care - are covered by pension plans, mostly the defined benefit kind. Pensions provide a broader social benefit beyond the cash in a pensioner's pocket. According to HOOPP, 7 per cent of all income in Ontario comes from defined benefit pensions, which pay out about $27 billion a year, money that supports the communities where people live. Keohane says 20 per cent of all income in Collingwood, for example, comes from pensions. He says it's a myth that taxpayers are footing the bill. In HOOPP's case, 80 cents of every dollar in the $61-billion fund come from investment returns.
  • There are several reasons why an individual can't hope to match the performance of a big fund with an RRSP. Big funds bring investing expertise and economies of scale to bear in a way that individuals cannot. It is precisely because they lack a "for-profit" motive that such funds can keep fees low and returns high. Think of how many fees you might pay along the way when investing - for advisers, buying and selling stocks and funds, trailer fees, management expense ratios, fees you can't see. Big funds are also "patient money," which means they can weather market ups and downs and not be forced to sell. The next "quarter" for HOOPP is 25 years, not three months.
  • OMERS, Ontario's largest pension plan, also reported strong results last week. OMERS manages the assets of 450,000 municipal employees and earned a 10-per-cent investment return in 2014. The fund stumbled during the financial collapse of 2008 and has been working its way out of a hole. In 2014, OMERS made more progress, increasing its funding level to 91 cents per dollar needed, up from 88 cents a year ago. There's still a long way to go to catch HOOPP, but it's going the right way. Our frayed faith and anger with our public institutions is well-deserved, and that general discontent spills over to public pension envy. But a better target would be private-sector employers who have been abandoning their workers because it's expedient, leaving them to make financial decisions in retirement they are often ill-equipped to make.
  • Adam Mayers writes about investing and personal finance. Reach him at amayers@thestar.ca. What is HOOPP? Healthcare of Ontario Pension Plan is the eighth-largest pension fund in Canada. It cover 295,000 people who work at hospitals, community care facilities, labs, clinics and addiction centres. Nurses are its largest membership group. Fifty of its pensioners are over 100 years old. HOOPP earned a 17.71-per-cent return in 2014, adding $9.1 billion to its assets, which now stand at $60.8 billion. Its average annual return over the past 10 years is 10.27 per cent. Source: HOOPP
Irene Jansen

Senate Committee Social Affairs review of the health accord. Evidence, October 6, 2011 - 0 views

www.parl.gc.ca/...49076-e.htm

accord home care senate

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Pamela Fralick, President and Chief Executive Officer, Canadian Healthcare Association
  • I will therefore be speaking of home care as just one pillar of continuing care, which is interconnected with long-term care, palliative care and respite care.
  • The short-term acute community mental health home care services for individuals with mental health diagnoses are not currently included in the mandate of most home care programs. What ended up happening is that most jurisdictions flowed the funding to ministries or other government departments that provided services through established mental health organizations. There were few provinces — as a matter of fact, Saskatchewan being one of the unique ones — that actually flowed the services through home care.
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  • thanks to predictable and escalating funding over the first seven years of the plan
  • however, there are, unfortunately, pockets of inattention and/or mediocrity as well
  • Six areas, in fact, were identified by CHA
  • funding matters; health human resources; pharmacare; wellness, identified as health promotion and illness and disease prevention; continuing care; and leadership at the political, governance and executive levels
  • The focus of this 10-year plan has been on access. CHA would posit that it is at this juncture, the focus must be on quality and accountability.
  • safety, effectiveness, efficiency, appropriateness
  • Canada does an excellent job in providing world-class acute care services, and we should; hospitals and physicians have been the core of our systems for decades. Now is the time to ensure sufficient resources are allocated to other elements of the continuum, including wellness and continuing care.
  • Home care is one readily available yet underused avenue for delivering health promotion and illness prevention initiatives and programs.
  • four critically important themes: dignity and respect, support for caregivers, funding and health human resources, and quality of care
  • Nadine Henningsen, Executive Director, Canadian Home Care Association
  • Today, an estimated 1.8 million Canadians receive publicly funded home care services annually, at an estimated cost of $5.8 billion. This actually only equates to about 4.3 per cent of our total public health care funding.
  • There are a number of initiatives within the home care sector that need to be addressed. Establishing a set of harmonized principles across Canada, accelerating the adoption of technology, optimizing health human resources, and integrated service delivery models all merit comment.
  • great good has come from the 10-year plan
  • Unfortunately, there were two unintended negative consequences
  • One was a reduction in chronic care services for the elderly and
  • a shift in the burden of costs for drugs and medical supplies to individual and families. This was due to early discharge and the fact that often a number of provinces do not cover the drugs and supplies under their publicly funded program.
  • Stakeholders across Canada generally agreed that the end-of-life expectations within the plan were largely met
  • How do we go from having a terrific acute care system to having maybe a slightly smaller acute care system but obviously look toward a chronic care system?
  • Across Canada, an estimated 30 to 50 per cent of ALC patients could and should benefit from home care services and be discharged from the hospital.
  • Second, adopt a Canadian caregiver strategy.
  • Third, support accountability and evidence-informed decision making.
  • The return on investment for every dollar for home care is exponentially enhanced by the in-kind contribution of family caregivers.
  • Sharon Baxter, Executive Director, Canadian Hospice Palliative Care Association
  • June 2004
  • a status report on hospice, palliative and end-of-life care in Canada
  • Dying for Care
  • inconsistent access to hospice palliative care services generally and also to respite care services; access to non-prescribed therapies, as well as prescription drug coverage
  • terminated by the federal government in March of 2008
  • the Canadian Strategy on Palliative and End-of-Life Care
  • Canadian Hospice Palliative Care Association and the Canadian Home Care Association embarked on what we called the Gold Standards Project
  • In 2008, the Quality End-of-Life Care Coalition released a progress report
  • progress was made in 2008, from the 2004 accord
  • palliative pharmaceutical plan
  • Canadians should have the right to choose the settings of their choice. We need to look for a more seamless transition between settings.
  • In 2010, the Quality End-of-Life Care Coalition of Canada released its 10-year plan.
  • Seventy per cent of Canadians at this point in time do not have access to hospice palliative care
  • For short-term, acute home care services, there was a marked increase in the volume of services and the individuals served. There was also another benefit, namely, improved integration between home care and the acute care sector.
  • last summer, The Economist released a document that looked at palliative services across 40 countries
  • The second area in the blueprint for action is the support for family caregivers.
  • The increasing need for home-based care requires us to step up and strive for a comprehensive, coordinated and integrated approach to hospice palliative care and health care.
  • Canadian Caregiver Coalition
  • in Manitoba they have made great strides
  • In New Brunswick they have done some great things in support of family caregivers. Ontario is looking at it now.
  • we keep on treating, keep on treating, and we need to balance our systems between a curative system and a system that will actually give comfort to someone moving toward the end of their life
  • Both the Canadian Institute for Health Information and the Canadian Health Services Research Foundation have produced reports this year saying it is chronic disease management that needs our attention
  • When we look at the renewal of health care, we have to accept that the days of institutional care being the focus of our health care system have passed, and that there is now a third leg of the stool. That is community and home care.
  • Over 70 per cent of caregivers in Canada are women. They willingly take on this burden because they are good people; it is what they want to do. The patient wants to be in that setting, and it is better for them.
  • The Romanow report in 2002 suggested that $89.3 million be committed annually to palliative home care.
  • that never happened
  • What happened was a federal strategy on palliative and end-of-life care was announced in 2004, ran for five years and was terminated. At best it was never funded for more than $1.7 million.
  • Because our publicly funded focus has been on hospitals and one provider — physicians, for the most part — we have not considered how to bring the other pieces into the equation.
  • Just as one example, in the recent recession where there was special infrastructure funding available to stimulate the economy, the health system was not allowed to avail itself of that.
  • As part of the 10-year plan, first ministers agreed to provide first dollar coverage for certain home-care services, based on assessed need, by 2006. The specific services included short-term acute home care, short-term community mental health care and end-of-life care. It appears that health ministers were to report to first ministers on the implementation of that by 2006, but they never did.
  • One of the challenges we find with the integration of mental health services is
  • A lot of eligibility rules are built on physical assessment.
  • Very often a mental health diagnosis is overlooked, or when it is identified the home care providers do not have the skills and expertise to be able to manage it, hence it moves then over to the community mental health program.
  • in Saskatchewan it is a little more integrated
  • Senator Martin
  • I think ideally we would love to have the national strategies and programs, but just like with anything in Canada we are limited by the sheer geography, the rural-urban vast differences in need, and the specialized areas which have, in and of themselves, such intricate systems as well. The national picture is the ideal vision, but not always the most practical.
  • In the last federal budget we got a small amount of money that we have not started working with yet, it is just going to Treasury Board, it is $3 million. It is to actually look at how we integrate hospice palliative care into the health care system across all these domains.
  • The next 10-year plan is about integration, integration, integration.
  • the Canadian Patient Safety Institute, the Health Council of Canada, the Canadian Health Leadership Network, the health sciences centres, the Association of Canadian Academic Healthcare Organizations, the Canadian College of Health Leaders, the Canadian Medical Association, the Canadian Nurses Association, the Canadian Public Health Association, the Canadian Agency for Drugs and Technologies in Health and Accreditation Canada
  • We are all meeting on a regular basis to try to come up with our take on what the system needs to do next.
  • most people want to be cared for at home
  • Family Caregiver Tax Credit
  • compassionate care benefit that goes with Employment Insurance
  • Have you done any costing or savings? Obviously, more home care means more savings to the system. Have you done anything on that?
  • In the last federal election, every political party had something for caregivers.
  • tax credits
  • the people we are talking about do not have the ability to take advantage of tax credits
  • We have a pan-Canadian health/human resource strategy in this country, and there is a federal-provincial-territorial committee that oversees this. However, it is insufficient
  • Until we can better collaborate on a pan-Canadian level on our human resources to efficiently look at the right mix and scope and make sure that we contain costs plus give the best possible provider services and health outcomes right across the country, we will have problems.
    • Irene Jansen
      Irene Jansen on 23 Jan 12
       
      get cite from document
  • We have not as a country invested in hospital infrastructure, since we are talking about acute care settings, since the late 1960s. Admittedly, we are moving away from acute care centres into community and home care, but we still need our hospitals.
  • One of the challenges is with the early discharge of patients from the hospital. They are more complex. The care is more complex. We need to train our home support workers and our nurses to a higher level. There are many initiatives happening now to try to get some national training standards, particularly in the area of home support workers.
  • We have one hospital association left in this country in Ontario, OHA. Their CEO will constantly talk about how the best thing hospitals can do for themselves is keep people out of hospitals through prevention promotion or getting them appropriately to the next place they should be. Jack Kitts, who runs the Ottawa Hospital, and any of the CEOs who run hospitals understand one hundred per cent that the best thing they can do for Canadians and for their institutions is keep people out of them. That is a lot of the language.
  • We have an in-depth brief that details a lot of what is happening in Australia
  • I would suggest that it is a potentially slippery slope to compare to international models, because often the context is very different.
  • Irene Jansen on 23 Jan 12
     
    Home Care
healthcare88

Provinces, Ottawa spar over health transfers; Ontario warns cuts will lead to 'declinin... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|tost|20161019|258655577

accord

shared by healthcare88 on 19 Oct 16 - No Cached
  • Toronto Star Wed Oct 19 2016
  • Provincial and territorial health ministers are imploring Ottawa not to diminish its role as a funding partner in health care any further. Ontario Health Minister Eric Hoskins, who co-chaired a meeting of his counterparts from across the country on Tuesday, said funding from Ottawa will be "inadequate" if the federal government proceeds with its plans to cut the annual increase in health transfers next year.
  • "(It) will result in a declining partnership," he told a news conference at the King Edward Hotel in Toronto. "What we are asking as provinces and territories is that the federal government ... not withdraw further, that we want them to sustain the level of partnership that traditionally has been there," he said. Canadians have seen that partnership "very seriously erode" since medicare was created about a half century ago when the federal government footed half the bill, Hoskins said. Today, Ottawa is paying only 20 per cent of the tab, a share that will decrease further if Ottawa next year cuts the annual increase in the Canada Health Transfer to 3 per cent from 6 per cent.
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  • Federal Health Minister Jane Philpott, who co-chaired Tuesday's talks, tried to steer the conversation away from money and toward system improvement, innovation and accountability. She repeatedly pointed out that Canada spends more on health care than many other developed countries that have superior health systems. She expressed disappointment that planned system improvements that Ottawa funded in the 2004 health accord did not materialize. Philpott indicated that she wants new funds to be targeted to such areas as mental health and system innovation. She also reiterated an earlier commitment to provide $3 billion for home care, including palliative care.
  • I have made it clear to them that we would love, for instance, to invest in innovation," she said. "I want to know how they want to use those investments in innovation. I have told them that I am very interested in mental-health care." Hoskins said his provincial and federal counterparts are on board with that, but that they need a boost in the annual increase in health funding as well just to maintain the status quo. "You can transform and we have to transform, but you have to do that in a way which respects and understands that you need to sustain the existing system," he said. Hoskins cited a Conference Board of Canada report that found that a spending increase of 4.4 per cent is needed "just to keep the lights on, just to keep the existing services working" because of pressures from a growing and aging population. Quebec Health Minister Gaétan Barrette said Ottawa's current plans for health spending will amount to $60 billion less over the next decade for the provinces and territories.
  • "It says to Canadians, 'We will not provide up to the level of $60 billion.' That's what's at stake," he said. The 2004 health accord - which includes annual funding hikes of 6 per cent - expires next spring. The former Conservative government decided unilaterally that annual health spending will increase at a lower rate of 3 per cent after that. The provincial and territorial ministers are hoping Prime Minister Justin Trudeau will reconsider that when the first ministers meet later this year. Hoskins said a 50-per-cent cut in the annual funding increase will translate to $1 billion less for the provinces and territories next year. Ontario alone stands to lose $400 million. Philpott apologized about confusion over comments she made earlier on accountability for funds. Some provincial and territorial ministers expressed anger over an insinuation that health transfers were not being spent on health. Philpott said that was not what she meant.
  • I apologize if people misunderstood," she said. "There is certainly no intention to make accusations." Philpott said the Canada Health Transfer, which stands at $36 billion, will increase by about $19 billion over the next five years. "It's really important for Canadians to know that we are going to continue to contribute to the Canada Heath Transfer," the federal minister said. Philpott said that over the last five years, $9 of every new $10 spent on health in Canada came from the Canada Health Transfer. "We are contributing he largest part to spending." In addition to the Canada Health Transfer, extra funds will be provided for targeted priorities with strings attached to ensure transformation goals are met, she said.
  • This is Canadians' money ... We want to find a way that we can work together so that as we agree to make new investments, that we have already got a sense of plan," Philpott said. In elaborating on why Ottawa should fund new, more efficient ways of providing health care while at the same time provide sufficient funding for the current health system, Hoskins offered the example of dialysis for kidney failure. The ministers discussed how it would make more sense to monitor blood pressure to prevent kidney failure and thereby lessen the need for dialysis, he noted. "That's great and we are all working toward that end, but you still have to provide dialysis today because that individual who needs it will be dead in three weeks without it," Hoskins said.
Govind Rao

Hospitals need money: Unions - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|sust|20150728|225807253

from heather cupe Ontario hospital campaign cuts

shared by Govind Rao on 28 Jul 15 - No Cached
  • The Sudbury Star Tue Jul 28 2015
  • The Ontario Council of Hospital Unions is calling on the Ontario government to end what it calls a five-year funding freeze for Health Sciences North that is now in its fourth year. During a press conference in Sudbury on Monday, officials with the council said the freeze has hit Northern Ontario patients hard, and that it's time for Sudbury MPP Glenn Thibeault to speak out on the issue.
  • "Sudbury and Northern Ontario overall are more affected by hospital cutbacks, which are exacerbated by the challenges of geography and by poverty and health status. As one of only four Liberal MPPs from northern Ontario, Mr. Thibeault has a responsibility to advocate for increased funding for hospitals and to stand up for the patients and their families," the OCHU's Michael Hurley said in a release. The hospital union council recently updated a report to include information specifically on Northern Ontario, entitled Pushed Out of Northern Hospitals, Abandoned at Home: After Twenty Years of Budget Cuts, Ontario's Health System is Failing Patients. "The hospital is in year four of a five-year funding freeze, so to bring the hospitals up to where they would be able to function -it's a 5.8% increase," said said OCHU northeast Ontario vice-president Sharon Richer. "Pharmaceuticals is an issue where their price go up year after year, equipment costs for the hospital goes up, doctors' wages go up, so it does add a pressure to northern hospitals.
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  • "We are asking for the reopening of the chronic beds and alternative level of care beds which have been closed because of the funding freeze. We are asking that the provincial government stop the closure of acute care beds and to put funding back into the public sector and not the private sector," said Richer. According to Sudbury District Health Unit data, Sudbury/ Manitoulin has greater rates for obesity, arthritis, and high blood pressure and death than the Ontario average.
  • "They are decreasing the funding to the hospital and they are increasing the amount of funding they are putting into home care, but we have yet to see that," Richer said. "Many patients who are in hospital who need home care, their family is asked if they are able to perform any type of care for them and as soon as the family says yes, then that is when home care is very much decreased. "The patients in Northern Ontario, that need cleaning of wounds or changing of dressing, many of them have to go into a clinic, nobody is able to go into their homes so that definitely is an issue for the rest of the family members who have to book off time to get their loved ones into a clinic. "We are currently seeing no extra funding put into home care for these individuals and when they are on a list, the list is very significant, so when they are actually able to receive care it's sometimes too late."
  • Hurley said patients are suffering as hospital's try to balance their books. "What families experience when they are sent home is that they are asked 'is there anybody who can help with the patient,' and if you answer yes to that, then you don't actually get to access care because you don't need it, but if you need it, then you are put on a triage system and only the most urgent cases actually get access to home care -that's the sad reality," said Hurley "What people experience ... is that they are sent home by themselves, and often they are sent home when they are still acutely ill. They are sent home when they have needs like IVs, complex mobility issues which are far beyond the abilities of their aged spouses to deal with -that's what we do we just send them home and this then becomes individualized and becomes an individual problem of care."
  • Dan Lessard, media and public relations officer for Health Sciences North, said the freeze on the hospital's budget has had little to no effect on the organizations ability to treat patients. "One of the things that we have done, recognizing that hospital base budgets have been relatively static for the past four years, is we have really launched into an exercise of trying to find as many efficiencies as we can so that we get more use out of the dollars that we already have," said Lessard.
  • Lessard said that creating efficiencies means anything from eliminating vacancies for positions that have had little to no applicants, reducing overtime through better scheduling, and reorganizing the way supplies are ordered and managed. "I think we have been pretty good at maintaining our services so what we have really tried to do is look at areas where we can be more efficient and smarter in the way we do things so that we are not causing patient services to suffer," Lessard said.
  • "That's the last thing we want to do, that's the last thing our patients want us to do, certainly the last thing the community wants us to do is to put in place measures that is going to impact patient care. "I think we have done a pretty good job at maintaining our services and maintaining the quality of care that we are giving patients -it's not easy, it is challenging and demanding but we have very very smart people here working very hard to make that happen." Thibeault, the Sudbury MPP, did not return phone calls asking for comment.
  • • Sharon Richer, left, northeast Ontario vice-president of the Ontario Council of Hospital Unions (OCHU), and Michael Hurley, president of OCHU, hold a press conference in Sudbury on Monday.
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?
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  • 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

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.
  • ...5 more annotations...
  • 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

Long-term care homes not up to minimum standards: report; Staffing levels an issue at 2... - 0 views

www.fpinfomart.ca/...244046042

from heather bc ltc cupe hospital inspections quality

shared by Govind Rao on 05 Apr 16 - No Cached
  • Vancouver Sun Tue Apr 5 2016
  • The vast majority of governmentfunded long-term care homes for seniors in B.C. do not meet Ministry of Health staffing guidelines. The Residential Care Facilities Quick Facts Directory, a report released by the Office of the Seniors Advocate, compiles staffing, serious incident reports and other qualityof-life measures for all publicly funded seniors homes in B.C. in 2014-15. Of the 292 governmentfunded facilities, 232 did not meet the ministry's staffing guideline, a recommendation of 3.36 hours of care per senior every day. This includes help with tasks such as toileting, feeding and bathing. Just 17 facilities
  • Of the 232 government-funded seniors homes below the staffing guidelines, 74 per cent were owned and operated by private businesses instead of health authorities or by a non-profit group, such as a church. All but two of the 25 care facilities providing the lowest number of staffing hours were in the Vancouver Coastal Health Authority. Isobel Mackenzie, the B.C. Seniors Advocate, and Jennifer Whiteside of the Hospital Employees Union, which represents care aides in long-term facilities, are calling on government to legislate minimum staffing levels instead of leaving it up to facility operators. "We regulate the staffing ratios in child care, why don't we regulate it in senior care?" said Mackenzie. She said she was surprised to learn how many seniors homes fall below provincial guidelines.
  • ...9 more annotations...
  • were meeting the guideline, while 33 facilities were exceeding it. (Information is missing on another 10 for a variety of reasons. For example, some were new.) The directory's data shows that a quarter of seniors in the homes have a diagnosis of depression and nearly one-third are being given anti-psychotic medication without a diagnosis of psychosis.
  • Your questions show we have some work to do here," she said. "I will specifically be writing to each Health Authority and the government on this issue. We have a target of care hours and here's how many of your facilities are at that or under that." Mackenzie said her office will also analyze the Residential Care Facilities Quick Fact directory data to determine whether facilities with low staffing levels may also have more seniors who are depressed or who are prescribed antipsychotics medication. She also wants to study whether these homes offer fewer amenities to boost quality of life such as recreational and occupational therapy. Mackenzie said the Quick Facts Directory, available online, provides numbers to back anecdotal evidence that quality of care has declined in many B.C. seniors homes. The directory will be updated annually, but does not include data on private nursing homes that receive no government funding.
  • "Anecdotally, everyone was saying hours (for staff) were being cut, but now you have quantitive evidence. For policy shifts (in government), they want to know the magnitude of the issue. Let's have a discussion on how we can fix this. Before you can deal with what homes are not providing recreational therapy and OT (occupational therapy), for instance, you have to fix the hours of care first," said Mackenzie. Whiteside said the figures showing the vast majority of government-funded homes are below ministry staffing guidelines prove what HEU members have been saying for years - that they are rushed in trying to care for seniors in nursing homes and concerned that seniors are suffering and workers are placed in dangerous situations when a senior acts out violently.
  • A recent Vancouver Sun series on violence in nursing homes found more than 1,000 physical assaults by seniors in long-term care facilities last year. And in the past four years in B.C., 16 seniors in care have been killed by other seniors suffering from dementia. "There's simply not enough time for them (care aides) to do their job and provide the care seniors need. When we establish what the level of care needed is, it needs to be mandatory. Clearly, there needs to be more strenuous accountability in this system for seniors - many of whom are frail," said Whiteside. Nor was she surprised to find 74 per cent of the privately owned and operated businesses failed to meet ministry guidelines. "The system is set up so Health Authorities are contracting with private providers and some of those private providers are subcontracting out some of the care to other contractors and at each phase there needs to be a profit made. It's not the kind of system to have for frail seniors. It's quite shocking to think this is the system we have for them," said Whiteside.
  • A Vancouver Sun request to interview Health Minister Terry Lake was not granted. However, the ministry sent an email stating there are no plans to introduce mandatory staffing levels. The recommended 3.36 direct care hours is a number used "as a starting point for planning decisions," the email said. "The standard that we want care providers to meet is high quality care at whatever level is most appropriate for an individual patient," the ministry email states. "Direct care hours are dependent on the individual's needs and are determined through a comprehensive assessment process involving the client, their family and staff. Experts all agree that having a legislated or policy requirement for staffing ratios and staffing hours is not appropriate, because of the complexity of patient needs." Daniel Fontaine, the CEO of the B.C. Care Providers Association, whose members represent approximately 60 per cent of the government's contracted-out beds, said home operators would be happy to provide 3.36 direct care hours, but the government funding isn't enough to reach this level.
  • We can only do what we are funded to do," said Fontaine. "While the government and health authorities are trying to bring those on the lower (staffing) levels up, it's been a slow process." One of the solutions could be to take some of the money spent in the acute care system and shift it into continuing care so seniors in long-term care facilities benefit, Fontaine said. Lorri Chmilar, who retired from nursing last year after working mainly for the Interior Health Authority, said the most stressful place she worked during her career was nine months spent in geriatric care. "Anyone who has worked in public care facilities has seen a decrease in staffing, decrease in activities, and decrease in quality of meals. What has increased is the amount of time in recording statistics, and basically CYA (cover your ass)," she said. "Understaffing is also a result of the poor mix of residents. It only takes one or two residents with severe dementia or severe physical impairments to increase the workload significantly to the detriment of the rest. To increase staffat this point, or to transfer a resident to a different care area is a major undertaking that requires much justifying and time. Nurses are derided for asking for extra assistance, if there is any to be had, and roadblocks to transfers are numerous. I fear for my family, and others, and the grey wave of us to come."
  • THE NUMBERS DRUGS WITHOUT DIAGNOSIS In B.C. facilities, an average of 31 per cent of residents were given antipsychotics without a diagnosis of psychosis. 133 facilities were above this average. 11 were at the average.
  • 136 were below the average, but just one reported zero cases of providing antipsychotics without a diagnosis of psychosis. DAILY PHYSICAL RESTRAINTS In B.C. facilities, an average of 11 per cent of residents have daily physical restraints placed upon them. 116 facilities are above the average.
  • 9 are at the average. 155 are below the average, of which 27 made no use of physical restraints. Source: Office of the Seniors Advocate, Province of B.C. © 2016 Postmedia Network Inc. All rights reserved.
Heather Farrow

Clarity needed re health-care funding - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|cbpo|20160831|255059584

ns cupe campaign cuts

shared by Heather Farrow on 31 Aug 16 - No Cached
  • Cape Breton Post Wed Aug 31 2016
  • On Aug. 17, members of the Canadian Union of Public Employees (CUPE) and its supporters rallied outside my constituency office in New Waterford over a one per cent reduction in long-term care funding outlined in this year's budget. Let me be clear. I have no problem with CUPE and its supporters voicing concern on issues. However, I do believe some clarity needs to be provided.
  • Our government is committed to caring for our citizens and improving our health care system. In Cape Breton alone, our long-term care facilities have received operating funding of over $100 million. And, since 2013 we have increased home support funding by $59.1 million, including $14.4 million this year. This increased funding allows more Nova Scotians to stay in their homes longer and benefit from quality care. During the 2016-17 budget, we asked long-term care facilities to find savings without impacting care offered to residents. This could be done through administration and by coming together to purchase supplies.
  • ...1 more annotation...
  • We appreciate any reduction of funding can create a pressure that must be managed. Therefore, staff from the Department of Health and Wellness met with sector representatives to discuss their concerns and possible solutions on how to address funding pressures individually and collectively. If operators decide to lay off employees or reduce hours that is a business decision, not one mandated by our government. Government has to make very difficult choices about where we spend taxpayers' money. We are focused on improving our health care system and finding new and improved ways to deliver the care Nova Scotians need. Thank you very much for your attention and remember my door is always open. David Wilton MLA, Cape Breton Centre
Irene Jansen

Senate Social Affairs Committee review of the health accord- Evidence - March 10, 2011 - 0 views

www.parl.gc.ca/...22evb-e.htm

accord senate

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Dr. Jack Kitts, Chair, Health Council of Canada
  • In 2008, we released a progress report on all the commitments in the 2003 Accord on Health Care Renewal, and the 10-year plan to strengthen health care. We found much to celebrate and much that fell short of what could and should have been achieved. This spring, three years later, we will be releasing a follow-up report on five of the health accord commitments.
  • We have made progress on wait times because governments set targets and provided the funding to tackle them. Buoyed by success in the initial five priority areas, governments have moved to address other wait times now. For example, in response to the Patients First review, the Saskatchewan government has promised that by 2014, no patient will wait longer than three months for any surgery. Wait times are a good example that progress can be made and sustained when health care leaders develop an action plan and stick with it.
  • ...97 more annotations...
  • Canada has catching up to do compared to other OECD countries. Canadians have difficulty accessing primary care, particularly after hours and on weekends, and are more likely to use emergency rooms.
  • only 32 per cent of Canadians had access to more than one primary health care provider
  • In Peterborough, Ontario, for example, a region-wide shift to team-based care dropped emergency department visits by 15,000 patients annually and gave 17,000 more access to primary health care.
  • We believe that jurisdictions are now turning the corner on primary health care
  • Sustained federal funding and strong jurisdictional direction will be critical to ensuring that we can accelerate the update of electronic health records across the country.
  • The creation of a national pharmaceutical strategy was a critical part of the 10-year plan. In 2011, today, unfortunately, progress is slow.
  • Your committee has produced landmark reports on the importance of determinants of health and whole-of- government approaches. Likewise, the Health Council of Canada recently issued a report on taking a whole-of- government approach to health promotion.
  • there have also been improvements on our capacity to collect, interpret and use health information
  • Leading up to the next review, governments need to focus on health human resources planning, expanding and integrating home care, improved public reporting, and a continued focus on quality across the entire system.
  • John Wright, President and CEO, Canadian Institute for Health Information
  • While much of the progress since the 10-year plan has been generated by individual jurisdictions, real progress lies in having all governments work together in the interest of all Canadians.
  • the Canada Health Act
  • Since 2008, rather than repeat annual reporting on the whole, the Health Council has delved into specific topic areas under the 2003 accord and the 10-year plan to provide a more thorough analysis and reporting.
  • We have looked at issues around pharmaceuticals, primary health care and wait times. Currently, we are looking at the issues around home care.
  • John Abbott, Chief Executive Officer, Health Council of Canada
  • I have been a practicing physician for 23 years and a CEO for 10 years, and I would say, probably since 2005, people have been starting to get their heads around the fact that this is not sustainable and it is not good quality.
  • Much of the data you hear today is probably 18 months to two years old. It is aggregate data and it is looking at high levels. We need to get down to the health service provider level.
  • The strength of our ability to report is on the data that CIHI and Stats Canada has available, what the research community has completed and what the provinces, territories and Health Canada can provide to us.
  • We have a very good working relationship with the jurisdictions, and that has improved over time.
  • One of the strengths in the country is that at the provincial level we are seeing these quality councils taking on significant roles in their jurisdictions.
  • As I indicated in my remarks, dispute avoidance activity occurs all the time. That is the daily activity of the Canada Health Act division. We are constantly in communication with provinces and territories on issues that come to our attention. They may be raised by the province or territory, they may be raised in the form of a letter to the minister and they may be raised through the media. There are all kinds of occasions where issues come to our attention. As per our normal practice, that leads to a quite extensive interaction with the province or territory concerned. The dispute avoidance part is basically our daily work. There has never actually been a formal panel convened that has led to a report.
  • each year in the Canada Health Act annual report, is a report on deductions that have been made from the Canada Health Transfer payments to provinces in respect of the conditions, particularly those conditions related to extra billing and user fees set out in the act. That is an ongoing activity.
  • there has been progress. In some cases, there has been much more than in others.
  • How many government programs have been created as a result of the accord?
  • The other data set is on bypass surgery that is collected differently in Quebec. We have made great strides collectively, including Quebec, in developing the databases, but it takes longer because of the nature and the way in which they administer their systems.
  • I am a director of the foundation of St. Michael's Hospital in Toronto
  • Not everyone needs to have a family doctor; they need access to a family health team.
  • With all the family doctors we have now after a 47-per-cent-increase in medical school enrolment, we just need to change the way we do it.
  • The family doctors in our hospital feel like second-class citizens, and they should not. Unfortunately, although 25 years ago the family doctor was everything to everybody, today family doctors are being pushed into more of a triage role, and they are losing their ability.
  • The problem is that the family doctor is doing everything for everybody, and probably most of their work is on the social end as opposed to diagnostics.
  • At a time when all our emergency departments are facing 15,000 increases annually, Peterborough has gone down 15,000, so people can learn from that experience.
  • The family health care team should have strong family physicians who are focused on diagnosing, treating and controlling chronic disease. They should not have to deal with promotion, prevention and diet. Other health providers should provide all of that care and family doctors should get back to focus.
  • I have to be able to reach my doctor by phone.
  • They are busy doing all of the other things that, in my mind, can be done well by a team.
  • That is right.
  • if we are to move the yardsticks on improvement, sustainability and quality, we need that alignment right from the federal government to the provincial government to the front line providers and to the health service providers to say, "We will do this."
  • We want to share best practices.
  • it is not likely to happen without strong direction from above
  • Excellent Care for All Act
  • quality plans
  • with actual strategies, investments, tactics, targets and outcomes around a number of things
  • Canadian Hospital Reporting Project
  • by March of next year we hope to make it public
  • performance, outcomes, quality and financials
  • With respect to physicians, it is a different story
  • We do not collect data on outcomes associated with treatments.
  • which may not always be the most cost effective and have the better outcome.
  • We are looking at developing quality indicators that are not old data so that we can turn the results around within a month.
  • Substantive change in how we deliver health care will only be realized to its full extent when we are able to measure the cost and outcome at the individual patient and the individual physician levels.
  • In the absence of that, medicine remains very much an art.
  • Senator Eaton
  • There are different types of benchmarks. For example, there is an evidence-based benchmark, which is a research of the academic literature where evidence prevails and a benchmark is established.
  • The provinces and territories reported on that in December 2005. They could not find one for MRIs or CT scans. Another type of benchmark coming from the medical community might be a consensus-based benchmark.
  • universal screening
  • A year and a half later, we did an evaluation based on the data. Increased costs were $400 per patient — $1 million in my hospital. There was no reduction in outbreaks and no measurable effect.
  • For the vast majority of quality benchmarks, we do not have the evidence.
  • A thorough research of the literature simply found that there are no evidence-based benchmarks for CT scans, MRIs or PET scans.
  • We have to be careful when we start implementing best practices because if they are not based on evidence and outcomes, we might do more harm than good.
  • The evidence is pretty clear for the high acuity; however, for the lower acuity, I do not think we know what a reasonable wait time is
  • If you are told by an orthopaedic surgeon that there is a 99.5 per cent chance that that lump is not cancer, and the only way you will know for sure is through an MRI, how long will you wait for that?
  • Senator Cordy: Private diagnostic imaging clinics are springing up across all provinces; and public reaction is favourable. The public in Nova Scotia have accepted that if you want an MRI the next day, they will have to pay $500 at a private clinic. It was part of the accord, but it seems to be the area where we are veering into two-tiered health care.
  • colorectal screening
  • the next time they do the statistics, there will be a tremendous improvement, because there is a federal-provincial cancer care and front-line provider
  • adverse drug effects
  • over-prescribing
  • There are no drugs without a risk, but the benefits far outweigh the risks in most cases.
  • catastrophic drug coverage
  • a patchwork across the country
  • with respect to wait times
  • Having coordinated care for those people, those with chronic conditions and co-morbidity, is essential.
  • The interesting thing about Saskatchewan is that, on a three-year trending basis, it is showing positive improvement in each of the areas. It would be fair to say that Saskatchewan was a bit behind some of the other jurisdictions around 2004, but the trending data — and this will come out later this month — shows Saskatchewan making strides in all the areas.
  • In terms of the accord itself, the additional funds that were part of the accord for wait-times reduction were welcomed by all jurisdictions and resulted in improvements in wait times, certainly within the five areas that were identified as well as in other surgical areas.
  • We are working with the First Nations, Statistics Canada, and others to see what we can do in the future about identifiers.
  • Have we made progress?
  • I do not think we have the data to accurately answer the question. We can talk about proxies for data and proxies for outcome: Is it high on the government's agenda? Is it a directive? Is there alignment between the provincial government and the local health service providers? Is it a priority? Is it an act of legislation? The best way to answer, in my opinion, is that because of the accord, a lot of attention and focus has been put on trying to achieve it, or at least understanding that we need to achieve it. A lot of building blocks are being put in place. I cannot tell you exactly, but I can give you snippets of where it is happening. The Excellent Care For All Act in Ontario is the ultimate building block. The notion is that everyone, from the federal, to the provincial government, to the health service providers and to the CMA has rallied around a better health system. We are not far from giving you hard data which will show that we have moved yardsticks and that the quality is improving. For the most part, hundreds of thousands more Canadians have had at least one of the big five procedures since the accord. I cannot tell you if the outcomes were all good. However, volumes are up. Over the last six years, everybody has rallied around a focal point.
  • The transfer money is a huge sum. The provinces and territories are using the funds to roll out their programs and as they best see fit. To what extent are the provinces and territories accountable to not just the federal government but also Canadians in terms of how effectively they are using that money? In the accord, is there an opportunity to strengthen the accountability piece so that we can ensure that the progress is clear?
  • In health care, the good news is that you do not have to incent people to do anything. I do not know of any professionals more competitive than doctors or executives more competitive than executives of hospitals. Give us the data on how we are performing; make sure it is accurate, reliable, and reflective, and we will move mountains to jump over the next guy.
  • There have been tremendous developments in data collection. The accord played a key role in that, around wait times and other forms of data such as historic, home care, long term care and drug data that are comparable across the country. Without question, there are gaps. It is CIHI's job to fill in those gaps as resources permit.
  • The Health Council of Canada will give you the data as we get it from the service providers. There are many building blocks right now and not a lot of substance.
  • send him or her to the States
  • Are you including in the data the percentage of people who are getting their work done elsewhere and paying for it?
  • When we started to collect wait time data years back, we looked at the possibility of getting that number. It is difficult to do that in a survey sampling the population. It is, in fact, quite rare that that happens.
  • Do we have a leader in charge of this health accord? Do we have a business plan that is reviewed quarterly and weekly so that we are sure that the things we want worked on are being worked on? Is somebody in charge of the coordination of it in a proper fashion?
  • Dr. Kitts: We are without a leader.
  • Mr. Abbott: Governments came together and laid out a plan. That was good. Then they identified having a pharmaceutical strategy or a series of commitments to move forward. The system was working together. When the ministers and governments are joined, progress is made. When that starts to dissipate for whatever reason, then we are 14 individual organization systems, moving at our own pace.
  • You need a business plan to get there. I do not know how you do it any other way. You can have ideas, visions and things in place but how do you get there? You need somebody to manage it. Dr. Kitts: I think you have hit the nail on the head.
  • The Chair: If we had one company, we would not have needed an accord. However, we have 14 companies.
  • There was an objective of ensuring that 50 per cent of Canadians have 24/7 access to multidisciplinary teams by 2010. Dr. Kitts, in your submission in 2009, you talked about it being at 32 per cent.
  • there has been a tremendous focus for Ontario on creating family health teams, which are multidisciplinary primary health care teams. I believe that is the case in the other jurisdictions.
  • The primary health care teams, family health care teams, and inter-professional practice are all essentially talking about the same thing. We are seeing a lot of progress. Canadian Health Services Research Foundation is doing a lot of work in this area to help the various systems to embrace it and move forward.
  • The question then came up about whether 50 per cent of the population is the appropriate target
  • If you see, for instance, what the Ontario government promotes in terms of needing access, they give quite a comprehensive list of points of entry for service. Therefore, in terms of actual service, we are seeing that points of service have increased.
  • The key thing is how to get alignment from this accord in the jurisdictions, the agencies, the frontline health service providers and the docs. If you get that alignment, amazing things will happen. Right now, every one of those key stakeholders can opt out. They should not be allowed to opt out.
  • the national pharmaceutical strategy
  • in your presentation to us today, Dr. Kitts, you said it has stalled. I have read that costing was done and a few minor things have been achieved, but really nothing is coming forward.
  • The pharmacists' role in health care was good. Procurement and tendering are all good. However, I am not sure if it will positively impact the person on the front line who is paying for their drugs.
  • The national pharmaceutical strategy had identified costing around drugs and generics as an issue they wanted to tackle. Subsequently, Ontario tackled it and then other provinces followed suit. The question to ask is: Knowing that was an issue up front, why would not they, could not they, should not they have acted together sooner? That was the promise of the national pharmaceutical strategy, or NPS. I would say it was an opportunity lost, but I do not think it is lost forever.
  • Irene Jansen on 23 Jan 12
     
    CIHI Health Canada Statistics Canada
Govind Rao

Patient care will suffer - unions - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|nbng|20150917|229461442

from heather cupe Ontario privatization campaign

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  • The North Bay Nugget Thu Sep 17 2015
  • Patient care at the North Bay Regional Health Centre will suffer dramatically" as the result of job cuts announced Wednesday, Michael Hurley says. Hurley, president of the Ontario Council of Hospital Unions/Canadian Union of Public Employees, made the statement Wednesday afternoon after hearing the news 158 full-time equivalent positions are being eliminated. No community in Ontario is suffering hospital cuts to the extent that the North Bay community is suffering them," Hurley said. The Liberals saddled North Bay with an enormously expensive P3 hospital after promising to scrap the deal, and they are cutting the hospital's budget by almost six per cent a year.
  • The province must step in immediately with funding to stop the bleeding out of vital patient services." The announcement also involves closing 30 beds. Paul Heinrich, the hospital's chief executive officer, said the effects will be felt throughout the facility. According to the council, the province has frozen hospital funding for the past four years, cutting budgets in real terms by more than 20 per cent. To deal with the significant provincial underfunding, the North Bay hospital has slashed nearly $50 million over the past three years, resulting in cuts to nursing, emergency, cleaning, portering, cataract surgery, psychiatric care and forensic units. For 2015, the hospital received $14 million less in provincial funding than it needed to just to maintain existing services. In 2014, the provincial funding deficit was $18 million. 40 nursing positions were eliminated in 2013 to counter a $14-million deficit," the council stated in a media release.
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  • Shawn Shank, president of the Canadian Union of Public Employees (CUPE) Local 139 which represents hundreds of front-line hospital staff, said unions expect to be notified within four weeks of the impact to personnel. This announcement has caused more anxiety in the workplace," he said. Now that people have heard that 158 number they are wondering if they are within that 158." According to the council, recently released health data shows an increase in patient readmission rates for North Bay in each year of the provincial funding freeze.
  • The re-admission spikes signal that the hospital is pushing patients out of hospital faster and faster and before they are well. Patients are being sent home and then re-admitted, acutely ill and often requiring longer, more costly hospital stays. Many individuals are paying with their health for a community hospital that isn't funded properly," Hurley said. Nipissing MPP Vic Fedeli took the government to task in the Ontario Legislature Wednesday afternoon. Fedeli blasted the Liberals in a member's statement for putting the health care of Nipissing residents at even greater risk. Today is an incredibly distressing day in my riding, especially for those people who rely on health services provided at the North Bay Regional Health Centre," he stated.
  • Today, a further 158 full-time staff at our hospital learned that their jobs are being cut by this government and more than half of those employees were nurses. This is in addition to the 197 front-line health care workers already cut at this hospital - again the majority of them were nurses. Speaker, that's 350 frontline health care workers that are gone." Fedeli said the Liberals are also closing 30 beds in addition to the 30 they already closed at the fiveyear- old hospital. This is not only devastating to the front-line health care workers, but more so for their patients, who are now rightfully concerned about access to the quality health care they need and deserve," he said.
  • The Liberal government has clearly put self-interest ahead of the health care of Northerners. This much I want to make clear, Speaker -we, the people of Nipissing, will not stand for this. We're fed up with the scandals that leave us to pay the price." j.hamilton-mccharles@sunmedia.ca
  • NUGGET FILE PHOTO • The elimination of 158 full-time equivalent positions at the North Bay Regional Health Centre brings the total loss of front-line health care workers to 350, Nipissing MPP Vic Fedeli stated Wednesday in the provincial legislature.
Irene Jansen

The Mowat Centre for Policy Innovation. A TRANSFORMATIVE BLUEPRINT FOR REDUCED COSTS, I... - 0 views

www.mowatcentre.ca/press-releases.php

abf private clinics competitive bidding it

shared by Irene Jansen on 23 Jan 12 - No Cached
  • the Mowat Centre at the University of Toronto has released a blueprint for transformative changes to the healthcare system
  • The report recommends five significant changes: • Modernize the organization of hospitals, with academic centres focused on diagnostic work-ups, specialty clinics providing routine procedures efficiently and accessibly, and networks of care that monitor patient well-being • Embrace the ‘‘virtualization’ of many existing services that are currently only delivered in person • Widely deploy digitization by reforming agencies so that they can respond to technological change more quickly and by providing more IT funding directly to providers • Encourage organic governance evolution without undertaking wholesale restructuring, and • Reform the way health services are purchased.
  • The report is part of the Shifting Gears Series on the transformation of public services and was supported financially by KPMG.
  • ...1 more annotation...
  • To read the full report, please click here
  • Irene Jansen on 23 Jan 12
     
    National Post coverage: Innovations seen as lowering health costs. National Post. Nov 1 2011 Tom Blackwell  Provinces must find ways to profit from efficiencies - like the steadily falling cost of cataract surgery. While favouring marketstyle competition, the academics draw the line at allowing a private tier of medicine or even expanding the role of privatehealth operators in the public system. Set up more stand-alone clinics, like those that do cataract surgeries. Move away from block funding of hospitals (an institution is paid a lump sum every year to cover most services) toward payments tied to treatment of individual patients. Cap increases in physicians' fees, link fees more closely to changes in technology and hold auctions in the public system, to get the best deal for providing some procedures. Experience suggests doctors may not welcome some of their proposals. In 2002, a $4-million study funded by the Ontario government - and initially supported by the Ontario Medical Association - recommended an overhaul of the fee schedule to better reflect the up-to-date value of each doctor service. It would have meant income drops for some specialists - such as the opthalmologists who do cataracts - while others would earn more. See also: Health Care reform? Despite frightful predictions of ever-rising costs, governments can reap savings by managing change Toronto Star Nov 1 2011  Opinion  Will Falk
Irene Jansen

Long-term care operators warn of cuts over new funding model (part 1) - 0 views

www2.canada.com/...story.html

abf Alberta ltc wages privatization

shared by Irene Jansen on 29 Jan 13 - No Cached
  • Two not-for-profit agencies that together operate more than 1,000 long-term care beds in Alberta say their operations are financially strained and they will need to consider staffing or service reductions unless the government gives them more money.
  • T he Shepherd's Ca re Foundation in Edmonton and Calgary-based Bethany Care Society say a new patient-based funding model from Alberta Health Services is insufficient to manage rising expenses.
  • AHS pushes ahead with the new funding model, which it says is designed to ensure equality for all long-term care residents, whether their care is provided by a public institution, a not-for-profit agency or a for-profit corporation.
  • ...2 more annotations...
  • uses a formula to take into account the needs of each patient, calculate the health resources required, and then allocate a standard funding amount
  • The old system was considered more uneven, in that different long-term care operators each received a block of funding based on individual agreements with health authorities.
Govind Rao

FREE SPEECH; Speech therapy can prevent a lifetime of struggles, but an early start is ... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150831|228230903

from heather waits specialty clinics privatization private clinics

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  • The Globe and Mail Mon Aug 31 2015
  • Four-year-old Eddie Hopkins is focused on a game of I spy. The object of his attention is a tube of lipstick in a picture. Can he say what it is? "Lipstick," he says, but it sounds more like "lit-git." Maybe lipstick is too hard. Can he say stick?
  • "Sti-ck," he says, hesitating before the k sound. One more try. "Sti-ick!" he shouts confidently, dividing the word into two. It seems like a small accomplishment, but for Eddie, it's the first and major step toward speaking normally. Like tens of thousands of children in Ontario, Eddie is in need of speech therapy. He has problems pronouncing the hard k sound, known as an unvoiced velar stop. He often switches it with the voiced velar stop, which most people know as the soft g sound, bringing him from "stick" to "stig." He also switches his sh and s sounds, and has issues with pronouncing two consonants together, such as the "cl" in "clown."
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  • The average number of people on wait lists as of May, 2015, is 611. Some regions have shorter wait lists, such as Toronto Central, which currently has zero. Others are in the four digits, such as the Central East CCAC, which stretches east from Victoria Park Avenue in Scarborough and north to Algonquin Park, and has 1,516 children waiting for speech therapy. Waiting that long can have a large impact on a child's ability to do well in school, according to Anila Punnoose, a director of Speech-Language and Audiology Canada. During the months or years children are waiting to get speech services, they can quickly fall behind in school, she said. A 1996 study found children with language deficits are more likely to experience social difficulties including interacting with their peers, which impacts their behaviour. Other studies have shown that children who don't get speech therapy early are at a greater risk of problems in their academic performance and mental health.
  • A lot of speech problems carry over to literacy, because a knowledge of speech sounds is crucial when learning to read, Punnoose said. "It's all about what you hear in those sounds. ... Do you know the beginning sounds in that word? A child who doesn't have good phonological awareness doesn't understand any of that," she said. When looking at school performance, Punnoose said early struggles carry through to later years. A child with speech problems who has difficulties learning in the early years won't be able to build on those lessons in later years as effectively as their peers, she said. Early intervention can mitigate and prevent those problems, she said. "If children are having severe difficulties with speech in kindergarten, it's a predictor that there's going to be academic difficulties, and especially reading and writing difficulties, by Grade 3," she said.
  • Jocelyn Fedyczko, Eddie's speech pathologist, has worked in a range that includes children from preschool all the way to teenagers. She said early intervention is crucial with young children such as Eddie. "The earlier you can help a child out, the more progress you see," she said. When a child gets to the top of the wait list, they get assessed again, and receive a block of treatment, usually around 10 or 12 sessions, says Peggy Allen, president of the Ontario Association of Speech-Language Pathologists and Audiologists (OSLA). That's often not enough to treat even minor to moderate issues such as Eddie's. Fedyczko said she can get through two to three sounds in that time, depending on the child. Many children have problems with more sounds than that, she said. But when a child finishes their block of treatment and needs more, because they haven't worked through all the sounds, for example, they go back to the bottom of the wait list, Allen said.
  • A spokesperson for the Toronto Central CCAC said they do not have an upper limit to the number of sessions per block assigned by a speech-language pathologist. The pathologist determines three goals for a child to achieve and assigns the number of sessions according to that. If after these sessions more goals are identified, the child is re-referred to the program, the spokesperson said. Parents who are worried about the impact waiting can have on their child can go to private clinics, if they have coverage or can afford the sessions out of pocket. Trish Bentley, Eddie's mother, decided to go for private therapy with Eddie's older brother Oliver. He was put on a six-month wait list for speech problems slightly more acute than Eddie's.
  • B.C.: Children's speech therapy is organized through the Ministry of Health, Ministry of Children and Family Development (MCFD) and through the Ministry of Education by way of school districts. Children are divided between preschool and school age. Preschool children go through regional health authorities. School-age children go through the school boards, but the pathologists there will often offer consultative services, rather than oneon-one speech therapy. B.C. also has a "no-wait-list" policy for children with autism, which translates to parents getting around $22,000 a year for therapy until the age of six, and $6,000 a year after that. Alberta: Health Services is in charge of speech therapy in that province. It offers both a preschool and a school program. The school program, unlike Ontario's, is done completely through the schools, with no CCAC-type system to refer out to. Saskatchewan: The school districts are responsible for speech therapy. Each school district divides up services slightly differently, though they all differentiate between children under three years, from three to five years, and from six to 18 years.
  • But the problems go deeper than a lack of funding, according to Allen. She said many of the issues in Ontario stem back to a series of agreements in the 1980s between the provincial Ministry of Long-Term Care, the Ministry of Education and the Ministry of Community and Social Services. These agreements divided up who is in charge of different treatments, between the school boards and the CCACs. At the time of their creation, these agreements made sense, but times and needs have changed, she said. "It's difficult when ministries make agreements that are frozen in time. It's very difficult to provide the kind of services that we all expect and want Ontarians to receive," she said. Dividing up the services is necessary when trying to manage resources, but the fragmentation is hurting children more than it's helping, Punnoose said.
  • Dividing services by language issues and other issues doesn't make sense when treating a child, she said. "You shouldn't be splitting up the kid," she said. Punnoose said she wants to see speech therapy come together under one roof. It would mean co-operation from all three ministries, as well as a major reorganization of the funding, but she believes it would be a better model for children. "Students are in schools the better waking part of their lives. Why wouldn't we have the services right there in an authentic environment where it's totally accessible," she said. There are changes coming.
  • Last December, the Ontario government announced more funding for preschool speech and language programs, as well as efforts to integrate speech services better, through its Special Needs Strategy. Punnoose says it's a good step. "The government recognizes that the system was broken," she said. For now, the choice for parents in many CCACs will be between long wait lists and paying for private service. Hunter-Trottier said many parents, even those with coverage, don't know about the latter option. "We sometimes get parents here in tears, saying, 'Oh my goodness, the services here, I wish I had known about that a year ago,' " she said. Bentley said she won't be looking at public services for Eddie, as she's happy with the service she gets at Canoe. "I'd be open to it, but I'm not going to actively seek that out," she said.
  • For Eddie, what matters is the progress he makes. Within 10 minutes of his trouble saying "lipstick," he was opening up a treasure chest, with a key. With little prompting, he used the same technique as before, separating the sounds of the word. "Kuh-ey," he said. Could he try it all together? He pauses for a second. "Key," he says, almost flawlessly, beaming at his success. SPEECH THERAPY IN EACH PROVINCE
  • Speech therapy, like all healthcare matters, is regulated differently in each province and territory in Canada. Information on how each system works is difficult to come by. But generally, most provinces have very similar systems - and challenges - according to Joanne Charlebois, CEO of Speech-Language and Audiology Canada. Charlebois said Ontario's wait times are probably worse than those in other provinces, but she's spoken to people across Canada who tell her similar stories. Here's a breakdown of how it works across the country. Ontario: Speech therapy for children falls under the responsibility of three ministries: the Ministry of Long-Term Care, the Ministry of Education and the Ministry of Community and Social Services. Children in Ontario are divided by age and by the nature of their speech problem. Children under school age qualify for Ontario's preschool speech and language program. Once in school, those children with language problems - major problems speaking or understanding words or sentences - go to a school speech pathologist, while any other problems, such as pronunciation, stuttering, voice and articulation are referred to the Community Care Access Centres, which employ contract speech pathologists.
  • Rather than wait those six months, Bentley took him to Canoe. "As time went on, we said enough of this, he's going to be past the point of catching the problem," she said. For families who don't have coverage and who can't afford private services, though, the only option is to wait. Finding the cause of the long waits is hard, but one thing is certain: It's not due to a lack of speech pathologists, according to Shanda Hunter-Trottier, the owner of S.L. Hunter Speechworks, another private clinic in Toronto. She used to have problems finding qualified speech pathologists, but now she's facing the opposite problem. "I've been practising for 26 years. ... In the last five years, [I] have more resumes than I can keep track of," she said. Rather, she says, it's a large web of problems that slows down the system. First among these is a lack of public funding. "There's a lot of speech pathologists that don't have jobs, but these places aren't hiring. The cutbacks have been atrocious," she said.
  • Manitoba: School districts are also in charge here. The inschool speech-language pathologists offer services from classroom-based programming to individual therapy. Quebec: The system here is more like Ontario's. Speechtherapy services are offered through the local community service centres (CLSC), similar to Ontario's CCACs. The CLSCs are not obliged to provide speech therapy in English, though some, especially in areas with a large anglophone population, usually do. Nova Scotia: The province has 28 speech and hearing centres, with 35 pathologists in total. They assess and provide treatment for children and adults. School boards in the province also have speech-language pathologists who also have a teacher's certificate.
  • Prince Edward Island: The province provides free speech services for children until they enter school. Northwest Territories: Speech therapists are only able to visit some remote communities once or twice a year. Instead, the province offers a service called Telespeech, where pathologists can help people without having to be physically present. Nunavut: The territory had no speech pathologists in 2013, according to Statistics Canada.
Irene Jansen

Government will not merge health and social care budgets for the present, minister says... - 0 views

www.bmj.com/...bmj.e527

ltc home care NHS england individualized funding

shared by Irene Jansen on 23 Jan 12 - No Cached
  • The government is not planning to merge health and social care
  • The minister was questioned by MPs on 17 January about integration, funding, and system reform in the final hearing of the committee’s inquiry into social care.
  • he said the government was doing many things to improve integration, such as setting new incentives for organisations to work differently, and a range of “nudges, pressures, and obligations” in the system. “The nearest thing to a game changer is personal budgets,” he said.
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  • MPs repeatedly challenged the minister to accept there was a funding crisis in social care, warning that this could undermine integration and possible reforms such as those recommended by the Dilnot Commission on Funding of Care and Support, published last year.
  • some experts estimated that 900 000 people in the UK were left without basic care.
  • The health committee is due to report its findings on social care before the government publishes a white paper on care and support in the spring.
Irene Jansen

Government has not acted to avoid repeat of Southern Cross care home collapse, say MPs ... - 0 views

www.bmj.com/...bmj.d7964

privatization chains individualized funding ltc nhs uk

shared by Irene Jansen on 23 Jan 12 - No Cached
  • The government needs to monitor the care market better at local and regional levels to minimise the risk of another provider like Southern Cross collapsing
  • A report from the House of Commons Public Accounts Committee published on Tuesday 6 December raises concerns about the trend towards fewer, larger providers of residential and home care.
  • The danger of having too few large providers in a particular area was highlighted when Southern Cross collapsed earlier this year (BMJ 2011;342:d3535, doi:10.1136/bmj.d3535), putting the welfare of 31 000 residents in jeopardy
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  • The group collapsed because it funded its expansion by selling the freeholds of most of its 750 homes on terms guaranteeing annual rent increases and was left with crippling debts when local authorities sought to limit the fees they would pay.
  • The report points out that while Southern Cross’s share of the national care home market was around 9%, it was as much as 30% in certain local authority areas in the north east of England.
  • The Department has nothing in place to oversee the market at the local level to avoid certain providers becoming too dominant in a region.
  • The Labour MP Margaret Hodge, who chairs the Committee of Public Accounts, said that local authorities’ budgets for residential care were shrinking and that some large scale providers were already in debt.
  • “There is currently no early warning system for providers getting into difficulty,”
  • With 63% of care home funding coming from the public purse, reduced funding from local authorities could destabilise the market or create problems for the NHS
  • Currently just 340 000 people, or 30% of eligible care users, have a personal budget enabling them to choose their care provider. The government wants all eligible users to control their personal budget by April 2013.
  • personal budgets will work only if people are given enough information about the choices available
Govind Rao

Seniors cry out for help as home care aide hours cut; But health authority says it's fo... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|vasn|20150522|221011705

from heather bc home care cuts

shared by Govind Rao on 26 May 15 - No Cached
  • Vancouver Sun Fri May 22 2015
  • Isabell Mayer takes the bus wearing her slippers because her feet are often too swollen to fit into shoes. The 81-year-old has a tough time getting to her favourite cut-rate grocery store because it takes more than an hour using her walker - including all the rest stops. These are the downsides of aging in ill health that she's taking in stride, but losing half of the home support hours she used to receive from the Vancouver Coastal Health authority sent her looking for help from her MLA. "I haven't been able to vacuum for 15 years," she says in her tiny living room in a subsidized seniors' apartment in east Vancouver.
  • "I can't wash the floor. The back and forth makes me dizzy." These are tasks that home support workers, paid by the health authority, used to do for her. But Vancouver Coastal has revisited the files of some seniors - the actual number was not available by deadline Thursday - to trim hours back. Only medically required assistance and personal care, typically a shower, are allowed.
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  • Seniors must find help for house cleaning, shopping or errands elsewhere, either by paying privately, relying on family and friends or turning to a replacement program funded by the United Way called Better at Home, which has received $22 million from the province. Vancouver-Mt. Pleasant NDP MLA Jenny Kwan says Mayer's story is similar to those she's heard from other seniors in her riding during the last month. At least five couples and individuals - most of them Chinese-speaking - contacted her about having their weekly home care hours cut in half. Most have gone from two hours to one, just enough time for a bath. "The government wants seniors to live longer at home, but if you don't provide the supports for them to live successfully and safely, how are they going to manage? That will only mean they are going to need hospitalization, residential care or assisted living," Kwan said. "It's pay now or pay later and pay more," she added, noting that a day in an acute care hospital bed costs taxpayers about $1,500, enough to pay for plenty of routine in-home care. The change in home support hours from Vancouver Coastal Health is part of a move to follow provincial rules more closely, said Bonnie Wilson, director of home and community care for the health authority.
  • Home support is supposed to help clients with daily needs including bathing, dressing, using the toilet, taking medication or setting up a meal. These are considered medical services. Home support workers are paid only to do those tasks and not a wider range of duties that were covered before policy changes about 10 years ago: visiting, transportation, light yard work, minor home repairs, light housekeeping and grocery shopping. "VCH's home support guidelines are consistent with the Ministry of Health and other health authorities. Historically the mandate for home support services used to be broader, but this was sometime before 2004 (the guidelines that preceded our current ones)," Wilson explained in an email. "This was at a time when there was no distinction between medical and non-medical support services, and when clients went to residential care much sooner than they are now."
  • The complex medical problems experienced by some of Canada's oldest residents reflect a growing trend: people are living much longer, but not necessarily in good health. They can often stay at home - and avoid the high cost of either private or publicly funded nursing in residential care - but home support workers are being called upon to deliver some services that formerly fell to nurses. Doing laundry or picking up groceries are long gone from their to-do list. Exceptions to that, says Wilson, are allowed if it's unsafe for workers or the client to be in the home because of the mess, or if a client risks eviction or has been refused other government-subsidized services such as HandyDart because of a lack of cleanliness.
  • In British Columbia, home care is typically provided and subsidized - depending on income - by a local health authority that contracts the duty to a handful of accredited private companies. Clients with higher incomes often hire their own help. In 2013-14, B.C's health authorities spent $1.1 billion on home support for about 39,000 clients. That compares to $1.8 billion spent on residential care for 27,308 seniors. In 2012-13, the province funded 7.37 million hours of home support, according to the Ministry of Health, 23 per cent more than three years earlier. B.C.'s Office of the Seniors Advocate is planning to survey all recipients of publicly funded home support in the province about their experiences for an upcoming report. The Minister of Health was unavailable for comment by press time.
Govind Rao

Medicare needs a culture change - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150728|225795170

from heather medicare accord innovation

shared by Govind Rao on 28 Jul 15 - No Cached
  • The Globe and Mail Tue Jul 28 2015
  • apicard@globeandmail.com 'Canada is a country of perpetual pilot projects," Monique Begin famously wrote in the Canadian Medical Association Journal. The former minister of health and welfare pithily described a long-standing, frustrating problem in our medicare system: We have solved every single problem in our health-care system 10 times over, but we seem incapable of scaling up the solutions. This inability to learn, to share and embrace innovation across jurisdictions, is explored thoughtfully in the new report of the Advisory Panel on Healthcare Innovation. The panel, led by David Naylor, a physician and former president of the University of Toronto, stressed that "Canada has no shortage of innovative healthcare thinkers, world-class health researchers, capable executives, or dynamic entrepreneurs who see opportunity in the health sphere."
  • But innovation is stifled by the structure and administration of the health system, and a dearth of leadership. Medicare - the name we give our publicly funded health insurance scheme - is, in fact, not a system at all; it's a collection of 14 federal, provincial and territorial programs that are neither integrated nor co-ordinated. Worse yet, within those programs, there is a near total absence of vision and goals. The role of our health bureaucrats is to hold the line on spending as best they can and, above all, ensure that the names of their political masters don't appear in damaging headlines. Improving patient care is rarely the No. 1 priority.
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  • The way our system is funded - predominantly with block transfers to hospitals and fee-for-service payments to physicians - encourages volume of procedures and the status quo. It does not reward quality of care, or responsible stewardship. In fact, when an individual or a program goes out on a limb and makes changes to improve efficiency or costeffectiveness, the benefits often accrue to others; perverse disincentives are commonplace and counterproductive. These problems and frustrations are not new. The Naylor report cites an example from 1974, when Canadian researchers published a landmark paper showing that nurse practitioners could do 70 per cent of doctors' work with no difference in outcomes or patient satisfaction.
  • Using NPs also saved money, but hiring more nurse practitioners was hampered by the fact that, generally speaking, doctors are paid on a fee-for-service basis and nurses are salaried. Four decades later, that same bureaucratic hurdle remains. Most other Western countries acted on the research: NPs are an integral part of healthcare delivery and most physicians are salaried. But in Canada, NPs are still grossly underused - except in pilot projects, of course.
  • We still negotiate physician and nurse contracts separately and our management of health-care human resources is a mess. Until you get workers with the right skills in the right place at the right time, you will never deliver seamless, patient-centered care and you will never control costs, because labour accounts for twothirds of all spending. As the NP story and countless not-actedupon research findings since illustrate, innovation is hampered by policy gridlock. The managers of the system, who are largely powerless and beholden to the whims of politicians, are with few exceptions profoundly mistrusting of entrepreneurship and pathologically risk-averse. For decades, we have produced reports about the need to transform health-care delivery and funding while, simultaneously, clinging to the same old way of doing things. It's a fundamental disconnect between evidence and action. If you don't take risks, you will never innovate. So how do we break the logjam?
  • According to the Naylor report, it has to begin with leadership, and it should come from Ottawa. One of the panel's central recommendations is the creation of an independent health innovation agency to not just fund pilot projects, but promote scaling-up, using searchable repositories of successful programs, financial incentives, regulatory change, all with the aim of spurring innovation. More resources alone will not ensure the scaling-up of good ideas. There needs to be partnership, commitment and monitoring to ensure implementation. In short, it's not more money the system needs, it's culture change - a shift from perpetual pilot projects to embracing best practices.
Govind Rao

Privatization: what it is, why it matters - Infomart - 0 views

www.fpinfomart.ca/...223358003

from heather NL privatization union

shared by Govind Rao on 23 Jun 15 - No Cached
  • The Telegram (St. John's) Tue Jun 23 2015
  • With oil prices down, an aging population and high unemployment, the conservative government of Newfoundland and Labrador is looking for a silver bullet to cut costs for public services and infrastructure. Their sights are settling on privatization to be that silver bullet. What is privatization? In its most narrow sense, privatization is the whole or partial sale of public services and/or infrastructure. It can include the sale of assets, functions or the entire institution.
  • With privatization, the service or infrastructure becomes funded and/or run by a private corporation. Privatization usually includes not only a change in ownership but also a change in the priorities, responsibilities and role of the state. Advocates of privatization offer free-market competition as the path to economic and social success, with promises of cost savings, lower risk, greater efficiency and more individual choice. Privatization takes several forms in Canada, including:
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  • ? full privatization: where a government enterprise is sold in full to private investors. ? publicly funded with services and management delivered privately, sometimes unknown to the consumer. ? public funding of private services: government provides vouchers to consumers for the purchase of goods and services from private providers.
  • ? public/private partnerships (P3s): full outside contracting, management and service delivery of traditionally delivered public services such as hospitals, roads, schools and prisons. This can include private finance, design, building, operation and possibly temporary ownership of an asset. Can privatization deliver? After decades of experimentation with privatization in different forms across Canada, the data is clear on the failure to deliver on its promises and the high cost society pays - multiple costs, not only in economic terms but also quality and access to services, quality and quantity of jobs, as well as transparency and accountability.
  • Public/private partnerships (P3s) are the fastest-growing model of privatization in Canada. The P3 models vary but all include the reliance on private sector borrowing to finance the development of public infrastructure projects in a long-term lease arrangement; it is effectively leasing rather than owning and sometimes that lease includes maintenance as well. P3s cost more. Governments have always been able to borrow money more cheaply than private corporations. According to a University of Toronto study of 28 P3 projects in Ontario, P3s cost, on average, 16 per cent more than a traditional public contract. A recent auditor general of Ontario report found that P3 projects cost the province $8 billion more than if they were done under the traditional model.
  • If they cost more, why do politicians promote them? Political expediency - in P3 lease agreements the debt stays off the books or is postponed for decades. P3s hide debt - which is a dream for politicians looking for easy wins in hard economic times. It is also ideological and it is about private sector lobbying and influence. Public services are a boon to private sector deliverers with guaranteed public payments and profit margins over the long term. Supporters of privatization claim that it leads to better pricing for the public as consumers. A comparison of privately owned Manitoba Telecom Services, privatized in 1997, to SaskTel, Saskatchewan's publicly owned telecommunications crown corporation shows this to not be true. Twenty years after privatization of MTS, the cost of a basic phone with SaskTel is $8 less per month than from MTS.
  • Private corporations demand a shroud of confidentiality in order to protect their competitive position. This means that privatization reduces both transparency and accountability. An example of this is the Ontario privatization of municipal water testing which has been linked to the May 2000 bacterial contamination of municipal water in Walkerton, Ont., led to the deaths of at least seven people and the serious illness of 2,300 more from water contaminated with E. coli. The absence of criteria governing quality of testing, and the lack of provisions made for notification of results to authorities contributed to the worst public health disaster involving municipal water in Canadian history.
  • Health care is a sector where there is huge pressure on government to control cost, particularly in Newfoundland and Labrador with the aging demographic. Private interests see great profit opportunities. But in health care, for-profit does not deliver. In Manitoba, living in a for-profit long-term care facility increased the odds of dying in hospital or being hospitalized.
  • In a metadata analysis of hospitals in the U.S., Dr. Philip Devereaux, a cardiologist at McMaster University, concluded that the death rate in for-profit hospitals was two per cent higher than in not-for-profit facilities. In Alberta, the Health Quality Council of Alberta's Long Term Care Family Experience Survey in 2012 found that, on average, private and volunteer operated facilities offered poorer quality in terms of staffing levels, care of residents' belongings, and assistance with daily living activities such as toileting, drinking and eating, than publicly operated ones.
  • The scathing Ontario auditor general report indicates that there needs to be extensive and comprehensive reviews of provincial privatization projects. Until proper cost-benefit analyses and public reviews and reform of private funding and procurement models occur, governments and public bodies should place moratoria on further public-private infrastructure contracts. The citizens pay either way, but they pay more in a privatized model - either as tax payers or out of pocket.
  • The government has alternatives. The Newfoundland and Labrador Federation of Labour has published a number of reports and fact sheets on the progressive revenue options open to the provincial government. There are a variety of progressive revenue options open to municipalities as well. There are no silver bullets. It is time to stop stigmatizing government and public services and recognize them for what they are: the way we pool our resources to buy services cheaper, control costs, and maintain accountability for quality.
  • his should be a debate based on evidence, not ideology. Mary Shortall, president, Unifor Local 597
Govind Rao

Hospital re-admission rates debated - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|pgsf|20151008|230920202

from heather Ontario cupe hospital readmissions campaign rural cuts

shared by Govind Rao on 08 Oct 15 - No Cached
  • Smiths Falls EMC Thu Oct 8 2015
  • A union representing employees at the Perth and Smiths Falls District Hospital (PSFDH) is charging that re-admission rates have risen 16.5 per cent over the past several years. Hospital management, however, is disputing this, pegging the number much lower, at about seven per cent. During a press conference at the Smiths Falls branch of the Royal Canadian Legion on Tuesday, Sept. 29, Michael Hurley, president of the Ontario Council of Hospital Unions (OCHU), said that their statistics were drawn from information stretching from 2009 to 2014 from the Canadian Institute for Health Information, and focused specifically on the PSFDH but also the Brockville General Hospital too.
  • "A re-admission is a system failure," said Hurley. "People who were discharged were coming back in...in significant numbers." John Jackson, president of CUPE (Canadian Union of Public Employees) local 2119, who works at the Perth and Smiths Falls District Hospital, agreed.
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  • "Where beds have been cut in the community, there has been a spike in re-admission rates," said Jackson. His own hospital saw 12 beds, six at each site, cut back in 2013. "I can't speak about individual cases," he added, but Mike Rodrigues, vice president of CUPE local 1974, who works at the Kingston General Hospital (KGH), has seen, first-hand, patients being sent home to free up beds at his workplace. "There are two huddles a day," said Rodrigues, where upper management and the hospital's chief executive officer confer at 9:15 a.m. and 2:15 p.m. to discuss "Who can go today? Who can we get out?" when there is "gridlock," at the hospital, such as long waiting room times. "It's difficult," Rodrigues said. But, "you tow the party line. They do what they are told."
  • He conceded that the doctors and nurses likely do a triage of who is best able, of all of the patients on the floor, to go home, but he has seen, in the last 10 years alone, women being sent home 10 to 12 hours after giving birth to a child, whereas, in 2005, that mother could have stayed three to four days in the hospital. Hurley said he has heard of patients who "are not well enough to be sent home...fighting with their doctors," who are trying to discharge them. "A lot of pressure is put on the family," from the hospital administration and doctors, Hurley added, with the hospital threatening to charge families as much as $300 to $1,000 a day for each additional day their loved one remains in hospital - something he says is illegal. He saw such a scenario with his own mother.
  • "She can't stay here," he was told. "'What're you going to do with her?' She died in hospital." Very often, according to Hurley, a patient may acquire a hospital-borne virus while recovering from a surgery, but "people are being moved through the system much more quickly," than they used to be, sometimes without sufficient recovery periods, and then, "the system has a second go at making them better." But this not only causes distress for the family and the health system, but also in the workforce too. "A huge number of people in Ontario do not have paid sick leave," said Hurley. "The personal cost to me (as a returning patient) is significant...It's a health setback, it's a psychological setback."
  • Hurley added that hospitals in both Kingston and Ottawa were experiencing similar re-admission rates. He added that he did not think that it was "entirely valid," to dismiss re-admission rates on the rising number of older people in the area, as Baby Boomers reach their retirement years. "They will try to downplay this," said Hurley, before adding that it was not a problem created at the Smiths Falls or Perth hospital sites themselves. "This is a system problem because they have been starved of funding." As for blaming the issue on the elderly, Hurley said that that was ageism.
  • Jackson lamented that while the hospital administration has tried its best to be as kind as it can with its cuts - with only one outright layoff - getting 12 beds cut from the local hospital system seems to be "how you get rewarded for efficiency." "It's time for the province to start funding the hospitals properly," said Hurley. One way that this could be addressed would be to raise the corporate tax rate. Administration response Later that week, in her office at the Great War Memorial Hospital site of the Perth and Smiths Falls District Hospital, president and chief administrative officer Bev McFarlane held a mini press conference of her own, alongside board chair Richard Schooley, to refute some of the union's allegations, starting with some of their numbers. "There is often another aspect of re-admissions," said Schooley during the interview on Thursday, Oct. 1. A patient could be, theoretically, discharged from hospital after recovering from heart surgery, then be re-admitted two weeks later after falling on some ice while shoveling snow from his driveway. Any admission to hospital within 30 days after a discharge would be counted as a re-admission - even if the cause was not directly related to the initial admission.
  • She hastened to add that her hospital was recently awarded the distinction of being one of the top five hospitals in the province for quick-time responses, for getting patients seen to and into an in-patient bed. According to the hospital's numbers, the occupancy rate for acute care hospital beds was as low as the high 60s per cent over the summer, and in the high 70s per cent this past spring. "You have to look at all of the other indicators," said Mc-Farlane. Schooley also noted that the hospital's admissions have gone up from more than 31,000 in 2009 to more than 37,000 in 2014-15, and that they estimate the real re-admission rate at about seven per cent.
  • How can you deal with more admissions with fewer beds?" asked McFarlane. "We are able to make you feel better in a shorter period of time." Gall bladder surgery used to require a seven-day stay in hospital, she said. Now, it is considered day surgery. "You aren't even admitted," she said. "The business of hospital care has changed over the years. The worst thing you can do is keep someone in an acute care bed when they don't need to be there." As for charging patients who refuse to leave the hospital because they do not believe that they are fully healed yet, Mc-Farlane did admit that "there is a rate that is charged, if there is a reasonable discharge plan and people refuse to leave," but she added that "I don't think we've ever done that here."
  • As for the union's assertion that the hospital had less money on hand, Schooley pointed out that gross hospital revenues rose from $43 million in 2010 to $51 million in 2015. In fact, the LHIN is giving the hospital more money as a type of efficiency bonus, having wrestled five years worth of deficits into a $1.2 million surplus in 2014, with a projected surplus of $1.6 million for 2015. "That's the cushion we are building," said Schooley, in anticipation of the LHIN providing them with less money in the coming years. "In case some of these funding change realities manifest themselves."
  • We have seen increases in our LHIN and Ministry of Health funding," added Schooley.
Govind Rao

Health care hampered by red tape; Bloated bureaucracy: That means there is less money a... - 1 views

www.fpinfomart.ca/...238303512

from heather Day court bc privatization private clinics

shared by Govind Rao on 20 Jan 16 - No Cached
  • Vancouver Sun Wed Jan 20 2016
  • Byline: Brian Day Source: Vancouver Sun
  • Over 60,000 B.C. residents have signed a petition against rising Medical Services Plan premiums. Organizers report that the wealthy pay the same fees as those earning $30,000. Their point is valid. But their anger would probably be tempered if the funds garnished from wage earners were being used efficiently. Few are probably aware of the Medical Services Commission (MSC), an unelected body responsible for spending the $4 billion-plus in MSP premiums and other taxes. Their mandate is "to facilitate reasonable access throughout B.C. to quality medical care, health care and diagnostic facility services for B.C. residents under MSP."
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  • Hundreds of thousands of patients on B.C. waiting lists know that role is not being fulfilled. The health minister and premier recently admitted that patients were waiting inappropriately long times, and a health region spokesperson reported some "life-saving" procedures were being delayed. Provincial health commissions were the brainchild of Tommy Douglas, who believed they should be chaired by doctors and never subject to political influence. But the MSC is always chaired by a politicallyappointed civil servant. Douglas supported premiums and felt they made the public cost-conscious, creating a sense of individual responsibility. He would never have condoned the practices of raising premiums to compensate for fiscal failures, nor reporting low-income earners, delinquent with their payments, to collection agencies. The commission is wasting health care funds as it displays contempt, in terms of its fiscal and social accountability, toward taxpayers.. In one example of carelessness and incompetence, I received cheques from them totalling hundreds of thousands of dollars, for services on patients that I had never seen. I also received confidential personal information on hundreds of patients unrelated to me or our clinic. When informed of their error, they responded: "Just mail them back." They were not inclined to investigate.
  • In Canada, health providers are compelled by law to share confidential patient files with government employees armed with the right to inspect and copy patients' files. Your health record is considered public property; you cannot block government access. Consent is not needed, and you are not notified when Big Brother is looking. Privacy rights have been legislated away. I witnessed a defeated provincial cabinet minister's medical file being reviewed by a newly elected government. In the 1989 tainted blood inquiry, Justice Horace Krever was "shocked by the inadequate laws, the abuses of confidentiality, and the fact that so many people - except the patient - had access to medical records." Little has changed.
  • The MSC is also charged with defining what services are "medically necessary" - and therefore publicly insured. They have never created a definition, but have arbitrarily designated clearly essential services such as ambulance, drugs, physiotherapy, artificial limbs, and dentistry as unnecessary, creating a true two-tier structure of care. The government's last action in delaying our constitutional challenge on patient rights resulted from a "last minute" discovery of 300,000 documents they were legally bound to provide. After a delay of more than seven years, the plaintiffs in the coming June trial will confirm that the Supreme Court of Canada's 2005 finding - that patients are suffering and dying on waiting lists - applies in B.C. Supporters of a system that limits timely access are complicit in such outcomes.
  • Our public sector health system (MSC included), is grossly overstaffed with non-clinical workers. A 2011 study revealed that Canada has 11 times as many public health bureaucrats per capita as Germany, where there are no waiting lists. Canada has 14 ministries of health, each with bloated bureaucracies and commissions scavenging dollars that should go to patient care. The mentality that cost inefficiencies can be balanced by increased taxes or "premiums" is responsible for our escalating charges. Independent health groups in Europe rated Canada as last in value for money compared to hybrid public-private systems that have accessible public systems. The Commonwealth Fund, a non-profit foundation focused on issues affecting lowincome groups, ranked Canada 10th of 11 health systems in developed nations.
  • What specific changes would I incorporate if I were minister of health? Apart from incorporating the best practices of other hybrid systems (including private-sector competition), I would dismantle the ministry and its committees and commissions. Then I would resign. The finance ministry could fund patients directly (thus empowering them), and also assign budgets to the newly emancipated, self-regulated health organizations, allowing them to cater directly to patient needs. Maybe our June constitutional court challenge will point us in that direction. Dr. Brian Day is an orthopedic surgeon, medical director of the Cambie Surgery Centre, and a former president of the Canadian Medical Association.
  • Dr. Brian Day says bureaucrats at the Medical Services Commission sent him cheques totalling hundreds of thousands of dollars for services on patients he had never seen.
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