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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.
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.
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  • 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.
  • Senator Eaton
  • 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.
  • there has been progress. In some cases, there has been much more than in others.
  • 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

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

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

from heather cupe federal election accord

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

Ontario plans health-care overhaul; Changes to include deep reforms for home care, incl... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20151124|234361282

from heather Ontario home care

shared by Govind Rao on 24 Nov 15 - No Cached
  • The Globe and Mail Tue Nov 24 2015
  • The Ontario government is preparing to overhaul health care in the province, including scrapping its troubled system for delivering home care and reforming primary care with the aim of improving patient access. The proposed changes, mapped out in a paper to be made public in the coming weeks, will be the focus of consultations in the new year and are expected to touch on all aspects of the health system.
  • A centrepiece of the proposals will be the expansion of the role played by the province's Local Health Integration Networks. At the same time, the province would eliminate Ontario's 14 Community Care Access Centres (CCACs), the public agencies responsible for overseeing the delivery of services such as nursing, physiotherapy and help with personal care for the sick and the elderly in their homes. The agencies have long been a lightning rod for criticism, and were the focus of a Globe and Mail investigation this year that found inconsistent standards of care and a lack of transparency that left patients and their families struggling to access services.
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  • As well, a report this fall from Ontario Auditor-General Bonnie Lysyk found that as little as 61 cents out of every dollar spent by the agencies goes to face-to-face client services, and discovered gaps in the level of care offered across the province. A second report on home care will be included in the Auditor-General's annual report in early December.
  • Suggested changes to the way primary care is delivered by family doctors and other health-care providers are also expected to gain wide attention, especially from doctors, who are in a battle with government over fees. Ontario Health Minister Eric Hoskins has been hinting for some time that change was in the works, but the existence of a policy paper and its contents have been kept under wraps.
  • Individuals familiar with different aspects of the document, who spoke to The Globe on the condition that they not be identified, describe it as "transformational" - a term that has become a favourite of the Health Minister. Earlier this month, Dr. Hoskins delivered a speech at a hospital conference in Toronto in which he repeatedly spoke of "system transformation" and the need for stronger "local governance."
  • The minister responded to questions from The Globe in a statement Monday night, saying that the ministry is "putting together a document which we hope will serve as a starting point for discussions and consultation about how we can better integrate various parts of the system and improve the patient experience." "We plan to share that discussion document in the coming weeks and will be engaging with our partners, including care providers and the public, to solicit feedback on those ideas to achieve deeper integration," the statement said.
  • The plans for change come at a critical time for Ontario's Liberal government as it looks to cut costs and tame the provincial deficit. To do that, keeping health-care spending in check is imperative, but the minister has also pledged to make improvements such as ensuring more people have access to primary care, and are not reliant on walk-in clinics and emergency rooms for after-hours nonurgent care. Any efforts to change how primary care is paid for or organized are likely to meet resistance from doctors, who are already at odds with the province after it imposed a contract and two rounds of fee cuts this year.
  • An expert panel report on primary-care reform - released quietly this fall and widely criticized by doctors - recommends dividing the province into "patient care groups," similar to school boards, with each group responsible for ensuring every resident in the area has access to primary care. As a prelude to the coming reform, at least one merger plan among two hospitals and a CCAC was paused this fall after the ministry advised the boards involved of the coming changes.
  • John Davies, chair of the board of William Osler Health System in Brampton, Ont., said merger talks with the Central West CCAC and Headwaters Health Care Centre in Orangeville, Ont., were suspended after deputy Health Minister Bob Bell wrote to them a few weeks ago advising them to suspend talks because of the coming reforms. Those familiar with the proposed reforms say the beefed-up local health networks will be given responsibility for overseeing home care, with front-line workers and case managers retaining their jobs.
  • "For the client, there will be no change," one source said. Some aspects of home care involving patients who have been hospitalized will continue to move over to a new model called "bundled care," which has been piloted by St. Joseph's Health System in Hamilton and was recently expanded to six other sites, one source said. The province will also look at tailoring care delivery to the needs of local communities, with different models possible for urban and rural settings, another source said.
Doug Allan

Portrait of caregivers, 2012 - 1 views

www.statcan.gc.ca/...89-652-x2013001-eng.htm

homecare

shared by Doug Allan on 28 Sep 13 - No Cached
  • Over one-quarter (28%), or an estimated 8.1 million Canadians aged 15 years and older provided care to a chronically ill, disabled, or aging family member or friend in the 12 months preceding the survey.
  • While the majority of caregivers (57%) reported providing care to one person during the past 12 months, assisting more than one care receiver was not uncommon. In particular, 27% of caregivers reported caring for two and 15% for three or more family members or friends with a long-term illness, disability or aging needs.
  • Providing care most often involved helping parents. In particular, about half (48%) of caregivers reported caring for their own parents or parents in-law over the past year (Table 1)
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  • In 2012, age-related needs were identified as the single most common problem requiring help from caregivers (28%) (Chart 1). This was followed by cancer (11%), cardio-vascular disease (9%), mental illness (7%), and Alzheimer’s disease and dementia (6%).
  • The majority of caregivers reported providing transportation to their primary care receiver, making it the most frequent type of care provided in the last 12 months (73%)
  • In addition, about half of caregivers (51%) reported that they performed tasks inside the care recipients’ home in the last 12 months, such as preparing meals, cleaning, and laundry. Another 45% reported providing assistance with house maintenance or outdoor work.
  • The most common types of care were not always the ones most likely to be performed on a regular basis (i.e., at least once a week). For instance, despite the fact that personal care and providing medical assistance were the least common forms of care, when they were performed, these tasks were most likely to be done more regularly.
  • Emotional support often accompanied other help to the care receiver. Nearly nine in ten caregivers (88%) reported spending time with the person, talking with and listening to them, cheering them up or providing some other form of emotional support. Virtually all caregivers (96%) ensured that the ill or disabled family member or friend was okay, either by visiting or calling.
  • Overall, caregivers spent a median of 3 hours a week caring for an ill or disabled family member or friend. This climbed to a median of 10 hours per week for caregivers assisting a child and 14 hours for those providing care to an ill spouse (Chart 3).
  • Most often, caregivers spent under 10 hours a week on caregiving duties. In particular, one-quarter of caregivers (26%) reported spending one hour or less per week caring for a family member or friend. Another 32% reported spending an average of 2 to 4 hours per week and 16% spent 5 to 9 hours per week on caregiving activities.  
  • For some, caregiving was a large part of their life - equivalent to a full time job. Approximately one in ten caregivers were spending 30 or more hours a week providing some form of assistance to their ill family member or friend.  These caregivers were most likely caring for an ill spouse (31%) or child (29%).5
  • The actual time spent performing tasks is often combined with time needed to travel to provide care. Approximately three-quarters (73%) of caregivers indicated that they did not live in the same household or building as their care receiver, meaning they often had to travel to reach the care recipients’ home. Just over half (52%), however, reported having to travel less than 30 minutes by car.  Roughly 12% of caregivers provided help to a family member who lived at least one hour away by car.
  • Certain health conditions required more hours of care. This was the case for developmental disabilities or disorders, where 51% of these caregivers were spending at least 10 hours a week providing help
  • Caring for an ill or disabled family member or friend can span months or years. For the vast majority of caregivers (89%), their caregiving activities had been going on at least one year or longer, with half reporting they had been caring for a loved one for four years or more.
  • Four provinces had rates above the national average of 28%, including Ontario (29%), Nova Scotia (31%), Manitoba (33%) and Saskatchewan (34%) (Textbox Chart 1). The higher levels of caregiving in Ontario, Nova Scotia and Manitoba were largely related to caring for a loved one suffering from a chronic health condition or disability, whereas in Saskatchewan, the higher level of caregiving was attributed to aging needs. 
  • Historically, caregivers have been disproportionally women (Cranswick and Dosman 2008). This was also true in 2012, when an estimated 54% of caregivers were women.
  • Although the median number of caregiving hours was similar between men and women (3 and 4 hours per week, respectively), women were more likely than their male counterparts to spend 20 or more hours per week on caregiving tasks (17% versus 11%). Meanwhile, men were more likely than women to spend less than one hour per week providing care (29% versus 23%) (Chart 5).
  • For instance, they were twice as likely as their male counterparts to provide personal care to the primary care receiver, including bathing and dressing (29% versus 13%).
  • Caregivers have multiple responsibilities beyond caring for their chronically ill, disabled or aging family member or friend. In 2012, 28% of caregivers could be considered “sandwiched” between caregiving and childrearing, having at least one child under 18 years living at home
  • The aging of the population, higher life expectancies and the shift in emphasis from institutionalized care to home care may suggest that more chronically ill, disabled and frail people are relying on help from family and friends than in the past. Using the GSS, it is possible to examine the changes in the number of caregivers aged 45 years and older, recognizing that methodological differences between survey cycles warrant caution when interpreting any results.
  • Bearing in mind these caveats, results from the GSS show that between 2007 and 2012, the number of caregivers aged 45 and over increased by 760,000 to 4.5 million caregivers, representing a 20% increase in the number of caregivers over the five years.
  • Having less time with children was an often cited outcome of providing care to a chronically ill, disabled, or aging family member or friend. About half (49%) of caregivers with children under 18 indicated that their caregiving responsibilities caused them to reduce the amount of time spent with their children.6
  • Overall, the vast majority of caregivers (95%) indicated that they were effectively coping with their caregiving responsibilities, with only 5% reporting that they were not coping well.7 However, the feeling of being unable to cope grew with a greater number of hours of care. By the time caregivers were spending 20 or more hours per week on caregiving tasks, one in ten (10%) were not coping well.  
  • In addition, while most were able to effectively manage their caregiving responsibilities, 28% found providing care somewhat or very stressful and 19% of caregivers indicated that their physical and emotional health suffered in the last 12 months as a result of their caregiving responsibilities.
  • The health consequences of caregiving were even more pronounced when caregivers were asked specific questions on their health symptoms. Over half (55%) of caregivers felt worried or anxious as a result of their caregiving responsibilities, while about half (51%) felt tired during the past 12 months (Chart 8). Other common symptoms associated with providing care included feeling short-tempered or irritable (36%), feeling overwhelmed (35%) and having a disturbed sleep (34%).8
  • The financial impacts related to caring for a loved one can be significant. Lost days at work may reduce household income, while out-of-pocket expenses, such as purchasing specialized aids or devices, transportation costs, and hiring professional help to assist with care, can be borne from caring for a loved one. In many cases, financial support, from either informal or formal sources, can ease the financial burden associated with caregiving responsibilities. Overall, about one in five caregivers (19%) were receiving some form of financial support. 
  • Doug Allan on 28 Sep 13
     
    Survey of care givers
Irene Jansen

Glazier et al. All the Right Intentions but Few of the Desired Results: Lessons on Acce... - 2 views

www.longwoods.com/...23041

ontario primary care doctors capitation payment methods chc p4p excellent

shared by Irene Jansen on 19 Sep 12 - No Cached
  • The common elements of reform include organizing physicians into groups with shared responsibilities, inter-professional teams, electronic health records, changes to physician reimbursement, incentive and bonus payments for certain services, after-hours coverage requirements, and telehealth and teletriage services.
  • Ontario's initiatives have been substantially different from those of other provinces in the scope, size of investment and structural changes that have been implemented.
  • These models have the same requirements for evening and weekend clinics, and for their physicians to be on call to an after-hours, nurse-led teletriage service.
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  • Despite this increased attachment, the chance of being seen in a timely way did not improve. Ontario's primary care models require evening and weekend clinics and on-call duties, and penalize practices for out-of-group primary care visits; therefore, these findings are unexpected. While many factors are likely involved, Ontario's auditor general noted two major faults: not establishing mechanisms for ongoing monitoring and evaluation, and not enforcing practices' contractual obligations, especially for after-hours care
  • The access bonus is reduced by outside primary care use but not by emergency department visits. Physicians responding rationally to such a financial incentive would logically direct their patients away from walk-in clinics and toward emergency departments. The access bonus also strongly discourages healthcare groups from working together to provide late evening and night coverage because all parties would lose financially. An incentive that costs more than $50 million annually should be structured to align better with health system needs.
  • A recent systematic review found insufficient evidence to support or not support the use of financial incentives to improve the quality of care (Scott et al. 2011).
  • Ontario's reforms occurred in the absence of routine measurement of primary care within practices, groups or communities and with limited accountability for how funds were spent.
  • Ontario adjusts capitation for only age and sex, whereas most other jurisdictions further adjust for expected healthcare needs, patient complexity and/or socioeconomic disparities (e.g., the Johns Hopkins Adjusted Clinical Groups http://www.acg.jhsph.org/). That may be why Ontario's primary care capitation models have attracted healthier and wealthier practices (Glazier et al. 2012).
  • Community health centres care for disadvantaged populations with superior outcomes (Glazier et al. 2012; Russell et al. 2009) and could play a larger role in Ontario's health system.
  • Unlike some other jurisdictions (National Health Service Information Centre for Health and Social Care 2012), Ontario has no routine measurement of primary care at the practice, group or community levels. It has no organized structures, such as the Divisions of General Practice in Australia (Australian Department of Health and Ageing 2012) or the Divisions of Family Practice in British Columbia (2010), that can help practices come together to improve care. It has also failed to hold practices accountable for their contractual obligations, including after-hours clinics.
  • In Ontario, there was little relationship between incentive payments and changes in diabetes care (Kiran et al. 2012), nor were there substantial improvements in most aspects of preventive care despite substantial incentives (Hurley et al. 2011). Similar cautionary tales about pay-for-performance can be found elsewhere in the health system (Jha et al. 2012).
  • Access to primary care has proven to be challenging in Canada, leaving it behind many developed countries in timely access and after-hours care, and more dependent than most on the use of emergency departments (Schoen et al. 2007).
  • A strong primary care system is consistently associated with better and more equitable health outcomes, higher patient satisfaction and lower costs (Starfield et al. 2005).
Govind Rao

Doctors call for national seniors strategy; Better service for aging population require... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150825|227804299

from heather cma seniors ltc continuing care

shared by Govind Rao on 25 Aug 15 - No Cached
  • The Globe and Mail Tue Aug 25 2015
  • Reshaping the health system to deal with the onslaught of aging baby boomers is urgent and needs to be a political priority, the head of the Canadian Medical Association says. "Addressing the growing and evolving health-care needs of Canada's aging population is one of the most pressing policy imperatives of our time," Dr. Chris Simpson told a news conference on Monday at the CMA's annual meeting. "The country must act now to create a health strategy to ensure that all seniors have access to effective, integrated, affordable care." He made the comments as the CMA, which represents the country's 80,000 physicians, residents and medical students, unveiled what it called a "policy framework to guide a national seniors' strategy for Canada."
  • The 33-page document calls for significant changes across the health-care continuum to make care more seamless and seniorfriendly in the following areas: Wellness and prevention: Pay attention to the social determinants of health and ensure seniors have adequate income, housing, food security and social connections to keep them in the community. Primary care: Ensure seniors have a primary-care provider and a co-ordinator of their chronic-care needs. Home care and community support: Provide sufficient longterm home care and support for unpaid caregivers. Acute and specialty care: Address the lingering issue of wait times for surgery and deal with the "alternate level of care" problem - seniors living in hospitals because they have nowhere else to go.
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  • Long-term care: Invest in infrastructure so there is an adequate number of beds, and so they are affordable, particularly for seniors with specialized needs, such as those with dementia. Palliative care: Promote advance-care planning and ensure everyone gets palliative care at the end of life. In a wide-ranging discussion, delegates to the CMA meeting identified a number of specific issues that are hampering the provision of care to seniors with chronic health conditions, such as the lack of electronic health records, the way health-care delivery is siloed in Canada, the absence of pharmacare, physician payment schemes that reward volume rather than quality of care, the lack of training in geriatrics and a lacklustre commitment to patient-centred care.
  • The overarching theme was that if care is going to be improved for the burgeoning population of seniors, it must begin with better co-ordination. Dr. David Naylor, who headed the federal Advisory Panel on Healthcare Innovation, also stressed this as an essential element of reform. In a keynote address to the CMA meeting, he said that while Canadians love their medicare system - at least in theory - the reality is that "the scope is narrow and performance is middling." Dr. Naylor said the main reason Canadians don't get good value for money when it comes to health spending is a lack of co-ordination of care. "The critical factor is integration of services," he said.
  • Right now, far too many patients, especially seniors with chronic conditions, are being cared for in hospitals rather than in the community and their care is disjointed, the CMA's report notes. Fixing that will, among other things, require a reorganization of roles between various health professions, including physicians, nurses and pharmacists. "All health-care professionals are going to have to do their bit to deal with this grey tsunami," he said, stressing that many innovative solutions have been put in place across the country, but they are too rarely scaled up.
  • Dr. Naylor said policy-makers, and federal politicians in particular, need to take a leadership role to ensure this happens. Dr. Simpson of the CMA also called for federal political parties to commit to a seniors' strategy during the current election campaign, and said he is confident they will. "We know they're thinking about it. We know their hearts are in the right place," he said. "Now we want them to start talking about seniors' health care in the context of the election campaign so people can cast their votes accordingly."
Govind Rao

What's holding up home-care reform? - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20151206|235237118

from heather home care Ontario reforms

shared by Govind Rao on 07 Dec 15 - No Cached
  • Toronto Star Sun Dec 6 2015
  • After months of planning and false starts, Ontario Health Minister Eric Hoskins finally has all the proof he needs to push ahead at full speed with sweeping changes to the province's troubled home-care system. So what's holding him up? For weeks, Hoskins has been signalling he will release a "discussion document" outlining radical reforms, including scrapping the beleaguered 14 Community Care Access Centres (CCACs) that co-ordinate home-care delivery across the province.
  • He received even more evidence this past week that it's time to transform the system with the release of auditor general Bonnie Lysyk's annual report. Lysyk listed a wide range of mismanagement, poor oversight and horror cases in which patients failed to get services such as nursing, physiotherapy and personal support on time or in enough quantity to make a lasting difference in their health. In many instances patients had to wait almost a year just for an initial assessment. In recent days, Hoskins has been telling key health-sector players he will release his discussion paper "before the holidays."
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  • The document is expected to propose shifting much of the CCACs' home-care planning and oversight roles to the 14 Local Health Integration Networks (LHINs) that now are responsible for overall regional planning, funding and health-care integration. The job of co-ordinating face-to-face services, which now falls to CCAC staffers, may be moved to primary care agencies, such as hospitals or community health clinics led by doctors or nurse practitioners. The goal is to save more than $200 million by eliminating the bureaucracy-heavy CCACs, with their high-paid executives, and directing the savings to front-line services.
  • More than 700,000 Ontario residents receive care annually at home or in community settings. The province spends $2.5 billion a year on home and community care, about 4 per cent of its total health budget. Despite overwhelming evidence that the system is in dire need of reform, Hoskins seems reluctant to move ahead with any speed. Two months ago his office cancelled a private lock-up for home-care stakeholders at which they were to discuss a "white paper" on reforms. Hoskins also scrapped plans for a special home-care task force on the grounds it would be viewed as just another stalling tactic. Still, Hoskins is indeed moving, albeit slowly.
  • On Nov. 20, he spoke privately with the board chairs and chief executive officers of the 14 CCACs about the coming changes. On Nov. 30, Bob Bell, the deputy health minister, met with the same CCAC bosses and while he didn't share any "concrete plans," he did suggest health ministry officials will consult with CCACs and other agencies about the proposed changes "in the new year." And on Dec. 1, Hoskins wrote to the CCAC bosses to explain that his ministry has every intention of "working together with CCACs to build a health care system that truly responds to the needs of patients and their families." Again, no specifics were mentioned. Clearly, Hoskins is dealing with a health-care establishment that is reluctant to change. That includes the CCACs, LHINs, doctors and his own bureaucrats.
  • LHIN officials, for example, don't want to be in charge of direct delivery of care. They have few staffers who actually know how to run a big health system on a day-to-day basis. At the same time, the LHINs have their own troubles, as Lysyk noted in her report. She said their "marching orders are not clear enough" and performance gaps are widening, especially on wait times. In the weeks ahead, Hoskins must address whether the LHINs are ready to assume greater duties, whether they should be in the health-care delivery sector at all and how to achieve better integration of hospitals, public health, primary care and home-care agencies. Also, he should look at whether all - not just some - home-care delivery should be left to private and non-profit service providers. Hoskins and his bureaucrats may be delaying the reform push until they develop "the perfect plan."
  • But Hoskins, who has shown true vision in this initiative, should view the document as the starting point - not the end point - for wholesale reforms that cut out an entire layer of costly bureaucracy and that improve the delivery of services that patients need and deserve. Everyone in the health-care sector is primed and ready to act, although not eagerly in all cases. Just as important is the fact that more delays and more wasted tax dollars won't fix the broken system. So it's time for Hoskins to end the needless holdups and move swiftly and boldly on behalf of the people who really matter - Ontario patients. Bob Hepburn's column appears Sunday. bhepburn@thestar.ca
  • Ontario Health Minister Eric Hoskins may be delaying action until his team develops "the perfect plan" for home-care delivery, Bob Hepburn writes. • Chris Young/THE CANADIAN PRESS file photo
Govind Rao

Psychotherapy can help fill the gap; We must adopt a more rational approach to the use ... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|ntgm|20150526|221260916

from heather mental health privatization

shared by Govind Rao on 26 May 15 - No Cached
  • The Globe and Mail Tue May 26 2015
  • apicard@globeandmail.com This is part of a series about improving research, diagnosis and treatment. When medicare was cobbled together in the 1950s and 1960s, provinces began to offer publicly funded insurance for hospital care and then physician services. But there was an important exception: "Institutions for the mentally disturbed" were not funded. Asylums (as psychiatric hospitals were called at the time) were not part of the health system because the care they offered was not deemed to be curative. Thus, mental health became the orphan of health care. Six decades later, the old-style asylums are gone. The long-term patients were "de-institutionalized" and many now live on the streets. The best psychiatric institutions, such as the Centre for Addiction and Mental Health and the Ontario Shores Centre for Mental Health Sciences, and the psychiatrists that came with them, were integrated into the mainstream hospital system.
  • But the false perception that mental illness is an affliction that can't really be treated remains. The combination of stereotype-embracing and structural oddity essentially means that psychologists have been tossed to the curb - or, more precisely, to the private health system. As a result, most Canadians who need psychological care require private insurance or pay out of pocket, and much mentalhealth care is left to general practitioners who, because of the fee-for-service payment system, have an incentive to prescribe pills rather than do psychotherapy. While psychotherapy doesn't have the greatest public image - many people envisage endless Woody Allenesque sessions on a couch where nothing is ever resolved - it is actually just as effective as medication in most cases, particularly for common conditions such as depression and anxiety. The evidence is strong.
  • ...3 more annotations...
  • Sadly, the offerings in our health system are driven as much by tradition as they are by evidence. We needn't be prisoners of our outmoded structures. In the fifties and sixties, we created a system to provide care in hospitals and in physicians' offices and it's almost impossible to break that mould and innovate - for example, by putting psychological care on an even footing with psychiatric/medicinal treatment. What we really need to do is provide care where people bring their mental-health problems - in primary care. As most provinces try to transition from a solo, fee-for-service model to multidisciplinary teams, it provides a perfect opportunity to bolster mental-health care by integrating psychologists onto teams. Other countries have done so, notably Britain and Australia, and the early evidence is that it's paying off. The fear, of course, is that providing public funding of psychological care will cost more. Of course it will. Estimates range from $950-million to $2.8-billion a year.
  • But the offering of psychological care doesn't have to be an open buffet like other aspects of health care, and some of the hundreds of millions now paid for (not always trained) doctors to provide psychotherapy can be spent more smartly. If done right, the investment should pay off down the road, in lower health costs, disability-insurance payouts and absenteeism. Because the greatest costs of mental illness arise when it is left untreated, and festers. Mental illness is common: 10 per cent to 25 per cent of women and 5 per cent to 12 per cent of men experience a major depression; 4 per cent to 7 per cent of Canadians suffer from anxiety disorder; 7 per cent to 12 per cent experience posttraumatic stress disorder; 10 per cent suffer from phobias; 5 per cent experience panic disorders; 2 per cent to 4 per cent suffer from obsessive compulsive disorder or eating disorders; 1 per cent to 2 per cent suffer from bipolar disorder or schizophrenia. For years, we have been focusing efforts on combatting the stigma, urging Canadians with mental-health disorders to come forward. But the care is not available for those who need it; waits stretch from months to years, and an estimated one in three adults and one in four children don't get care at all.
  • Psychotherapy can help fill the gap. There are 8,000 psychologists in Canada. About three-quarters are in private practice, charging $100 to $200 an hour, and roughly one-third work exclusively in the public system, where there is no charge to patients. Canadians spend about $950million on psychological care, most of it covered by private insurance and workers compensation; but a good chunk, about one-third, is paid out of pocket. We have a mixed health-funding model in this country, but when it comes to mental-health care, we don't have the mix right. Too many people are being denied care because they can't afford it, or because their workbased insurance provides paltry benefits for psychological care. As it stands, mental-health care remains an orphan. We can take another big step toward correcting this by adopting a more rational approach to the use and funding of psychological care.
Irene Jansen

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

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

accord hhr senate

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

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

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

from heather dental health medicare research

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

Paramedicine expands to rural communities in B.C. - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|bccp|20160427|245817592

bc ems cupe rural

shared by Heather Farrow on 02 May 16 - No Cached
  • Williams Lake Tribune Wed Apr 27 2016
  • Alexis Creek, Anahim Lake, Bella Bella and Bella Coola have been named as remote B.C. communities that will welcome community paramedicine. Alexis Creek, Anahim Lake, Bella Bella and Bella Coola have been named as some of the 73 rural and remote B.C. communities that will welcome community paramedicine, a program that offers residents enhanced health services from paramedics. Health Minister Terry Lake made the announcement Wednesday.
  • "The Community Paramedicine Initiative is a key component of our plan to improve access to primary health-care services in rural B.C.," Lake said. "By building upon the skills and background of paramedics, we are empowering them to expand access to care for people who live in rural and remote communities, helping patients get the care they need closer to home." The program is just one way the Province is working to enhance the delivery of primary care services to British Columbians. The services provided may include checking blood pressure, assisting with diabetic care, helping to identify fall hazards, medication assessment, post-injury or illness evaluation, and assisting with respiratory conditions.
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  • Under this program, paramedics will provide basic health-care services, within their scope of practice, in partnership with local health-care providers. The enhanced role is not intended to replace care provided by health professionals such as nurses, but rather to complement and support the work these important professionals do each day, delivered in non-urgent settings, in patients' homes or in the community. "As a former BC Ambulance paramedic, I understand the potential benefits of community paramedicine," said Jordan Sturdy, MLA for West Vancouver-Sea to Sky. "Expanding the role of paramedics to help care for the health and well-being of British Columbians just makes sense." Community paramedicine broadens the traditional focus of paramedics on pre-hospital emergency care to include disease prevention, health promotion and basic health-care services. This means a paramedic will visit rural patients in their home or community, perform assessments requested by the referring health care professional, and record their findings to be included in the patient's file. They will also be able to teach skills such as CPR at community clinics.
  • "Community paramedics will focus on helping people stay healthy and the specific primary care needs of the people in these communities," said Linda Lupini, executive vice president, BC Emergency Health Services. "This program also allows us to enhance our ability to respond to medical emergencies by offering permanent employment to paramedics in rural and remote areas of the province." "Community paramedicine brings improved patient care and more career opportunities to rural and remote areas," said Bronwyn Barter, president, Ambulance Paramedics of BC (CUPE 873). "Paramedics are well-suited to take on this important role in health-care provision." Community paramedicine was initially introduced in the province in 2015 in nine prototype communities. The initiative is now expanding provincewide, and will be in place in 31 communities in the Interior, 18 communities in northern B.C., 19 communities on Vancouver Island, and five communities in the Vancouver coastal area this year.
  • At least 80 new full-time equivalent positions will support the implementation of community paramedicine, as well as augment emergency response capabilities. Positions will be posted across the regional health authorities. The selection, orientation and placement process is expected to take about four months. Community paramedics are expected to be delivering community health services in northern B.C. this fall, in the Interior in early 2017, on Vancouver Island and the Vancouver coastal area in the spring of 2017. BC Emergency Health Services has been co-ordinating the implementation of community paramedicine in B.C. with the Ministry of Health, regional health authorities, the Ambulance Paramedics of BC (CUPE 873), the First Nations Health Authority and others. Copyright 2016 Williams Lake Tribune
Irene Jansen

telegraphjournal.com - Rethinking health spending | Adam Huras - Breaking News, New Bru... - 0 views

telegraphjournal.canadaeast.com/...1449893

primary care health council of canada

shared by Irene Jansen on 23 Jan 12 - No Cached
  • FREDERICTON - New health spending needs to be put towards primary health care, even if it's at the expense of funding for the province's hospitals, says the CEO of the Health Council of Canada.
  • "As patients and as citizens we need to start clamoring for more investments in primary health care and say that we think we have sufficient resources in our hospital system," Abbott said.
  • Abbott said the focus must be on a community team-based approach to extend hours and keep patients from visiting hospital emergency rooms for health-care needs that are not emergencies.
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  • Health Minister Madeleine Dubé said Friday that changes to primary health care will be driven in part by the opinions received at the Primary Health Care Summit held in Fredericton this week.
  • But Dubé stopped short of saying primary health care would come before the needs in acute care.
  • Premier David Alward also expressed a need for the province to move towards greater preventative health-care measures alongside of strengthening primary health care in the province.
  • reinvest some of the money we have within the system now into things like prevention
  • Primary Health Care Steering Committee
  • The committee is to forward recommendations derived from the summit to the provincial government by early 2012.
Doug Allan

The Caring Economy - Medium - 0 views

medium.com/...omy-of-senior-care-87598644726

homecare privatization

shared by Doug Allan on 06 May 15 - No Cached
  • Home care, a growth area in Canada’s health care system, is an existing solution that helps make aging at home a reality. In fact, seniors who access home care support — privately or publicly—have a 40 percent reduced likelihood of admission to a nursing home facility.
  • In Ontario, more than 10,000 seniors are waiting- for 262 days, on average- to access home care services, which calls for the private sector to bridge the gap between the services available and the urgent need for home care.
  • In 2010, the private home care sector accounted for $1.48 billion and is expected to continue to grow as publicly available services become more restrictive and the senior population continues to grow. Though the volume of paid care reached 60 million hours per year in addition to 90 million hours of government subsidized care, the rising need for private care continues to grow, along with the aging population that it serves.
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  • To make aging at home a reality for all Canadians, we must redesign the delivery of home care to make it more accessible, accountable and affordable.
  • As government funding continues to decline, unpaid caregivers — typically a spouse or child — are having to fill the gap or pay out of pocket to hire care privately. In 2007, approximately 3.1 million Canadians, largely women between the ages of 45–64 years old (44%) (StatsCan 2012), were estimated to act as an informal caregiver to their loved ones, providing over 1.5 billion hours of care annually.
  • These caregivers provide 10 times the number of care hours by formal services, which is not only taxing on their personal well-being and their relationship with their recipient, but also on Canada’s economy — the cost to businesses from absenteeism and turnover related to unpaid care was estimated to be $1.28 billion in 2007.
  • The Caring Economy is made up of for-profit marketplaces that serve the needs of others. Like the Sharing Economy, it is a marketplace that empowers neighbours to care for neighbours— removing the need for corporations to intervene. Through the latest mobile technology, businesses in the caring economy connect the supply of care to the demand for care.
  • In the Caring Economy, there are two key end users: the demand side that needs to hire care and are willing to pay and the supply side that has time and is looking to help. Demand side users can build their own personalized team of care providers, communicate directly within the platform, and pay on demand via mobile payments — a seamless, convenient and transparent process. This is made possible through a peer-to-peer marketplace that uses mobile technology to efficiently manage the relationships between paid care-workers to primary caregivers and their loved ones — on demand. Simply put, it is Uber for home care.
  • At its core, this model redesigns how care is delivered to make ‘aging in place’ a reality. The model’s objective is threefold — to help seniors age with dignity, to unburden their family caregivers, and to turn compassionate people and Personal Support Workers (PSWs) into ‘micro-entrepreneurs’ — providing them with an opportunity to earn a 20–30% higher wage- a win, win, win.
  • The Uplift® smartphone platform delivers on-demand home care services — at the touch of a button. As a company, we are laser focused on harnessing the latest mobile technology and analytical problem solving to deliver a superior user experience that fulfills the aging population’s demand for higher quality care. We are setting the new standard.Our app is an affordable solution to expensive agency fees. We offer 30–50% lower fees than private agencies. We are also an innovative substitute to long-term care.As an organization, we are devoted to making a positive impact in the world. Moreover, we are a pioneer of the ‘caring economy’ — where neighbours can care for neighbours and caregivers are empowered.
Heather Farrow

Pharmacare won't come soon: minister; Warns CMA meeting in Vancouver that indigenous he... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|vasn|20160824|254542102

pharmacare

shared by Heather Farrow on 24 Aug 16 - No Cached
  • Vancouver Sun Wed Aug 24 2016
  • Federal health minister Jane Philpott said Tuesday a national pharmacare program is likely years away because of more pressing priorities like primary care, improved health for indigenous people, better care for those with mental illness, and more home care for seniors. "I do not want to promise anything I don't know I can deliver on," she told about 600 delegates and observers at the annual Canadian Medical Association meeting in Vancouver.
  • "National pharmacare, you know if you've seen my mandate letter (from Prime Minister Justin Trudeau), does have to do with the cost of drugs and there's impressive work we can do in the next few years to drive down costs," she said. Philpott suggested the government will, for now, focus on bulk buying, price regulations and negotiations with pharmaceutical companies, rather than a full program covering the costs of drugs for those who can't afford them. While Philpott, a doctor, said she "gets" how a pharmacare program would be beneficial, but there are other problems like "horrendous and unacceptable gaps in care for indigenous people and we need frank conversation about where our priorities should be."
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  • Philpott said one of the misconceptions about the future of health care is that demographics - a silver tsunami related to an aging population - is going to bankrupt government coffers. While she acknowledged that seven per cent of $1,000-a-day hospital beds are taken up by seniors and 14 per cent of beds are occupied by patients who should be in alternate levels of care, Philpott threw cold water on the "doom and gloom" forecasts that an aging population means "massive infusions of cash" are needed to sustain public health care. Sticking to the federal government's commitment to inject another $3 million over four years into home care, she noted it's not only cost effective but preferred by patients and their families.
  • "Most seniors prefer care in the comfort of their home and not in hospitals." Doctors of B.C. president Dr. Alan Ruddiman told Philpott that the "harsh reality" is that certain provinces like B.C. are struggling to meet the health-care needs of aging populations, so the CMA is advocating in favour of federal demographic-based "top ups." But Philpott wouldn't reveal where negotiations will go on that point and said there are 14 health ministers, including herself, who have to hammer out an agreement.
  • The reality is I don't know how this is going to end up. A lot of this will come down to basic principles of fairness." While Canada spends more per capita than many other countries, Philpott said she's concerned about international rating systems that show Canada gets poorer outcomes compared to countries such as Australia, the United Kingdom, France and Germany. During a press scrum, a journalist noted that all those other countries have parallel public/private systems. But Philpott insisted the federal government is only interested in how those other countries deliver care within the publicly funded realm. "Our government is firmly committed to upholding the Canada Health Act. That act has principles around accessibility and universality and it means Canadians have access to care based on need, not on ability to pay," she said. "You cannot have a growing, thriving middle class unless you have a publicly funded universal health care system."
  • Philpott attempted to dissuade doctors of the notion that the federal role is merely to transfer money to the provinces ($36 billion this year), maintaining that the government and "this minister of health" is determined to be engaged in health system transformation. The provinces have begun the slow process of negotiations with the federal government on a renewal of the Canada Health Accord to be signed sometime next year. But some health ministers have complained that the feds have given no indication about how much money they can expect. It's been more than a decade since the provinces and the federal government negotiated transfer payments and Philpott said that while the last round led to improvements like shorter waiting times in some surgical areas, "it did not buy change. So we should use this opportunity to trigger innovation."
  • Philpott said real change will incorporate digital health records and the banishment of anachronisms like fax machines. Patients should be seamlessly connected, in real time, to their health care providers, hospital, home care, pharmacy and lab. "What is it going to take to get there? Pragmatism, persistence and partnership. Changes require courage and practicality." Doctors gave her enthusiastic applause for stating that low socioeconomic status represents one of the greatest barriers to good health and "that is why this government believes that the economy and jobs and a stronger middle class will reduce social inequity." She said in 2016, the federal government has earmarked $8.4 billion in spending on social and economic conditions for indigenous communities. Earlier Tuesday, on the second day of the three-day annual meeting, doctors passed numerous motions that will now go to their board for further discussion before becoming official policy.
  • Delegates passed a motion introduced by Ontario doctor Stephen Singh of the Canadian Society of Palliative Care Physicians that aims to distinguish between palliative care ("neither to hasten or postpone death") and medical assistance in dying. Most palliative care doctors don't want to serve as gatekeepers to doctor-assisted dying, but they do want to consult with patients who have life-limiting illnesses in order to help mitigate their suffering.
Irene Jansen

The primary care prescription - 0 views

www.edmontonjournal.com/...story.html

doctors primary care alberta

shared by Irene Jansen on 23 Jan 12 - No Cached
  • "Our appetites have been whetted" with the province's push for primary care reform, said Bailey, who cochairs the provincial committee of the primary care network physician leads. Each of Alberta's five health zones is represented by one such primary care doctor.
  • Alberta Health and Wellness has made the expansion of primary care one of its priorities. By 2013-14, it aims to have 73 per cent of Albertans enrolled in a primary care network, compared to the 62 per cent in 2009-10.
  • Bailey backs the philosophy, but said the government must follow through with appropriate resources. Primary care networks like his receive $50 per enrolled patient, an amount that hasn't been increased since the program was first launched in 2005.
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  • Bailey's network is using its surplus to pay its nurse practitioners and other team members - and the pot is disappearing. Moe said the excess $1 million will be depleted by the end of the fiscal year.
  • "We've been operating in a nonsustainable model," Bailey said. "If we were to maintain all the programs we currently run in many (primary care networks), it would take close to twice the $50 just to maintain, let alone to expand."
  • But negotiations for a new physician contract broke down earlier this year and the existing contract was stretched to June 2012. The Alberta Medical Association's new Calgarybased president, Dr. Linda Slocombe, said primary care networks are a "critical" part of moving forward.
  • We have 80 per cent of doctors in the province within them
  • Concerned, too, that more services are being downloaded onto primary care networks. They are expected to play a huge role in treating and preventing obesity, whereas such programs were historically offered in hospitals and paid for by the health authority, Bailey said.
  • And yet he said Alberta's system is still too reliant on having doctors do most of the work, rather than let them focus on the complex cases while dietitians or pharmacists help manage diabetes or the overweight.
  • provincial executive leaders in this area will meet in Calgary Oct. 14 and 15 to come up with a consensus document for the AMA to present to the government in negotiations.
Govind Rao

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

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

from heather accord campaign ally

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

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

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

from heather privatization medicare

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

Ontario hospitals unprepared for aging population - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20150423|219020120

from heather Ontario hospital ageing seniors

shared by Govind Rao on 23 Apr 15 - No Cached
  • Toronto Star Thu Apr 23 2015
  • With the provincial government set to table its budget today, much of the public discussion to date has focused on the future of alcohol sales and power generation in the province. While these issues are important, we must not lose sight of other priorities - particularly how best to care for our aging population. While Ontario hospitals have not received an inflationary funding increase over the last three years, the province's 149 public hospitals have been working very hard to adapt to meet the needs of patients. Hospitals have worked hard to help the government meet its financial objectives by improving operating efficiencies and reducing costs while also enhancing patient care. Over the past decade, Ontario hospitals have become the most efficient in Canada. Despite serving a record number of patients, wait times have gone down and more people are getting the care they need faster in areas such as cancer surgery, cardiac procedures, cataract surgery, and hip and knee replacement. And they're doing so with the fewest hospital beds, per citizen, of any Canadian province.
  • However, hospital leaders are now facing some very challenging budget decisions to contain costs and meet the ever-increasing service needs of Ontarians.
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  • When we established our universal health care system more than 50 years ago, the average Ontarian was 27 years of age and less likely to be living with chronic and complex health issues. In contrast, 60 per cent of our total hospital days last year were amongst older Ontarians, particularly those living with multiple health issues, and with minimal social supports.
  • When these patients end up in hospitals, it becomes a particular challenge to get them back in their own homes. In fact, more than 14 per cent of Ontario's hospital beds are currently occupied by patients like these who cannot be discharged because we don't have the right types of services available in the community. By having to stay in hospital, these patients aren't getting the kind of care that they should. And by remaining in hospital, the cost of their care and cost to their overall health is much higher than it actually needs to be. The majority of these patients are waiting for less costly at-home care services through home and community care agencies, or care in more supervised or assisted living environments, such as nursing homes. We also know that too many older Ontarians are still sent to nursing homes when there isn't enough home care, which is less expensive, available. With these growing pressures coming to a head, now is the time to act and make sure that our province can continue to provide the high-quality care that Ontarians want, need and deserve.
  • It is time to invest aggressively in home and community care, nursing home and assisted living services, and other vital areas so that patients can stay healthy and independent in their communities for as long as possible and when hospitalized, be discharged quickly and safely to get quality care in their community.
  • We need to identify the right mix of services to ensure all Ontarians can get the right kinds of care where and when they need it. That means knowing the right number of beds needed in hospitals or long-term care homes, as well as the number of assisted living spaces, home care hours, and primary care and mental health services required to meet the needs of our aging population. Given the exploding need for different kinds of services, it also means we need to be innovative by creating new models of care.
  • While the government has recently acknowledged the importance of robust health-service capacity planning, neither we nor any other Canadian jurisdiction currently has such a plan. This is worrisome because what we do know with absolute certainty is that the number of older Ontarians will double over the next two decades. With service demands growing rapidly at the same time that the system moves to further contain cost growth, we owe it to patients and clients to meet their changing health care needs not only for today but for the decades still to come.
  • Ontario needs clear-eyed and effective long-term planning to ensure its health care system has the ability meet the evolving health care needs of Ontarians. Until we know exactly what services the people of Ontario need, our system won't have the long-term plan required to meet them. Dr. Samir Sinha is director of geriatrics at Mount Sinai and the University Health Network Hospitals and provincial lead of Ontario's Seniors Strategy. Anthony Dale is president and CEO of the Ontario Hospital Association.
Govind Rao

Taxes: not always a dirty word; Civilized society, with universal health care, is fuell... - 0 views

www.fpinfomart.ca/...210311340

from heather medicare taxes accord

shared by Govind Rao on 12 Dec 14 - No Cached
  • Hamilton Spectator Fri Dec 12 2014
  • "Try to think of a word more hated than "taxes"! Right! Let's lay our cards on the table and say we are talking taxes. Politicians promise lower taxes and, therefore, more disposable income if we vote for them. They turn "taxes" into a hated word. The promise of lowering them is like luring a bear to a honey pot because many of the electorate believe they will be better off financially. This is a myth. One has only to note all the "extras" for which you would fork out on a daily basis - that is, if you are fortunate enough to have the income. It's been said "taxes are what one pays for a civilized society."
  • And we are civilized, aren't we? Taxes pay for all the services we expect to receive in a first-world country: health care, social workers, schools, libraries, bridges, roads, clean drinking water and sanitation, parks, food and building inspectors - and more. If these necessities are not being delivered it's likely taxes are being misappropriated or are insufficient - or maybe both. It's clear we have allowed ourselves to be bamboozled by politicians who promise that if we vote for whoever is electioneering, we shall have halcyon shopping days using the extra money that otherwise would have been lifted from us in taxes. The word "bamboozled" is used advisedly. Take our hospitals. In the 21st century, in Canada, are these institutions meeting the needs of all Canadians, no matter the income? The answer is no. This is not to say that there are not many patients who feel they have received good care. But we are talking about "all Canadians" and not only those who have spun the wheel and been lucky. There are so many horror stories in the media concerning mistakes made and neglect of patients that you feel sorry for conscientious staff from all hospital departments who may feel their efforts are not appreciated. These employees go to work each day and do their best, despite being overworked and stressed.
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  • For years polls have told us that health care is Canadians' No. 1 concern. Yet federal governments, in particular the present one, have handed down to provinces insufficient funding, thus our health care system finds itself in palliative care. One cannot mention hospitals without speaking of their fundraising campaigns. No matter how you slice the pie, fundraising doesn't seem to be the way to run a first world health care system. What if donations dry up due to a national or global economic downturn? Solid federal funding, the disbursement of which is scrutinized by an informed electorate, must result in careful management by our health and finance ministers. This is really "standing on guard for thee" and being a proud Canadian.
  • For some time now, Hamilton's hospital walls and elevator doors have been plastered with massive posters of smiling doctors and patients urging us to "make a difference." It would be interesting to know the grand yearly total of staff salaries, equipment, office rents, printing, mail-outs, massive posters, and full-page newspaper and television advertisements. Even our telephone calls are met with the suggestion that the caller might like to make a donation. How can our health care system survive, expand and improve while being so reliant on the whims of donors? Further, let's not forget the multiplicity of other organizations that are also urgently fundraising - health care has to contend with these.
  • And it may not be widely known that it is the current government's intention to make another $36 billion in health care cuts over 10 years after 2015. This doesn't convey a picture of a future robust not-for-profit system which Canadians maintain is their No. 1 concern. If Tommy Douglas, medicare's founder, were to walk hospital corridors today, it is likely he would see this aggressive fundraising as one gigantic begging bowl. It is all so tacky.
  • According to their literature, the Registered Nurses' Association of Ontario has set goals for public health, primary care, hospital care, home care and rehab, complex and long-term care. Further, Canadian Doctors for Medicare state its first goal is "to help continuously improve publicly funded health care in Canada." These goals cannot be achieved without a big injection of tax dollars which, spent wisely, enable our public health care professionals to deliver the quality of health care Canadians need and deserve. Think about it! Louise Rogers lives in Dundas.
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