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Govind Rao

Contracting out of surgical preparation and delivery - 2 views

www.ochu.on.ca/contracting_out.php

from heather cupe ontario hospital private clinics privatization

shared by Govind Rao on 24 Nov 14 - No Cached
  • Contracting Out Hospital Work to Private Clinics – Backgrounder For years CUPE has been concerned the Ontario government would transfer public hospital surgeries and diagnostic tests to private clinics. CUPE began campaigning in earnest against this possibility some years ago with a tour of the province by British Health Secretary Frank Dobson who talked about the disastrous British experience with private surgical clinics.Unfortunately, the provincial Liberal government has now moved in this direction. The door opened a few years ago with the introduction of fee for service hospital funding (sometimes called Activities Based Funding). Then in the fall of 2013 the government announced regulatory changes to facilitate this privatization, with the government finally announcing Request for Proposals for the summer of 2014.
  • Hospitals are the main focus of the government’s health care cuts. They do not see community hospitals as providing a broad range of services to the local ... [Read More]population, but instead wish to remove an untold range of services from local hospitals and transfer them to specialized private clinics. The proposal would remove the most lucrative, high volume and easiest procedures from community hospitals. The remaining community hospitals would be left with the most difficult services. If they chose to compete with the private clinics, they would have to specialize in a narrow range of services. The government’s plan is the opposite of one-stop, integrated public health care. This proposed privatization of surgeries and diagnostic tests is in addition to the aggressive attempts to remove non-acute care services from hospitals (e.g. outpatient clinics, complex continuing care, rehabilitation, long-term care, primary care, etc.). As acute care currently accounts for only about 1/3 of current hospital funding, these attacks are a grave threat to the viability of community hospitals, and in fact we are now seeing a wave of hospital shut-downs that is somewhat reminiscent of the Mike Harris era. Despite the government’s rhetoric about keeping care non-profit, services that are being cut from local hospitals now are being privatized to for-profit owned corporations. Even if the private clinics did start out as non-profit (which has not been the case so far) the whole system of private clinics could be privatized with a stroke of a pen.
  • Ontario Health Care Privatization: The push for health care privatization in Ontario picked up in 2001 when Ontario Health Minister Tony Clement announced two privatized P3 hospital projects, the Royal Ottawa and the Brampton Civic (part of William Osler Health Centre). Spirited community-based campaigns, including P3 plebiscites in many towns, forced the Liberal government to greatly narrow the scope of the privatization of support jobs (i.e. CUPE jobs) in subsequent P3 hospitals. Nevertheless privatization of the hospital financing continues, despite revelations by the provincial Auditor General that confirmed claims by CUPE and others that the Osler project cost hundreds of millions more due to the P3.
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  • MRI and CT Clinics: The PC government also tried to set up private MRI and CT clinics outside of hospitals. Community/labour campaigns however were able to stop this. A key factor was that, to increase their revenue, the private clinics were allowed to bill private patients for a certain number of hours each week (with the rest of the week dedicated to patients paid for by the public system). As the public insurance system must pay for all ‘medically necessary’ hospital services, the government was left to try to explain why any reputable clinic would allow patients to subject themselves to such tests for medically unnecessary reasons. Since this episode, private clinics have been in the news – but mostly for the wrong reasons. Private surgical and diagnostic clinics: Initially, the government let the emerging industry slip entirely free of public reporting and oversight. However, after the September 2007 death of Krista Stryland, a young mother who underwent liposuction at a Toronto cosmetic clinic, the government required the industry to face some modest oversight in 2010. Unfortunately this was not by a public authority, but through self-regulation by the doctors (even though the doctors themselves had lobbied to expand this private industry).
  • Then in the fall of 2011, following disclosure that 6,800 patients would have to be notified that faulty infection control procedures at a private clinic could have exposed them to HIV or hepatitis, the then Health Minister, Deb Matthews, declined to introduce oversight by a public authority, despite public pressure. Instead she comments, “Government can’t do everything. A professional (regulating body) like the College of Physicians and Surgeons, they take responsibility for their members....At this point I am delighted the College is taking that responsibility seriously and has found a problem that we need to fix.” Eventually the College of Physicians and Surgeons released a report on the private clinics that mentions that some 29% of the private clinics fall short in some way – but the College would not indicate which ones – or how they fell short. This caused public uproar, with the Toronto Star playing a leading role (as it would continue to do). Again, the government promised improvements. In the last two months however, the Star has followed up and revealed (after our urging) that the public reports from the College of Physicians and Surgeons fall far short. They also ran a series of often front page stories on serious quality problems at private clinics.
Irene Jansen

Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Inc... - 1 views

www.plosmedicine.org/...10.1371%2Fjournal.pmed.1001244

privatization quality costs excellent

shared by Irene Jansen on 31 Mar 13 - No Cached
  • Studies evaluated in this systematic review do not support the claim that the private sector is usually more efficient, accountable, or medically effective than the public sector
  • Irene Jansen on 31 Mar 13
     
    Summary by Anna Marriott, Oxfam Access and responsiveness * Studies that measured utilization by income levels tended to find the private sector predominately serves the more affluent. In Colombo, Sri Lanka, where a universal public health service exists, the private sector provided 72% of childhood immunisations for the wealthiest, but only 3% for the poorest. * Waiting times are consistently reported to be shorter in private facilities and a number of studies found better hospitality, cleanliness and courtesy and availability of staff in the private sector. Quality * Available studies find diagnostic accuracy, adherence to medical management standards and prescription practices are worse in the private sector. * Prescribing subtherapeutic doses, failure to provide oral rehydration salts, and prescribing of unnecessary antibiotics were more likely in the private sector, although there were exceptions. * Higher rates of potentially unnecessary procedures, particularly C-sections, were reported at private facilities. In South Africa for example, 62% of women delivering in the private sector had C-sections, compared with 18% in the public sector. * Two country studies found a lack of drug availability and service provision at public facilities, while surveys of patients' perceptions on care quality in the public and private sector provided mixed results. Patient outcomes * Public sector provision was associated with higher rates of treatment success for tuberculosis and HIV as well as vaccination. In South Korea for example, TB treatment success rates were 52% in private and 80% in public clinics. Similar figures were found for HIV treatment in Botswana. Accountability, transparency and regulation * While national statistics collected from public sector clinics vary considerably in quality, private healthcare systems tended to lack published data on outcomes altogether. Public-private partnerships also lacked data. * Several reports ob
Govind Rao

Private clinics don't work: ex-health secretary; Britain's Dobson warns against moving ... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|hbsp|20150915|229291500

from heather privatization private clinics Ontario cupe hospital campaign

shared by Govind Rao on 15 Sep 15 - No Cached
  • The Hamilton Spectator Tue Sep 15 2015
  • A former British health secretary is warning Ontario not to push surgeries out of hospitals and into private clinics after an effort to do the same ended with "dismal failure" in the United Kingdom. Attempts to have the private sector deliver public services has ended with abandoned contracts, increased costs, compromised care and a growing roster of consultants promoting enterprising clinics to government, Frank Dobson says. "There's a sort of huge, rather sleazy industry now that are people who worked in the National Health Service who are now running private clinics," the retired MP said during a stop in Hamilton on Monday.
  • Union representatives acknowledged job losses are a concern, but their overriding issue is the quality of patient care. "We are looking at this government to make changes and make a commitment to stop their private clinics from happening and put the patients first," Kevin Cook, OCHU regional vice-president, said at a news conference at the Barton Street East legion Monday. The province hasn't yet "shifted low-risk procedures to out-of-hospital clinics," Ministry of Health and Long-Term Care spokesperson David Jensen wrote in an email.
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  • Private enterprise hasn't made health care more efficient, but rather more sluggish, the longtime Labour Party politician said. Bloated corps of lawyers, accountants and consultants hired by government now fret over tenders and contracts, which must be watertight, he noted. Dobson cited one case in which a woman suffering from a serious hemorrhage bled out during surgery because the private clinic didn't have an emergency blood supply. "The answer from the clinic was the contract didn't say we had to have an emergency blood supply," he said. Dobson is touring Ontario cities with officials from the Ontario Council of Hospital Unions (OCHU) and CUPE to discourage provincial plans from bringing more surgeries and procedures into the private fray.
  • However, with the shift, the ministry hopes to provide patients with "quicker access to complex surgeries because hospitals will be able to get to more complex procedures sooner." Ontario hospitals have struggled to do more with less in an era of cost-cutting and provincially mandated, balanced budgets. But giving private operators a bigger piece of the pie won't lower wait times nor reduce costs, said Dr. Wayne Taylor, executive director of the public policy think-tank Cameron Institute. "I don't see any value added in having something privately owned or publicly owned if it's still government money. What we need frankly is private-pay health care so that people have a choice." However, firms aren't exactly chomping at the bit to delve into health care, the former McMaster professor added, calling it a low-return investment.
  • Many MRI operators in Ontario dropped off the map about a decade after they set up shop, he noted. "Half of them are still around. Half of them went out of business." A number of private clinics in Hamilton provide OHIP-insured services, such as the Hamilton Endoscopy Centre on James Street South, Pain Care Clinics - Hamilton West, on Main Street West, and the Hamilton Vein Clinic on Upper Wentworth Street. Dobson argues private-sector imperatives and health-care needs are strange bedfellows, recalling how earlier this year one firm operating a U.K. hospital threw in the towel when its care fell under scrutiny and business looked bad. That was Circle Health, which gave up running Hinchingbrooke Hospital after three years because it was "no longer viable," the BBC reported. "The ultimate discipline in a market is if you can't make a go at it, you go bust, and it closes down. Well, you can't allow it to close down because patients need to be looked after," Dobson said.
  • Taylor, however, who calls the National Health Service a "disaster," says the private-public operating debate is a "red herring." He has heard of some "quality issues" at privately run colonoscopy clinics. If a doctor punctures a colon at a hospital, there's backup, Taylor said, but, in private clinics, "I don't know." Success depends on proper regulation, Taylor said. The Liberal government has come under scrutiny for not providing adequate oversight of private clinics, notably after a bacterial outbreak at a Toronto pain clinic in 2012 went unpublicized as it infected nine patients there.
Govind Rao

Clinics a ripoff: critic ; HEALTH: Private health clinics cost more, former UK health m... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|sust|20150916|229381229

from heather cupe Ontario hospital private clinics privatization campaign

shared by Govind Rao on 16 Sep 15 - No Cached
  • The Sudbury Star Wed Sep 16 2015
  • A former health minister from the United Kingdom says he believes "private clinics are a bad option for the people of Canada." Frank Dobson, who was health minister from 1997 to 2000 in Tony Blair's Labour Party government, made a stop in Sudbury on Tuesday. Dobson was invited by the Ontario Council of Hospital Unions (OCHU) to speak about the pitfalls of privatization of health-care services in the United Kingdom. He is visiting eight other communities in the province to give his take on health-care privatization and how it may affect the health-care system in Ontario. "I wouldn't recommend the British model to anyone because it has basically been a rip off," Dobson said.
  • "The money going into running the system (in Britain) has gone up from between four and six per cent of the total National Health Service spending to somewhere between 12 and 15 per cent of NHS spending going on this semi-commercial system and that is somewhere around 8 billion pounds a year extra going on the cost of running the services (that are) not going on patient care, Dobson said. Dobson also provided other examples of why the system is flawed in the Britain.
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  • "The problems we found is the private sector genuinely believe they will be more efficient and when they discover they can't be much more efficient than our National Health Service, or for that matter, your public health services here, they have to start cutting back on standards and in quite a number of cases now in Britain, they've taken over a franchise (clinic) and can't make a go of it, so then hand it back because they can't cope with actually running a decent service," Dobson said. He also said that drawing up contracts with private clinics is complicated and costly. "The people creating the contract try to cover every eventuality in the contract, and they need to do that because in Britain we had a case where a woman had a major hemorrhage in a small hospital and they didn't have an emergency blood supply, so they sent someone to the nearest NHS hospital to get some blood.
  • "By the time they got back, the woman had bleed out and died. When (officials of private clinic) were pressed about this, they said, 'Oh well, it didn't specify in the contract that we had to have an emergency blood supply,'" Dobson said. He said the contracts "have to be water tight, and it means legions of lawyers, accountants and management consultants" drawing up contracts and "that is money that is not going" into patient care.
  • Kevin Cook, of OCHU, who is travelling with Dobson, said that the Canadian Union of Public Employees and OCHU oppose the Ontario government's plans to expand the use of private specialty clinics to deliver services currently being provided by local hospitals. "First of all, this isn't about the job losses (with our members), this is about patient safety and the patients come first," Cook said. "We are concerned with infection control issues" ... there are different measures in hospitals then there are in private clinics. Hospitals have an infection control team, they have the department that cleans the instruments, then it goes to the doctor, so there is a different chain within the private clinics.
  • "They are not going to have the same standards" as a hospital, Cook said. Cook gave an example of how things can go wrong in a private clinic. In September 2007, a patient bled to death undergoing liposuction surgery at a private clinic in Ontario. The tragedy happened a few months after Dobson visited Ontario and cautioned the provincial government on allowing private surgery and procedure clinics to open in Ontario. "We are asking the Ontario government to stop the private clinics. It is not cheaper; it will cost us in the long run. And they keep saying it is a savings, but it is not," Cook said.
  • Dobson agreed. "The thing I try to get across is this ... everyone in Canada knows that you spend, roughly speaking, half as much as the Americans spend in their health-care system. So the idea that a competitive system like theirs is cheaper, doesn't make a lot of senses. And it also means that the private sector is trying to come in and take over what is essentially in Canada and Britain, a very, very, cost-effective health-care system. "Always remember, with private businesses, their primary duty is to provide their shareholders with profit," Dobson said. sud.editorial@sunmedia.ca
  • Frank Dobson, right, a former health minister in the United Kingdom, spoke to reporters about the pitfalls of private clinics during a visit to Sudbury on Tuesday. Looking on is Kevin Cook, of the Ontario Council of Hospital Unions.
Irene Jansen

Healthcare Policy Vol. 7 No. 1 2011 Do Private Clinics or Expedited Fees Redu... - 0 views

www.longwoods.com/...22528

waits privatization private clinics wcb

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Discussion: An overall difference of approximately three work weeks in disability duration may have meaningful clinical and quality-of-life implications for injured workers. However, minimal differences in expedited surgical wait times by private clinics versus public hospitals, and small differences in return-to-work outcomes favouring the public hospital group, suggest that a future economic evaluation of workers' compensation policies related to surgical setting is warranted.
  • In 2004, for example, WorkSafeBC (the workers' compensation system in British Columbia) paid almost 375% more ($3,222) for an expedited knee surgery performed in a private clinic than for a non-expedited knee procedure in a public hospital ($859) (both fees represent the aggregation of facility, surgical and anaesthetists' fees)
    • Irene Jansen
      Irene Jansen on 23 Jan 12
       
      ownership and quality (for-profit = worse quality)
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  • As a policy under the workers' compensation insurance system, expedited fees were effective in reducing wait time to surgery. While a difference of only two weeks may not improve longer-term clinical outcomes post-surgery, it represents a reduction in the total disability duration (i.e., pain, suffering, quality of life) for the injured worker and increases the worker's likelihood of successfully returning to work; the reduced disability duration also represents a cost saving to the workers' compensation system for time-loss benefits and to employers who pay compensation premiums based on the frequency and duration of their claims experience.
    • Irene Jansen
      Irene Jansen on 23 Jan 12
       
      See two paragraphs down, which suggests that expedited patients did not in fact return to work faster.
  • the provision of surgeries "after hours" or within private clinics may result in a redistribution of finite resources (e.g., surgeons, surgeon time, surgical staff) from one insurance provider to another, favouring those associated with higher fees, thus creating inequities. An evaluation of the effect of workers' compensation policies on inequity in the provincial healthcare system was not part of this study and warrants future investigation.
  • Despite surgery wait time differences, injured workers in the public hospital group tended to do slightly better in terms of time to return to work after surgery compared to workers in the private clinic group
  • . In this case, the improved outcomes were a shorter disability duration and earlier return to work for injured workers. Some might argue that the approximate one-week difference was not statistically significant and, as such, the provision of surgeries with private clinics "does no harm" within the context of the workers' compensation environment. Yet, as with expedited fees, it remains unclear whether the reliance on for-profit clinics increases capacity for surgeries with costs borne appropriately by employers and industries for work-related injuries, or whether they redistribute finite resources away from the provision of surgeries within the public healthcare system. Further, minimal differences in disability duration for patients treated by private clinics relative to those treated in public hospitals, given the added cost associated with surgeries performed in for-profit clinics, suggest that a future economic evaluation of this workers' compensation policy is warranted.
  • the time leading up to surgery may be confounded by co-morbidities and that individuals with complications may be directed to the public system
  • A difference of approximately two weeks in surgery wait time associated with the expedited fee policy may have meaningful clinical and quality-of-life implications for injured workers, in addition to being cost-effective policy for workers' compensation insurance systems, but did not affect the return-to-work time post-surgery as part of total disability duration. Minimal (and not statistically significant) differences in disability duration were observed for surgeries performed in private clinics versus public hospitals.
  • Irene Jansen on 23 Jan 12
     
    An overall difference of approximately three work weeks in disability duration may have meaningful clinical and quality-of-life implications for injured workers. However, minimal differences in expedited surgical wait times by private clinics versus public hospitals, and small differences in return-to-work outcomes favouring the public hospital group, suggest that a future economic evaluation of workers' compensation policies related to surgical setting is warranted.
Govind Rao

Province enlists private surgery clinics; $10M plan for up to 1,000 procedures takes ai... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|vasn|20150602|221789192

from heather bc private clinics privatization

shared by Govind Rao on 02 Jun 15 - No Cached
  • Vancouver Sun Tue Jun 2 2015
  • "The use of private surgical clinics within the publiclypaid and publicly-administered health care system has always been an important part of the system," he said. Of the 541,885 publicly-funded surgeries in 2013, 14, 5,503 were done in private facilities using public money. The Vancouver Island Health Authority is seeking private clinics to conduct 55,000 day surgeries over five years to ease the pressure on hospital operating rooms.
  • Vancouver Coastal Health said it expects to fund 350 additional surgeries, including day surgeries conducted in leased private operating rooms. Fraser Health said it would provide 500 extra procedures over the summer. "About one per cent of the surgeries done in British Columbia are actually done in private clinics but paid for publicly," said Lake, who described an "unprecedented demand" and unacceptable waiting times facing the public system. "We want to see if we can optimize that. I think patients want to have their surgeries done. If the quality is there, and it reduces wait lists and is paid for and administered by the public system, I think British Columbians would agree with that approach."
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  • The announcement comes as the provincial government prepares to defend itself in a lawsuit filed by Brian Day, an orthopedic surgeon, co-owner of the Cambie Surgery Centre and 2016 presidential candidate for Doctors of B.C. Day contends in his suit that patients should have the constitutional right to pay for care in private clinics if waits in the public system are too long.
  • "I think this is a good initiative. I think it's, in a way, brave of the government to do this when it's involved in a lawsuit," said Day. He said the province's announcement did not put it in an awkward position going into the court case, given that "contracting out has been going on for years," but it showed that the public sector is stressed to the point that it cannot handle the workload. "Obviously I support what the government's doing here, but I think there's a touch of hypocrisy going on when they're involved in a lawsuit where they claim that wait lists are not the fault of the hospitals or themselves but the fault of the doctors," Day said. "There are two wait lists.
  • There are the patients waiting for surgery. Then there are the surgeons waiting to be able to do the surgery. ... The surgeons are waiting because they can't get operating time." Day's lawsuit is expected to last seven months and is tentatively scheduled in the B.C. Supreme Court at the end of the year. Under current laws, private clinics are not supposed to collect money from patients if the treatment is an insured service in the public system. Lake said B.C. remains fully against a two-tier health system, but the government has used private clinics in the past and considers many of its physicians to be private health care contractors.
  • B.C. is turning to private clinics to help ease a massive backlog of surgeries, even as it prepares to fight a court battle against private medicine. Health Minister Terry Lake announced $10 million on Monday to push through common surgical procedures - orthopedics, hernias, cataracts, gall bladder, plastic surgery, and ear, nose and throat procedures - for those waiting more than 40 weeks. The extra money will be used to conduct up to 1,000 new surgeries, some of which will be done in private clinics when there are no available operating rooms in public hospitals.
  • A Health Ministry official said the "cost of doing procedures in a private surgical facility is generally comparable to what it would have cost to do them in a public health care facility" but could not offer a specific comparison. There were almost 72,000 adults waiting for surgery in B.C. at the end of April. Approximately 90 per cent of patients receive surgeries within 33 weeks, according to a government website.
  • The reality is we're still struggling with wait times despite a huge increase in the number of surgeries that we are performing each and every year," said Lake. NDP critic Judy Darcy chastised the government for turning to private clinics when underfunding has left some hospital surgical rooms empty. The government estimates 82 per cent of its 295 operating rooms are fully operational, with the rest unused due to financial or staffing shortages.
  • "It's a very small Band-Aid on a very big problem," said Darcy. "It's yet another short-term fix that shifts services to private clinics rather than addressing the serious problems in the public system." If the province properly funded the public operating rooms it could help retain staff and have a better long-term impact on waiting times than short-term contracts with the private sector, she said.
  • Darcy also accused government of "talking out of both sides of its mouth" by relying on public surgical suites to knock down waiting times while at the same time fighting against them in court. Lake said the $10 million will also be used to "optimize the booking system" for surgeries, which could mean sending a patient to a hospital outside their home city if it has extra capacity in an operating room.
  • He also suggested B.C. could move to a "first available surgeon model" where patients are referred to whoever can conduct the surgery quickest rather than to a preferred surgeon. The government will announce further ways it intends to increase surgical capacity later this year. rshaw@vancouversun.com mrobinson@vancouversun.com
Govind Rao

Health authority weighs bids from three private clinics - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|vitc|20150610|222403632

from heather private clinics privatization bc surgery legislation

shared by Govind Rao on 23 Jun 15 - No Cached
  • Times Colonist (Victoria) Wed Jun 10 2015
  • Island Health is evaluating proposals from three private clinics as it works toward contracting out up to 55,000 publicly funded day procedures over the next three to five years - the health authority's largest and longest contract yet to reduce wait times. Once the contract or contracts are awarded, Island Health could be the leader in using private clinics for publicly funded day surgeries in the province. "We're looking at doing things differently and if we're out ahead and this is a success, I hope other jurisdictions follow us," said Suzanne Germain, spokeswoman for Island Health. By the May 29 deadline, Island Health had received three responses to its April request for proposals. Island Health wants private clinics to provide up to 4,000 day surgeries - everything from knee and hernia repairs to gallbladder removals - each year over a three-to five-year contract for a maximum of 20,000 procedures. Island Health is
  • also looking for a private clinic or clinics to provide up to 4,000 endoscopic procedures - colonoscopies - on the south Island and up to 3,000 endoscopies in the central Island each year over the same period for a maximum of 35,000.
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  • Norm Peters, Island Health's executive director for surgical services, estimates it will take six to eight weeks to evaluate the proposals, choose one or more preferred proponents and hammer out agreements. "We're just in the start of the review stage," Peters said.
  • Depending on what's proposed, Island Health could be awarding one contract to a single company or two contracts to different companies on the south and central Island. B.C. Health Minister Terry Lake said the use of private clinics for publicly funded day procedures is strengthening the public system by increasing the number of more complex surgeries that can be carried out in hospitals.
  • Of 541,885 publicly funded surgeries in B.C. in 2013-14, 5,503 were done in private facilities. In 2013-14, Island Health funded 160 day surgical procedures to be performed in private clinics. That was less than the previous year when Island Health contracted out 511 publicly funded procedures for adults to private clinics and 31 for children for a total of 542.
  • Interior Health contracted out the most publicly funded day surgeries in 2013-14 to private facilities - 2,053 adult procedures and 173 pediatric procedures for a total of 2,226. If Island Health goes on to fund a maximum of 10,000 procedures annually over the next five years through private clinics, the health authority will lead the province in doing so.
  • Peters said with more day surgeries, such as varicose vein procedures, being performed by private clinics, more capacity is created in hospitals to perform hip and knee procedures, which also have long wait-lists. Edition: Final
Govind Rao

Funds should be better invested in Canada's public health care system - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|bcvi|20150915|229391583

from heather bc privatization private clinics

shared by Govind Rao on 16 Sep 15 - No Cached
  • Campbell River Mirror Tue Sep 15 2015
  • Our provincial government is seeking to change the BC Health Act to permit patient stays of up to three nights in private, for profit, surgery clinics so their plan into the future is to embrace private, for profit, surgery clinics. In the provincial government's own report it states the reason why our public hospital operating rooms sit idle quite often is due to lack of funding. The government and Island Health think it is okay to contract out these surgeries because the surgeries are still being publicly funded but our taxpayer dollars will be spending more for the profit margin.
  • It is extremely concerning that our provincial government is contracting up to 55,000 surgeries to a private, for profit, surgery clinic which is yet to be built. If this company is locating in Victoria they must have received assurance for long term commitments to enable them to locate there permanently. Surgical Centres Ltd. is "based" in Calgary, they have two private, for profit, surgery clinics in Calgary, two in B.C., two in Saskatchewan. Are the owners American?
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  • Dr. Brendon Carr (president and CEO of Island Health) when asked at the Island Health Board meeting here in June stated that there will be a premium in cost for the surgeries at the private clinic. We know private, for profit, health care is more expensive. He said they have the information and would provide it, but when I wrote and asked what the difference in cost for the taxpayers between surgeries in public or private, for profit, operating rooms, Mr. Peters declined to answer the question.
  • It is extremely concerning that our provincial government is contracting up to 55,000 surgeries to a private surgery clinic Re: Deal with private contractor could reduce surgery wait times - J.R. Rardon. The above noted article was in the Aug. 26, Campbell River Mirror. Reading the headline I have to ask "but at what cost?"
  • I pointed out to Dr. Carr that we have a shortage of doctors in Canada and he agreed. He said it would be the same doctors doing the surgeries in the private, for profit, surgery clinics. I asked how they can usurp our doctors into the private system without straining our public system more. He just said they will be watching it. That doesn't bode well for our public operating rooms. I fear that our provincial government is seriously undermining our position in defending the Dr. Brian Day court case on behalf of all British Columbians. At the very least it looks like a huge conflict of interest when they are seeking to contract an enormous number of surgeries to private clinics.
  • Our provincial and federal governments seem determined to starve the public health care system in favour of private, for profit, health care. They have let the surgery wait lists increase substantially. Our federal government refused to renegotiate the Canada Health Accord and brought in a new funding formula. They are telling us they are "increasing"  funding of the transfer payments to the provinces by three per cent, tied to the cost of living. Currently they are paying six per cent annually so this actually is a massive cut to the provinces for public health care in the amount of $36 billion over the next 10 years. With the federal government's cuts to health care funding, the share of federal CHT cash payments in provincial-territorial health spending will decrease substantially from 20.4 per cent in 2010-11 to less than 12 per cent over the next 25 years. This, according to the Parliamentary Budget Office, will bring the level of federal cash support for health care to historical lows. National Medicare was implemented across Canada by provinces and territories on the understanding that the federal government would contribute roughly 50 percent of the spending on Medicare.
  • Canadians are vehemently opposed to private health care whether it is using our public tax dollars or not. Canadians should not have to suffer and wait a long time for surgery. Funds would be far better invested in the public health care system which is being starved by our governments. It is very difficult for Canadians to see our medicare in serious jeopardy. The Canadian Medical Assoc., Canadian Doctors for Medicare, Canadian Health Coalition, Council of Canadians, B.C. Health Coalition, HEU, CUPE, Citizens for Quality Health Care and many others are united to protect, strengthen and expand our public health care. Please check out their websites and get more information. Please vote in the next two elections and vote for health care for the benefit of all Canadians. Lois Jarvis Citizens for Quality Health Care Campbell River
Govind Rao

Expansion of surgeries at private clinics faces delays; Many details must be worked out... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|vasn|20150611|222488543

from heather private clinics surgery bc privatization legislation

shared by Govind Rao on 23 Jun 15 - No Cached
  • Vancouver Sun Thu Jun 11 2015
  • A provincial proposal to shrink surgical waiting times by letting private surgery clinics do more complex operations could take up to two years to implement, says the registrar of the College of Physicians and Surgeons of BC. That's because of changes to legislation that may be required to allow private facilities to keep patients for up to three nights and other changes to ensure they are more like hospitals, with security guards, full meals, a variety of health professionals, labs, imaging suites and even intensive-care units. Currently, the college allows private facilities to do procedures requiring a maximum one-night stay. "We applaud the minister of health for thinking outside the box to address the issue of access to care," said the registrar, Dr. Heidi Oetter, referring to the idea of expanding publicly funded access to private facilities. The proposal is in a Health Ministry discussion paper.
  • In an interview, Oetter said expanding the types of surgeries the province pays for at private clinics is not easy to sort out quickly. "There's a role for the private facility sector. But this requires an extensive review," said Oetter, adding it could take from 18 to 24 months. The government has set up a Surgical Services Secretariat that will work with the college on changes to laws and procedures to enable longer stays in private facilities, if that direction is chosen.
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  • While private facilities like the Cambie Surgery Centre and the Centric Health Surgical Centre (formerly False Creek Surgical Centre) consider themselves hospitals, the college makes a distinction and Oetter said private facilities are inspected and accredited for one-night stays only. "We think of them as private facilities, not hospitals. When you think of hospitals, you think of 24-hour staff, security guards, meals and so on," she said.
  • There are nearly 80,000 adults and children waiting for surgery in B.C. hospitals and median waiting times have not changed in several years despite reforms. According to the policy paper, 90 per cent of elective surgery patients got their surgery within 40 weeks in 2013/14, while the rest waited longer. In 2013/14, 5,503 publicly funded operations were performed in private facilities, down from the 7,839 cases performed in private clinics the year before. Another 541,886 scheduled (elective) operations were done in B.C. public hospitals. There are about a dozen private surgery centres in B.C. offering a range of operations, general anesthetics and overnight stays.
  • About 50,000 people pay for their procedures themselves each year in private facilities. Renee Hourigan, spokeswoman for Centric, declined to comment. Dr. Brian Day, owner of the Cambie Surgery Centre, said it would be easy to accommodate patients for longer periods and to meet any new requirements. "We're not going to hire a chef, but we already provide snacks and meals to patients. We give them menus and they choose what they want and the food is delivered."
  • Cambie has five operating rooms plus a dental procedure suite and seven private post-op recovery rooms. He said whether the facility is a hospital or not is really a matter of semantics. "Think about all the tiny community hospitals around B.C. and you can see that we are far more advanced and closest to the best hospital in B.C. Our staff are all the best you can get." Day said Cambie has been inspected and approved not only by the college but by the national body that audits and accredits hospitals - Accreditation Canada. Such accreditation isn't mandatory, but college approval is required.
  • About 700 B.C. surgeons have privileges to work at private surgery centres. Under B.C. law, any facility where surgeons work must be inspected and accredited by the college to ensure high standards of care and patient safety. Sarah Plank, a spokeswoman for the Health Ministry, said the government is analyzing what kind of cases might be suitable for funded private surgery centres. The process is in the early stages so a timeline of up to two years is "not unreasonable," she said.
Doug Allan

Hospitals left to fix 'crisis' of problems from weight-loss surgeries done at for-profi... - 0 views

news.nationalpost.com/...ies-done-at-for-profit-clinics

clinics privatization

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  • Like thousands of other Canadians struggling with obesity, the Toronto woman, helped by her mother, had paid for weight-loss surgery at a private Ontario clinic, won over by marketing that promised rapid, effortless slimming.
  • Within three years, though, she needed revision surgery after the restrictive band implanted around her stomach in 2008 slipped. Then she felt that fateful pop, followed by violent, breathtaking pain, and the clinic’s pledge of post-op care began to crumble, forcing her to visit two public hospitals for urgent help.
  • Beth spent a week in one facility before the band, which had literally fallen apart inside her abdomen, was surgically removed, all costs picked up by the provincial medicare system.
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  • Surgeons working in taxpayer-funded hospitals across the country say they are routinely helping pick up the pieces of privately performed weight-loss operations.
  • Patients show up complaining of serious complications, unpleasant side effects or just the inability to shed pounds after an investment that can top $16,000 — and limited help from the company that originally treated them.
  • An Edmonton program has estimated the cost to taxpayers of treating patients who had gastric bands implanted by for-profit clinics in Canada and out of country at millions of dollars, and suspects it has seen only the “tip of the iceberg.”
  • “I think it’s a crisis, to be honest. It may explode at some point when all these people have ongoing issues,” said Daniel Birch, an Edmonton surgeon. “It’s a tremendous cost to the patient and to the system, with no sustainable quality-of-life change.”
  • Patients typically indicate they received little support from their clinics, which seem anxious to recruit patients but less eager to provide crucial care after the operation, said David Urbach, surgical director of the Toronto Western Hospital’s bariatric unit.
  • “They privatize the profit and they socialize the losses,” he charged. “All the risk is borne by the public system.”
  • Yet the mere fact that patients are paying to undergo surgery at private clinics with uncertain success rates highlights another problem: backlogs in the public system that can force obese patients to wait years for an operation, said Dr. Birch.
  • “It isn’t just the public system that’s dealing with the complications,” the specialist said. “They [other clinics] are my nemesis, too.”
  • The problem, in fact, may not be the procedure itself. Surgeons in public hospitals say many private clinics seem to skimp on the crucial preparation and after-care needed to make any bariatric procedure work. The actual operation makes it harder to over-eat, but major diet, lifestyle and psychological adjustments are also needed.
  • “It’s very naïve to think that a simple surgical procedure will fix a complex behavioural and genetic and societal problem,” said Teodor Grantcharov, a surgeon at Toronto’s St. Michael’s Hospital.
  • In contrast, her only prep before the band was implanted was to meet with a clinic sales consultant. Afterward, she had brief visits so the device could be adjusted, a revision surgery and one appointment with a nutritionist whom she said was barely qualified.
  • A paper published in May by his team estimated the cost to the system of treating 62 patients who had problems after private weight-loss operations in other provinces or countries was $1.8 million.
  • In Toronto, Dr. Grantcharov said about 10% of the 80-100 bariatric surgeries he does every year are to take out failed bands, the majority implanted at private clinics in Canada.
  • Ontario did boost its spending on the field in 2009, and Toronto’s Dr. Urbach maintains wait lists are now a thing of the past. Dr. Birch in Alberta is unconvinced, arguing Ontario has “not even touched” the true backlog of patients who need the operation.
  • In B.C., the College of Physicians and Surgeons has tried instead to bolster the standards of the for-profit clinics. It took the rare step of imposing rules for private weight-loss surgery, requiring that they be offered only as part of a comprehensive weight-loss plan, and that clinics report long-term outcomes.
Irene Jansen

Medecins Québécois pour un Regime Public. Two-Tier Radiology: Quebec's Creep... - 2 views

www.mqrp.qc.ca

doctors quebec coalition ally private clinics

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  • Irene Jansen on 19 Nov 12
     
    Our 2012 annual report is now available in English The report shows: "While it has more material and human resources, Quebec is less effective than Canada as a whole in providing accessible medical imaging services. The exclusion from public coverage of CAT scan, MRI and ultrasound tests performed outside a hospital leads to joint public-private practice that has the effect of draining resources from the public to the private sector. This damaging distortion leads to problems of access to medical imaging for most patients…"  The report documents the inequitable, inefficient, costly and potentially unsafe utilization of medical imaging technology in Quebec's unique and highly privatized system.  One aspect, the relatively effective use of technology in hospitals compared to private clinics (which would be better yet if the system were entirely public), is clearly not limited to Quebec: "According to a 2008 study by Bercovici and Bell of public hospitals and private clinics offering MRIs in several provinces, including Quebec, the rate of use of machines is about 50% higher in hospitals than in private clinics: an average of 14.7 hours of operation per day during the week and 11.8 hours per day on weekends for hospital machines, compared to 9.7 hours per day during the week and 8.2 hours per day on weekends for machines in clinics." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645224/ The recommendations are also valuable information. 
Govind Rao

'We have the evidence ... Why aren't we providing evidence-based care?'; Mental illness... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150523|221089241

from heather mental health privatization

shared by Govind Rao on 26 May 15 - No Cached
  • The Globe and Mail Sat May 23 2015
  • It's 4:30 on a Friday afternoon at her Sherbrooke, Que., clinic and Marie Hayes takes a deep breath before opening the door to her final patient of the day, who has arrived without an appointment. The 32-year-old mother immediately lists her complaints: She feels dizzy. She has abdominal pain. "It is always physical and always catastrophic," Dr. Hayes will later tell me. In the exam room, she runs through the standard checkup, pressing on the patient's abdomen, recording her symptoms, just as she has done almost every week for months. "There's something wrong with me," the patient says, with a look of panic. Dr. Hayes tries to reassure her, to no avail. In any case, the doctor has already reached her diagnosis: severe anxiety. Dr. Hayes prescribed medication during a previous visit, but the woman stopped taking it after two days because it made her nauseated and dizzy. She needs structured psychotherapy - a licensed therapist trained to bring her anxiety under control. But the wait list for public care is about a year, says Dr. Hayes, and the patient can't afford the cost of private sessions.
  • Meanwhile, the woman is paying a steep personal price: At home, she says, she spends most days in bed. She is managing to care for her two young children - for now - but her husband also suffers from anxiety, and the situation is far from ideal. Dr. Hayes does her best, spending a full hour trying to calm her down, and the woman is less agitated when she leaves. But the doctor knows she will be back next week. And that their meeting will go much the same as it did today. In its broad strokes, this is a scene that repeats itself in thousands of doctors' offices every day, right across the country. It is part and parcel of a system that denies patients the best scientific-based care, and comes with a massive price tag, to the economy, families and the health care system. Canadian physicians bill provincial governments $1-billion a year for "counselling and psychotherapy" - one third of which goes to family doctors - a service many of them acknowledge they are not best suited to provide, and that doesn't come close to covering patient need. Meanwhile, psychologists and social workers are largely left out of the publicly funded health-care system, their expertise available only to Canadians with the resources to pay for them.
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  • Imagine if a Canadian diagnosed with cancer were told she could receive chemotherapy paid for by the health-care system, but would have to cough up the cash herself if she needed radiation. Or that she could have a few weeks of treatment, and then be sent home even if she needed more. That would never fly. If doctors, say, find a tumour in a patient's colon, the government kicks in and offers the mainstream treatment that is most effective. But for many Canadians diagnosed with a mental illness, the prescription is very different. The treatment they receive, and how much of it they get, will largely be decided not on evidence-based best practices but on their employment benefits and income level: Those who can afford it pay for it privately. Those who cannot are stuck on long wait lists, or have to fall back on prescription medications. Or get no help at all. But according to a large and growing body of research, psychotherapy is not simply a nice-to-have option; it should be a front-line treatment, particularly for the two most costly mental illnesses in Canada: anxiety and depression - which also constitute more than 80 per cent of all psychiatric diagnoses.
  • Why aren't we providing evidence-based care?" .. The case for psychotherapy Research has found that psychotherapy is as effective as medication - and in some cases works better. It also often does a better job of preventing or forestalling relapse, reducing doctor's appointments and emergency-room visits, and making it more cost-effective in the long run.
  • Therapy works, researchers say, because it engages the mind of the patient, requires active participation in treatment, and specifically targets the social and stress-related factors that contribute to poor mental health. There are a variety of therapies, but the evidence is strongest for cognitive behavioural therapy - an approach that focuses on changing negative thinking - in large part because CBT, which is timelimited and very structured, lends itself to clinical trials. (Similar support exists for interpersonal therapy, and it is emerging for mindfulness, with researchers trying to find out what works best for which disorders.) Research into the efficacy of therapy is increasing, but there is less of it overall than for drugs - as therapy doesn't have the advantage of well-heeled Big Pharma benefactors. In 2013, a team of European researchers collated the results of 67 studies comparing drugs to therapy; after adjusting for dropouts, there was no significant difference between the most often-used drugs - selective serotonin reuptake inhibitors (SSRIs) - and psychotherapy.
  • The issue is not one against the other," says Montreal psychiatrist Alain Lesage, director of research at the Douglas Mental Health University Institute. "I am a physician; whatever works, I am good. We know that when patients prefer one to another, they do better if they have choice." Several studies have backed up that notion. Many patients are reluctant to take medication for fear of side effects and the possibility of difficult withdrawal; research shows that more than half of patients receiving medication stop taking it after six months. A small collection of recent studies has found that therapy can cause changes in the brain similar to those brought about by medication. In people with depression, for instance, the amygdala (located deep within the brain, it processes basic memories and controls our instinctive fight-or-flight reaction) works in overdrive, while the prefrontal cortex (which regulates rational thought) is sluggish. Research shows that antidepressants calm the amygdala; therapy does the same, though to a lesser extent.
  • But psychotherapy also appears to tune up the prefrontal cortex more than does medication. This is why, researchers believe, therapy works especially well in preventing relapse - an important benefit, since extending the time between acute episodes of illnesses prevents them from becoming chronic and more debilitating. The theory, then, is that psychotherapy does a better job of helping patients consciously cope with their unconscious responses to stress.
  • According to treatment guidelines by leading international professional and scientific organizations - including Canada's own expert panel, the Canadian Network for Mood and Anxiety Treatments - psychotherapy should be considered as a first option in treatment, alone or in combination with medication. And it is "highly recommended" in maintaining recovery in the long term. Britain's independent, research-guided scientific body, the National Institute for Health and Care Excellence, has concluded that therapy should be tried before drugs in mild to moderate cases of depression and anxiety - a finding that led to the creation of a $760million public system, which now handles therapy referrals for nearly one million people a year.
  • In 2012, Canada's Mental Health Commission estimated that only about one in three adults and one in four children are receiving support and treatment when they need it. Ironically, anti-stigma campaigns designed to help people understand mental illness may only make those statistics worse. In Toronto, for instance, putting up posters in subway stations in 2010 had the unexpected effect of spiking the volume of walk-ins at nearby emergency rooms by as much as 45 per cent in 12 months. Dr. Kurdyak treated many of them at CAMH. The system, he says, "has been conveniently ignoring this unmet need. It functions as if two-thirds of the people suffering won't get help." What would happen if the healthcare system outright "ignored" two-third of tumour diagnoses?
  • Essentially, argues Dr. Lesage, adding therapy into the health-care system is like putting a new, highly effective drug on the table for doctors. "Think about it," he says. "We have a new antidepressant. It works as well as many others, and it may even have some advantages - it works better for remission - with fewer side effects. The patients may prefer it. And [in the long run] it doesn't cost more than what we have. How can it not be covered?" ..
  • A heavy price This isn't just a medical issue; it's an economic one. Mental illness accounts for roughly 50 per cent of family doctors' time, and more hospital-bed days than cancer. Nearly four million Canadians have a mood disorder: more than all cases of diabetes (2.2 million) and heart disease (1.4 million) combined.
  • Mental illness - and depression, in particular - is the leading cause of disability, accounting for 30 per cent of workplace-insurance claims, and 70 per cent of total compensation costs. In 2012, an Ontario study calculated that the burden of mental illness and addiction was 1.5 times that of all cancers, and more than seven times the cost of all infectious diseases. Mental illness is so debilitating because, unlike physical ailments, it often takes root in adolescence and peaks among Canadians in their 20s and 30s, just as they are heading into higher education, or building careers and families. Untreated, symptoms reverberate through all aspects of life, routinely trapping people in poverty and homelessness. More than one-third of Ontario residents receiving social assistance have a mental illness. The cost to society is clearly immense.
  • Yet, when family doctors were asked why they didn't refer more patients to therapy in a 2008 Canadian survey, the main reason they gave was cost. For many Canadians, private therapy is a luxury, especially if families are already wrestling with the economic fallout from mental illness. Costs vary across provinces, but psychologists in private practice may charge more than $200 an hour in major centres. And it's not just the uninsured who are affected.
  • Although about 60 per cent of Canadians have some form of private insurance, the amount available for therapy may cover only a handful of sessions. Those with the best benefits are more likely to be higherincome workers with stable employment. Federal public servants, notably, have one of the best plans in the country - their benefits were doubled in 2014 to $2,000 annually for psychotherapy. Many of those who can pay for therapy are doing so: A 2013 consultant's study commissioned by the Canadian Psychological Association found that $950-million is spent annually on private-practice psychologists by Canadians, insurance companies and workers compensation boards. The CPA estimates t
  • These are the patients that family doctors juggle, the ones who eat up appointment time, and never seem to get better, the ones caught on waiting lists. Sometimes, they have already been bounced in and out of the system, received little help, and have become wary of trying again. A 40-something mother recovering from breast cancer, suffering from chronic depression post-treatment, debilitated by fear her cancer will return. A university student, struggling with anxiety, who hasn't been to class for three weeks and may soon be kicked out of school. A teenager with bulimia removed from an eatingdisorder program because she couldn't follow the rules. They are the ones dangling on waiting lists in the public system for what often amounts to a handful of talk-therapy sessions, who don't have the money to pay for private therapy, or have too little coverage to get the full course of appointments they need.
  • Canada's investment does not match that burden. Only about 7 per cent of health-care spending goes to mental health. Even recent increases pale when compared to other countries: According to a study by the Canadian Mental Health Association, Canada increased per-capita funding by $5.22 in 2011. The British government, meanwhile, kicked in an extra 12 times that amount per citizen, and Australia added nearly 20 times as much as we did. Falling off a cliff, again and again
  • In Winnipeg, Dr. Stanley Szajkowski watched for months as his patient, a woman in her 80s, slowly declined. Her husband had died and she was spiralling into a severe depression. At every appointment, she looked thinner, more dishevelled. She wasn't sleeping, she admitted, often through tears. Sometimes she thought of suicide. She lived alone, with no family nearby, and no resources of her own to pay for therapy. "You do what you can," says Dr. Szajkowksi. "You provide some support and encouragement." He did his best, but he always had other patients waiting.
  • hat 30 per cent of private patients pay out-ofpocket themselves. When the afflicted don't seek help, the cost isn't restricted to their own pocketbook. People with mental-health problems are significantly more likely to abuse drugs and alcohol, and to become physically sick, further increasing health-care costs. A 2014 study by Oxford University researchers found that having a mental illness reduced life expectancy by 10 to 20 years, roughly the same as did smoking and obesity. A 2008 Statistics Canada study linked depression to new-onset heart disease in the general population. A 2014 U.S. study found that women under the age of 55 are twice as likely to suffer or die from a heart attack, or require heart surgery, if they have moderate to severe depression. The result: clogged-up doctors' offices, ERs, and operating rooms. And an inexorable burden for the patients' families forced to fill the gaps in caregiving - or carry on when they lose a loved one.
  • Patients refer to it as falling repeatedly off a cliff. And they can only manage the climb back up so many times. Family doctors interviewed for this story admitted that they are often "handholding" patients with nowhere else to go. "I am making them feel cared for, I am providing a supportive ear that they may not get anywhere else," says Dr. Batya Grundland, a physician who has been in family practice at Toronto's Women's College Hospital for almost a decade. "But do I think I am moving them forward with regard to their illness, and helping them cope better? I am going to say rarely." More senior doctors have told her that once in a while "a light bulb goes off" for the patients, but often only after many years. That's not an efficient use of health dollars, she points out - not when there are trained therapists who could do the job better. However, she says, "in some cases, I may be the only person they have."
  • Family doctors aren't the only ones struggling to find therapy for their patients. "I do a hundred consultations a year," says clinical psychiatrist Joel Paris, a professor at McGill University and research associate at the Montreal Jewish General, "and one of the most common situations is that the patient has tried a few anti-depressants, they have not responded very well, and from their story it is obvious they would benefit from psychotherapy. But where do they go? We have community clinics here in Montreal with six-to-12-month waiting lists even for brief therapy." A fractured, inefficient system
  • "You fall into the role that is handed to you," says Antoine Gagnon, a family doctor in Osgoode, on the outskirts of Ottawa. He tries to set aside 20-minute appointments before lunch or at the end of the day to provide "active listening" to his patients with anxiety and depression. Many of them are farmers or self-employed, without any private coverage for therapy. "Five of those minutes are spent talking about the weather," he says, "and then maybe you get into the meat of the problem, but the reality is we don't have the appropriate amount of time to give to therapy, even to listen, really." Often, he watches his patients' symptoms worsen over several months, until they meet the threshold of a clinical diagnosis. "The whole system could save on productivity and money if people were actually able to get the treatment they needed."
  • But these issues aren't insurmountable, as other countries have demonstrated. Britain, for instance, has trained thousands of university graduates to become therapists in its new public program, following research showing that, as long they have the proper skills, people don't need PhDs to be effective therapists. Australia, which has created a pay-for-service system, also makes wide use of online support to cost-effectively reach remote communities.
  • Except for a small fraction of GPs who specialize in psychotherapy, few family doctors have the training - or the time - to provide structured therapy. Saadia Hameed, a GP in a family-health team in London, Ont., has been researching access to psychotherapy for an advanced degree. Many of the doctors she has interviewed had trouble even producing a clear definition of therapy. One told her, "If a patient cries, than it's psychotherapy." Another described it as "listening to their woes." A 2007 survey of 163 family doctors in Ontario found that almost four out of five had not received training in cognitive behavioural therapy, and knew little about it. "Do family doctors really need to do that much psychotherapy," Dr. Hameed asks, "when there are other people trained - and better trained - to do it?"
  • What further frustrates treatment for physicians and patients is lack of access to specialists within the system. Across the country, family doctors describe the difficulty of reaching a psychiatrist to consult on a diagnosis or followup with their patients. In a telling 2011 study, published in the Canadian Journal of Psychiatry, researchers conducted a real-world experiment to see how easily a GP could locate a psychiatrist willing to see a patient with depression. Researchers called 297 psychiatrists in Vancouver, and reached 230. Of the 70 who said they would consider taking referrals, 64 required extensive written documentation, and could not give a wait-time estimate. Only six were willing to take the patient "immediately," but even then, their wait times ranged from four to 55 days. Psychiatrists are in increasingly short supply in Canada, and there's strong evidence that we're not making the best use of these highly trained specialists. They can - and often do - provide fee-for-service psychotherapy in a private setting, which limits their ability to meet the huge demand to consult with family doctors and treat the most severe cases.
  • A recent Ontario study by a team at CAMH found that while waiting lists exist in both urban and rural centres, the practices of psychiatrists in those locations tend to look very different. Among full-time psychiatrists in Toronto, 10 per cent saw fewer than 40 patients, and 40 per cent saw fewer than 100 - on average, their practices were half the size of psychiatrists in smaller centres. The patients for those urban psychiatrists with the smallest practices were also more likely to fall in the highest income bracket, and less likely to have been previously hospitalized for a mental illness than those in the smaller centres.
  • And those therapy sessions are being billed with no monitoring from a health-care system already scrimping on dollars, yet spending a lot on this care: On average, psychiatrists earn $216,000 a year. There is nothing to stop psychiatrists from seeing the same patients for years, and no system to ensure the patients with the greatest need get priority. In Australia, Britain and the United States, by contrast, billing for psychiatrists has been adjusted to encourage them to reduce psychotherapy sessions and serve more as consultants, particularly for the most severe cases, as other specialists do.
  • As the Canadian system exists now, says Benoit Mulsant, the physician-in-chief at CAMH and also a psychiatrist, the doctors in his specialty "can do whatever they please. If I wanted, I could have a roster of actor patients who tell me entertaining stories, and I would be paid the same as someone who is treating homeless people. ... By treating the rich and famous, there is zero risk of being punched in the face by a patient." Left out in all this, by and large, are other professionals who can provide therapy. It doesn't help that the rules are often murky around who can call themselves psychotherapists. While psychologists and social workers are licensed under their professional associations, in some provinces a person can call himself a marriage counsellor or music therapist with no one demanding they be certified. In 2007, Ontario passed a law to regulate psychotherapists, requiring them to register with a provincial college that would set standards and handle complaints. Currently, however, the law is in limbo, although the government has said it will finally bring it into force by December. The brain keeps many secrets
  • Science, however, has yet to find depression's equivalent of insulin. Despite being scanned, poked and stimulated over and over and over again, the brain keeps its secrets. The "chemical imbalance" theory is now viewed as simplistic at best. It may not do much for patients, either: A 2014 study published in the journal Behaviour Research and Therapy suggested that, rather than reassuring them, focusing on the biological explanation for depression actually made patients feel more pessimistic and lacking in control. SSRIs work by increasing the amount of serotonin, a chemical that helps deliver messages within the brain and is known to influence mood. But researchers aren't sure why the drugs help some patients and fail with others. "Basically, it's like we have a bucket of water and we pour it over the patient's head," says Dr. Georg Northoff, the University of Ottawa's Michael Smith chair of Neurosciences and Mental Health. "But you want a drug that injects the water in a very specific brain regions or brain system, which we don't have."
  • Critics of therapy have argued that it's basically "good listening" - comparable to having a sympathetic friend across the kitchen table - and that in the real world of mercurial patients and practitioners of varying abilities, a pill just works better. That's true in many cases, especially when the symptoms are severe and the patients is suicidal: a fast-acting medication is safer, and may even be necessary before starting talk therapy. The staunchest advocates of therapy do not suggest it should be the first course of treatment for psychosis, or debilitating chronic depression, or mania - although, in those cases, there is evidence that psychotherapy and medication work well in tandem. (A 2011 meta-analysis found that patients with severe depression who received a combination approach had higher recovery rates and were less likely to drop out of treatment.) But drugs also don't work as well as the manufacturers would like us to think. Roughly one-third of patients given a drug will see no benefit (although they often respond to a second or third medication). In randomly controlled trials, drugs often perform only marginally better than sugar pills.
  • Yet it's talk therapy that the public often views most skeptically. "Until you go to a therapist, or a member of your family has a serious psychological problem, people are unsympathetic [about therapy]," says Dr. Paris, the Montreal psychiatrist. "They are very skeptical, and they don't believe the research. It's amazing, because pharmaceutical trials will get approval for a drug on the basis of two clinical trials that they paid for. And we have 100 clinical trials and no one believes us."
  • Dr. Ajantha Jayabarathan, an assistant professor at Dalhousie University's medical school, spent her early years as a family doctor in Spryfield, N.S., trying to manage an overload of mental-health cases. Most of her patients had little insurance; there was one reduced-cost counselling service in town, but the waiting lists were long. In 2000, her group practice became a test site for a shared-care project, which gave the doctors access to a mental-health team, including weekly in-person consultations with a psychiatrist. "It was transformative," she says. "We looked after everything in-house.
  • Over time, Dr. Jayabarathan says, she learned how to properly assess mental illness in patients, and how to use medication more effectively. "I just made it my business to teach myself what to do." It's the kind of workaround GPs are increasingly experimenting with, waiting for the system to catch up. Who would pay - and how?
  • The case for expanding publicly funded access to therapy is gaining traction in Canada. In 2012, the health commissioner of Quebec recommended therapy be covered by the province; it is now being studied by Quebec's science-based health body (INESSS), which is expected to report back next year. A new Quebec-based organization of doctors, researchers and mental-health advocates called the Coalition for Access to Psychotherapy (CAP) is lobbying the government.
  • In Manitoba, the Liberal Party - albeit well behind in the polls - has made the public funding of psychologists one of its campaign platforms for the province's spring 2016 election. In Saskatchewan, the government commissioned, and has since endorsed, a mental-health action plan that includes providing online therapy - though politicians have given themselves 10 years to accomplish it. Michael Kirby, the former head of the Canadian Mental Health Commission, has been advocating for eight annual sessions of therapy to be covered for children and youth in need.
  • There are significant hurdles: Which practitioners would provide therapy, and how would they be paid? What therapies would be covered, and for how long? Complicating every aspect of major mentalhealth change in Canada is the question of who should shoulder the cost: the provinces or Ottawa. In a written statement in response to questions from The Globe and Mail, federal Health Minister Rona Ambrose lobbed the issue back at her provincial counterparts, pointing out that the Canada Health Act does not "preclude provinces and territories from extending public coverage to other services or providers such as psychologists."
  • One result can be overloaded family doctors minimizing mental-health problems. "If you have nothing to offer someone," asks Dr. Anderson, "how much are you going to dig around to find out what is going on?" Some doctors also admit that the lack of resources can lead to physicians cherry-picking patients who don't have mental illness. And yet family physicians alone bill about $361million a year for counselling or psychotherapy in Canada - 5.6 million visits of roughly 30 minutes each. This is a broad category, and not always specifically related to mental health (some of it includes drug counselling, and a certain amount of coaching is a necessary part of the patient-doctor relationship). When it is psychotherapy, however, doctors admit it's often more supportive listening than actual therapy.
  • So how would Canada pay for access to such therapy? It wouldn't be cheap, in the short term. The savings would come from what Canadians would not have to spend in the long term: in additional medical and drug costs, emergency-room visits and hospital stays, and in unnecessary disability payments, to say nothing of better long-term health outcomes for patients given good care earlier. Some of the figures being tossed around sound staggering. Rolling out a version of Britain's centre-based program across Canada would cost $950-million. Michael Kirby's plan would amount to $1,000 annually per patient. A 2013 report commissioned by the Canadian Psychological Association calculated that, based on predicted need, and assuming no coverage from private health-care plans, providing an average of six sessions of therapy a year would cost an estimated $2.8-billion annually.
  • But any of those figures would still be a fraction of the roughly $210-billion that Canada spends annually on health care. Figuring out how to make the system most costeffective is, according to sources, currently delaying the INESSS report to the Quebec government. "You need to facilitate the government," says Helen- Maria Vasiliadis, a professor of community health at the University of Sherbrooke. "You can't be going to policymakers and showing them billions and billions of dollars. People start having heart attacks. With evidence in hand, we have to present possible solutions."
  • An insurance-based plan is the proposal that has emerged from the Quebec-based CAP group, which sent its proposal to Quebec's health minister last month. In its design, the system would work much like Quebec's public drug plan - Quebeckers not covered through work plans would contribute to a provincial insurance program for therapy. That would be similar to the system that Germany has used for decades. One step forward, one step back
  • Last year, the Sherbrooke clinic where Marie Hayes works received provincial funding for a part-time psychologist and a full-time social worker. With a roster of 25,000 patients, the clinic team laid out clear guidelines for the psychologist, who would consult on cases and screen patients, and be limited to a mere four sessions of actual counselling with any one patient. "We wanted to be careful she didn't become a waiting list - like everything in the system," says Dr. Hayes. The social worker helps guide patients into services such as housing and addiction counselling. They have also offered group sessions for depression management at the clinic. As stretched as those new professionals are in such a large practice, Dr. Hayes says the addition of that mental-health team is improving the care she can provide patients. Recently, for instance, the 32- year-old mother with anxiety attended sessions with the psychologist. "She is making progress," says Dr. Hayes, "slowly."
  • At Women's College Hospital in Toronto, Dr. Grundland is not so lucky. Asked to describe a difficult case, the family-practice physician mentions a patient suffering from depression after a lifechanging accident. Every month, doctor and patient would repeat the same conversation they'd already had more than a dozen times - and make little real headway. Her patient, says Dr. Grundland, needs a trained therapist: someone she can see regularly, to help her move past her frustration, counsel her about addiction, and ease the burden on her family.
  • But there's no extra money in the patient's budget for a psychologist. "I do my best," Dr. Grundland says, "but it's not my area of expertise." Meanwhile, the patient isn't getting better, and in the time that it takes to make it through one appointment with her, Dr. Grundland could see three other people with problems she was actually trained to treat. "But," says Dr. Grundland, "she has nowhere else to go." Erin Anderssen is a feature writer at The Globe and Mail. OPEN MINDS How to build a better mental health care system
  • The Centre for Addiction and Mental Health has purchased advertisements to accompany this series. While CAMH professionals are quoted in this story, the organization had no involvement in the creation or production of this, or any other story in the series. $20.7-billion The cost, according to a 2012 Conference Board of Canada report, of lost productivity each year due to mental illness. What else does $20-billion represent?
  • $20B: Canadian spending on national defence, 2012-13 $20B: Market valuation of Airbnb, 2015 $21B: Kitchener-CambridgeWaterloo region's GDP, 2009 $21B: Amount food manufacturing contributed to the economy, 2012
Govind Rao

User fees threatened for patients across Canada if court challenge negotiations fail to... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|wcnw|20140929|205044899

from heather private clinics privatization ontario bc court coalition

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  • Canada Newswire Mon Sep 29 2014
  • TORONTO, Sept. 29, 2014 /CNW/ - As Ontario's new Health Minister Dr. Eric Hoskins sits down with provincial and territorial Health Ministers for their fall meeting this week, experts and patient advocates hope that he'll carry a strong message. Across Canada advocates are calling on the B.C. Health Minister to hang tough on the Medicare court challenge which threatens open season on patient user fees for surgeries, diagnostics and other procedures. The case was scheduled to begin on September 8, but lawyers for both Brian Day, owner of one of the largest private clinics in Canada, and the B.C. government asked the court for a delay in order to negotiate a settlement. Negotiations are now happening behind closed doors and the court date is delayed until March 2015.
  • Following a provincial audit in 2012 which revealed that Day was charging hundreds of thousands of dollars in unlawful user fees to patients, Day filed a Charter Challenge to nullify the laws that he was violating. His case aims to bring down the laws that protect single-tier Medicare and forbid clinics like his from extra-billing patients and charging user fees for care that currently must be provided without charge under the public health care system. The litigation has far-reaching implications for the entire country. Day's clinics were first exposed by patients who complained they were unlawfully billed for medical procedures. The B.C. government responded by trying to audit the clinics. Day refused to let in auditors until forced by a court order, and even then the clinics did not fully comply with auditors. Auditors had access to only a portion of the clinics' billings and only one month's worth of data. Nevertheless, what they found was astonishing. In a period of about 30 days, patients were subject to almost half a million dollars in user charges. The five patients who brought the initial legal petition have had their trial delayed while Day's Charter Challenge to the laws upholding single-tier Medicare is heard. They are still waiting for redress.
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  • "In order to protect patients, the B.C. government must hold private clinic owners and operators accountable when they break the laws prohibiting extra-billing and user fees," said lawyer Steven Shrybman, a partner at Sack Goldblatt Mitchell who is acting for the B.C. Health Coalition and Canadian Doctors for Medicare, intervenors in the court challenge. Shrybman is well-known for his successful Supreme Court challenge against Ontario's attempted sale of Hydro One and the recent election fraud cases in Federal Court. "Though the challenge was launched in British Columbia, it has the potential to bring two-tier care to Canadians across the country," he warned. "Advocates of public health care from Ontario and across the country are calling on the B.C. government to take a tough stand in these negotiations. These are the laws that uphold Medicare and defend patients," said Dr. Ryan Meili, Vice-Chair of Canadian Doctors for Medicare. "A simple slap on the wrist encourages more violations in provinces from coast to coast."
  • The problem is already creeping into Ontario, according to Natalie Mehra, executive director of the Ontario Health Coalition, where the government is proposing to expand private clinics. "Patients are being confused by private clinic operators who are manipulating them into paying thousands of dollars for health care services that they have already paid for in their taxes," she warned. "The public should know that you cannot be charged by a doctor or private clinic operator for surgery, diagnostic tests or any other medically necessary hospital or physician service. Extra user fees charged to sick and elderly patients are unlawful and immoral and governments should be delivering that message." Advocates warned that this court case should also raise alarm bells in Ontario's government about the dangers of private clinics. At risk is our public health system in which access to health care is based on need, not wealth. SOURCE Ontario Health Coalition
Govind Rao

Island Health lining up deal for 55,000 day procedures; Contract with Calgary firm woul... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|vitc|20150827|227964670

from heather bc private clinics privatization

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  • Times Colonist (Victoria) Thu Aug 27 2015
  • Island Health is hammering out a deal with a Calgary-based company to contract out up to 55,000 publicly funded day procedures to reduce wait-lists over the next three to five years. In coming weeks, the health authority aims to conclude contract negotiations with Surgical Centres Inc., which operates Nanaimo's Seafield Surgical Centre, as well as clinics in New Westminster, Regina, Saskatoon and Calgary.
  • Norm Peters, Island Health's executive director for surgical services, said the two sides are completing details for volumes of surgeries, types of procedures, location and timelines. "We are optimistic that we'll have something going in early 2016," Peters said Wednesday. Once the contract is signed and the space is leased, renovated and equipped, the facility must be accredited by the College of Physicians and Surgeons of B.C. In April, Island Health requested proposals for private clinics to provide up to 4,000 day surgeries - such as hip, knee, shoulder and hernia repairs, varicose vein procedures, and gall-bladder removals - each year over a three-to five-year contract for a maximum of 20,000 procedures.
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  • It was also looking for a private clinic to provide up to 4,000 colonoscopies on the south Island and up to 3,000 in the central Island each year over the same period, to a maximum of 35,000. The preferred lease site for the Victoria clinic is believed to be the five-storey professional office building in the new $100-million Eagle Creek Village.
  • The site, at Helmcken Road and Watkiss Way near Victoria General Hospital in View Royal, is being developed by Vancouverbased Omicron. Jessica Ng, Omicron's development manager, confirmed it's in negotiations with the Surgical Centres to lease out 15,000 square feet on the third floor of the professional office space. "Hopefully, they choose us as a preferred location," Ng said. The preferred site must meet the requirements of the College of Physicians and Surgeons of B.C. and be near a hospital for the convenience of patients, staff and doctors, Peters said.
  • "That does narrow it down to a few locations," he said. The proponent has confirmed the site would be ready to meet Island Health's timelines, Peters said. The B.C. Health Ministry, as outlined in a document called Future Directions for Surgical Services in B.C., is moving toward shifting appropriate publicly funded day surgeries to private clinics.
  • It is also exploring ways to allow stays of up to three days as part of a long-term strategy to manage wait-lists in the province. Overnight stays would require changes to the Hospital Act. Peters said overnight stays won't be part of this contract. "There is a desire provincially to look at that as a future stage, but that is not part of this initial contract with the preferred proponent." Island Health began awarding contracts for day surgeries to private clinics in 2004.
  • The NDP has said Island Health's call for contracts is an entrenchment of stop-gap measures where use of private clinics to reduce wait times drains funding, doctors and nurses from the public to the private system. "It's a worrisome trend," NDP critic Judy Darcy said when the plan to contract out was announced. She called the contract a short-term fix and just the tip of the iceberg in the move toward long-term privatization.
  • Peters said contracting out day procedures to private clinics saves Island Health millions in capital costs, reduces wait times for day surgeries, and opens up hospital operating room time for more complex surgeries. "This is not the privatization of health-care services," Peters said. "This is a benefit overall to not only those people waiting for surgery but it's a cost-effective way of delivering health care so we can invest in other areas." Of 541,885 publicly funded surgeries in B.C. in 2013-14, 5,503 were done in private facilities. ceharnett@timescolonist.com
Heather Farrow

Kenney, Hoffman spar over private health care option; PC leadership hopeful calls for m... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|cahr|20160816|253937793

conservatives privatization private clinics

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  • Calgary Herald Tue Aug 16 2016
  • Oh, no. We're into it again - back to the endless, arid Alberta debate on public versus private health care. Jason Kenney, the early bird unofficial Progressive Conservative leadership candidate, said Monday he thinks Albertans deserve more health options, on the models of Quebec and British Columbia. Kenney was answering questions about the Herald story that revealed MRI wait times in Calgary are up 20 per cent. Too many people are on the list who don't belong there, and the machines are idle too much of the time. "I think there needs to be more flexibility in the way the system is administered," Kenney told the CBC's David Gray.
  • "It means allowing people more options like the model in Quebec, which is universal and complies with the Canada Health Act." The interviewer asked if that means more private care. "As long as it's competition within the public system and everybody gets access to quality health care, I don't see any reason why Albertans should have less
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  • choices than British Columbians or Quebecers do," answered Kenney. Health Minister Sarah Hoffman has an answer: if Kenney wants a policy brawl over the injection of more private options, he's welcome to it. "I'm not surprised that he's trying to find ways to expand privatization in the health-care system," she said in an interview. "Certainly, that's unfortunate." As you'd expect from a federal Conservative, Kenney blames centralized decision-making. "I just believe that local management of resources is a lot more sensible than hyper-centralized control," he told the Herald. "You know, when hospitals are given a limited budget for a limited number of hours they can service people, that gets out of alignment with the actual local demand."
  • But Hoffman figures Albertans don't want another major shift in how health care is run, after watching a pack of failed experiments in the PCs' waning years. She has doctors and officials working on two related problems - how to get more use out of the city's publicly owned MRI machines, and how to make sure everyone on the list really needs the test. I asked if she eventually plans to fold the province's vast array of private clinics, including imaging centres, under the government wing through public ownership.
  • We're not planning on doing a full overhaul," she said. "In general, Albertans are proud of what we've got. I don't have any drastic plans for changing the way those programs are administered." As often happens, when you sift through the rhetoric the opponents are quite close together. Most New Democrats would agree with another Kenney statement (as long as they're weren't aware who said it): "We need to ensure our health care has adequate funding, that it's publicly administered, that it's universally available, that it complies with the Canada Health Act." The key point is not who owns the assets, but who pays the bill. If health care pays, it hardly matters whether you get the test in a public hospital or a private clinic.
  • The MRI dispute is a good example of how the public-private debate has become so futile and misleading. Nine MRI machines in Calgary are publicly owned. They perform the tests for people on the waiting list. But there are also three MRIs in privately owned clinics.
  • The province doesn't fund MRI tests in those private clinics. The PCs wouldn't, and now the NDP won't either. And yet, health care funds virtually every other imaging test, including X-rays, ultrasounds and mammograms. Those exams are done every day in the very same clinics that own the private MRIs. The cost of a private test is $750, which probably explains why those machines are underused despite the long public wait.
  • Simple answer, right? The province should just start funding tests on the private MRIs. Asked why she doesn't do that, Hoffman says, "Why would you pay to rent something when you already own it and you're only using it half the time?" OK then, why not use what you've got? Why does that have to be so ridiculously difficult? Health care in Alberta is extraordinarily complex, and because of that, far beyond the reach of simplistic rhetoric about private and public delivery. That debate is just a distraction from the real issue - making the system work. Do that, please. Don Braid's column appears regularly in the Herald dbraid@postmedia.com
Govind Rao

Private-public partnerships a misplaced fascination - Infomart - 0 views

www.fpinfomart.ca/...210311455

from heather p3 ontario fraud

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  • Waterloo Region Record Fri Dec 12 2014
  • Ontario's Liberal government has an almost pathological desire to involve the private sector in public business. When awarding contracts for new power plants, it has favoured private electricity firms over publicly owned Ontario Power Generation. It insists that large-scale public construction projects, such as hospitals, be handled by private firms paid from the public purse. It is anxious to contract out the delivery of public medicare services to private clinics. For a while, it even privatized regulation, giving industry groups the authority to charge consumers fees for handling electronic and other kinds of waste. In one notorious case, the Liberal government established an arm's-length public agency called Ornge to run the province's air ambulance service. Then, inexplicably, it allowed this agency to set up a web of privately owned, profit-making subsidiaries. Finally, someone has blown the whistle.
  • On Tuesday, provincial auditor general Bonnie Lysyk zeroed in on just one element of the pathology - the government's overweening urge to have private-sector firms design, fund, construct and manage public projects. The government refers to these as alternative financing and procurement schemes. It says they save taxpayers money. Do they? Lysyk looked at 74 public-private projects started since 2005 to answer that question. She found that, in total, they cost $8 billion more than if they had been built and managed by the government alone. In one telling example, she looked at the construction of two near-identical buildings for an unnamed Mississauga college. The first, handled by the public sector, was completed on time and on budget. Over the objection of both the college and then mayor Hazel McCallion, the government decreed that the second building be funded and handled by a private project manager. When the figures are adjusted for inflation and other variables, that second building is expected to cost taxpayers 10 per cent more per square foot. The reason is straightforward. Big projects are always built with borrowed money. And governments can borrow far more cheaply than private firms.
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  • Private project managers also tend to charge higher legal and management fees. As well, they must return profits to their owners. Aficionados of public-private partnerships insist that while all of this may be true, privately managed projects are far more likely to come in on time and under budget. That is the argument used by Infrastructure Ontario, the body charged with handling public-private deals. It says that if the 74 projects had been handled by the public sector, delays and overruns would have cost taxpayers - in net terms - about $6 billion more. It also says that publicly managed projects are five times more likely to come in over budget than privately managed ones. Is any of this true? Lysyk is not convinced. She points out that Infrastructure Ontario has no empirical evidence to back up its claims and instead bases them on the judgment of outside advisers who, her report says, make their case "anecdotally" and tend to cast publicly managed projects "in a negative light." She also notes that Infrastructure Ontario's initial cost estimates for public-private partnerships are systematically inflated. One result (which she is too polite to mention) is that private-public schemes usually appear to come in under budget. That makes everyone look good.
  • The Liberals may be the grand priests of private-public partnerships. But they are not the only ones to embrace this particular theology. In the 1990s, Bob Rae's New Democratic Party government famously arranged for a private consortium to finance, build and operate Highway 407, largely to avoid saddling the province with $1 billion more in debt. Yet in the end, the Rae government had to borrow the $1 billion itself - and then pass it on to the consortium. The private-sector partners just couldn't raise the cash as cheaply. Little has changed since then. On the face of it, public-private partnerships seem a good way to save money. In reality, as Lysyk has confirmed, they usually cost taxpayers more. Thomas Walkom is a news services columnist.
Govind Rao

Private clinics under fire for charging 'block fees' - 0 views

www.ottawacitizen.com/story_print.html

from heather private clinics clinics fees Ontario

shared by Govind Rao on 07 Oct 13 - No Cached
  • Private clinics under fire for charging ‘block fees’  By Elizabeth Payne, OTTAWA CITIZENOctober 2, 2013
  • The closure of the Ottawa Hospital’s endoscopy clinic at its Riverside campus earlier this year — which saved the province $1 million — means private clinics are handling growing numbers of procedures such as colonoscopies,
  • Patients at some Ottawa endoscopy clinics are being asked to shell out $80 in block fees before undergoing medical procedures that are covered by OHIP. It’s part of a trend that, critics say, pushes ethical boundaries and violates the principles of the Canada Health Act.Natalie Mehra of the Ontario Health Coalition, a network of health activist groups, says block fees represent the “creeping introduction of user fees” into the health system, something that is increasingly common and has accelerated with the transfer of medical procedures from hospitals to private clinics.In Ottawa, the closure of the Ottawa Hospital’s endoscopy clinic at its Riverside campus earlier this year — which saved the province $1 million — means private clinics are handling growing numbers of procedures such as colonoscopies, a key cancer prevention tool. Many private clinics charge no additional fees, but at least two Ottawa clinics do.
Govind Rao

Patient-rights group demands say in changes to medical fees; No one on government commi... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|mtgz|20150619|223082131

from heather Quebec private clinics privatization doctors primary care

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  • Montreal Gazette Fri Jun 19 2015
  • Patients are being frozen out of the Quebec government's plans to approve new medical fees that doctors will be able to levy in private clinics, a patient-rights association charged Thursday. The Alliance des patients pour la santé, representing 1.5 million Quebecers with chronic illnesses, is demanding that it be included in a government committee that will determine which so-called accessory fees will be approved. The committee is to include representatives from the Health Department, the medical federations and an independent expert - but not patient advocates.
  • "We deplore the absence of patients in this decision-making process," said Michel Roy, an association spokesperson. "The perspective of patients' needs to be taken into account in this whole debate, and that hasn't happened so far." Joanne Beauvais, Health Minister Gaétan Barrette's press attaché, was unavailable to comment on the alliance's request.
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  • However, Barrette issued a statement Thursday saying that the goal of his proposed amendment to the medicare law is to end the "abuse" of incidental fees that some private clinics have been billing patients. In some cases, patients have been charged almost $200 for eye drops. But Barrette will also make it possible for some private clinics to charge fees that would now be considered illegal. "We believe that the amendment that will be debated ... constitutes a balance between the protection of the public against excessive fees and the preservation of services that are provided in private clinics," Barrette said in the statement. "The clinics that offer these services have always been part of the health and social services (network), and it would be irresponsible on our part to act in such a way that could lead to their closing."
  • But Roy countered that accessory fees are a form of two-tier medicine, allowing some patients with private insurance to bypass lengthy waits in the public system by going to private clinics. He noted that the government already subsidizes many private clinics, and there is no reason for patients to be charged extra. François Loubert, co-president of the Association des cliniques médicales du Québec, acknowledged that doctors who bill the medicare board for certain procedures in a private clinic do get paid more than if they carried out the same medical act in a hospital. He cited as an example a $40 fee for a type of consultation that a doctor in private practice can bill the Régie de l'assurancemaladie du Québec. For the same consultation in a hospital, the doctor could bill RAMQ only $25.
Heather Farrow

[Friends of Medicare urge provincial government to legislate against private donor-paid... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|prpw|20160923|256518363

Alberta coalition cbs private clinics privatization

shared by Heather Farrow on 20 Sep 16 - No Cached
  • Prairie Post West Fri Sep 23 2016
  • Friends of Medicare urge provincial government to legislate against private donor-paid plasma collection By Rose Sanchez Southern Alberta Officials with the Friends of Medicare and BloodWatch.org were on a five-city tour of Alberta last week, in an effort to raise awareness about private, for-profit donor-paid plasma collection in the country. Both organizations would like to see a voluntary plasma collection system in Canada done through Canadian Blood Services, and provincial and territorial governments pass legislation to ensure private, for-profit donor-paid plasma "brokers" can't set up shop. About 40 people were in attendance at the Lethbridge stop on Sept. 12, while only a half dozen made it out to the Medicine Hat meeting Sept. 13. "It's sad that we have to have this discussion after what we've learned from the tainted blood scandal of the 1980s. We need to remind Canadians the importance of what happened back then," said Sandra Azocar, executive director of the Friends of Medicare (FOM). "Blood and plasma collection must remain voluntary and public and not be contracted out to anyone else."
  • Earlier this year, officials with FOM caught wind that Canadian Plasma Resources (CPR) was exploring the possibility of opening private, for-profit donor-paid plasma clinics in Alberta. CPR attempted to open a clinic in Ontario a few years ago, until the provincial government there, after a strong public lobby, introduced legislation to stop it from setting up shop. Friends of Medicare officials took their concerns about this to the provincial health minister. "We've been asking since that initial meeting, for (the provincial government) to put in legislation banning the practice for paid-for-plasma clinics," said Azocar. "We all know (free) markets work well, but it does not work well in health-care ... Friends of Medicare supports a publically-regulated, not-for-profit voluntary blood collection system in Canada." Azocar said private for-profit, donor-paid plasma collection needs to be banned in provincial law across Canada, as it has already been in both Ontario and Quebec.
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  • Kat Lanteigne, executive director for BloodWatch.org and writer of the play Tainted based on three-years of research about the tainted blood scandal, travelled to Alberta to help spread the message about concerns about private, donor-paid plasma collection. Lanteigne said these types of clinics had started to show up in Ontario in the last few years. "This is a big-pharma push," she said. "If they can build a clinic and get a licence from Health Canada then they can open without the province's permission." She said that the private sale and collection of blood and plasma introduces risk into the system. She also dispelled another myth that plasma is being imported into the country. She said that is not the case, as about 70 per cent of the drugs produced from plasma is what is being imported. When successful in the fight to get Ontario to legislate against private, donor-paid plasma collection at the end of 2014, and because Quebec has a similar law, Lanteigne said they made the mistake of thinking that because the largest provinces in Canada had done this, the rest of the provinces would follow suit.
  • Instead, as part of one of her first decisions, the new federal Liberal Health Minister approved CPR opening a clinic in Saskatchewan. Lanteigne says the Saskatchewan government, led by Premier Brad Wall, then approved the private, donor-paid plasma collection business to open in Saskatoon, "in between a pawn shop and a pay-day loan company." "This collection facility is a blood broker. They are literally a middle man Ñ a source to get profits. "We're asking the provinces and territories to pass voluntary blood donation acts which adds blood and plasma to their existing human tissue acts ..." Lanteigne explained. There is a lot of information on the BloodWatch.org website about the issue, including an informative timeline. The organization also has a Heart Watch rating system. Alberta currently has three hearts and Lanteigne would like to see that increase to five. "Saskatchewan has broken our hearts," she adds.
  • Kim Storebo, CUPE Local 46 president who works with Canadian Blood Services (CBS), also spoke at the event. She said CUPE supports a public, voluntary-based blood system in Canada, adding CBS needs to increase the number of its own plasma collection sites. The organization has been slowly closing locations since 2012. "There is no evidence the collection of plasma from paid donors will create self-sufficiency," she said. "Under no circumstances should there be payment of blood plasma donors with cash or cash-in-kind equivalents." The union wants to see blood and plasma collection remain the sole responsibility of Canadian Blood Services and for the organization to expand its plasma collection and its work hours and ensure stable and consistent hours for its employees. As part of the wrap-up of the Alberta tour officials with FOM, BloodWatch.org and CUPE presented an online SumOfUs petition with more than 15,000 signatures to provincial health minister Sarah Hoffman asking for all provincial governments to "implement legislation that ensures no for-profit, donor-paid blood plasma collection clinics are allowed to operate in Canada." Azocar assured those at the meetings that Friends of Medicare would continue to lobby the Alberta government this fall and next spring during the Legislature sittings.
Govind Rao

Ontario Council of Hospital Unions - defending healthcare in every community - 0 views

www.ochu.on.ca

from heather cupe Ontario private clinics privatization

shared by Govind Rao on 17 Sep 13 - No Cached
  • Request for an inquest was denied; Family sues hospital for son's death, Sept. 12 Toronto Star - Mon Sep 16 2013 Family sues hospital for son's death, Sept. 12
  • the Ontario Council of Hospital Unions (OCHU), which represents front-line staff at St. Joseph's in Hamilton where the death occurred, publicly called for an inquest.
  • To target health care workers and take away their right to choose by making the flu shot mandatory, is misdirected in the face of recent evidence that 41 per cent of people who get a flu vaccine receive no protection against the flu,” says Michael Hurley the president of the Ontario Council of Hospital Unions (OCHU).
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  • Mandatory flu shot for health staff misdirected November 2, 2012To save lives, prevent thousands of needless deaths stop provincial policies that cause medical errors, bed sores and superbug ... [Read More]infections
  • Mandatory Flu Vaccinations for Health Care Workers CUPE encourages health care workers to get an influenza vaccination if they can safely do so. But making flu shots mandatory for health care workers is a serious intrusion on the freedom and personal autonomy of health care workers that may sometimes have detrimental effects on their own health.Forcing people to take flu shots against their will may well undermine public confidence in vaccination programs, even vaccination programs with an excellent results and high safety standards.
  • Govind Rao on 16 Oct 13
     
    Union calls for halt to move procedures from hospitals to private clinics Submission by the Ontario Council of Hospital Unions / CUPE on the Proposed amendment to O. Reg. 264/07 made under the Local Health System Integration Act, 2006 and A Regulation under the Independent Health Facilities Act - Prescribed Persons .  The Ontario Council of Hospital Unions / CUPE represents 30,000 workers in hospitals across the province, including Registered Practical Nurses, service workers, and administrative workers. We are opposed to the government’s plan to move surgical, diagnostic, and other work from public hospitals to private clinics. Our objections can be summarized as falling within seven distinct areas: 1] Quality • Even minor operations can go wrong. We believe that, in contrast with hospitals, it is unlikely private clinics will be able to handle emergencies and that they will likely simply call EMS. Will ambulances be able to move patients to hospitals when things go wrong? (We say “when” advisably, as sooner or later there will be problems.) Indeed, private surgical clinics first came to public attention when a patient died and the paramedics arrived to find a patient with no vital signs. Is it appropriate to establish a system that inherently requires extra time to effectively treat patients who fall into emergency situations? This is particularly troubling as underfunding and restructuring have challenged EMS response times. The government and government officials must be prepared to accept responsibility for such deaths if this plan is approved. 
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