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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

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

www.fpinfomart.ca/...223358003

from heather NL privatization union

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

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

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

from heather NB hospital food cuts

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

Province in talks with health-care contractor; union raises concerns - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|nbml|20150923|229859350

from heather NB hospital privatization cupe

shared by Govind Rao on 23 Sep 15 - No Cached
  • Miramichi Leader Wed Sep 23 2015
  • The province expects to have completed talks with a private contractor for the management of health-care cleaning and food services before the end of the year. Bruce McFarlane, Health Minister Victor Boudreau's director of communications, said that the province is "still in current discussions with the preferred proponent and we hope to have completed the process sometime this fall." McFarlane sent The Daily Gleaner an email statement Friday afternoon after the New Brunswick Council of Hospital Unions CUPE local 1252 released a 20-page document critical of the government's plan to privatize housekeeping, food services and porter services at hospitals. "We want to clarify that we are only outsourcing the management of the services," said McFarlane, who added that the ministry had not yet received the document.
  • CUPE staff will remain in their union and will continue to be employees of the Province of New Brunswick." Norma Robinson, president of CUPE Local 1252, said she is "very concerned that the Liberal government is negotiating with a private firm to take over the management of food and cleaning services in the province's hospitals." Robinson said she's worried the move could lead to further privatization. In an interview with Brunswick News in April, Boudreau said the government wants to give the private sector a greater role in the province's health-care system.
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  • Boudreau has said the move will save the province millions of dollars through efficiencies brought in by a private company. However, the union's document paints a poor picture of privatization of services in health-care facilities in other jurisdictions. "We believe it is important for New Brunswickers to understand the impact of such a move, especially when it comes to the cleanliness of a building which the public relies on everyday," Robinson said. Last year, the Horizon Health Network started a regular audit of the cleanliness of hospitals being serviced by unionized public sector workers. Auditor General Kim MacPherson reported that health-care workers weren't cleaning their hands as required and that the standards to do so weren't even the same within the two regional health authorities.
  • Robinson said Friday that policies have been established and changes made that are addressing cleanliness concerns. "And they have improved on their targets of cleaning in the hospital sector," she said. The union claims its research into the three companies they believe are being considered to take over those services - Sodexo, Aramark and Compass - shows a poor track record. The union said it's also concerned about the quality of food declining. The union wants to keep the management of hospital environmental services in-house. It also wants fair wages and benefits for cleaning and food services staff to ensure against high turnover and gaps in training. The union also stated lay-offs and staff reductions would be a poor way to balance the budget.
  • "The cost associated with treating hospital-acquired infections, managing public relations fiascoes and defending lawsuits would defeat any possible savings while destroying the public trust." The Province of New Brunswick expects to have completed talks with a private contractor for the management of health-care cleaning and food services before the end of the year.
  • Bruce McFarlane, Health Minister Victor Boudreau's director of communications, said Friday that the province is "still in current discussions with the preferred proponent and we hope to have completed the process sometime this fall." McFarlane sent The Daily Gleaner an email statement Friday afternoon after the New Brunswick Council of Hospital Unions CUPE local 1252 released a 20-page document critical of the government's plan to privatize housekeeping, food services and porter services at hospitals. "We want to clarify that we are only outsourcing the management of the services," said McFarlane, who added that the ministry had not yet received the document.
  • "CUPE staff will remain in their union and will continue to be employees of the Province of New Brunswick." Norma Robinson, president of CUPE Local 1252, said she is "very concerned that the Liberal government is negotiating with a private firm to take over the management of food and cleaning services in the province's hospitals." Robinson said she's worried the move could lead to further privatization. In an interview with Brunswick News in April, Boudreau said the government wants to give the private sector a greater role in the province's health-care system.
  • Boudreau has said the move will save the province millions of dollars through efficiencies brought in by a private company. However, the union's document paints a poor picture of privatization of services in health-care facilities in other jurisdictions. "We believe it is important for New Brunswickers to understand the impact of such a move, especially when it comes to the cleanliness of a building which the public relies on everyday," Robinson said. Last year, the Horizon Health Network started a regular audit of the cleanliness of hospitals being serviced by unionized public sector workers. Auditor General Kim MacPherson reported that health-care workers weren't cleaning their hands as required and that the standards to do so weren't even the same within the two regional health authorities.
  • Robinson said Friday that policies have been established and changes made that are addressing cleanliness concerns. "And they have improved on their targets of cleaning in the hospital sector," she said. The union claims its research into the three companies they believe are being considered to take over those services - Sodexo, Aramark and Compass - shows a poor track record. The union said it's also concerned about the quality of food declining. The union wants to keep the management of hospital environmental services in-house. Calls made to Sodexo, Aramark and Compass were not returned by press time.
Govind Rao

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

www.fpinfomart.ca/...210311455

from heather p3 ontario fraud

shared by Govind Rao on 12 Dec 14 - No Cached
  • 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

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

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

from heather waits specialty clinics privatization private clinics

shared by Govind Rao on 01 Sep 15 - No Cached
  • The Globe and Mail Mon Aug 31 2015
  • Four-year-old Eddie Hopkins is focused on a game of I spy. The object of his attention is a tube of lipstick in a picture. Can he say what it is? "Lipstick," he says, but it sounds more like "lit-git." Maybe lipstick is too hard. Can he say stick?
  • "Sti-ck," he says, hesitating before the k sound. One more try. "Sti-ick!" he shouts confidently, dividing the word into two. It seems like a small accomplishment, but for Eddie, it's the first and major step toward speaking normally. Like tens of thousands of children in Ontario, Eddie is in need of speech therapy. He has problems pronouncing the hard k sound, known as an unvoiced velar stop. He often switches it with the voiced velar stop, which most people know as the soft g sound, bringing him from "stick" to "stig." He also switches his sh and s sounds, and has issues with pronouncing two consonants together, such as the "cl" in "clown."
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  • The average number of people on wait lists as of May, 2015, is 611. Some regions have shorter wait lists, such as Toronto Central, which currently has zero. Others are in the four digits, such as the Central East CCAC, which stretches east from Victoria Park Avenue in Scarborough and north to Algonquin Park, and has 1,516 children waiting for speech therapy. Waiting that long can have a large impact on a child's ability to do well in school, according to Anila Punnoose, a director of Speech-Language and Audiology Canada. During the months or years children are waiting to get speech services, they can quickly fall behind in school, she said. A 1996 study found children with language deficits are more likely to experience social difficulties including interacting with their peers, which impacts their behaviour. Other studies have shown that children who don't get speech therapy early are at a greater risk of problems in their academic performance and mental health.
  • A lot of speech problems carry over to literacy, because a knowledge of speech sounds is crucial when learning to read, Punnoose said. "It's all about what you hear in those sounds. ... Do you know the beginning sounds in that word? A child who doesn't have good phonological awareness doesn't understand any of that," she said. When looking at school performance, Punnoose said early struggles carry through to later years. A child with speech problems who has difficulties learning in the early years won't be able to build on those lessons in later years as effectively as their peers, she said. Early intervention can mitigate and prevent those problems, she said. "If children are having severe difficulties with speech in kindergarten, it's a predictor that there's going to be academic difficulties, and especially reading and writing difficulties, by Grade 3," she said.
  • Jocelyn Fedyczko, Eddie's speech pathologist, has worked in a range that includes children from preschool all the way to teenagers. She said early intervention is crucial with young children such as Eddie. "The earlier you can help a child out, the more progress you see," she said. When a child gets to the top of the wait list, they get assessed again, and receive a block of treatment, usually around 10 or 12 sessions, says Peggy Allen, president of the Ontario Association of Speech-Language Pathologists and Audiologists (OSLA). That's often not enough to treat even minor to moderate issues such as Eddie's. Fedyczko said she can get through two to three sounds in that time, depending on the child. Many children have problems with more sounds than that, she said. But when a child finishes their block of treatment and needs more, because they haven't worked through all the sounds, for example, they go back to the bottom of the wait list, Allen said.
  • A spokesperson for the Toronto Central CCAC said they do not have an upper limit to the number of sessions per block assigned by a speech-language pathologist. The pathologist determines three goals for a child to achieve and assigns the number of sessions according to that. If after these sessions more goals are identified, the child is re-referred to the program, the spokesperson said. Parents who are worried about the impact waiting can have on their child can go to private clinics, if they have coverage or can afford the sessions out of pocket. Trish Bentley, Eddie's mother, decided to go for private therapy with Eddie's older brother Oliver. He was put on a six-month wait list for speech problems slightly more acute than Eddie's.
  • B.C.: Children's speech therapy is organized through the Ministry of Health, Ministry of Children and Family Development (MCFD) and through the Ministry of Education by way of school districts. Children are divided between preschool and school age. Preschool children go through regional health authorities. School-age children go through the school boards, but the pathologists there will often offer consultative services, rather than oneon-one speech therapy. B.C. also has a "no-wait-list" policy for children with autism, which translates to parents getting around $22,000 a year for therapy until the age of six, and $6,000 a year after that. Alberta: Health Services is in charge of speech therapy in that province. It offers both a preschool and a school program. The school program, unlike Ontario's, is done completely through the schools, with no CCAC-type system to refer out to. Saskatchewan: The school districts are responsible for speech therapy. Each school district divides up services slightly differently, though they all differentiate between children under three years, from three to five years, and from six to 18 years.
  • But the problems go deeper than a lack of funding, according to Allen. She said many of the issues in Ontario stem back to a series of agreements in the 1980s between the provincial Ministry of Long-Term Care, the Ministry of Education and the Ministry of Community and Social Services. These agreements divided up who is in charge of different treatments, between the school boards and the CCACs. At the time of their creation, these agreements made sense, but times and needs have changed, she said. "It's difficult when ministries make agreements that are frozen in time. It's very difficult to provide the kind of services that we all expect and want Ontarians to receive," she said. Dividing up the services is necessary when trying to manage resources, but the fragmentation is hurting children more than it's helping, Punnoose said.
  • Dividing services by language issues and other issues doesn't make sense when treating a child, she said. "You shouldn't be splitting up the kid," she said. Punnoose said she wants to see speech therapy come together under one roof. It would mean co-operation from all three ministries, as well as a major reorganization of the funding, but she believes it would be a better model for children. "Students are in schools the better waking part of their lives. Why wouldn't we have the services right there in an authentic environment where it's totally accessible," she said. There are changes coming.
  • Last December, the Ontario government announced more funding for preschool speech and language programs, as well as efforts to integrate speech services better, through its Special Needs Strategy. Punnoose says it's a good step. "The government recognizes that the system was broken," she said. For now, the choice for parents in many CCACs will be between long wait lists and paying for private service. Hunter-Trottier said many parents, even those with coverage, don't know about the latter option. "We sometimes get parents here in tears, saying, 'Oh my goodness, the services here, I wish I had known about that a year ago,' " she said. Bentley said she won't be looking at public services for Eddie, as she's happy with the service she gets at Canoe. "I'd be open to it, but I'm not going to actively seek that out," she said.
  • For Eddie, what matters is the progress he makes. Within 10 minutes of his trouble saying "lipstick," he was opening up a treasure chest, with a key. With little prompting, he used the same technique as before, separating the sounds of the word. "Kuh-ey," he said. Could he try it all together? He pauses for a second. "Key," he says, almost flawlessly, beaming at his success. SPEECH THERAPY IN EACH PROVINCE
  • Speech therapy, like all healthcare matters, is regulated differently in each province and territory in Canada. Information on how each system works is difficult to come by. But generally, most provinces have very similar systems - and challenges - according to Joanne Charlebois, CEO of Speech-Language and Audiology Canada. Charlebois said Ontario's wait times are probably worse than those in other provinces, but she's spoken to people across Canada who tell her similar stories. Here's a breakdown of how it works across the country. Ontario: Speech therapy for children falls under the responsibility of three ministries: the Ministry of Long-Term Care, the Ministry of Education and the Ministry of Community and Social Services. Children in Ontario are divided by age and by the nature of their speech problem. Children under school age qualify for Ontario's preschool speech and language program. Once in school, those children with language problems - major problems speaking or understanding words or sentences - go to a school speech pathologist, while any other problems, such as pronunciation, stuttering, voice and articulation are referred to the Community Care Access Centres, which employ contract speech pathologists.
  • Rather than wait those six months, Bentley took him to Canoe. "As time went on, we said enough of this, he's going to be past the point of catching the problem," she said. For families who don't have coverage and who can't afford private services, though, the only option is to wait. Finding the cause of the long waits is hard, but one thing is certain: It's not due to a lack of speech pathologists, according to Shanda Hunter-Trottier, the owner of S.L. Hunter Speechworks, another private clinic in Toronto. She used to have problems finding qualified speech pathologists, but now she's facing the opposite problem. "I've been practising for 26 years. ... In the last five years, [I] have more resumes than I can keep track of," she said. Rather, she says, it's a large web of problems that slows down the system. First among these is a lack of public funding. "There's a lot of speech pathologists that don't have jobs, but these places aren't hiring. The cutbacks have been atrocious," she said.
  • Manitoba: School districts are also in charge here. The inschool speech-language pathologists offer services from classroom-based programming to individual therapy. Quebec: The system here is more like Ontario's. Speechtherapy services are offered through the local community service centres (CLSC), similar to Ontario's CCACs. The CLSCs are not obliged to provide speech therapy in English, though some, especially in areas with a large anglophone population, usually do. Nova Scotia: The province has 28 speech and hearing centres, with 35 pathologists in total. They assess and provide treatment for children and adults. School boards in the province also have speech-language pathologists who also have a teacher's certificate.
  • Prince Edward Island: The province provides free speech services for children until they enter school. Northwest Territories: Speech therapists are only able to visit some remote communities once or twice a year. Instead, the province offers a service called Telespeech, where pathologists can help people without having to be physically present. Nunavut: The territory had no speech pathologists in 2013, according to Statistics Canada.
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.
Govind Rao

Time to speak up on health services - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|brrt|20150520|220833984

from heather Ontario coalition campaign cuts

shared by Govind Rao on 20 May 15 - No Cached
  • Brockville Recorder and Times Wed May 20 2015
  • Since fears for the future of Brockville General Hospital's maternity ward became public in February, there has been a consistent chorus of voices calling on the public to "speak up" for local health care. Now, with three consecutive meetings dedicated to the future of local or regional health services, local residents cannot argue they did not have a chance to be heard. There has been plenty of speaking up already, in the form of social media advocacy and a rally in front of BGH by the Canadian Union of Public Employees (CUPE) in April.
  • If it's more advocacy-driven events one seeks, there is always the Ontario Health Coalition's "Public Meeting to Save Our Hospital Services," scheduled for Thursday, May 28, at 7 p.m. at the Brockville Convention Centre. However, it would be wrong to underestimate the importance of the public meetings organized by local health care institutions. On Tuesday, the South East Local Health Integration Network (LHIN) held a public open house seeking input on the future of regional health services. The event drew many people already involved with BGH and its operations, in particular hospital board members, as well as members of the broader general public. Not counting those already in the sector, organizers say, the four-hour event drew 38 people. Their input will contribute toward the development of a health care plan for the broader region of Southeastern Ontario.
  • ...1 more annotation...
  • It would have been more productive, however, had more members of the general public attended. People who did not attend can still answer a survey online, through May 29, at www.surveymonkey.com/s/healthcaretomorrow. BGH officials at the event were eager to remind people that another open house, this one specific to the future of the local hospital, is scheduled for Tuesday, June 2, from 5 p.m. to 8 p.m. at the 1000 Islands Mall. The June 2 meeting will give the public a chance to hear directly from BGH officials about the challenges the hospital faces as it tries to address a $1.9-million shortfall. BGH officials have pledged to listen to the public on how it will deal with that shortfall. They have also promised that, while service delivery may be changed as efficiencies are sought, the services themselves will not be reduced. This is an important opportunity -one of many, we hope -to show them the public is watching. This is not a meeting to skip. @RipNTearRon on Twitter
Govind Rao

Moncton health-care workers stage lunchtime protest at City Hall - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|mott|20150502|219648140

from heather NB cupe campaign cuts

shared by Govind Rao on 04 May 15 - No Cached
  • Times & Transcript (Moncton) Sat May 2 2015
  • About 200 unionized health care workers staged a noon-hour rally in front of city hall Friday to protest privatization of government services and warned Liberal Premier Brian Gallant that they won't put up with cost cutting that takes away jobs. The large crowd of workers marched east along Main Street, complete with banners, protest signs and noisemakers, to gather at City Hall for the rally. Last week, Health Minister Victor Boudreau said the Liberal government is negotiating with a private firm to take over management of food and cleaning services in the province's hospitals. Boudreau said the move would save the province millions of dollars through efficiencies brought in by a private company.
  • The Liberal government has stressed the need to find the $500 to $600 million in new revenue and cuts it says is required to fix the province's finances. Boudreau said last week the move would likely have an impact on existing staff, but did not know how significant that impact would be. He said front line hospital services would not be impacted by the privatization of food and cleaning services. Boudreau says in an opinion column in Saturday's Times & Transcript that the goal of contracting out food and cleaning services is to find new management practices that will save money for the taxpayers.
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  • "The goal is to introduce new technologies and inventive management practices, while achieving significant savings throughout the health-care system by standardizing the processes around managing these services, coordinating their planning and improving operational efficiency," Boudreau said. "Close to 1,800 people work to deliver food and cleaning services in New Brunswick hospitals. These employees are a vital part of our delivery of health care and the vast majority of them will continue to be government employees and CUPE members." But union officials said they don't believe it. They see the food service privatization as the tip of a much bigger iceberg that will lead to more cuts to jobs and, eventually, a lower level of service for New Brunswick taxpayers. Norma Robinson, president of CUPE Local 1252, said the union represents over 1,200 hospital support staff, paramedics, licensed practical nurses, patient care attendants and others. She said the Gallant government is trying to pick up on a plan that was started by the Alward Conservatives.
  • Robinson says union officials were called into a meeting last Thursday and told about the privatization plan. "This is not just about the jobs, it's about the service," Robinson said after her speech to the city hall rally. "We're talking about taking a publicly owned service and putting it in the hands of a private-for-profit corporation. It's not going to cost less, it's going to cost more because they are going to want to make a profit. That's our point, we don't want private companies coming in and taking over any public service in this province," Robinson said. "This is the tip of the iceberg. There are several areas they could look at to privatize. They are not being transparent with their information. They are doing a review of all services in the province, not just in hospitals. It's looking at all levels of government." Robinson called on taxpayers and voters to voice their anger at potential reductions in service as a result of cost-cutting and privatization. "We want answers. We want this stopped. We don't want privatization to come into this province, so we are going to try to stop this before this disease spreads and completely engulfs New Brunswick," Robinson said.
  • Patrick Colford, president of the New Brunswick Federation of Labour, was another speaker at the rally who said it was time for workers in the province to rise up against the government and fight cost-cutting that results in service reductions. "It's a taxpayer issue and where do taxpayers want their money spent?" he said after his speech. "Whether you are unionized or not, you are still a taxpayer. Is this about protecting jobs? Yes it might be but that's not the whole picture by any means. It's about protecting services that we depend on every day. "Talk to anybody who's ever been on EI and how frustrating it gets trying to talk to a human being to get answers, or somebody who goes to Service New Brunswick and has to take a number and sit there and wait. Or when you go to the emergency room and sit there and wait. All these cuts do is divide the population. Nobody wants to cut services and when the government comes in and says they are going to cut these public services and save X amount of dollars, people don't see the whole picture. The people who do are being vocal about it."
Irene Jansen

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

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

accord home care senate

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

shared by Irene Jansen on 19 Nov 12 - No Cached
  • 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

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

www.fpinfomart.ca/...210197890

from heather p3 ontario

shared by Govind Rao on 11 Dec 14 - No Cached
  • Toronto Star Thu Dec 11 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.
  • ...3 more annotations...
  • 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 the 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.
  • 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.
  • Thomas Walkom's column appears Wednesday, Thursday and Saturday.
Govind Rao

Shift continuing care to public sector; For-profit facilities do an inferior job, write... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|edjn|20151209|235447866

from heather continuing care ltc Alberta privatization quality

shared by Govind Rao on 09 Dec 15 - No Cached
  • Edmonton Journal Wed Dec 9 2015
  • Alberta's continuing care facilities have a patchwork of ownership models. While these facilities are all funded by public money, they are owned and operated either publicly, through Alberta Health Services and its subsidiaries (CapitalCare in Edmonton and Carewest in Calgary), or privately, by both non-profit organizations and for-profit corporations. There are issues that exist regardless of who the provider is: staffing levels are not meeting the needs of patients and continuing care is chronically underfunded in Alberta. However, fixing only those issues ignores the bigger picture.
  • Evidence provided by the 2013 Parkland Institute report From Bad to Worse shows that Alberta's publicly owned long-term care facilities are "significantly better than for-profit facilities" for hours of care they provide to each facility resident. This should not come as a surprise, since the primary responsibility of a for-profit corporation is to ensure adequate shareholder return on investment. These facilities are funded by government dollars, and information made public last year shows corporations expecting to make an average profit level of 27 per cent, or $5,500 per bed, per year. That money would be better spent on care for Albertans instead of being pocketed by shareholders.
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  • A large portion of those profits are possible because of unregulated "hospitality" fees, and an operational funding model that does not require government funds for front-line staffto actually go toward staffpay. No regulation exists for staff-to-patient ratios or to ensure patient and family councils are welcomed at each facility. Contracts between these providers and the government are confidential, meaning Albertans do not have the right to know how much public money is being doled out or what the terms of the contract are, and whether or not care is the No. 1 priority in these arrangements. This "wild west" model of continuing care providers was set up by the previous PC government, but it remains in place under the NDP government. However, there is hope positive change is coming. While the PC government significantly expanded the role of for-profit corporations in continuing care, the new government has taken a different position. Responding to promises from the previous government to open new care beds in Alberta, on Nov. 19, 2014, then-opposition leader Rachel Notley said in the legislature, "We don't argue with the need for more spaces for seniors; we do think that they should be publicly funded, publicly delivered."
  • In the same spirit, the NDP's election platform promised to open 2,000 public long-term care beds and "end the PCs' costly experiments in privatization, and redirect the funds to publicly delivered services." The previous government not only stopped building new public beds, but also unnecessarily closed hundreds of functional public long-term care beds and often funded the construction of replacement beds owned by for-profit corporations. Some of the closed facilities are currently empty and could still be reopened for public use.
  • In light of the problems the previous government created by funding private, for-profit care, the new government should begin by standardizing and limiting fees charged to residents, disclosing the amounts these corporations are being given and spending on direct care and how much of the public money is going to their shareholders, and setting standards for staff-topatient ratios. The most meaningful sign the new government can send would be to make good on their promise to open 2,000 public long-term care spaces, where profit is not a factor and care is the No. 1 priority. Fulfilling that promise should be the government's first step to phasing out private, for-profit continuing care. Our public health care dollars should not be given to corporate shareholders; it should be spent on care for Albertans. Private, for-profit care facilities are no more acceptable than Ralph Klein's short-lived private, for-profit hospitals. Noel Somerville is the chair of Public Interest Alberta's Seniors Task Force. Sandra Azocar is the executive director of Friends of Medicare.
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.
  • ...42 more annotations...
  • 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

We have lots to learn on health care; Spending: Systems in other countries lead way in ... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|vasn|20150228|215425955

from heather international comparisons medicare privatization

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  • Vancouver Sun Sat Feb 28 2015
  • Americans spend a king's ransom on health care - 17.9 per cent of GDP, versus 10.9 per cent here - yet the U.S. finishes last in a Commonwealth Fund ranking based on 11 developed countries' health care quality, access, efficiency and equity. Before you start feeling too smug about this, consider that Canada ranked second-last. And before you reject everything in the Americans' health care tool chest, consider that some approaches they embrace and we shun - letting private insurance plans run in parallel to public plans, for example, or allowing private payments for services exclusively covered by government insurance in Canada - have been adapted and adopted by the higher-ranked countries in limited and careful, but highly effective, ways.
  • And here's the kicker - all of these countries' public systems cover a broader range of services than Canada, with its narrow focus on doctors' fees and hospital costs. Blomqvist and Busby note that Canadian governments cover about 70 per cent of our health care expenditures, roughly the average of all 34 OECD countries. But, thanks to pervasive restrictions that prevent or sorely limit private funding of ever-rising hospital and doctorrelated costs, little or no public money is available to fund things like universal outpatient drugs, eye care and dental plans that other countries routinely provide for citizens.
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  • As analysts Ake Blomqvist and Colin Busby note in a new C.D. Howe Institute study, "Many other countries, in Europe and elsewhere, also have systems that cost much less than the American one and that, arguably, are at least as equitable as Canada's, if not more so." Yet, "No other country is modelling their health-financing system around the Canadian example," they add. "None of them seem to think that a monopoly approach to paying for most health services is the best way to achieve equity and efficiency goals."
  • Many of these restrictions do not flow from the Canada Health Act, but rather from provincial laws. For example, Victoria, not Ottawa, prohibits doctors who opt out of the Medicare system from getting any payments from public funds, or doctors who work within the public system from billing patients over and above what the government pays. These restrictions, the study argues, impose big costs. To illustrate this, it focuses on how health care is paid for in four countries - the U.K., Australia, Switzerland and the Netherlands - whose health systems are considered to be among the world's best.
  • "Their guiding principles are similar to those within the Canadian health care system. All endorse universal public coverage and access for a defined core set of services, the belief that costs should be borne by society at large ... and high standards of care." In all these countries, public spending covers a significantly smaller percentage of hospital and doctor-related costs than in Canada, leaving the balance to be paid by private insurance for those who have it. (The range is from 65-85 per cent for hospital costs, compared to 92 per cent in Canada, and 60-90 per cent for doctors fees, compared with 99 per cent in Canada.)
  • But their governments also cover 45-67 per cent of drug and other outpatient medical costs, compared with 35 per cent in Canada. The authors consider, and ultimately dismiss, the view that any deviation from Canada's single-payer system would result in higher costs - an often-cited factor when sky-high U.S. health costs are dissected, but not an issue in countries that have a more carefully balanced mix of public and private funders.
  • Nor do they buy the argument that the public sector would lose out if privately paid health services were allowed to compete for doctors and patients. Indeed, other countries have found that competition can improve service and lower costs. The bottom line is that Canada's health care system only looks as good as many of us like to think it is when we compare it to the American system. And other countries have figured out better ways to fully respect the same vaunted principles Canada aspires to while providing more or better care at comparable cost. We could learn from them.
Irene Jansen

A preference for private health - 0 views

www.leaderpost.com/...story.html

private clinics sk

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  • we should absolutely be sympathetic to the idea of experimenting with our health care system to deliver better care for our public dollars. And some of the other initiatives currently underway within the Ministry of Health (such as a focus on "lean" organization) might plausibly serve the purpose.
  • When it comes to privatizing services, though, the disastrous experiences of British Columbia, Manitoba, Ontario, the United Kingdom and others that have seen higher costs for worse results from forprofit operators
  • over the past couple of years, the Saskatchewan Party has pushed Saskatchewan's major health regions into hiring private operators to carry out surgical and imaging procedures
  • ...3 more annotations...
  • If the Saskatchewan Party had wanted to meaningfully test the relative merits of private and public delivery for expanded health care services, it could easily have done so - guiding one of the province's major health regions toward increasing capacity through a private service delivery model, and the other toward expanded public service delivery. And it could then have compared the two to see which produced better returns on our public funding.However, that would have involved actually supporting some enhanced public service delivery - which is apparently utterly unacceptable to the Saskatchewan Party. And more importantly, it would have created a risk that the public system might perform better on the evidence.
  • Wall has tip-toed around the reality that in some cases the public/private mix has led to fewer services being performed than in the public system we started with.
  • there's been no evidencebased policy at work in our healthcare system under the Saskatchewan Party. Instead, the Wall government has been manufacturing policybased "evidence" to support its spin in favour of private service delivery
Govind Rao

World Public Services Day 2015: Fair taxes fund strong public services | Canadian Union... - 0 views

cupe.ca/es-fund-strong-public-services

from heather taxes international union corporation

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  • Jun 22, 2015
  • On World Public Services Day, CUPE is calling for corporations to pay their fair share of taxes so we can all have strong public services.
  • It’s a call that crosses borders, targeting multinationals that set up shop in tax havens to avoid paying their fair share. Canadian corporations hid at least $199 billion in offshore tax havens last year, avoiding at least $2 billion in taxes that could have funded public services and infrastructure. Those are the official reported figures: the amounts actually held by unreported by Canadian corporations and wealthy individuals in tax havens are much higher.
Govind Rao

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

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from heather bc private clinics privatization

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  • 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 care under attack in Quebec; Why the Trudeau government must act now to save hea... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|shrc|20151116|233774979

from heather quebec privatization private clinics

shared by Govind Rao on 16 Nov 15 - No Cached
  • The Record (Sherbrooke) Mon Nov 16 2015
  • The people of Quebec will only benefit from a universal, free and comprehensive health-care system if there is strong and swift intervention by the federal government. Otherwise, Quebec will likely be the first province to slip out of the Canadian health care scheme. In fact, Quebec's current health care laws and practices do not respect the principles set out in the Canada Health Act. During the past decade, the core principle of health care - that medically necessary care should be universally covered and paid through public funds - has gradually eroded in Quebec. The process has been a slow but steady sum of small legislative changes that have benefited practitioners over patients. The result has been governmental tolerance for grey-zone billing practices and impressive fee-charging creativity from medical entrepreneurs.
  • The turning point was probably the Supreme Court of Canada Chaoulli ruling in 2005. The decision said that prohibiting private medical insurance was a violation of the Quebec Charter of Human Rights and Freedoms, particularly in light of long wait times for some health services. The ruling has fed steady development and acceptance of a two-tier health care system in Quebec. The expectation that medically necessary care will be free in Quebec is less and less warranted. Some specialists in public hospitals propose faster access to their patients - for a fee - or less invasive interventions through their for-profit clinics. In such clinics, doctors are still paid by Quebec's public health insurance, but patients are often billed for the rental of the surgery room, for local anesthetics or for access to more advanced technologies. hile officially illegal, such practices are widespread. Stories abound about W eye drops or anesthetics that cost the clinics cents being billed to patients for hundreds of dollars.
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  • This clearly puts the doctors involved in a conflict of interest. In a health system experiencing a significant shortage of practitioners, medical resources are drained from public hospital-based "free" care and into private purses. It also ties health care quality and accessibility to a patient's wealth - precisely what the Canada Health Act tries to prevent. For example, Montreal Children's Hospital - one of Montreal's two pediatric university hospitals - has decided to stop offering many medically necessary services. Instead, it will direct some patients to a new outpatient clinic. There, parents may be billed for such services as dermatology, endocrinology, general pediatrics and other important specialized care.
  • This steady disintegration of the principles of health care could soon be irreversible. Premier Philippe Couillard's new Bill 20 will legalize direct patient billing for medically necessary services provided outside of hospitals. The provincial government is confident that Ottawa won't intervene to enforce the Canada Health Act in Quebec (the federal government hasn't intervened in the past decade). Bill 20 makes legal practices that were grey-zone breaches in the universal public health system. This is creates a parallel, legal private health-care system subsidized by public health insurance. This could be the final blow to health care in Quebec. An unhealthy coalition - the Couillard government, private clinic owners, medical federations, private insurers and even some hospital administrators - is irresistibly pushing to decrease the care offered in public institutions and to increase the market share of direct payment and privately insured services. The only chance to save health care in Quebec is direct intervention by the federal government. Prime Minister Justin Trudeau and federal Health Minister Jane Philpott must enforce the Canadian Health Act in Quebec, even cutting federal health transfers until the province conforms.
  • Doing anything less will mean access to care according to a Quebec patient's wealth, rather than their needs. Astrid Brousselle is a professor in the Community Health Department, and researcher at the Centre de recherche de l'Hopital Charles-LeMoyne, Universite de Sherbrooke and Canada Research Chair in Evaluation and Health System Improvement. Damien Contandriopoulos is a professor in Nursing and a researcher at the Public Health Research Institute at University of Montreal (IRSPUM). CIHR Research Chair in Applied Public Health.
Govind Rao

Liberals revive crucial coverage for needy; Government reverses course on proposal that... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|tost|20141209|209988181

from heather ontario dental health

shared by Govind Rao on 09 Dec 14 - No Cached
  • Toronto Star Tue Dec 9 2014
  • The Liberal government scrambled Monday to reverse a proposal that would have resulted in thousands of children of low-income families being denied preventative dental health services. "Our government will ensure that no child will lose access to preventive dental services that they are currently eligible to receive," an email from Health Minister Eric Hoskins' office stated.
  • NDP MPP France Gélinas earlier in the day warned that because the Liberal government is proposing to slash income-based eligibility in half, some 15,000 children in Toronto alone will not have access to dental services. This number was supported in an August report from the Toronto Board of Health. "It is a partial victory," said Gélinas. "These are shocking and appalling cuts that strike at the heart of vital public-health services in our province," she told a news conference at Queen's Park in the morning.
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  • Gélinas said a single mom with two children making $43,432 can now access dental-health services, but the proposed change would see that net-income eligibility reduced to $23,275 effective next summer. "We were aware of what the NDP highlighted this morning so we are committed to ensuring that children of low-income families will not lose coverage," Hoskins' spokesman Gabe De Roche told the Star. Public-health units across the province are mandated to provide preventative dental care to children of low-income families, but Gélinas cautions that in northwestern Ontario only 80 of 4,000 children seen under the program last year would qualify under the new rules.
  • Preventive oral health services delivered by public health units, as mandated in the Ontario Public Health Standards, includes scaling, fluoride varnish and fixing cavities. "We believe that investing in preventative dental care saves tens of millions of dollars in health-care costs down the road," Gélinas told reporters. Premier Kathleen Wynne fired back in the legislature that because of changes made earlier this year through the $30 million Healthy Smiles program, 70,000 more kids from low-income families are receiving dental care, but Dr. Melvin C. Hsu, the manager of Dental and Oral Health Services at Toronto Public Health, told the Star that increase was taken into consideration when the board calculated that 15,600 children will lose preventative dental services.
  • "From our point of view we want to prevent disease and when you let disease progress it will cost much more and the health of the child suffers ... and that means 15,000 children may be more vulnerable to oral disease," Hsu said. Opposition critics, the Canadian Union of Public Employees (CUPE), public-health officials and families that benefit from the plan all agree the proposed change must be scrapped. Tim Maguire, president of local 79, CUPE, said thousands of kids receive dental-health screenings annually. "If you leave someone without the ability to have dental work, all of a sudden you are into an emergency department. That's the most costly form of health care we can have," Tory MPP Bill Walker said.
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