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Govind Rao

What will the "sharing economy" mean for health care? - Healthy Debate - 0 views

healthydebate.ca/...sharing-economy-health-care

from heather home care staffing contracting out privatization

shared by Govind Rao on 29 Jun 15 - No Cached
  • by Will Falk (Show all posts by Will Falk) May 27, 2015
  • This is the “sharing economy”.
  • An under-appreciated feature of the return of sharing, however, is the impact on government— not only as regulator, but also as a deliverer of public services. Though a strict definition of the sharing economy does not translate perfectly into publicly provided programming, its key principles— creating trust through feedback, community collaboration, scheduling efficiency, asset optimization, and payment settlement— are well-suited to entrepreneurialism in public sector delivery models, including in healthcare.
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  • One early indicator is the resurrection of the house call.
  • Now, there is a mass of mobile app developers swarming to revitalize this home-based care model. Pager, for example, is the brainchild of sharing economy pioneer and Uber co-founder Oscar Salazar. It markets itself as allowing users to see a doctor within two hours in the patient’s home, office, or hotel room. Companies like @mendathome, @HealApp, @medicast, and firstlineapp.com deliver similar services and are creating access and price competition.
  • In 2014, Uber delivered free nurse-administered flu shots to customers in Boston, New York, and Washington. Another company is seeking to enable hospitals to easily rent-out their bulky and unused medical equipment or, conversely, temporality access specialized equipment quickly and without the sizeable expense of purchasing.
  • allows for the home to become the site of much more care.
  • Sharing economy models of diagnostics are emerging both for clinicians and for their patients.  Figure1 is a Toronto mobile health start-up and peer to peer network that has created an “Instagram for doctors”, allowing medical professionals to seek input on complex cases by posting relevant images and information. And well established websites like CureTogether.com and PatientsLikeMe.com have fostered a peer coaching culture that lets patients share stories of treatment regimes and generate real-time research networks.
  • More recently, @Crowdmed has launched a crowd-sourced diagnostic service that uses “medical detectives” to better characterize rare and complex conditions.
  • How long will it take before hospitals start leveraging their idle operating room and facility hours to generate revenues and improve the timeliness and quality of procedures (AirOR)? We can already request a personal support worker or registered nurse through start-up services like eAdvocate and myPSW. We should expect established providers to emulate these start-ups, just as the traditional taxicab companies have started to emulate Uber. CCACs, for example, may use sharing economy-like services to match patient needs with clinicians and patient support workers.
  • As decentralization takes hold and more care moves from institutions and medical offices into the home, how will we deal with our overbuilt capacity? 
  • Can we trust clinical professionals to self-organize within their scopes of practice?
  • Will Falk is the Managing Partner – Health Industries at PwC Canada, an Executive Fellow at the Mowat Centre and an Adjunct Professor at the Rotman School of Management at the University of Toronto. Follow Will on Twitter @willfalk
Irene Jansen

CUPE Saskatchewan: The Facts on Shared Services in Health Care < Health care, Saskatche... - 0 views

cupe.ca/...shared-services-health-care

shared services sk

shared by Irene Jansen on 23 Jan 12 - No Cached
  • This document provides an overview of Shared Services in health care across the country and background on the proposal for shared services in Saskatchewan.
Irene Jansen

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

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

accord senate

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

Auditor calls for overhaul of spending on home care - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150924|229939622

from heather home care audit Ontario

shared by Govind Rao on 24 Sep 15 - No Cached
  • The Globe and Mail Thu Sep 24 2015
  • Ontario's Auditor-General says the government needs to take a "hard look" at the way it delivers home care after an 18-month investigation found that as little as 61 cents out of every dollar spent goes to face-to-face client services and discovered gaps in the level of care offered across the province. The report, released Wednesday, focuses on the 14 local provincial agencies, called Community Care Access Centres, that are responsible for managing services, such as nursing, physiotherapy and help with personal care, for about 700,000 people each year in their home and the community. Most of that work is in turn contracted to service providers that range from large corporations to nonprofit agencies.
  • The audit paints a picture of a system riddled with inconsistencies, where the care available depends on where you live, and with administrative costs that account for between 19 per cent and 39 per cent of the $2.4-billion the province spends each year on home care, depending on how that overhead is defined.
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  • The auditor's findings come after a report to the government from a blue-ribbon panel in the spring that called on the province to make home-care services easier to navigate and more accountable. An investigation by The Globe and Mail also found a system plagued by uneven access to care, byzantine processes and a troubling lack of transparency for both patients and family caregivers.
  • "The time has come for the government to take a hard look at how CCACs deliver services to patients," Auditor-General Bonnie Lysyk said. "The solution is not simply to add new programs and make adjustments to existing services," she added. "This will only leave core problems and inconsistencies entrenched."
  • Getting it right is crucial for the Ontario government as it, like other provinces, looks to shift an ever-increasing share of health care out of expensive beds in hospitals and long-term care and into the home. The increasing emphasis on home care for the sick and the elderly is also what patients are demanding, and comes as many, including the Canadian Medical Association, say it's a change that is needed as the country's population ages.
  • Ontario's Minister for Health and Long-Term Care, Eric Hoskins, has vowed to repair the home-care system, laying out a 10-point plan in response to the expert panel report and setting up working groups with a threeyear time frame to make changes. He accepted all of the auditor's findings on Wednesday, saying he intends to "deepen" reform efforts and singling out the recommendation for a review of the way home care is delivered.
  • "This gives us the opportunity to be bold and be transformational," he said, but stopped short of saying what form such change would take. Dr. Hoskins said it is "premature" to say if the current system of access centres should be scrapped, as critics of the system have long suggested.
  • Catherine Brown, executive director of the group that represents the province's 14 CCACs, took issue with the audit's definition of direct-care spending, noting that time spent in consultations, case management and travelling to homes is a necessary part of delivering care and should not be considered part of overhead costs. "I don't think people understand the complexity of getting service to people in their homes," she said. Kevin Smith, the chief executive officer of St. Joseph's Health System in Hamilton and a member of the expert panel, said the audit provides valuable numbers on which to base future discussions.
  • The experience in the province of cutting wait times, he said, showed that "data, money and embarrassment" are a powerful combination to lead to change. NDP health critic France Gelinas, a member of the committee that asked for the report in the spring of 2014, said the audit confirms the system is broken.
  • "The structure has failed us and it is costing us a pile of money," she said. Among the audit's findings:
  • The province's 14 CCACs manage 264 separate contracts with 160 different agencies, and there is no standard rate for the same services among those contracts. The cost of an hour of care varies even among contracts involving the same CCAC and service provider.
  • In a sample of three CCACs, the nursing costs ranged from $49 to $73 an hour and personal support costs from $26 to $49 an hour. Pay for top executives jumped by 27 per cent between 2009 and 2013, to an average of $249,000.
  • Compensation for other senior executives increased 16 per cent during that time. Rapid-response nursing teams, created in 2011 and employed directly by the CCACs, failed to see patients within 24 hours about half the time, with some teams not available on weekends.
  • CCACs report 92 per cent of expenses are for direct patient care. That drops to 81 per cent when overhead and profit for service providers are taken out, the auditor finds, and to 72 per cent when documentation, travel time and training are not included. When case co-ordination is removed, it falls to 61 per cent.
  • The report is the first of two on home care by the AuditorGeneral. The second part, to be included in her annual report later this year, will focus on personal support workers. An examination of Ontario's 14 Local Health Integration Networks is also expected at that time.
Govind Rao

OMA mulls legal action over new cuts - 0 views

www.cmaj.ca/...E441

from heather doctors bargaining cuts Ontario

shared by Govind Rao on 22 Oct 15 - No Cached
  • CMAJ October 20, 2015 vol. 187 no. 15 First published September 21, 2015, doi: 10.1503/cmaj.109-5159
  • Lauren Vogel
  • The Ontario Medical Association (OMA) is considering legal action if the province won’t return to the bargaining table with a new, impartial process for settling disputes over physician pay. In October, the Ontario government plans to impose another 1.3% cut to all fees paid to doctors. This follows January’s 2.65% cut to doctors’ fees and other unilateral reductions in funding for continuing medical education, walk-in clinic visits, doctors who enrol healthy patients in their practices and family health teams in well-serviced areas.
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  • OMA President Dr. Mike Toth says the province owes doctors a “fair, reasonable negotiation done in good faith.” This ought to include an impartial, binding process for resolving an impasse between the parties, he adds. “There’s a power imbalance if the government can go through a series of negotiations and still have the right to unilateral action without any recourse.” OMA wants negotiations to go through a form of mediation–arbitration that would give a neutral third party the power to issue a binding decision in cases where the province and doctors can’t agree. Failing that, “we’re also looking at our legal options,” Toth says.
  • Eight of the provinces and territories currently have a binding dispute resolution mechanism, although they may not often use it, he explains. The Canadian Medical Association also gave its support to OMA’s request for mediation-arbitration at its August General Council meeting in Halifax. Normally, the national doctors’ association doesn’t get involved in provincial pay disputes, but in this case there could be national implications. According to Steven Barrett, a constitutional lawyer with Sack Goldblatt Mitchell in Toronto, if physicians feel there isn’t a fair process for determining their compensation within Medicare, they may be more willing to advocate for their right to practise and bill outside the public system.
  • Negotiations between doctors and the Ontario government have stalled since January, after the OMA rejected a proposal to cap growth in the physician services budget at 1.25%. Ontario ended up imposing the cap anyway, despite the fact that its own estimates peg the current rate of growth in demand for medical services at 2.7%. This means doctors won’t be reimbursed if patient demand for their services exceeds the limits of the public purse.
  • The province hasn’t given the OMA current data on health care use, but it’s “probably a safe bet to say it’s running over budget,” says Toth. Stephen Skyvington, a former manager of government relations for the OMA, recently reported that Ontario is withholding the data to prevent doctors from slowing their work in protest of pending claw backs.
  • David Jensen, a spokesperson for the Ministry of Health and Long-term Care, denies that this is the case. “The ministry continues to share data with the OMA per our data sharing agreement.” Jensen neither confirmed nor denied reports that spending on physician services is running 10%–20% over budget. In theory, doctors can protest pay cuts through work slowdowns and strikes, but it’s often not politically or ethically feasible because of the essential nature of their services. Nevertheless, “we’re obviously looking at all of our options right now,” says Toth.
  • The OMA successfully brought Ontario back to the bargaining table in 2012 by launching a constitutional challenge to unilateral cuts imposed by the government of the day. Ultimately the parties resolved their differences out of court, producing fee agreements for fiscal years 2012/13 and 2013/14. At the same time, the OMA agreed to the current negotiating framework, in which the government may act unilaterally if an impasse remains after receiving help from a facilitator and advice from a conciliator. “During the latest round of negotiations, this process was followed,” explains Jensen, for the ministry. A binding dispute resolution process “wasn’t on the table” in 2012, says Toth. “We couldn’t get to it at that time but we think we can get to it now.”
Govind Rao

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

www.fpinfomart.ca/...238303512

from heather Day court bc privatization private clinics

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

CUPE Nova Scotia concerned about what we don't know in Shared Services Review < Health ... - 0 views

cupe.ca/...cotia-concerned-what-dont-know

shared services ns cupe

shared by Irene Jansen on 05 Mar 12 - No Cached
  • CUPE Nova Scotia President Danny Cavanagh says, “We are not surprised that private consultants Ernst and Young recommended privatizing some services in our health care system. The company’s track record clearly supports this direction.
  • the government did not accept their recommendation to privatize laundry services
  • who will be providing these merged services? The minister talked about an ‘alternative service delivery’ model. What is this agency? Who are these workers? Will they be union, or non-union?
  • ...2 more annotations...
  • But this is only phase one of the review exercise. We are quite worried about future cuts and mergers of services.
  • more than 50 job losses in finance and administration
Doug Allan

The Caring Economy - Medium - 0 views

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

homecare privatization

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

shared by Govind Rao on 23 Jun 15 - No Cached
  • 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&nbsp;services.
  • It’s a call that crosses borders, targeting multinationals that set up shop in tax havens to avoid paying their fair&nbsp;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&nbsp;higher.
Govind Rao

Home care rethink is needed; Cost-cutting measures at CCACs have fragmented and confuse... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|hbsp|20150321|216869446

from heather home care Ontario cuts

shared by Govind Rao on 23 Mar 15 - No Cached
  • Hamilton Spectator Sat Mar 21 2015
  • Home care in Ontario has been a controversial subject for decades. In 1995, the Mike Harris government implemented Community Care Access Centres or CCACs, and a managed competition model for service providers. This system changed the face of home care, but did it cause more harm than good? In the 1980s and 1990s, political parties unanimously agreed that reform was needed, as there was no formal home care system and provincial government spending in health care was too high. Each party proposed a new home care model, and after their election the Harris government passed the Home Care and Community Services Act.
  • CCACs were introduced to better help individuals live independently at home and to provide information about care options through community support agencies. However, the introduction of a competitive procurement process was driven by an effort to cut costs. The managed competition model allowed CCACs to contract out to several different service providers. Long-standing not-for-profit service providers began to be replaced by private, for-profit service providers. Between 1995 and 2001, the for-profit share in Ontario home care rose from 18 per cent to 46 per cent, while the not-for-profit shares dropped by 28 per cent. After a contract with a service provider expires, CCACs are able to hire a new set of service providers.
Govind Rao

New assistance programs for paramedics underway - Infomart - 0 views

www.fpinfomart.ca/...216147549

from heather ems NB

shared by Govind Rao on 11 Mar 15 - No Cached
  • The Daily Gleaner (Fredericton) Wed Mar 11 2015
  • After a national survey of paramedics released last month documented high stress levels among New Brunswick's emergency medical professionals, officials with Ambulance New Brunswick announced they'd be bringing forward new programming to assist employees. So far there's no word on when those new programs will be available, though it looks like work is underway to prepare them for an upcoming roll-out. In October 2014, the Paramedic Association of Canada invited paramedics from coast to coast to fill out a confidential online survey, which asked questions to assess whether or not they've struggled with mental health problems.
  • Designed by a clinical psychologist who works with the Toronto Paramedic Services, the poll was completed by more than 6,000 paramedics. Nearly 350 of the roughly 1,100 paramedics working in New Brunswick shared their experiences for the survey. Their responses provided some troubling statistics about the pressures these skilled individuals face on the job and in their personal lives. About 30 per cent of the responding paramedics reported they'd contemplated suicide. When asked if they knew any co-workers who had thought about taking their own lives, that number more than doubled to 70 per cent. About 79 per cent said they've worried about a colleague's well-being.
  • ...5 more annotations...
  • Ambulance NB has a number of resources already in place to support its paramedics, flight nurses and medical dispatchers. There's a critical incident stress-management program, which is supported by the Department of Health and the College of Psychologists of New Brunswick. It offers peer-to-peer support for paramedics who've responded to difficult calls. The provincial ambulance service also has a free, confidential employee and family assistance program. It's available around the clock and offers employees one-on-one counselling to help them cope with stresses from work or home. Tracy Bell, a spokeswoman for Ambulance NB, told The Daily Gleaner in February that the organization was taking steps to expand its offerings to paramedics.
  • "We recognize that we need to do more to support our front-line employees and are taking the necessary steps to get there," she said. "In addition to existing resources, Ambulance NB will be introducing an expanded employee support program in the coming weeks. We are also looking seriously at what options are available in terms of facilitating direct access to a mental health professional or network of professionals for our employees. We hope to be able to be able to share news of these new initiatives with staff very soon." When the newspaper asked for an update this week, Bell said Ambulance NB is still working on this project. "Ambulance NB looks forward to being able to share news of new mental health supports with our employees soon," she said. "Our priority is to share information first with our paramedics, dispatchers and flight nurses." Judy Astle, president of paramedics union CUPE Local 4848, said she's still waiting for some more information. "They supposedly have what they're calling an enhanced employee assistance program. But we have not seen the details as a union yet," she said.
  • "We have a labour management meeting coming up next week. They may present it there. That's what we're hoping." Astle said enhancing the mental health resources for paramedics should help many professionals deal with the difficulties they experience in the line of duty. "Anything that's going to try to prevent high levels of stress in our job is valuable. It's hard to do. But the support is needed out there," she said. "It's a very trying job, to say the least. What affects me may not affect someone else. But what could affect them may not affect someone else. It's often a build up of things." MLA Ross Wetmore, the Progressive Conservative member who represents the Gagetown-Petitcodiac region, recently introduced a private member's bill in the New Brunswick legislature designed to eliminate the need for first responders to prove their post-traumatic stress disorder was caused while on the job. If it passes, that could eliminate the mountains of red tape that many first responders now face as they seek benefits while on leave for treatment.
  • Specifically, Bill 15 would amend the Workers' Compensation Act to presume post-traumatic stress disorder in first responders has been caused by "a traumatic event or a series of traumatic events to which the worker was exposed" while at work. That would apply to both current and former firefighters, paramedics, police officers and sheriffs who have been diagnosed as having PTSD by a physician or psychologist. A second part of the bill would require workers' compensation to offer, "treatment by culturally competent clinicians who are familiar with the research concerning treatment of first responders for post-traumatic stress disorder." Astle said she supports the bill, and says it could really help first responders as they struggle to get the help they need. "That was fantastic. That's a step in the right direction," she said. "People are talking about it more, are relating to it more. In our job, we're supposed to be the 'tough guy.' We have to share with our co-workers some of the things that are bothering us. Most of us do that. We talk it out." Chris Hood, executive director of the Paramedics Association of New Brunswick, said he's going to be meeting with government soon to ask for their support of this legislation, though he currently doesn't know how they feel about such a program. "We don't know whether or not government is going to support it," he said.
  • Hood said his organization wants to join the effort to make life easier for paramedics. So it's announced a few goals for the future. "We're working towards increased screening and education prior to entering the profession, improved training during the (early stages of your career), high-quality mental health support through a team of dedicated practitioners during your employment, and then the presumptive diagnosis legislation (introduced by Wetmore)," he said.
Govind Rao

Grits sets sights on schools, health care for possible cuts - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|frdg|20151128|234663362

from heather NB cupe hospital cuts

shared by Govind Rao on 01 Dec 15 - No Cached
  • The Daily Gleaner (Fredericton) Sat Nov 28 2015
  • FREDERICTON * An education expert is warning the provincial government against reducing the number of educational assistants in classrooms, saying it will put major pressure on teachers. Paul Bennett, the director of Schoolhouse Consulting, supports several changes to the education system the provincial government is considering to save costs, including cutting the number of teachers to match declining enrolment and increasing class sizes. But in order to cut the number of educational assistants, Bennett said the provincial government would have to look at making changes to its inclusive model of delivering education.
  • "If they simply take away educational assistants, they're going to make the job of the classroom teacher next to impossible in New Brunswick with the number of special education kids and the expectations already on their (plate)," Bennett said. After months of consultation, the province presented a list of possible cuts and revenue-generating options on Friday, with the goal of finding between $500 million to $600 million to eliminate the deficit. After further consultation, the government is expected to decide which options to move forward with by the time the 2016-17 budget is introduced.
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  • The New Brunswick branch of the Canadian Union of Public Employees accused the government of fear-mongering by releasing the wish list, while the president of the New Brunswick Union said generating revenue should be at the top of the list for the provincial government. "We are always open to looking at ways to improve the quality of public services, so long as there are no job losses among public sector workers who are already stretched to the max," Susie Proulx-Daigle said in a statement. "We also believe public services need to stay public." Education
  • In schools, the government may cut additional teachers on top of the 249 teaching positions slashed in the 2015-16 budget. Enrolment has declined by 30 per cent over the past 23 years, but the number of teachers hasn't seen a significant decline. Cutting one teacher for every 20 students who leave New Brunswick's school system could save $10 million to $12 million, the government estimated. "What was done in the first budget was done," said Health Minister Victor Boudreau, who is responsible for overseeing the program review. "What we're saying is we could continue doing the same on an annual basis." Other options include increasing the maximum class size by four students per class, which could save $50 million to $70 million, and reducing the number of educational assistants to meet enrolment, a move that could save $3 million to $6 million. They may also privatize all custodial services within the education system, estimating savings of $5 million to $7 million, and convert pensions for school bus drivers, nursing home workers and custodians to the shared risk model ($7.5 million to $9 million in estimated savings).
  • The New Brunswick Teachers' Association was not available to comment on the possible cuts on Friday afternoon. Bennett believes the government could find savings and have little impact on classrooms by cutting the number of teachers and increasing class sizes.
  • He said research shows that class size reductions only have an impact on student performance up to Grade 3. After that, he said they don't have much impact and can be expensive. The New Brunswick government decreased class sizes about a decade ago and officials say that has cost taxpayers $50 million per year. But he is "extremely nervous" about basing cuts of educational assistants on financial considerations alone, arguing it could add tremendous pressure to teachers.
  • I think they need to re-think that." He's also disappointed the government isn't considering suggestions from a paper he co-wrote in January, which suggests the New Brunswick government could find savings by contracting out bus services in some of its school districts, which would produce competition. Health care
  • The provincial government is considering closing rural hospitals, trimming the number of full-service emergency rooms or centralizing specialized services in one location, like the New Brunswick heart centre in Saint John. The government estimates that could save between $50 million to $80 million. Gilles Lanteigne, president and CEO of Vitalité Health Network, said there isn't enough detail in the report to give him a sense yet of how it might affect service delivery in the francophone health authority. The health network is rolling out a plan to reduce 99 acute care beds in order to save $10 million.
  • The president of CUPE Local 1252, the union representing hospital workers, is concerned about "significant job losses" that could come from closing rural hospitals. But Norma Robinson is also concerned about the impact on people who live in rural New Brunswick and will have to drive up to an hour to get to an emergency room or to a major urban centre for specialized services. The government estimates 90 per cent of New Brunswickers live within an hour's drive of an emergency room. Universities
  • The province is also considering changing the funding model for universities, moving toward a performance-based formula that focuses on criteria like graduation rates and limiting duplication. The possible changes could save between $15 million and $45 million, the government says.
Govind Rao

Let Blood Services lead the way - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|ntnp|20150414|218428860

from heather pharmacare cbs drugs

shared by Govind Rao on 14 Apr 15 - No Cached
  • National Post Tue Apr 14 2015
  • I magine having to choose between putting food on the table or buying necessary medication. Research suggests this is the case for one in 10 Canadians who can't afford to fill their prescriptions. Canada is the only country with universal health care that does not also have universal drug coverage. Even for those who do have private or public drug coverage, there are discrepancies in what and who is covered from province to province. Canadians also pay more for drugs than citizens in almost any other Western nation. These are just a few of the arguments that have reignited calls for a national pharmacare program. It is not a new concept, but one that is gaining traction as leaders are turning over every stone to "bend the cost curve" in health care downward. In a recently published study in the Canadian Medical Association Journal (CMAJ), health economists and researchers concluded a universal drug program could actually save Canadians billions of dollars. Great savings are achieved by pooling provincial and territorial needs and resources to increase buying power, eliminate duplication and establish a platform for collaboration and cost-sharing. If health-care leaders are looking for proof that provinces and territories can do more together than they can on their own when it comes to the provision of life-saving and enhancing drug therapies, they need look no further than the blood system they created close to 20 years ago.
  • Many are aware that since its creation in 1998, Canadian Blood Services has been in the business of collecting, processing and distributing blood components in all provinces and territories outside Quebec. But few realize we have also been running a national formulary of biological drugs, providing universal and equitable access to plasma-derived medicine at no cost to patients for nearly two decades. Our organization has sole responsibility for managing a national portfolio of plasma-derived products and their synthetic alternatives worth about $500 million a year. These life-saving pharmaceuticals are used to treat people with hemophilia and other bleeding disorders, patients with inherited and acquired immune disorders, burn and trauma victims, and many others. A national, scalable, cost-shared infrastructure and logistics network ensures the right product gets to the right patient, at the right time.
  • ...3 more annotations...
  • Our approach to managing this drug portfolio is based on best practices in public tendering. This means we provide a competitive, transparent mechanism to achieve best pricing. In fact, governments are benefiting from Canadian Blood Services' success in negotiating an estimated $600 million in savings over five years through 2018 - a testament to the value of pan-Canadian buying power and proof of concept of one of the arguments in the CMAJ study. Some detractors of tendering suggest it can put supply at risk by placing all the purchaser's eggs in that one proverbial basket. However, in our process, we avoid single-sourcing whenever possible, not only to encourage competitive pricing, but to ensure security of supply. Carrying multiple brands of a product, purchasing them in smaller, diverse lots, and negotiating a dedicated and guaranteed "safety stock" are all measures we take to mitigate risks to supply disruption.
  • We have also focused on product choice by incorporating stakeholder (physician and patient) input where appropriate in our tendering processes. Through our medical directors, we provide expert advice when a physician has a patient-based issue that could benefit from an additional specialist perspective - added value for patients and health systems. We also independently qualify new suppliers and audit them periodically, adding another layer of vigilance and product safety for patients. We are often aware early on of supplier issues in bringing products to market or maintaining adequate Canadian supplies, which helps to mitigate the risk of shortages. Because of our governance structure, once a plasma-derived drug is accepted in our portfolio, it becomes available in all jurisdictions. This practice effectively reduces geographic or financial barriers to care, and is consistent with the principles of universal access informing the Canada Health Act and medicare. Equitable access also encourages consistency of practice, and fosters pan-Canadian dialogue on best practices for optimal product utilization. Canadian Blood Services collaborates with health-system leaders, including governments, transfusion medicine physicians and others, to help ensure appropriate utilization and to further control costs.
  • By offering our experience, we are not proposing Canadian Blood Services should bulk-purchase other drugs or that our model is a "cookie cutter" solution to apply to national pharmacare, in part or in whole. Rather, we are suggesting there are important lessons from our 17 years' experience that can be leveraged, and that a national drug program is not only possible - it is already being done, with significant benefits to patients and health system funders. A system that ensures no Canadian patient is left unable to afford life-saving medication, while at the same time driving down system costs, is not only good politics, it's good policy. National Post Dr. Graham Sher is CEO of Canadian Blood Services.
Govind Rao

Extendicare's U.S. exit: Bad news for the fast money, good news for dividend investors ... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150123|213007492

from heather privatization ltc continuing care corporation

shared by Govind Rao on 27 Jan 15 - No Cached
  • The Globe and Mail Fri Jan 23 2015
  • It's no secret that our population is aging, or that investing along demographic lines has been popular for two decades. So why are shares of Extendicare Inc., a big operator of nursing homes, withering away? There are a couple of reasons, in my opinion, and both are temporary, making the stock a buy for both potential capital gains and generous income, with a current yield of 7.5 per cent. Extendicare is one of the bigger publicly listed owners and operators of senior care centres, with a market capitalization of about $568-million. The company has had its share of ups and downs, including a foray into the United States that didn't go that well and from which the company has almost exited.
  • That exit - a sale of the U.S. business that should close in the second quarter - will bring in a lot of cash but also remove a distraction for management, as the U.S. business was plagued by legal problems. Extendicare agreed to sell its U.S. division late last year, with an expected closing date in the next few months. Net proceeds from the sale will amount to more than $220-million (U.S.), which will be put to work expanding and improving the Canadian business.
  • ...3 more annotations...
  • Extendicare has also announced a big share buyback, so some of the money may be used for that as well. The first reason the stock is down is likely that it had attracted a lot of "hot" money - hedge funds and other traders hoping the sale of the U.S. business would bring a quick buck in the form of a special dividend. The sale price ended up being on the low end of the expected range, which frustrated these traders. But worse, in their eyes, was that the company plans to reinvest the proceeds rather than paying out a big fat dividend.
  • It didn't take long for the acrimony to start flowing, with irate investors calling out management for supposedly poor decision-making. On paper, their arguments are plausible. The U.S. operations are bigger than the Canadian business, so it's easy to believe arguments that the dividend is at risk because once you take out the U.S. division there's not enough cash flow coverage for the current dividend. But that's a false argument because it assumes the $220-million net proceeds from the sale can't be put to work to generate more cash to support the existing dividend - and perhaps increase it. By way of example, Extendicare just acquired the home health care division of Revera, a smaller competitor, for $83-million. That values the assets at 6.5 times projected earnings before interest, taxes, depreciation and amortization, a good multiple. Analyst Doug Loe at Euro Pacific Canada likes the deal, noting it's a good bolt-on acquisition for Extendicare's existing home-care operations and that home care is increasingly touted by experts as a way to reduce the overall cost of health care in Canada.
  • Mr. Loe also believes that this acquisition goes some way to reduce the risk to the dividend. While the U.S. operations are strained by compressing margins and rising insurance costs, Extendicare still generates more than half its cash flow from south of the border. But this accretive acquisition adds about 10 cents of cash flow per share. The dividend is 48 cents, so assuming half the funds for the dividend are coming from the United States, the company has already replaced a good proportion of it with an investment of $80-million. It has another roughly $200-million to deploy so it appears that the fears of a dividend cut are overblown as long as the company can deploy funds in a reasonable way, whether by acquisition or re-investment in its existing operations to increase revenue and profits. I have to think that with an aging population and growing demand for such services, Extendicare should not have much difficulty making judicious decisions with its cash and I'm happy to collect a nice dividend while I wait to see what they do with that big war chest of cash. Fabrice Taylor, CFA, publishes the President's Club investment letter, for which he and The Globe and Mail have a distribution agreement. He holds shares of Extendicare. Extendicare (EXE) Close: $6.45, down 5C/
Heather Farrow

Referendum on agenda; Health coalition to introduce effort to save local hospitals - In... - 0 views

www.fpinfomart.ca/...245347159

Ontario coalition hospital cuts campaign

shared by Heather Farrow on 22 Apr 16 - No Cached
  • Welland Tribune Fri Apr 22 2016
  • A provincewide referendum could make it "politically impossible" to close hospitals, says an Ontario Health Coalition board member. Doug Allan said a referendum the coalition is planning will "make it so that these cuts, and the threatened closure of the Port Colborne hospital, can be stopped - to make it politically impossible for that to happen." Allan, a Toronto area resident, told a group of about 80 people at the Guild Hall in Port Colborne Wednesday night that "saving your hospital will be like a beacon for the rest of the province of what a community can do that stands up for it."
  • Niagara Heath Coalition chair Sue Hotte said details about a referendum will be released during a media conference Monday, but the initiative will include ballot boxes set up in public locations in communities across Ontario, such as businesses, municipal offices and physician clinics and workplaces. Although petitions bearing tens of thousands of signatures submitted to the provincial government in recent years have failed to stop the province's plans for Niagara hospitals, Hotte said the scope of the referendum should allow it to garner far more response. Hotte said it will have a profound impact on the provincial government.
  • ...5 more annotations...
  • Allan said similar provincewide campaigns have had significant impacts in the past, such as stopping health-care privatization plans. He said the most recent referendum the Ontario coalition organized pertained to allowing private clinics to conduct some hospital surgeries, "and we collected 100,000 votes on an issue that I don't think is quite as well known as the cuts to our hospitals." "This is a much bigger issue, and I think we can get an even bigger vote," Allan said. "We need to collect the votes, send them offto the legislature, we need to do it collectively right across the province and send a very loud message. I think we can send an extremely loud message in Port Colborne because of the circumstances that we're looking at here." The meeting was organized to discuss the provincial government's plans to close hospitals in Port Colborne, Welland and Fort Erie and replace them with a single new hospital in Niagara Falls.
  • Niagara Health System in an e-mail to The Tribune Tuesday said Angela Zangari, executive vice-president and project lead, and NHS president Suzanne Johnston "have been across all NHS sites over the past few weeks sharing the preferred designs for a new south hospital at Lyons Creek and Montrose roads and a new ambulatory care/urgent care and longterm care development in Welland at King and Third streets. "We believe it is important to share information with our staff, many of whom have been engaged in planning activity for the projects. "Dr. Johnston is committed to working with staffto discuss planning on a regular basis. In addition she will be continuing to meet with community leaders to plan forward." At Wednesday' night's coalition meeting, several residents shared concerns about access to health-care services, including Aubrey Foley. "I don't want to offend anyone from Welland, but I live in Port Colborne, my hospital is in Port Colborne and this is where it should remain," the 71-year-old said.
  • He said his city of 19,000 people has a "deplorable walk-in service for health care." "It is not acceptable. There is no reason for it to be the way it is today," he said, while noting Dunnville, a town of 11,000 people, has a "fully functional hospital with free parking." "If Dunnville can do that, we can do this very easily," Foley said. Former mayor and regional councillor Bob Saracino said he will do whatever he can to save the Welland hospital, but the community must also work together to keep the urgent care centre running in Port Colborne. "When it comes to health, we must be one," he said.
  • Saracino said health care "is not a privilege, but it is a fundamental right that we have under the Canada Health Act." While Hotte said she agrees Niagara Falls needs a new hospital, "it should not be at the expense of people in Port Colborne, Welland, Wainfleet, Pelham - over 94,000 people losing access to hospital services." "No way! We need to keep the hospitals open and access to services," Hotte said.
  • About 80 people attend Wednesday night's meeting at Guild Hall about the planned closure of Port Colborne hospital. • Photos By Allan Benner, Tribune Staff / Ontario Health Coalition board member Doug Allan speaks at a meeting to discuss efforts to save Port Colborne hospital.
Irene Jansen

House of Commons Committees - OGGO (41-1) - Notice of Meeting - Number 021 (Official Ve... - 0 views

www.parl.gc.ca/...Publication.aspx

shared services federal

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Shared Services Canada &nbsp; Services partagés Canada &nbsp; Liseanne Forand, President &nbsp; Liseanne Forand, présidente &nbsp; Grant Westcott, Chief Operating OfficerPresident's Office
  • New Entity Shared Services Canada
Govind Rao

Why We Need to Transform Teacher Unions Now | Alternet - 1 views

www.alternet.org/...d-transform-teacher-unions-now

from heather us union activist

shared by Govind Rao on 06 Feb 15 - No Cached
  • This work reminds me of the words of activist/musician Bernice Johnson Reagon, of Sweet Honey in the Rock: “If you are in a coalition and you are comfortable, that coalition is not broad enough.”
  • February 6, 2015
  • Immediately following Act 10, Walker and the Republican-dominated state legislature made the largest cuts to public education of any state in the nation and gerrymandered state legislative districts to privilege conservative, white-populated areas of the state.
  • ...62 more annotations...
  • By Bob Peterson / Rethinking Schools
  • long history of being staff-dominated.
  • And it has. In New Orleans, following Katrina, unionized teachers were fired and the entire system charterized.
  • But it recognizes that our future depends on redefining unionism from a narrow trade union model, focused almost exclusively on protecting union members, to a broader vision that sees the future of unionized workers tied directly to the interests of the entire working class and the communities, particularly communities of color, in which we live and work.
  • It requires confronting racist attitudes and past practices that have marginalized people of color both inside and outside unions.
  • Having decimated labor law and defunded public education, Walker proceeded to expand statewide the private school voucher program that has wreaked havoc on Milwaukee, and enacted one of the nation’s most generous income tax deductions for private school tuition.
  • For nearly a decade we pushed for a full-time release president, a proposal resisted by most professional staff.
  • “Social Justice Unionism: A Working Draft”
  • Social justice unionism is an organizing model that calls for a radical boost in internal union democracy and increased member participation.
  • business model that is so dependent on staff providing services
  • building union power at the school level in alliance with parents, community groups, and other social movements.
  • The importance of parent/community alliances was downplayed
  • instead of helping members organize to solve their own problems.
  • Our challenge in Milwaukee was to transform a staff-dominated, business/service-style teachers’ union into something quite different.
  • only saw the union newsletter after the staff had sent it to the printer.
  • Key elements of our local’s “reimagine” campaign and our subsequent work include:
  • Building strong ties and coalitions with parent, community, and civic organizations,
  • broader issues
  • action.
  • earliest victories was securing an extra $5/hour (after the first hour) for educational assistants when they “cover” a teacher’s classroom.
  • lobby
  • enlist parents
  • we amended the constitution
  • consistently promoting culturally responsive, social justice teaching.
  • encourage members to lead our work.
  • release two teachers to be organizers
  • appear en masse at school board meetings
  • to shift certain powers from the staff to the elected leadership
  • new teacher orientation and mentoring are available and of high quality.
  • The strength of the Chicago Teachers Union (CTU) 2012 strike,
  • rested in large part on their members’ connections to parent and community groups
  • Karen Lewis
  • Portland, Oregon, and St. Paul, Minnesota
  • In Milwaukee, our main coalition work has been building Schools and Communities United,
  • We wanted to move past reacting, being on the defensive, and appearing to be only against things.
  • Key to the coalition’s renewal was the development of a 32-page booklet, Fulfill the Promise: The Schools and Communities Our Children Deserve.
  • concerns of the broader community beyond the schoolhouse door
  • English and Spanish
  • Currently the coalition’s three committees focus on fighting school privatization, promoting community schools, and supporting progressive legislation.
  • schools as hubs for social and health support,
  • This work reminds me of the words of activist/musician Bernice Johnson Reagon, of Sweet Honey in the Rock: “If you are in a coalition and you are comfortable, that coalition is not broad enough.”
  • Our new professional staff is committed to a broader vision of unionism with an emphasis on organizing.
  • We need to become the “go-to” organizations in our communities on issues ranging from teacher development to anti-racist education to quality assessments.
  • nonprofit organization, the Milwaukee Center for Teaching, Learning, and Public Education
  • We provide professional development and services to our members
  • reclaim our classrooms and our profession.
  • We partner with the MPS administration through labor/management committees
  • multiple committee meetings, inservice trainings, book circles (for college credit), and individual help sessions on professional development plans or licensure issues.
  • we offered workshops that drew 150 teachers at a time.
  • More teachers were convinced to join our union, too, because our teaching and learning services are only open to members.
  • mandate 45 minutes of uninterrupted play in 4- and 5-year-old kindergarten classes
  • We also won a staggered start
  • convincing the school board to systematically expand bilingual education programs throughout the district.
  • school-based canvassing around issues and pro-education candidates, and organizing to remove ineffective principals.
  • With the plethora of federal and state mandates and the datatization of our culture,
  • It’s clear to me that what is necessary is a national movement led by activists at the local, state, and national levels within the AFT and NEA—in alliance with parents, students, and community groups—to take back our classrooms and our profession.
  • social justice content in our curriculum
  • waiting to use any perceived or real weakness in public schools as an excuse to accelerate their school privatization schemes,
  • On the other hand, speaking out can play into the hands of the privatizers as they seek to expand privately run charters
  • including participation on labor/management committees, lobbying school board members, and balancing mass mobilizations with the threat of mass mobilizations.
  • In the end, we recognize a key element in fighting privatization is to improve our public schools.
  • In Los Angeles, an activist caucus, Union Power, won leadership of the United Teachers Los Angeles, the second largest teacher local in the country.
Irene Jansen

NDP balks at privatizing hospital food services | The Chronicle Herald - 1 views

thechronicleherald.ca/...atizing-hospital-food-services

ns ndp hospital food laundry contracting out shared services

shared by Irene Jansen on 25 Jan 13 - No Cached
  • The NDP government has no plans to allow Capital Health to contract out food services, even though it loses money consistently, Health Minister David Wilson said Thursday.
  • Authority officials also said they’ve asked the government for the last three years to allow them to contract out food services
  • last March’s announcement to merge health authorities’ administrative services
  • ...2 more annotations...
  • The report recommended privatizing laundry services, but the government rejected the idea.
  • “We’re working with the unions, we’re working with the health authorities, we’re working with the boards that are around the province to find those savings.”
Govind Rao

North Bay suffering because of Liberal austerity agenda: CUPE Ontario president - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|nxbg|20151212|235740323

from heather cupe Ontario rural hospital cuts

shared by Govind Rao on 15 Dec 15 - No Cached
  • Financial Buzz Sat Dec 12 2015
  • NORTH BAY, ONTARIO--(Marketwired - Dec 12, 2015) - From hospital service cuts to workers locked out at Ontario Northland, skyrocketing hydro rates and a loss of good manufacturing jobs, North Bay is feeling the full force of the Liberal government's austerity agenda, CUPE Ontario President Fred Hahn told the Unity for Our Community rally today in North Bay
  • "You can't cut your way to prosperity," said Hahn, president of Ontario's largest union. "Cuts to public services are devastating to communities. North Bay is witnessing this first-hand with huge service cuts and mass layoffs at the hospital. But Kathleen Wynne's unflinching support for austerity and privatization is hurting every corner of the community."
  • ...5 more annotations...
  • Skyrocketing hydro rates are making Ontario less attractive to manufacturers, making it harder to replace the good jobs being lost at Bombardier or Ontario Northland, he said.
  • "Hydro rates started going up after Mike Harris and the Conservatives started privatizing generation, and they shot up with the Liberals' private energy deals, like the sole-source Samsung contract for wind," he said. "This will get much worse with the sale of Hydro One to private interests. We'll also lose the oversight of public accountability officers like the Auditor General." Hahn was speaking to a crowd of North Bay residents calling on Queen's Park to take action to stop the loss of good jobs and quality public services in their community.
  • The rally organized by the North Bay and District Labour Council, began at the Ontario Northland building, then made its way to City Hall. Speakers included Canadian Labour Congress President Hassan Yussuff, new Ontario Federation of Labour President Chris Buckley, NDP MP Charlie Angus (Timmins-James Bay), NDP MPP John Vanthof (Temiskaming-Cochrane) and Sharon Richer, vice-president of the Ontario Council of Hospital Unions
  • "It's Kathleen Wynne listened to Ontarians. Almost 85 percent of the public and 194 municipalities oppose the Hydro One sell-off," said Hahn. "The Liberals need to listen to the people, not to Bay Street. We need quality public services and good jobs in our communities. We need at-cost, not-for-profit electricity. We need profitable corporations to pay their fair share so working-class people don't pay any more for disastrous Liberal austerity and privatization schemes."
  • CUPE is Ontario's community union, with more than 250,000 members providing quality public services we all rely on, in every part of the province, every day. CUPE Ontario members are proud to work in social services, health care, municipalities, school boards, universities and airlines.
Govind Rao

Share of health spending on doctors increases - 0 views

www.cmaj.ca/...E506

from heather doctors wages chc

shared by Govind Rao on 22 Dec 15 - No Cached
  • CMAJ December 8, 2015 vol. 187 no. 18 First published November 9, 2015, doi: 10.1503/cmaj.109-5191
  • Carolyn Brown
  • After years of erosion, doctors’ share of health spending has rebounded to levels last seen in the 1980s, according to the Canadian Institute for Health Information’s (CIHI’s) annual release of national health expenditure data. But it comes from a pie that is slowly shrinking, as health spending has not kept pace with inflation and population growth.
  • ...12 more annotations...
  • Figures compiled in CIHI’s database over 40 years show the share spent on physicians hit an all-time high in 1988, then slowly declined until 2007, when it turned around, growing at about 2.2% annually. It now accounts for 15.5%, comparable to levels seen in the late 1980s. Hospital spending has decreased from 45% of total health spending in the mid-1970s to just under 30% today, whereas drug spending has been increasing since the mid-1980s to account for just under 16% of spending.
  • “The guild has done a great job of protecting our income,” Dr. David Naylor said, referring to medical associations’ success in negotiations with governments. “But wouldn’t you expect [the share of spending on physicians] to drop a little?” Naylor, past president of the University of Toronto and chair of the Advisory Panel on Healthcare Innovation, spoke at a panel discussion on the CIHI findings, held Oct. 29 in Ottawa.
  • He said the “constancy of focus on doctors, drugs and hospitals … speaks to the stasis in the system. If anything, it’s in a state of arrested development.” While overall health spending has gone up in dollar terms, amounting to $6105 per capita in 2015, it has declined as a proportion of gross domestic product (GDP). After the 2008–2009 recession, health spending fell from 11.6% of to an estimated 10.9% of GDP today. When inflation and population growth are taken into account, health spending also shows a decline.
  • The first half of this movie seems similar to what happened in the 1990s,” said Don Drummond, an economist at Queen’s University. He said that in the 1990s, government austerity led to a decline in health spending, but a return to a good economy resulted in health spending growing “much faster than economic growth.”
  • In regard to the similar spending decline after 2011, Drummond asked “did we create efficiencies or just cut off the money and create pressure?” Drummond and Naylor clearly think that efficiencies are lacking. The solution, said Naylor, is integrating services, including home care and virtual care. “There’s not a single province that has taken steps in that direction.”
  • CMA President Cindy Forbes agreed. “We need integrated, appropriate and high-quality care.” She gave the example of a patient in an acute care hospital discharged to community care and later moving to palliative care. “The patient goes through three different systems. They all have their own budgets and caregivers. These silos have to be broken down so it’s one system.”
  • She stressed the need for a national seniors’ strategy to address a population that is aging and living longer, often with complex, multiple diseases. Integrated services could address the patients needing an alternative level of care who currently occupy 20% of beds in acute care hospitals, she said. “They are not ‘bed blockers,’” she said. “They are waiting for long-term or home care.”
  • Naylor also thinks changing the way physicians are paid is part of the solution. “The fee schedule is full of perverse incentives. It doesn’t create ‘integrative quarterbacks.’ There should be rewards for good prescribing and shorter hospital stays.”
  • Wide variations in the price tag for health care among provinces and territories also stood out in the data. Costs in Canada’s provinces range from $5665 per person per year in Quebec to $7036 in Newfoundland and Labrador. (In the territories, costs are much higher.) Seven provinces devote more than 40% of their budget to health, of which two devote more than 45%.
  • Demographics and geography account for some of the variation, according to Brent Diverty, CIHI’s vice-president of programs, especially costs to transport critical cases from remote areas. However, panellists expressed concern about inequalities in quality of care and access.
  • “People who are covered for a drug in one province are not covered in another,” pointed out Forbes. “Especially cancer drugs, which are expensive.”
  • Naylor added, “There’s a huge challenge for the [federal/provincial/territorial ministers] to understand this variation. We need to unbundle why these disparities occur. How do we get to a common higher ground as Canadians?”
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