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Irene Jansen

Senate Social Affairs Committee review of the health accord, Evidence, September 29, 2011 - 0 views

www.parl.gc.ca/...49055-e.htm

accord waits senate

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Christine Power, Chair, Board of Directors, Association of Canadian Academic Healthcare Organizations
  • eight policy challenges that can be grouped across the headers of community-based and primary health care, health system capacity building and research and applied health system innovation
  • Given that we are seven plus years into the 2004 health accord, we believe it is time to open a dialogue on what a 2014 health accord might look like. Noting the recent comments by the Prime Minister and Minister of Health, how can we improve accountability in overall system performance in terms of value for money?
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  • While the access agenda has been the central focal point of the 2004 health accord, it is time to have the 2014 health accord focus on quality, of which access is one important dimension, with the others being effectiveness, safety, efficiency, appropriateness, provider competence and acceptability.
  • we also propose three specific funds that are strategically focused in areas that can contribute to improved access and wait time
  • Can the 2014 health accord act as a catalyst to ensure appropriate post-hospital supportive and preventive care strategies, facilitate integration of primary health care with the rest of the health care system and enable innovative approaches to health care delivery? Is there an opportunity to move forward with new models of primary health care that focus on personal accountability for health, encouraging citizens to work in partnership with their primary care providers and thereby alleviating some of the stress on emergency departments?
  • one in five hospital beds are being occupied by those who do not require hospital care — these are known as alternative level of care patients, or ALC patients
  • the creation of an issue-specific strategically targeted fund designed to move beyond pilot projects and accelerate the creation of primary health care teams — for example, team-based primary health care funds could be established — and the creation of an infrastructure fund, which we call a community-based health infrastructure fund to assist in the development of post-hospital care capacity, coupled with tax policies designed to defray expenses associated with home care
  • consider establishing a national health innovation fund, of which one of its stated objectives would be to promote the sharing of applied health system innovations across the country with the goal of improving the delivery of quality health services. This concept would be closely aligned with the work of the Canadian Institutes of Health Research in developing a strategy on patient oriented research.
  • focus the discussion on what is needed to ensure that Canada is a high performing system with an unshakable focus on quality
  • of the Wait Time Alliance
  • Dr. Simpson
  • the commitment of governments to improve timely access to care is far from being fulfilled. Canadians are still waiting too long to access necessary medical care.
  • Table 1 of our 2011 report card shows how provinces have performed in addressing wait times in the 10-year plan's five priority areas. Of note is the fact that we found no overall change in letter grades this year over last.
  • We believe that addressing the gap in long-term care is the single more important action that could be taken to improve timely access to specialty care for Canadians.
  • The WTA has developed benchmarks and targets for an additional seven specialties and uses them to grade progress.
  • the lack of attention given to timely access to care beyond the initial five priority areas
  • all indications are that wait times for most specialty areas beyond the five priority areas are well beyond the WTA benchmarks
  • we are somewhat encouraged by the progress towards standardized measuring and public reporting on wait times
  • how the wait times agenda could be supported by a new health accord
  • governments must improve timely access to care beyond the initial five priority areas, as a start, by adopting benchmarks for all areas of specialty care
  • look at the total wait time experience
  • The measurements we use now do not include the time it takes to see a family physician
  • a patient charter with access commitments
  • Efficiency strategies, such as the use of referral guidelines and computerized clinical support systems, can contribute significantly to improving access
  • In Ontario, for example, ALC patients occupy one in six hospital beds
  • Our biggest fear is government complacency in the mistaken belief that wait times in Canada largely have been addressed. It is time for our country to catch up to the other OECD countries with universal, publicly funded health care systems that have much timelier access to medical care than we do.
  • The progress that has been made varies by province and by region within provinces.
  • Dr. Michael Schull, Senior Scientist, Institute for Clinical Evaluative Sciences
  • Many provinces in Canada, and Ontario in particular, have made progress since the 2004 health accord following large investments in health system performance that targeted the following: linking more people with family doctors; organizational changes in primary care, such as the creation of inter-professional teams and important changes to remuneration models for physicians, for example, having a roster of patients; access to select key procedures like total hip replacement and better access to diagnostic tests like computer tomography. As well, we have seen progress in reducing waiting times in emergency departments in some jurisdictions in Canada and improving access to community-based alternatives like home care for seniors in place of long-term care. These have been achieved through new investments such as pay for performance incentives and policy change. They have had some important successes, but the work is incomplete.
  • Examples of the ongoing challenges that we face include substantial proportions of the population who do not have easy access to a family doctor when needed, even if they have a family doctor; little progress on improving rates of eligible patients receiving important preventive care measures such as pap smears and mammograms; continued high utilization of emergency departments and walk-in clinics compared to other countries; long waits, which remain a problem for many types of care. For example, in emergency departments, long waits have been shown to result in poor patient experience and increased risk of adverse outcomes, including deaths.
  • Another example is unclear accountability and antiquated mechanisms to ensure smooth transitions in care between providers and provider organizations. An example of a care transition problem is the frequent lack of adequate follow-up with a family doctor or a specialist after an emergency department visit because of exacerbation of a chronic disease.
  • A similar problem exists following discharge from hospital.
  • Poorly integrated and coordinated care leads to readmission to hospital
  • This happens despite having tools to predict which patients are at higher risk and could benefit from more intensive follow-up.
  • Perverse incentives and disincentives exist, such as no adjustment in primary care remuneration to care for the sickest patients, thereby disincenting doctors to roster patients with chronic illnesses.
  • Critical reforms needed to achieve health system integration include governance, information enablers and incentives.
  • we need an engaged federal government investing in the development and implementation of a national health system integration agenda
  • complete absence of any mention of Canada as a place where innovative health system reform was happening
  • Dr. Brian Postl, Dean of Medicine, University of Manitoba, as an individual
  • the five key areas of interest were hips and knees, radiology, cancer care, cataracts and cardiac
  • no one is quite sure where those five areas came from
  • There was no scientific base or evidence to support any of the benchmarks that were put in place.
  • I think there is much less than meets the eye when we talk about what appropriate benchmarks are.
  • The one issue that was added was hip fractures in the process, not just hip and knee replacement.
  • in some areas, when wait-lists were centralized and grasped systematically, the list was reduced by 30 per cent by the act of going through it with any rigour
  • When we started, wait-lists were used by most physicians as evidence that they were best of breed
  • That continues, not in all areas, but in many areas, to be a key issue.
  • The capacity of physicians to give up waiting lists into more of a pool was difficult because they saw it very much, understandably, as their future income.
  • There were almost no efforts in the country at the time to use basic queuing theory
  • We made a series of recommendations, including much more work on the research about benchmarks. Can we actually define a legitimate benchmark where, if missed, the evidence would be that morbidity or mortality is increasing? There remains very little work done in that area, and that becomes a major problem in moving forward into other benchmarks.
  • the whole process needed to be much more multidisciplinary in its focus and nature, much more team-based
  • the issue of appropriateness
  • Some research suggests the number of cataracts being performed in some jurisdictions is way beyond what would be expected to be needed
  • the accord did a very good job with what we do, but a much poorer job around how we do it
  • Most importantly, the use of single lists is needed. This is still not in place in most jurisdictions.
  • the accord has bought a large amount of volume and a little bit of change. I think any future accords need to lever any purchase of volume or anything else with some capacity to purchase change.
  • We have seen volumes increase substantially across all provinces, without major detriment to other surgical or health care areas. I think it is a mediocre performance. Volume has increased, but we have not changed how we do business very much. I think that has to be the focus of any future change.
  • with the last accord. Monies have gone into provinces and there has not really been accountability. Has it made a difference? We have not always been able to tell that.
  • There is no doubt that the 2004-14 health accord has had a positive influence on health care delivery across the country. It has not been an unqualified success, but nonetheless a positive force.
  • It is at these transition points, between the emergency room and being admitted to hospital or back to the family physician, where the efficiencies are lost and where the expectations are not met. That is where medical errors are generated. The target for improvement is at these transitions of care.
  • I am not saying to turn off the tap.
  • the government has announced, for example, a 6 per cent increase over the next two or three years. Is that a sufficient financial framework to deal with?
  • Canada currently spends about the same amount as OECD countries
  • All of those countries are increasing their spending annually above inflation, and Canada will have to continue to do that.
  • Many of our physicians are saying these five are not the most important anymore.
  • they are not our top five priority areas anymore and frankly never were
  • this group of surgeons became wealthy in a short period of time because of the $5.5 billion being spent, and the envy that caused in every other surgical group escalated the costs of paying physicians because they all went back to the market saying, "You have left us out," and that became the focus of negotiation and the next fee settlements across the country. It was an unintended consequence but a very real one.
  • if the focus were to shift more towards system integration and accountability, I believe we are not going to lose the focus on wait times. We have seen in some jurisdictions, like Ontario, that the attention to wait times has gone beyond those top five.
  • people in hospital beds who do not need to be there, because a hospital bed is so expensive compared to the alternatives
  • There has been a huge infusion of funds and nursing home beds in Ontario, Nova Scotia and many places.
  • Ontario is leading the way here with their home first program
  • There is a need for some nursing home beds, but I think our attention needs to switch to the community resources
  • they wind up coming to the emergency room for lack of anywhere else to go. We then admit them to hospital to get the test faster. The weekend goes by, and they are in bed. No one is getting them up because the physiotherapists are not working on the weekend. Before you know it, this person who is just functioning on the edge is now institutionalized. We have done this to them. Then they get C. difficile and, before you know, it is a one-way trip and they become ALC.
  • I was on the Kirby committee when we studied the health care system, and Canadians were not nearly as open to changes at that time as I think they are in 2011.
  • there is no accountability in terms of the long-term care home to take those patients in with any sort of performance metric
  • We are not all working on the same team
  • One thing I heard on the Aging Committee was that we should really have in place something like the Veterans Independence Program
  • some people just need someone to make a meal or, as someone mentioned earlier, shovel the driveway or mow the lawn, housekeeping types of things
  • I think the risks of trying to tie every change into innovation, if we know the change needs to happen — and there is lots of evidence to support it — it stops being an innovation at that point and it really is a change. The more we pretend everything is an innovation, the more we start pilot projects we test in one or two places and they stay as pilot projects.
  • the PATH program. It is meant to be palliative and therapeutic harmonization
  • has been wildly successful and has cut down incredibly on lengths of stay and inappropriate care
  • Where you see patient safety issues come to bear is often in transition points
  • When you are not patient focused, you are moving patients as entities, not as patients, between units, between activities or between functions. If we focus on the patient in that movement, in that journey they have through the health system, patient safety starts improving very dramatically.
  • If you require a lot of home care that is where the gap is
  • in terms of emergency room wait times, Quebec is certainly among the worst
  • Ontario has been quite successful over the past few years in terms of emergency wait times. Ontario’s target is that, on average, 90 per cent of patients with serious problems spend a maximum of eight hours in the emergency room.
  • One of the real opportunities, building up to the accord, are for governments to define the six or ten or twelve questions they want answered, and then ensure that research is done so that when we head into an accord, there is evidence to support potential change, that we actually have some ideas of what will work in moving forward future changes.
  • We are all trained in silos and then expected to work together after we are done training. We are now starting to train them together too.
  • The physician does not work for you. The physician does not work for the health system. The physician is a private practitioner who bills directly to the health care system. He does not work for the CEO of the hospital or for the local health region. Therefore, your control and the levers you have with that individual are limited.
  • the customer is always right, the person who is getting the health care
  • It is refreshing to hear something other than the usual "we need more money, we absolutely need more money for that". Without denying the fact that, since the population and the demographics are going to require it, we have to continue making significant investments in health, I think we have to be realistic and come up with new ways of doing things.
  • The cuts in the 1990s certainly had something to do with the decision to cut support staff because they were not a priority and cuts had to be made. I think we now know it was a mistake and we are starting to reinvest in those basic services.
  • How do you help patients navigate a system that is so complex? How do you coordinate appointments, ensure the appointments are necessary and make sure that the consultants are communicating with each other so one is not taking care of the renal problem and the other the cardiac problem, but they are not communicating about the patient? That is frankly a frequent issue in the health system.
  • There may be a patient who requires Test Y, X, and Z, and most patients require that package. It is possible to create a one-stop shop kind of model for patient convenience and to shorten overall wait times for a lot of patients that we do not see. There are some who are very complicated and who have to be navigated through the system. This is where patient navigators can perhaps assist.
  • There have been some good studies that have looked at CT and MRI utilization in Ontario and have found there are substantial portions where at least the decision to initiate the test was questionable, if not inappropriate, by virtue of the fact that the results are normal, it was a repeat of prior tests that have already been done or the clinical indication was not there.
  • Designing a system to implement gates, so to speak, so that you only perform tests when appropriate, is a challenge. We know that in some instances those sorts of systems, where you are dealing with limited access to, say, CT, and so someone has to review the requisition and decide on its appropriateness, actually acts as a further obstacle and can delay what are important tests.
  • The simple answer is that we do not have a good approach to determining the appropriateness of the tests that are done. This is a critical issue with respect to not just diagnostic tests but even operative procedures.
  • the federal government has very little information about how the provinces spend money, other than what the provinces report
  • should the money be conditional? I would say absolutely yes.
Heather Farrow

Care staff support bill for more 1-on-1 time - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|tidp|20160505|246326122

cupe Ontario ltc staffing legislation

shared by Heather Farrow on 05 May 16 - No Cached
  • The Timmins Daily Press Thu May 5 2016
  • Passing motorists honking in support of the large group of picketers outside Extendicare Timmins Wednesday, may have assumed the front-line care staff at the residence were on strike. The members of CUPE Local 3172 were actually holding the first of a three-day information picket to express their support for the Time To Care Act (Bill 188) which has passed first reading in the Ontario legislature.
  • They are hoping the private member's bill, which was tabled by MPP France Gélinas (NDP - Nickel Belt) last month will pass all three readings required for it to become law. Brenda Laronde, president of CUPE Local 3172 which represents 230 employees at Extendicare Timmins, including front-line care staff and maintenance workers, said the purpose of the information picket is to "spread awareness of Bill 188 ... If it gets passed, it will give a standard of care for all nursing home residents in long-term care. It will give them a four-hour standard of care. Right now there is no standard." Laronde explained the challenges staff at long-term care facilities have in providing the care which they feel the residents deserve. She said with staffing levels at many of these long-term care facilities, days are tightly scheduled and there is very little time to socialize with the residents.
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  • Despite this being a newly introduced bill, Laronde said front-line care workers at long-term care facilities in Ontario have been fighting to have this for years. "This campaign (to legislate more time for individual long-term care residents) has been going on for many years and it's finally got a bill," said Laronde. MPP Gilles Bisson (NDP - Timmins-James Bay), explained, "It's a bill that has yet to be debated. It's been introduced. We're waiting for it to be debated." The fact the bill was introduced by a the health critic of the NDP doesn't mean the Liberals will automatically shoot it down as an act of partisan politics, said Bisson.
  • "You don't have enough time to sit and talk with them. It's always a rush. Everything has time constraints. You have to be in the dining room by 8:30; you have to be out by whenever; you have to have a shower today - I mean, that's their home. And you actually want to sit with them and talk with them, but you just don't have the time. You can't even get to know your residents. You know them by seeing them every day but you don't really get to know their background, or their history, you know, what they did before. You try to get to know them but you don't have the time to spend with them." If Bill 188 passes, all long-term care homes in the province will be required to stafftheir facilities adequately enough to provide a minimum four-hour standard of care for each resident each day.
  • "There are a number of bills put forward, quite frankly, by members of the opposition that wind up becoming law," he said. "In fact, France Gélinas has been very successful in putting forward a number of private member's bills that the government adopted as their own bill." The Extendicare Timmins workers intend to hold information pickets again on Thursday and Friday. © 2016 Postmedia Network Inc. All rights reserved. Illustration: • Ron Grech, The Daily Press / Front-line care staffat Extendicare Timmins held an information picket Wednesday afternoon to express their support for Bill 188 which is currently going through the Ontario legislature. The NDPinitiated bill, referred to the Time To Care Act, would make a minimum four-hour daily care a legal standard for long-term care residents.
Govind Rao

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

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

from heather mental health privatization

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

Health care system has been under attack - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|crcn|20150325|217118231

from heather cupe hospital bc accord campaign

shared by Govind Rao on 25 Mar 15 - No Cached
  • Campbell River Courier-Islander Wed Mar 25 2015
  • It's time for Canadians to take back the public health care agenda. For far too long, forces have been chipping away at our most cherished social program. To get a glimpse of the future facing public health care today, just follow the money. This March 31 marks the first anniversary of a decade-long $36 billion cut to health care transfers to the provinces by Ottawa. B.C.'s share of that historic 10-year long reduction totals $5 billion.
  • I think we can all agree that less money for health care is not what is needed for our province. In fact, a Conference Board of Canada report released last August determined Victoria must invest $1.8 billion more than budgeted for health care between 2014 and 2017 just to maintain current service levels. With an aging population requiring more complex care, this deliberate underfunding of services by both federal and provincial governments is playing out in very ugly ways - and the signs are everywhere. Take the growth in private health care. For a third-year in a row, B.C. was fined for allowing illegal extra-billing of patients for services that are supposed to be without cost to all Canadians under the Canada Health Act. Later this June, a B.C.-based private hospital owner will push for the reintroduction of two-tier medicine into Canada at the province's Supreme Court. Then there's the impact on seniors' care. According to a poll conducted last September, many of B.C.'s frail elderly do not receive the attention they require.
  • ...2 more annotations...
  • Approximately three-quarters of B.C. care aides surveyed said they are forced to rush through basic care for the elderly and disabled because of high workloads and reduced staffing. And let's not forget the workers who bear the brunt of health care cuts. Between January 21 and February 26, nearly 1,500 health care workers were laid-off at care homes and hospitals across B.C. because of contracting out or contract flips. Any former workers rehired at these facilities can expect to start at the bottom of the employment ladder. Some will lose their pension, others will receive lower probationary wages and most will have zero-earned vacation time. It's plain to see public health care is going down a bad road.
  • As we head towards a federal election, Canadians have an opportunity to think about how they can best vote for health care in 2015. The next government in Ottawa can take immediate steps to put our nation's signature social program back on the right track. That means your vote - and the vote of your family and friends - can make a difference in electing MPs that will fight for health care. They say voters get the government they deserve. And we certainly are due for leadership in Ottawa that puts the future of a strong public health care system front and centre in their election promises. To learn more about what can be done to save public health care, please visit saveourhealthcarebc.ca online. Bonnie Pearson, HEU Secretary-Business Manager
Govind Rao

The median cost of a US nursing home tops $91,000 a year, forcing families to reconside... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|wcpa|20150720|225269556

from heather us ltc insurance seniors dementia costs privatization

shared by Govind Rao on 21 Jul 15 - No Cached
  • Canadian Press Mon Jul 20 2015
  • NEW YORK, N.Y. - Doris Ranzman had followed the expert advice, planning ahead in case she wound up unable to care for herself one day. But when a nursing-home bill tops $14,000 a month, the best-laid plans get tossed aside. Even with insurance and her Social Security check, Ranzman still had to come up with around $4,000 every month to cover her care in the Amsterdam Nursing Home in Manhattan. "An awful situation," said her daughter, Sharon Goldblum. Like others faced with the stunning cost of elderly care in the U.S., Goldblum did the math and realized that her mother could easily outlive her savings. So she pulled her out of the home. For the two-thirds of Americans over 65 who are expected to need some long-term care, the costs are increasingly beyond reach. The median bill for a private room in a U.S. nursing home now runs $91,000 a year, according to a report from the insurer Genworth Financial. One year of visits from home-health aides runs $45,760.
  • Goldblum estimates that she and her mother spent at least $300,000 over the last two years for care that insurance didn't cover. "If you have any money, you're going to use all of that money," Goldblum said. "Just watch how fast it goes." How do people manage the widening gap between their savings and the high cost of caring for the elderly? Medicare doesn't cover long-term stays, so a large swath of elderly people wind up on the government's health insurance program for the poor, Medicaid. For those solidly in the middle class, however, the answer isn't so simple. They have too much money to apply for Medicaid but not enough to cover the typical three years of care. Some 60 per cent of Americans nearing retirement - those between the ages of 55 and 64 - have retirement accounts, according to the Employee Benefit Research Institute. The median balance is $104,000.
  • ...5 more annotations...
  • Combined with other savings and income, that amount might provide some retirees with all they need for decades. But everything changes when, for instance, an aging father struggling with dementia requires more help than his wife and children can manage. Plans that looked solid on paper are no match for their bills. "Within the first year most people are tapped out," said Joe Caldwell, director of long-term services at the National Council on Aging. "Middle-class families just aren't prepared for these costs." Many who can afford it buy insurance to help pay for long-term care years in advance, when insurers are less likely to reject them. But even those with insurance, like Ranzman, come up short. Forced to improvise, they sell the house and lean on family. They move in with their adult children, or arrange for their children to move in with them.
  • Some can save money by switching to different facilities. On average, a shared room in a nursing home runs nearly $11,000 a year less than a private room, and a room in an adult-family home runs cheaper still. Still, there's not a lot of room for creativity, said Liz Taylor, a self-employed geriatric care manager in Lopez Island, Washington. "The amount of care you need dictates the price," she said, "and there aren't that many ways around it." Hiring an aide to spend the day with an elderly parent living at home is often the cheapest option, with aides paid $20 an hour in some parts of the country. But hiring them to work around the clock is often the most expensive, Taylor said. "Needing help to get out of bed to use the bathroom in the middle of the night means you need a nursing home," she said.
  • EVICTED To Roslyn Duffy, it seemed that her mother, Evelyn Nappa, had everything she needed. After a stroke made it difficult to live alone, Nappa moved from Arizona to Seattle to be near her daughter and soon settled into The Stratford, an assisted-living facility, where she quickly made friends of fellow residents and the staff. "The care was great," Duffy said. "We loved that facility." With the sale of the house in Arizona, Nappa's savings appeared sufficient to cover 10 years at The Stratford, enough to last until she reached 100. Duffy said that the home's directors told her not to worry about her mother running out of money and winding up on Medicaid, even though the government program pays just a portion of what many facilities charge. After all, many of the same homes that refuse to admit seniors on Medicaid will keep those who spend all their savings and wind up on the program. "'We will keep her here' - that's what they said," Duffy recalls. "But I didn't get that in writing." A representative from the nursing home declined to comment.
  • As Nappa's dementia progressed, she needed more attention. That meant moving her from an independent unit that cost $3,000 a month, to a dementia unit that cost $6,000. Trips to the emergency room, hearing aids and other costs that Medicare didn't cover added up. Soon enough, the money that was supposed to last 10 years was gone in two. Duffy enrolled her mother in Medicaid, confident that The Stratford's management would keep its promises. Two months later, she received a letter saying her mother had 30 days to find a new home. Duffy protested, writing letters to the management and local newspapers, and succeeded in keeping her mother at the Stratford for two months until social workers helped line up an adult family home willing to take Medicaid payments.
  • But the stress and the change of surroundings strained her mother's health, Duffy said. Six weeks after moving, she was dead. "She declined so quickly," Duffy said. "Being in familiar surroundings is hugely important for dementia patients. There's no doubt in my mind that the move hastened her death. It was devastating, just devastating." NEW HOME Ranzman's story has a happier ending. Her daughter pulled her out of the Amsterdam Nursing Home and rented a house in Smithtown, Long Island, with a patio and a backyard full of azaleas and trees. It was Ranzman's own space. She had round-the-clock aides, a large window and plenty of sunlight. Her daughter, Goldblum, noticed that Ranzman's memory improved quickly. Her mother seemed happier and more alert. "It was less than half the cost of a nursing home and a million times nicer," Goldblum said. "She showed such improvement." Goldblum paid $36,000 a year for the house and her mother's long-term care insurance paid the home-health aides. The move saved around $250,000 a year in expenses. What's more important to Goldblum is that her mother seemed content when she died in April at age 86, lying in bed and surrounded by family. "It was a wonderful ending," she said.
Irene Jansen

After all the months of debate, does the health bill actually stack up in law? | Left F... - 1 views

www.leftfootforward.org/...loucestershire-legal-challenge

nhs campaign social care bill trade competition

shared by Irene Jansen on 05 Apr 12 - No Cached
  • a test case campaign to challenge the establishment of a social enterprise – namely Gloucestershire Care Services Community Interest Company – has been fought and won by 76 year old Michael Lloyd, working with ‘a cross party coalition of anti-cuts campaigners’.
  • They argued the local PCT had acted unlawfully in planning to hand over management of nine county hospitals and 3,000 community health staff in what would have been the biggest planned transfer (so far) to a social enterprise in the country.
  • the Lansley edict of July 2011, that £1 billion of NHS services would be opened up to competition.
  • ...12 more annotations...
  • NHS Gloucestershire had not put this work out to tender, nor explored in-house/NHS options which, campaigners say, would have made tendering unnecessary in the first place
  • only reduced staff terms and conditions upon the service leaving the NHS, would offer a key cost saving
  • any cost gain would be significantly reduced by the new social enterprise VAT bill
  • which would not have applied under the internal NHS model
  • “The South West is leading the charge to social enterprise – with 15,000 of 25,000 staff in the UK, likely to be affected by reduced terms and conditions, coming from the region.”
  • Lansley’s ‘do it quick never mind the risk’ stick, the underbelly of which we highlighted last week
  • the Hull example, where aside from the one-off transfer costs, when NHS Hull morphed into a social enterprise, they found the need to build an entire new wing to house the extra administrative staff – those who had been ‘cut loose’ from the NHS – because the new enterprises are required to have their own duplicate back office functions where previously they could draw on NHS central resources.
  • as long as matters are kept within the NHS there is no contract on which EU procurement law ‘actually bites’,
  • this result at the High Court also begs the question: now the Bill is passed, exactly how far are our current NHS providers obliged to put existing services out to competitive tender?
  • The Gloucestershire example seems to demonstrate there are more angles to take than even the government themselves had considered in their own search for profiteering loopholes.
  • Will it really be possible, as Professor Allyson Pollock advises, to “stop all commercial contracts”, citing the danger of the government continuing to claim commercial confidentiality trumps the public’s right to know about contract decisions.
  • The PCT is legally obliged to: 1). Involve public; 2). Consider NHS options; 3). Invite ‘expressions of interest’ (in bidding) – crucially, not the same as ‘inviting bids’; before 4). Deciding what to do, which may or may not involve ‘inviting bids’, depending on whether NHS bodies come forward, which would mean they didn’t need to go to stage of open tender, i.e. inviting bids.
Irene Jansen

It's not too late to save the NHS from the barbarians | Seumas Milne | Comment is free ... - 0 views

www.guardian.co.uk/...l-privatisation-health-service

nhs privatization legislation

shared by Irene Jansen on 26 Jan 12 - No Cached
  • As a group of lawyers and health academics spell out in the Lancet medical journal this week, if the health and social care bill is passed in its amended form it will abolish England's model of "tax-financed, universal healthcare", pave the way for a "US-style health system" based on "mixed funding" and fatally undermine "entitlement to equality of healthcare provision".
  • the government's parallel attempt to drive through the deepest cuts in the history of the NHS.
  • One of its own advisers, Chris Ham, has even raised the spectre of a an "NHS version of the Arab spring".
  • ...6 more annotations...
  • Along with the health unions, the doctors' British Medical Association, the Royal College of Nurses and the Royal College of Midwives are now all demanding the bill be scrapped.
  • Cameron and Lansley insist they don't plan to privatise the NHS, of course. But that's exactly what's happening on the ground even before the bill hits the statute book. The first private company to take over an NHS hospital, the Tory-linked Circle Health, won the contract to run Hinchingbrooke hospital in Cambridgeshire in November, even as it admitted it may not be able to "provide a consistent level of service to its patients".
  • And the government has been in talks with international health corporations about taking over 20 more, while private companies are already running local doctors' services and preparing to administer the clinical commissioning groups of GPs
  • Add to that ministers' announcement last month that they would raise the cap on the proportion of income English hospitals can raise from private work from about 2% to 49%
  • whereas the existing law allows private provision, the coalition bill will require it
  • it also opens the way for the privatisation of funding, the introduction of charging and top-up payments for services that are currently free, and the cherry-picking of patients by commissioning groups
Irene Jansen

TheSpec - Home care's 'race to the bottom' - 1 views

www.thespec.com/...home-care-s-race-to-the-bottom

home care on two tier wages union competitive bidding substitution integration

shared by Irene Jansen on 30 Apr 12 - No Cached
  • St. Joseph's Home Care is ready to compete for a flood of opportunity believed to be coming this fall when the province is expected to overhaul how contracts are awarded.
  • The home care agency — run by the same organization as St. Joseph's Hospital and Villa — cut wages by up to 15 per cent in all new contracts it wins.
  • The $13.96 starting hourly rate is now below Hamilton's living wage of $14.95. It takes five years to reach the top rate of $15.31.
  • ...9 more annotations...
  • That's also below the starting wage of $16.07 for personal support workers, dietary aides, health aides and home cleaners.
  • Kim Ciavarella, president of St. Joseph's Home Care. “We introduced this new tier so we'd be able to bid on those contracts. It positions us very nicely.”
  • The 190 workers came close to striking over the two-tier system that sees lower wages go to staff working on any new contracts
  • “We feel it's a race to the bottom,” said Bill Hulme, community care lead for the Service Employees International Union Local 1 Canada, which represents 10,000 home care workers including those at St. Joseph's.
  • The low wages, combined with a lack of job security, have made home care the most unstable sector of the health care system and the hardest in which to retain staff, says Jane Aronson, a home care researcher and director of McMaster's school of social work.
  • “I find it unfathomable that at the same time the provincial and federal governments keep saying home care is very important, it's organized so those who are its front line staff won't have security and in this instance won't even have a living wage,” she said. “It's not a field people can afford to work in very long so we lose people with skills.
  • home care workers make far less than the hourly wage because they're often not paid for their transportation time between clients
  • The province halted competitive bidding in January 2008 to try to resolve some of these issues. It's expected something new will be in place this fall.
  • St. Joseph's Health System is testing what it calls “bundled care,” which involves the province giving a set amount of money to provide diagnostic, hospital, long term care and home care to patients with a co-ordinator overseeing it all and acting as a point of contact.
Govind Rao

Barrette sparks unrest; Health minister's reform plans panned by many - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|mtgz|20150107|211920693

from heather Quebec cuts reforms legislation

shared by Govind Rao on 07 Jan 15 - No Cached
  • Montreal Gazette Wed Jan 7 2015
  • But Dr. Gaétan Barrette, Quebec's health minister since April, seems to thrive offthe criticism as he pushes ahead with major reforms to the province's health-care system.
  • The big question, though, is whether the minister has the support of the public and the medical community to accomplish those reforms - already dubbed "la révolution Barrette" - when the National Assembly reconvenes on Feb. 10.
  • ...13 more annotations...
  • "I'm here to listen to the province's eight million people, not the 8,000" general practitioners, Barrette told reporters on Nov. 28, the day he made public one of his more controversial proposals - threatening doctors with penalties of up to 30 per cent of their income if they don't see more patients.
  • Most people who observe the health-care system would say something had to give, something needed to be done," said Antonia Maioni, a professor in McGill University's Institute for Health and Social Policy.
  • During a heated exchange in the National Assembly with Diane Lamarre, the PQ's health critic, Barrette insinuated that she might be suffering from a "form of epilepsy" after she kept repeating the same questions about Bill 10. That remark drew a rebuke from House Speaker Jacques Chagnon.
  • But it's not Barrette's zingers that have made him so polarizing as health minister: it's his plans to overhaul the public system and the way he's gone about it.
  • Barrette, by comparison, announced his reforms only four months after being appointed health minister. None of his proposals - from abolishing regional health agencies to penalizing doctors financially - were alluded to in the Liberal election platform.
  • The reforms were unveiled in quick succession as Bills 10 and 20, with no public consultation beforehand.
  • Barrette has had a hard time garnering widespread support for Bill 10, his effort at restructuring Quebec's health system. The bill has two goals: to downsize Quebec's costly, Byzantine health bureaucracy, and to streamline the governance of its institutions.
  • Critics have assailed Bill 10 not so much for its goal of cutting administrative costs by more than $200 million a year as its objective to eliminate the boards of directors of many health institutions - from rehab centres to hospitals. Quebec's anglophone community is particularly concerned that many bilingual institutions would vanish in "one fell swoop," as former Liberal MNA Clifford Lincoln has warned. The bill would also confer on the health minister - in this case, Barrette - the power to hand-pick members of so-called mega boards.
  • 140 amendments in December
  • continue to make services available in English - a measure that critics contend is still no guarantee for the anglo community. The relatively high number of amendments - even for a complex piece of legislation like Bill 10 - would suggest that Barrette underestimated both the opposition to his reforms and the possible unintended consequences.
  • In November, Barrette tabled Bill 20, which the minister himself described as "first the carrot, now the stick."
  • Like his first piece of legislation, Bill 20 has two goals: to compel both medical specialists and family doctors to follow more patients or risk being docked their pay; and to no longer cover in vitro fertilization under medicare.
  • Many couples and fertility specialists are also incensed by his plan to de-list IVF from medicare, denouncing his proposals as draconian and hastily formulated. There's no doubting that Barrette's proposed reforms are part of the Liberal government's austerity agenda. But beyond that, it's not so clear what his overall vision might be for Quebec's beleaguered health system, critics argue. And that lack of vision might mean the difference between whether those reforms succeed or fail.
Govind Rao

NDP's cautious foray into health care - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|tost|20150916|229367780

from heather ndp federal election

shared by Govind Rao on 16 Sep 15 - No Cached
  • Toronto Star Wed Sep 16 2015
  • Tom Mulcair is tiptoeing carefully into the health-care minefield. The New Democratic Party leader is downplaying his pledge to reverse Conservative cutbacks that would cost the health-care system $36 billion over 10 years. He is emphasizing instead an array of useful but relatively cheap promises that focus on specific areas - from long-term care to physician shortages. Most are cribbed from former NDP leader Jack Layton's 2011 election platform.
  • All have political appeal in that they are targeted at identifiable groups, such as seniors. But given the fact that health care in Canada is delivered by the provinces, many would not be easily implemented. Mulcair's promise to increase the supply of physicians, for instance, may not resonate with provincial governments that, in the end, have to pay doctors' wages. Ontario, for one, insists that it faces an oversupply of physicians. As a result, it has cut back the number of hospital residencies.
  • ...7 more annotations...
  • All provincial governments would be happy to get their share of the $1.8 billion that Mulcair has earmarked for home care and nursing homes. But few would agree to let Ottawa tell them how to spend this extra cash. If Quebec, say, wants to spend any new nursing-home money on prenatal care, then that's what it will do. Mulcair, a former provincial cabinet minister, must know this.
  • That anyone is talking at all about health care is welcome. So far neither the Conservatives nor the Liberals have had much to say about something that Canadians say is top of mind. And the areas that Mulcair highlighted this week are ones of real concern: long-term care, mental health, dementia, home care, physician and nursing shortages. Still, it is striking to see how cautious the NDP has become.
  • The party quite properly takes credit for inventing Canadian universal public health insurance. But unlike medicare's original architects, it no longer talks of expanding this social program to cover dental work and drugs. It doesn't talk of how to deal with those private clinics, in British Columbia and elsewhere, that are trying to get around medicare's rules. It doesn't talk of using the penalties prescribed in the Canada Health Act to deal with extra billing.
  • Nor does it respond to one of the key recommendations of Roy Romanow's 2002 royal commission - the need for Ottawa to provide at least 25 per cent of the funds going to medicare. Romanow, a former Saskatchewan NDP premier, pointed out that this was necessary if medicare were to remain a truly national program with enforceable national standards. Mulcair says he wants to negotiate a new health accord with the provinces to replace the one that ended last year. But he doesn't say what he wants this new accord to accomplish. Last year, the NDP leader promised he would reverse Prime Minister Stephen Harper's planned cutbacks. He said that, starting next year, he would use any fiscal surplus to ensure that health transfers to the provinces continue to rise by 6 per cent annually.
  • If provincial arithmetic is correct, this would cost the federal treasury roughly $3.6 billion annually. Where Mulcair stands on this promise now is unclear. The parliamentary budget officer does predict a $600-million budgetary surplus next year. But that prediction assumes the planned Conservative cuts to health transfers will have taken in place. Politically, Mulcair's caution is understandable.
  • In federal election campaigns, Canadians often list health care as one of their key concerns. But they don't always vote accordingly. In 2000, for instance, then NDP leader Alexa McDonough ran on a platform that focused on health care. It was detailed and comprehensive. It was in sync with everything the polls said voters wanted. And it was a flop. In the election that year, voters fled the NDP. The party ended up losing six of its 19 seats. Those around Mulcair remember that time. They know that it's good politics to remind voters about Tommy Douglas, the former NDP leader known as the father of medicare.
  • They also know that it's not necessarily good politics to be as bold as Douglas.
Irene Jansen

Lamentable media coverage and state deception, the scandal of NHS legislation | openDem... - 0 views

www.opendemocracy.net/...ion-scandal-of-nhs-legislation

nhs social care bill media

shared by Irene Jansen on 27 Mar 12 - No Cached
  • The Health and Social Care Bill has just passed through Parliament. A huge step towards privatising the NHS has been taken. The most cherished of UK public institutions is being dismantled and large private providers are already signing contracts. All this is against the wishes of a large majority of the public and an even larger majority of health-care professionals.
  • The Department of Health had already been infiltrated by McKinseys consultants under New Labour (see Player and Leys, 2011 ↑ ).
  • Professional opposition was widespread. Keep Our NHS Public ↑ , 38 Degrees ↑ , Spinwatch ↑ and others began scrutinising the bill and campaigning at an early stage. New local BMA groups sprang up all over the country in an attempt to force their leadership to engage with its ordinary members about their concerns. Numerous articles and blogs appeared, written by health professionals who had scrutinised the bill in far more detail than politicians or journalists[i]. Public meetings took place regularly - and across the UK, not limited to England. Many demonstrations took place. Marathons were run. Barely any of this was reported
  • ...3 more annotations...
  • Lansley’s long term links and dialogue with private health care lobbyists and providers was barely mentioned (see Spinwatch
  • this is a large step towards privatisation. Bupa, currently flooding the UK with advertising, knows this. So do Virgin, Sainsbury’s, United Healthcare, Circle, and Care UK.
  • £20 billion of ‘efficiency savings’ are really £20 billion of ‘cuts
Govind Rao

Adoption of Bill 10: A Sad Day for Democracy | Jeff Begley - 0 views

www.huffingtonpost.ca/...bill-c-10_b_6648250.html

from heather Quebec cuts legislation

shared by Govind Rao on 10 Feb 15 - No Cached
  • Posted: 02/10/2015
  • The Couillard government has chosen its camp: it has decided to side with the powerful who have no qualms about crushing conflicting or dissenting voices in order to impose their vision. It took less than a year for the man who presented the Liberals as the most respectful and transparent government in our history to attack democracy. And what better opportunity to ride roughshod over democracy than a bill that dismantles our public system of health care and social services?
  • Contrary to what various columnists say, I don't find it surprising that Minister Barrette wanted to cut off debate and push through Bill 10. It's the cornerstone that will make it possible to move ahead with more privatization in health care and social services. The government will group services together to make them more attractive for private enterprise. You're not convinced? Well then, just ask yourself why the Federation of Chambers of Commerce is already salivating over the business opportunities that the bill will bring. In fact, this is practically the only group that has given the bill whole-hearted support. And why is the minister giving himself the right to award contracts to the private sector?
Irene Jansen

In defence of the NHS: why writing to the House of Lords was necessary -- McKee et al. ... - 0 views

www.bmj.com/...bmj.d6535.full

reforms nhs

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Last week more than 400 public health doctors, specialists, and academics from across the country wrote an open letter to the House of Lords stating that the Health and Social Care Bill will do “irreparable harm to the NHS, to individual patients, and to society as a whole,” that it will “erode the NHS’s ethical and cooperative foundations,” and that it will “not deliver efficiency, quality, fairness, or choice.”1
  • our concerns are based on a wealth of evidence, much published in peer reviewed journals
  • There are many problems with the bill. For one, it abolishes direct accountability of the secretary of state for health to secure comprehensive care for the whole population and the mechanisms and structures for securing that duty.6 The health secretary has also stated that equitable resource allocation will no longer be his direct responsibility and that national resource allocation formulas will change from area based populations to GP registrations, a move that portends a shift towards a model of competing insurance pools or funds, for which the evidence from other countries is adverse.7 8
  • ...4 more annotations...
  • The bill will usher in a new era of commercialisation but still does not make clear the public duties of the economic regulator, Monitor.
  • And while the proposed duties of clinical commissioning groups remain weak, they will be given the freedom to compete for or select their registered populations, as well as “flexibilities” in defining which services to provide. Allowing clinical commissioning groups to also enter into joint ventures with private companies will create inequalities in entitlement to care and introduce commercial conflicts of interest.
  • New commercial actors will be driven to compete and maximise income, overshadowing the need to cooperate and collaborate in ways that place the patient and population at the heart of the health system. The absence of clear responsibilities for geographically defined populations will make it difficult, if not impossible, to link clinical NHS commissioning with social care services or with plans and interventions to act on the social determinants of health.
  • the bill hands over greater control over public budgets to the dictates of the market
Irene Jansen

MPs are urged to end inaction on social care reform | BMJ - 0 views

www.bmj.com/...bmj.e12

home care england

shared by Irene Jansen on 23 Jan 12 - No Cached
  • A coalition of experts has called on politicians of all parties to agree urgent reforms of adult social care in England
  • have written to the Daily Telegraph urging “fundamental and lasting reform” of a system that they say harms society, the economy, and the dignity of elderly and disabled people (http://tgr.ph/tIkRRk).
  • The signatories warn that an estimated 800 000 elderly people are being left without basic care and as a result are “lonely, isolated and at risk.” Others face losing their homes and savings because of soaring care bills, while disabled people are deprived of the support they need to live independently.
  • ...4 more annotations...
  • Signatories to the letter include Hamish Meldrum, chairman of the British Medical Association, Brendan Barber, general secretary of the Trades Union Congress, and representatives of the British Red Cross and leading health insurers.
  • The current coalition government is expected to produce a white paper on social care by April in response to recommendations from the independent Dilnot commission into the funding of care and support, published in July 2011 (BMJ 2011;343:d4261, doi:10.1136/bmj.d4261).
  • Andrew Dilnot, an economist, recommended a new partnership model under which people would pay up to a maximum £35 000 (€42 000; $55 000) towards the cost of their care and be eligible for full state support beyond that.
  • He has since said that the country’s economic woes should not be an excuse for inaction and argued that it was “nonsense” for anyone to suggest that reform would be too expensive to implement (BMJ 2011;343:d7689, 28 Nov, doi:10.1136/bmj.d7689).
Govind Rao

Empty beds push Alzheimer's home to brink; Owners of cutting-edge Alzheimer Centre of E... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20150709|224489008

from heather dementia ltc Ontario privatization

shared by Govind Rao on 09 Jul 15 - No Cached
  • Toronto Star Thu Jul 9 2015
  • At a time when the number of people with dementia is rising, a state of the art home for Alzheimer's patients in north Toronto is on the verge of bankruptcy - because many of its beds are empty. B'nai Brith, which opened the home's doors to the public 18 months ago, has struggled to fill the 44 rooms and pay the bills despite $5.4-million funding from the federal government and the assistance of Western University's Ivey International Centre for Health Innovation.
  • As of two weeks ago, the home had $65,000 in reserves and a cash "burn rate" of $50,000 a month. It owes $11 million to creditors, including a bank, a construction company and firms that leased televisions, washing machines, DVD players, Nintendo Wii game systems and a karaoke machine, all part of the care package that families pay $7,500 a month to support. "Hopefully, someone else will come in and take the home over, and take it to the next level," new B'nai Brith CEO Michael Mostyn said in an interview.
  • ...6 more annotations...
  • Now the four-storey retirement home is under insolvency protection and up for sale. Court documents prepared by the home's owner warn that if a solution is not found it would "jeopardize" the care of the handful of residents now living in the Alzheimer Centre of Excellence near Bathurst St. and Finch Ave. Meanwhile, bills are piling up.
  • Mostyn and others involved in the process stressed that the residents of the home are the priority in this process. Last fall, Mostyn replaced Frank Dimant, who ran B'nai Brith for 36 years and came up with the plan for the home. Dimant said it took too long to build and he mistakenly kept a sign up saying "opening soon," which led to a loss of confidence in the community as construction dragged on. Those funding the project became concerned. "My policy was always to beg and plead (with the bank) and try for another day," former CEO Dimant said in an interview. "Things caught up, I guess." The Alzheimer Society of Canada states that in 2011, the most recent figures on its website, 747,000 Canadians were living with Alzheimer's disease and other dementias.
  • Researchers predict that will rise to 1.4 million by 2031. Dimant said he spotted this trend years ago and he envisioned a "beautiful modern facility." B'nai Brith, known for community lodges, social housing, sports programs and its work combating anti-semitism, began designing the project in 2002. Some of the land was donated, some purchased. Donations were sought, and the federal government kicked in money, some of it earmarked for work done for the home by specialists in innovative health care at Western University. Western professor Anne Snowdon would not answer questions about the home, saying "we no longer have any affiliation with this organization."
  • Just before it opened in 2013, B'nai Brith issued a release promising to "offer new hope to families afflicted by the cruelty of Alzheimer's disease." "We understand you only want what's best for your loved one. And we truly offer the most caring approach to living with Alzheimer's. By offering cutting-edge programs. By collaborating on therapies at the forefront of Alzheimer's research. And by providing the highest quality of personal, loving care that makes the difference between living with the disease, and living."
  • The home boasts beautiful gardens, well-appointed private rooms, and round- the-clock care. "If you build it, they will come," said Dimant, acknowledging more should have been done to market the home before it opened. The other problems? Officials at B'nai Brith say the monthly charge - $7,500 - was too high. Then there were issues with the home. For example, none of the washrooms are wheelchair accessible. All residents must be able bodied, something that in hindsight was a mistake, officials say. The home opened in December 2013 with four residents. During Dimant's time it rose to 17. Recently, it has reached 20 residents. There are more staff than residents at the home, with 12 full-time staff and 20 part-timers.
  • nsolvency documents prepared by the home show that in February, the home wrote to the Bank of Nova Scotia to say it would be out of cash within two months and could not continue loan payments. Between then and now, the bank worked with the home (and then the insolvency trustee) to come up with a plan to sell the home. The home cost about $16 million to build and outfit. There were numerous work stoppages, cost overruns, and some legal action regarding unpaid contractors bills over the lengthy construction process. A selling price has not been set for the home. B'nai Brith's Mostyn said he is committed to returning his organization to the community work it has done so well over the years. "My goal has been to modernize the way the charity conducts its business. That means taking advantage of new technologies and improving on the many grassroots initiatives and community services that B'nai Brith provides, like our principled advocacy initiatives, sports leagues, food basket programs and affordable housing," he said.
Govind Rao

More spent on taxes than food, shelter and clothing - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|wifp|20150828|228050643

from heather taxes privatization medicare

shared by Govind Rao on 28 Aug 15 - No Cached
  • Winnipeg Free Press Fri Aug 28 2015
  • CANADIANS spend more on taxes than on food, clothing and shelter combined, according to a study released Thursday. The study by the Fraser Institute shows the average Canadian family spent 42.1 per cent of its income on taxes while 36.6 per cent went to the combined basic necessities of food, clothing and shelter. In its study, the non-partisan, public policy think-tank looked at an average family in Canada earning $79,010 in 2014. While 42.1 per cent of that income went to taxes, just 21 per cent was spent on shelter, 11 per cent on food and five per cent on clothing.
  • That translated to $33,272 in total taxes compared to $28,887 on food, clothing and shelter combined. "With growth in the total tax bill outpacing the cost of basic necessities, taxes now eat up more family income, so families have less money available to spend, save or pay down household debt," Charles Lammam, director of fiscal studies at the Fraser Institute and co-author of the study, said in a statement. However, a community advocate cautions people should remember taxes cover programs such as health care that would have to be paid by families as necessities if those programs didn't exist. "There's no question we're paying far more in taxes, but what tends to be really misleading is to state that we are paying more in taxes than we are paying in necessities in life when you take into account medicare because that's part of the reasons taxes went up after 1961," said Harold Dyck, a community social-assistance advocate with Winnipeg Harvest, referring to Canada establishing its universal health-care program. A key focus of the study was a comparison of taxes paid in 2014 by families with taxes paid by families in 1961. It found an average family's tax bill has risen 1,886 per cent in the past 53 years while average income increased by 1,480 per cent, a slower rate than taxes.
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  • In 1961, the scales tipped the other way as the average family spent 33.5 per cent on taxes and 56.5 per cent on food, clothing and shelter. "Over the past five decades, the tax bill for the average Canadian family has ballooned, and now the amount of money going to taxes is greater than what's spent on life's basic necessities," Lammam said in a statement. The study noted the total tax bill considered reflected "both visible and hidden taxes families pay to the federal, provincial and local governments, including income taxes, payroll taxes, sales taxes, property taxes, health taxes, fuel taxes, alcohol taxes and more." Dyck said it is necessary to consider the 1961 date as the baseline for the comparison to get a clearer picture.
  • "From 1961 back, we did not have a national medicare program. Since then we have, and that is definitely part of our tax dollars. We now have free access to this necessity of life, medical care," he said. "A portion of that tax burden needs clarification so people aren't left with the impression that this (tax dollars) goes into some netherworld where we never see anything coming back to us," Dyck said. "It (the study) is a subtle way to get people's ire up that we want taxes cut, cut, cut without asking what does that mean and how would that impact Canadians in the end? What services are we going to lose? There are many other things you can consider necessities. Taxes pay for our highways and roads, hospitals, education system, all these things that should also be considered necessities."
  • The study showed average families in 1961 earned an average of $5,000 and paid taxes worth $1,675. In the past 53 years, the average family's tax bill increase of 1,886 per cent outpaced price increases to food (561 per cent), clothing (819 per cent) and shelter (1,366 per cent). Dyck said the focus should be on where the waste takes place in use of tax dollars and ways to reduce that waste. The study also found the percentage of income used to pay taxes has risen steadily since 2008 when 40.9 per cent of income was spent on taxes. ashley.prest@freepress.mb.ca
Heather Farrow

Ottawa should boost medicare - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|vitc|20160731|252782352

accord medicare

shared by Heather Farrow on 04 Aug 16 - No Cached
  • Times Colonist (Victoria) Sun Jul 31 2016
  • Talks are about to begin on drawing up a new national health accord. By all accounts, we're in for a slugfest. The current accord, which expires this year, was introduced by prime minister Paul Martin in 2004. Over its lifetime, it delivered $345 billion in federal transfers to the provinces. In annual terms, that means Ottawa pays for about 25 per cent of public-sector health costs. The provinces are responsible for the remainder. The original deal was a win for both sides. The provinces gained multi-year funding stability. And Ottawa extracted a commitment.
  • The premiers agreed, in exchange for the money, to improve wait times in five priority areas - coronaryartery bypass surgery, hip and knee replacements (counted separately), radiation therapy for cancer and cataract surgery. So why are the two levels of government at daggers drawn this time around? First, although the provinces did reduce wait times initially, the trend has largely stalled in recent years, and in some cases reversed. Between 2011 and 2015, there was no significant improvement in radiation therapy and knee replacement. Wait times for hip replacement and cataract surgery grew longer, and the provinces never did agree on appropriate wait times for coronary-bypass surgery.
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  • Equally concerning, wait times are defined here as the interval between seeing a specialist and receiving treatment. But that doesn't count the growing delay most patients face before they meet a specialist. Ottawa isn't impressed. Second, there are indications the federal government wants to strike out on its own. Prime Minister Justin Trudeau's health minister, Jane Philpott, has said she's "not convinced" that putting more cash into the accord is the right way to go.
  • She believes federal funds should be used instead to boost home care, mental-health services and palliative care. And that has infuriated the premiers. Constitutionally speaking, they are responsible for health-care delivery. Yet here we have a federal minister suggesting she wants to steer the ship.
  • The provinces have already signalled this means war. Quebec Premier Philippe Couillard and B.C. Health Minister Terry Lake, will lead a spirited defence against further intrusions into provincial jurisdiction. And they have a case to make. When universal health care was first introduced in Parliament, the provinces feared that any such commitment would ruin them. The federal government met that concern by pledging to fund half the costs.
  • But that isn't what happened. Today, Ottawa pays only a quarter of the bill, and that bill is rapidly rising. In 1975, health expenditures, countrywide, were less than $50 billion. Today, they've reached $230 billion, and these are constant dollars, adjusted for inflation. The result is that, as federal cost-sharing declines, the provinces are struggling to make up the shortfall.
  • In 2013, more than 12,000 jobs in health care and social assistance were eliminated in B.C. That is one symptom of the emerging crisis. There are many more: Too few GPs, unacceptable wait times to see a specialist, crowded hospital emergency departments. If Philpott chooses to redirect the remaining federal cash to new priorities that will create additional strains on the system, fur will fly.
  • The minister's desire to steer funding into neglected areas of care is admirable. But first, she needs to get the ship off the rocks. Adding more ballast to a foundering vessel is no solution. Certainly Philpott is in a stronger position than Paul Martin, whose minority government hung by a thread when the first accord was negotiated. But the need for federal assistance is growing clearer, and more urgent. Our health-care program was a uniquely Canadian creation. The government of Canada has an obligation to step up and save it.
Govind Rao

Private MRIs wrong prescription - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|relp|20151026|232213388

from heather diagnostics private clinics privatization Saskatchewan

shared by Govind Rao on 26 Oct 15 - No Cached
  • The Leader-Post (Regina) Mon Oct 26 2015
  • In the final sitting of the legislature before the spring election, Premier Brad Wall's government plans to pass Bill 179 to facilitate private user-pay MRIs in Saskatchewan. As a longtime family doctor, I see this as a cynical political move that caters to public fears about long wait lists for imaging, but which will actually work to make things worse for patients who truly need an MRI.
  • There is very clear evidence that, far from relieving pressures in the public system, offering a separate stream for the wealthy to jump the queue actually lengthens public wait lists. This has been shown over and over again, whether it be with cataract surgery, diagnostic imaging or surgical procedures. MRI is no different.
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  • In Alberta, where private MRI facilities advertise and operate, the median wait time for an MRI is much longer (80 days) than in Saskatchewan (28 days). Furthermore, the wait has lengthened in the public system in Alberta since privatized facilities came on the scene. The explanations are complex, but siphoning human capacity (doctors and technologists), as well as other resources, from the public system into the private and more lucrative stream plays a big role. So does the market generation of increased demand by deceptive advertising and promotion of privatized services.
  • Medical tests should be ordered in accordance with evidence-based guidelines about their usefulness and indications. Patient access to MRI is currently prioritized in Saskatchewan health-care facilities on the basis of medical need, from Level I (a life-threatening diagnosis or treatment requiring MRI within 24 hours) to a Level IV (stable patients needing long range diagnosis or management allowing for delay of 30-90 days).
  • This system works and prioritizes appropriately. While patients sometimes feel that an urgent MRI will make a difference to their outcome, this is rarely the case. When it is the case, patients are prioritized and get urgent access. Allowing private MRI's based on ability to pay and jump the queue will trample this well-developed, equitable system. It will allow the wealthy or anxious to bypass this system and result in two-tiered care.
  • And the queue-jumping is not just limited to getting an MRI. It will extend to preferential and quicker access to treatment options, such as specialist care and surgery based on the MRI results if positive.
  • The Wall government and the private MRI operators that will profit from this legislation have proposed a two-for-one deal, suggesting that one public MRI scan will be done for every private MRI performed. Don't be fooled. This will not get around the problem of prolonging public wait lists since it will siphon resources from the public system. If we really need more MRIs, why not increase capacity in the public system instead?
  • While MRI can be a useful tool, when inappropriately used it can lead to overdiagnosis or "false positives." This then triggers a costly cascade of subsequent investigations or interventions to reassure either physician or patient MRI technology has important limitations, and frequently finds unrelated non-significant abnormalities that frighten patients. For example, 90 per cent of healthy individuals over 60 years of age with no symptoms of back pain show degenerative abnormalities on MRI. Similarly, the vast majority of adults over 50 show knee damage on MRI and only clinical assessment by a doctor identifies whether or not these findings are significant. Early MRI has not been shown to improve outcomes in low back pain and may actually make for worse outcomes. A doctor examining for red flag symptoms can identify the very small number of patients for whom an MRI is useful.
  • Many MRI scans are therefore unnecessary. Allowing patients to purchase an investigation they don't need wastes resources, bypasses the role of an informed health-care provider, and may in the end actually harm patients with needless investigations and interventions. Physicians are engaged in initiatives to "choose wisely" in testing. Throwing the door open to investigations based on ability to pay, rather than medical need, flies in the face of sensible approaches to health resources.
  • We live in a society obsessed with health. Selling fear of sickness is profitable. But access to MRIs is not our most urgent health-care need. To suggest otherwise is to obscure the social and economic determinants that define who is healthy and who is not, and to further shift resources away from the sick towards the worried well.
  • Let's promote greater equity, not less, and preserve health care based on need, not two-tiered care based on ability to pay. Let's trust health-care providers to counsel patients about the right test at the right time and to prioritize patients appropriately. The marketplace has no role in these decisions.
  • Dr. Sally Mahood is a Regina family doctor and an associate professor, Family Medicine, University of Saskatchewan.
Govind Rao

Saving costs, hurting families - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246200|ntnp|20150313|216302039

from heather Quebec cuts

shared by Govind Rao on 13 Mar 15 - No Cached
  • National Post Fri Mar 13 2015
  • Gaetan Barrette, Quebec's Minister of Health, recently announced proposed legislation that would change how the province funds in vitro fertilization (IVF) for women unable to conceive without medical assistance. Women would have to sign a declaration stating that they had been sexually active for a sustained period, and were still unable to become pregnant. Women over the age of 42 would not be eligible for IVF at all. Minister Barrette, I would like to introduce you to Mikey, my little boy. I had him when I was 43 and I am not alone. The trend toward later motherhood is significant in most Western countries today. The proportion of Canadian women giving birth in their early forties has doubled since 1988, and in the U.S., it has quadrupled. The decision when to have a child is very personal. It is also widely acknowledged that women today are under tremendous social pressures to "be responsible," complete their education and establish financial and relationship stability prior to starting a family. Having a child later in life is not always a mere preference; often it is the result of how our current social structure limits the choices open to women. But by the time it is "socially responsible" to have a child, it may become biologically challenging. Our fertility declines and we are racing against our biological clocks. This is precisely when some need the assistance of IVF to conceive.
  • I am not certain why you chose 42 as a threshold (perhaps you are relying on policy advice from Douglas Adams' Hitch Hiker's Guide to the Galaxy, that suggested "42" is the answer to the meaning life). But this age threshold discriminates between women who are lucky enough to conceive spontaneously in their forties, and those who need assistance. It also discriminates between me and my husband, for whom there is no age limit in your Bill. Is it medically riskier to have a baby after 40? Yes, it is. Does the risk justify not having a baby? In most cases, it does not. And in almost all cases, this is a decision that a woman should have the liberty to make for herself. Women are making much riskier decisions without government intrusion, such as undergoing plastic surgery. They are making them for more trivial reasons than the desire to bring a child into the world.
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  • Your proposed Bill 20 is meant to improve health-care access and cut costs in Quebec. But by banning access to IVF for women over 42, it is overstepping its objectives and violating the rights of citizens. Choosing to limit public funding for a service, when trying to save money, is one thing; but banning it completely, even when people choose to pay out of their own pockets, is an entirely different matter. When you were recently challenged on this point, you said that this is not a matter of cost but rather of "protecting mothers and children." My son and I are doing very well, thank you for your concern. And like other mothers who conceived in their 40s, I would appreciate some respect for my autonomy. This justification of 42 as an age limit for IVF is good old-fashioned paternalism that has no place in today's society. Under the guise of protection, this Bill represents an attack on Quebec women and mothers.
  • To make things worse, Bill 20 is threatening physicians with heavy fines if they direct me to another province or jurisdiction where I can privately access IVF after 42. This is an alarming violation of the professional autonomy of a doctor to refer patients, not to mention a violation of a woman's freedom to have access to health information she needs. In 2010, the Quebec government introduced a program that funded every aspect of IVF for everyone, an unprecedented level of coverage in North America. The program was in such high demand that it cost much more than expected, $261 million to date. Looking back, there is wide agreement in Quebec that the hasty introduction of the program in the absence of reflection and public consultation led to very problematic consequences. You, Minister Barrette, famously criticized this program for being an "open bar" and allowing access to IVF without appropriate restrictions.
  • But the fix for bad policy is not another bad policy. Proposing ethically and socially appropriate conditions of eligibility for publicly funded IVF is a laudable objective. The thoughtful and well-argued report published in June 2014 by the Quebec Commissioner for Health and Well-being, based on an extensive public consultation, proposes many such conditions that would allow cutting costs while respecting considerations of justice and equity. Conditions on access to public funding may be justified.
  • But there is no way to justify draconian measures that have nothing to do with cost control, but are rather an affront to women's rights. Rather than protecting us from IVF, you should protect us from unwarranted government intrusion. Vardit Ravitsky is an associate professor in the Bioethics Program at the School of Public Health, University of Montreal.
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