Skip to main content

Home/ CUPE Health Care/ Group items tagged specialty clinics

Rss Feed Group items tagged

Filter: All | Bookmarks | Topics Simple Middle
Govind Rao

ServiceOntario: Making It Easier - Government of Ontario, Canada - 0 views

www.ontariocanada.com/...view.do

from heather Ontario private clinics privatization

shared by Govind Rao on 19 Aug 13 - No Cached
  • A Regulation under the Independent Health Facilities Act - Prescribed Persons Ministry: Ministry of Health and Long-Term Care
  • The Ministry of Health and Long-Term Care (Ministry) is proceeding to establish community-based specialty clinics as per Ontario's January 2012 Action Plan for Health Care. Shifting low-risk ambulatory services from a hospital to a community-based setting represents an opportunity to improve access and the patient experience, maintain quality and outcomes of services, and realize reductions in costs for routine services currently performed in a hospital setting.
  • August 12, 2013
  • Govind Rao on 19 Aug 13
     
    Ontario has started consultations on legislative changes which will see the creation of more specialty clinics - one of the elements of the Action Plan for Health Care announced in January 2012. The intent is to move low-risk ambulatory services from hospitals to community-based settings. These non-profit specialty clinics will operate as part of the Independent Health Facility (IHF) program. There are over 1,000 IHFs in Ontario, most of which provide diagnostic services although some offer surgical or other medical procedures. The changes the government has in mind will see the new clinics, as well as all IHFs, come under the planning and funding umbrella of the 14 Local Health Integration Networks. Cancer Care Ontario will also be able to fund the clinics should they provide cancer-related services.
Govind Rao

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

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

from heather cupe Ontario hospital private clinics privatization campaign

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

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

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

from heather mental health privatization

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

Warning flags about excessive wait times, privatization among issues identified by Audi... - 1 views

www.web.net/ohc

ltc waits private clinics coalition ag Ontario

shared by Govind Rao on 13 Dec 12 - No Cached
  • The Auditor General found wait times for long-term care that are extraordinary. Crisis clients are waiting more than three months for placement and wait times have tripled.
  • In Ontario’s privatized clinics (Independent Health Facilities) the Auditor found inadequate monitoring, poor inspections, a lack of financial oversight and inequitable access to care.
  • Ontario’s Wynne Government Plans to Bring In Private Clinics: Threatens Non-Profit Community Hospital Care The Ontario government plans to introduce private specialty clinics to take the place of local community hospitals’ services. The government’s proposal would bring in legal regulations under the Independent Health Facilities Act and the Local Health System Integration Act to usher in private clinics and shut down services in community hospitals. Ontario’s Auditor General reported in 2012 that more than 97% of the private clinics under the Independent Health Facilities Act are private for-profit corporations. The Ontario Health Coalition warned about the costs and consequences of private clinics for patient care in a press conference at Queen’s Park today. In addition to the danger of for-profit privatization, coalition director Natalie Mehra raised concerns about poorer access to care and destabilization of local community hospitals.
  • ...2 more annotations...
  • The Auditor General found wait times for long-term care that are extraordinary. Crisis clients are waiting more than three months for placement and wait times have tripled.
  • In Ontario’s privatized clinics (Independent Health Facilities) the Auditor found inadequate monitoring, poor inspections, a lack of financial oversight and inequitable access to care.
Cheryl Stadnichuk

Review gives good marks to surgical speed-up | Regina Leader-Post - 1 views

leaderpost.com/...ood-marks-to-surgical-speed-up

private clinics SK wait times

shared by Cheryl Stadnichuk on 27 Apr 16 - No Cached
  • Adjust Comment Print Janice MacKinnon remembers NDP-leaning friends who were aghast at the prospect of private surgical clinics in the home of medicare — until they actually used them. The clinics worked and they’ve cut Saskatchewan’s surgical wait times from the longest in the country to the shortest, said MacKinnon, who gave the Saskatchewan Surgical Initiative a positive review in a Fraser Institute study released Tuesday.
  • MacKinnon said there were other important elements, like a Supreme Court decision that told governments, “if you have a monopoly on the service, you have to provide it in a timely way.” As well, the government had just received Tony Dagnone’s “Patient First” report that, as she interpreted it, said health care should be done for the benefit of patients, not for others in the system — like doctors, nurses, hospital staff, and their unions. She said the government followed up by bringing into the initiative working groups of physicians, nurses and hospital managers, all encouraged to focus on speeding up the process for patients.
  • MacKinnon contrasted this with an attempt at cutting wait times in the 1990s that went nowhere because health-care unions told the public that changes wouldn’t work. The surgical initiative, one the other hand, went over the unions’ heads to the public itself. Health Minister Duncan Duncan acknowledged Tuesday wait times have lengthened in recent months, particularly in the Regina and Saskatoon health regions, and reflecting increased demand. “We’ll be mindful of that in this fiscal year, when the budget comes out,” he said, adding “we don’t want to lose the ground that we did gain.”
  • ...1 more annotation...
  • MacKinnon also challenged two frequent criticisms of private clinics: that they’d cream off the easiest surgeries and steal the best staff. Instead, she says surgeries were assigned by health regions and clinics hired retired nurses and nurse practitioners who liked the better hours and low-hassle atmosphere. She noted that surgeries — which covered only an array of specialties, not a complete list of surgeries — came in 26 per cent cheaper than in hospitals. “I think it was extremely well done.” Only in Canada, she said, would there be any fuss over who owns the clinics providing service in a single-payer system, MacKinnon said.
  • Cheryl Stadnichuk on 27 Apr 16
     
    Former SK NDP Finance Minister Janice MacKinnon is now shilling for the Fraser Institute promoting private clinics to reduce surgical wait times. The root problem of wait times if the structure and funding of Medicare, she says.
Govind Rao

"Are private surgery clinics safe? Are they cheaper than public hospitals?" Not in the ... - 0 views

www.ochu.on.ca/...cs_tour_hamilton_kitchener.php

from heather cupe Ontario hospital private clinics privatization campaign

shared by Govind Rao on 11 Sep 15 - No Cached
  • 11/September/2015
  • HAMILTON and KITCHENER/WATERLOO, Ont. – Private surgery and procedure clinics are a “colossal and expensive failure” in the United Kingdom (UK) and Ontario should learn from the UK’s “dismal experience and not expand their use,” says Frank Dobson, a former UK health minister. Dobson is in Ontario for a series of media conferences including one in Hamilton on Monday, September 14 at 10 a.m. at the Royal Canadian Legion, Branch 58, 1180 Barton Street East and one in Kitchener/Waterloo at 1 p.m. at the Royal Canadian Legion, Branch 412, 601 Wellington Street North.
  • The Ontario government plans to expand the use of private specialty clinics to deliver procedures and surgeries now provided by local community hospitals. This model of care, says Dobson, is not working well in England where there is concern about care quality and where private clinics have walked away from surgery contracts, leaving thousands of patients in the lurch. Data shows, that each year in the UK nearly 6,000 patients are transferred to public hospitals following operations at private clinics that have gone wrong.
Heather Farrow

Quebec plans to introduce 50 superclinics by 2018 | Montreal Gazette - 0 views

montrealgazette.com/...-to-ease-pressure-on-hospitals

Quebec private clinics legislation cma

shared by Heather Farrow on 02 May 16 - No Cached
  • April 25, 2016
  • Quebec Health Minister Gaétan Barrette has announced a plan to introduce 50 so-called superclinics in the province to offer front-line health services and ease the crush of cases in emergency rooms. “We are one step closer to strengthening and consolidating the organization of medical services for the entire population of Quebec,” Barrette said Monday. “Complementing services offered by family medicine groups, the superclinic model will reduce the waiting time for emergencies and provide faster access to primary care and specialized services.” Barrette, who is hoping to have the clinics operating by 2018, said those who’d benefit in particular are people still looking for a family doctor.
  • Heather Farrow on 02 May 16
     
    Quebec will open 50 "superclinics" by 2018 to reduce the pressure on emergency rooms from non-urgent medical cases and provide faster access to primary and specialty services. The clinics will be required to run at least 12 hours a day; offer blood-testing and diagnostic imaging; and provide 80% of services to people without a family doctor.
Irene Jansen

Will Falk (Mowate Centre). October 31 2011. How to reform health care - thestar.com - 0 views

www.thestar.com/...107--how-to-reform-health-care

accord shared services specialty clinics abf

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Modernize the organization of hospitals
  • specialty clinics providing routine procedures efficiently and accessibly
  • with public funding and in partnership with traditional hospitals
  • ...4 more annotations...
  • Policy-makers should strengthen regional bodies, specialty care networks, and support mergers and acquisitions that build scale.
  • Reform the way health services are purchased. The health-care pricing system is fundamentally broken. Global budgeting for hospitals and inflation in fee-for-service payments for doctors need to be urgently reformed in most provinces.
  • These reforms do not rely on new revenues or any form of privatization to create a fiscally sustainable system. They could all take place within the Canada Health Act and are consistent with its principles.
  • Will Falk is executive fellow in residence at the Mowat Centre at the University of Toronto. He is lead author of a new report, Fiscal Sustainability and the Transformation of Canada's Healthcare System.
Irene Jansen

The Mowat Centre for Policy Innovation. A TRANSFORMATIVE BLUEPRINT FOR REDUCED COSTS, I... - 0 views

www.mowatcentre.ca/press-releases.php

abf private clinics competitive bidding it

shared by Irene Jansen on 23 Jan 12 - No Cached
  • the Mowat Centre at the University of Toronto has released a blueprint for transformative changes to the healthcare system
  • The report recommends five significant changes: • Modernize the organization of hospitals, with academic centres focused on diagnostic work-ups, specialty clinics providing routine procedures efficiently and accessibly, and networks of care that monitor patient well-being • Embrace the ‘‘virtualization’ of many existing services that are currently only delivered in person • Widely deploy digitization by reforming agencies so that they can respond to technological change more quickly and by providing more IT funding directly to providers • Encourage organic governance evolution without undertaking wholesale restructuring, and • Reform the way health services are purchased.
  • The report is part of the Shifting Gears Series on the transformation of public services and was supported financially by KPMG.
  • ...1 more annotation...
  • To read the full report, please click here
  • Irene Jansen on 23 Jan 12
     
    National Post coverage: Innovations seen as lowering health costs. National Post. Nov 1 2011 Tom Blackwell  Provinces must find ways to profit from efficiencies - like the steadily falling cost of cataract surgery. While favouring marketstyle competition, the academics draw the line at allowing a private tier of medicine or even expanding the role of privatehealth operators in the public system. Set up more stand-alone clinics, like those that do cataract surgeries. Move away from block funding of hospitals (an institution is paid a lump sum every year to cover most services) toward payments tied to treatment of individual patients. Cap increases in physicians' fees, link fees more closely to changes in technology and hold auctions in the public system, to get the best deal for providing some procedures. Experience suggests doctors may not welcome some of their proposals. In 2002, a $4-million study funded by the Ontario government - and initially supported by the Ontario Medical Association - recommended an overhaul of the fee schedule to better reflect the up-to-date value of each doctor service. It would have meant income drops for some specialists - such as the opthalmologists who do cataracts - while others would earn more. See also: Health Care reform? Despite frightful predictions of ever-rising costs, governments can reap savings by managing change Toronto Star Nov 1 2011  Opinion  Will Falk
Govind Rao

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

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

from heather waits specialty clinics privatization private clinics

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

Nursing shortages forecast - BC News - Castanet.net - 0 views

www.castanet.net/...Nursing-shortages-forecast

from heather bc nursing staffing

shared by Govind Rao on 01 May 15 - No Cached
  • Apr 30, 2015
  • The head of the BC Nurses' Union is painting a dire picture of nursing on Vancouver Island. Gayle Duteil said nursing shortages will continue to get worse as private clinics 'poach' staff from the public health-care system. Duteil said the culprit is the contracting out of 55,000 day surgeries to private clinics. "Where do they think the specialty trained operating room nurses will come from?" asked Duteil, who also questions why taxpayers' dollars are going to non-profit clinics instead of the public system.
Irene Jansen

Demographic squeeze demands health-care reform (re Macdonald-Laurier Institute Looming ... - 0 views

www.calgaryherald.com/...story.html

sustainability demographics privatization neoliberalism

shared by Irene Jansen on 21 Feb 12 - No Cached
  • economist Christopher Ragan has calculated that, on cur-rent spending trends and tax rates, the public sec-tor deficit generated by aging would reach a little over four per cent of GDP in 2040, a figure over and above any deficits governments might run for other reasons. If we were running a deficit of that size today, it would be $67 billion.
  • health care in Canada is not underfunded, but is, rather, underperforming.
  • The Macdonald-Laurier Institute recently published five essays by leading Canadian thinkers on how best to deal with the looming demographic deficit.
  • ...4 more annotations...
  • MacKinnon suggests diverting services away from traditional hospitals, which in her words, are "expensive, heavily unionized, and therefore difficult to manage efficiently." She believes services delivered by private clinics, focusing on specialty care, can deliver better ser-vices at a lower cost.
  • She also wants patients diverted from expensive and crowded emergency rooms and other costly facilities to primary health clinics where family doctors - on salary rather than fee for service - would work as part of a team, including physiotherapists, counsellors, nutritionists and others. Public-private partnerships should be used to build more long-term care facilities so that elderly patients can be cared for in less expensive purpose-built facilities.
  • Two contributors suggested making health-care services a taxable benefit. Another suggestion was to allow patient copayments for medical services.
  • Brian Lee Crowley and Jason Clemens are the editors of the Macdonald-Laurier Institute's recent publication, Canada's Looming Fiscal Squeeze: Collected Essays on Solutions, available at www. macdonaldlaurier.ca.
Irene Jansen

Waiting for a health-care crisis - 0 views

www.ottawacitizen.com/...story.html

privatization innovation neoliberalism hospitals p3 funding

shared by Irene Jansen on 14 Feb 12 - No Cached
  • The Macdonald-Laurier Institute recently published five essays by leading Canadian thinkers on how best to deal with the looming demographic deficit. Three of the five essays included focused discussions and recommendations on healthcare spending.
  • Professor Janice MacKinnon, finance minister under NDP Premier Roy Romanow when Saskatchewan wrestled so successfully with deficits and over-spending in the early 1990s
  • suggests diverting services away from traditional hospitals, which in her words are "expensive, heavily unionized, and therefore difficult to manage efficiently." She believes private clinics, focusing on specialty care, can deliver better services at a lower cost.
  • ...4 more annotations...
  • She also wants patients diverted from expensive and crowded emergency rooms and other costly facilities to primary health clinics where family doctors - on salary rather than fee-for-service - would work as part of a team
  • Public-private partnerships should be used to build more long-term care facilities
  • Two contributors suggested making healthcare services a taxable benefit. Another suggestion was to allow patient copayments for medical services.
  • Brian Lee Crowley and Jason Clemens are the editors of the Macdonald-Laurier Institute's recent publication, Canada's Looming Fiscal Squeeze: Collected Essays on Solutions (macdonaldlaurier.ca)
Govind Rao

Kitchener doctor faces fraud charges - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|kwrc|20141210|210102567

from heather ontario private clinics

shared by Govind Rao on 11 Dec 14 - No Cached
  • Waterloo Region Record Wed Dec 10 2014
  • A Kitchener anesthetist specializing in pain management has been charged with two counts of fraud after he billed the Ontario government for services he didn't provide. The Ontario Provincial Police Anti-Rackets branch arrested and charged Dr. Kulbir Singh Billing, 63, on Monday night. He will appear in Ontario Court in January. He faces two counts of fraud over $5,000. OPP Sgt. Peter Leon said the charges stem from billings to the Ontario government from 2010 to 2013. Leon said billings were made to the Ontario Health Insurance Plan and the Workplace Safety and Insurance Board for services that were not provided.
  • Billing is registered with The College of Physicians and Surgeons of Ontario and has a private practice on River Road East in Kitchener. He also has another practice at Palmerston District Hospital. Billing had a private clinic at Guelph General Hospital but stopped the practice after a dispute with the hospital over rent in 2009. The Guelph hospital notified the college that Billing's privileges at the hospital would be suspended on a temporary basis, effective April 4, 2014. Billing graduated from Bhopal University in 1975 and received his specialty in anesthesiology in 1984. He is also fluent in Hindi and Punjabi. lmonteiro@therecord.com, Twitter: @MonteiroRecord
Heather Farrow

Ontario doctors' fight turns Trump-style nasty - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20160811|253584818

Ontario doctors bargaining court

shared by Heather Farrow on 11 Aug 16 - No Cached
  • Toronto Star Thu Aug 11 2016
  • It's hard at times to feel too much sympathy for the Ontario Medical Association. That's because over the years, the OMA has operated as a rich, powerful, self-interested lobby group on behalf of the province's 42,000 doctors and medical students. The association, which always insists it really isn't a lobby group, has launched legal actions against the provincial government to protect fees paid to doctors, unveiled nasty attack ads aimed at Liberal governments with the aim of defeating them, waffled on the issue of increased privatized health care and even staged a three-week strike back in 1986 in protest over legislation to end extra-billing by doctors.
  • Combined, these actions have soured the public's respect for the OMA. Simply stated, we like our own doctors, but we don't like the doctors' association. But that's changing now that the OMA finds itself in the unprecedented position of being the target of vile attacks from vocal, hard-line members within its own midst.
  • ...11 more annotations...
  • Indeed, this nasty internal fight is remarkably similar to what the Republican Party establishment is undergoing in the U.S., with angry OMA dissidents unleashing Donald Trump-style brutishness and Tea Party-style radicalism to scare patients, silence critics and ultimately take over the OMA leadership. Suddenly, the OMA deserves our sympathy because this time it is actually taking on the good fight for Ontario patients.
  • The conflict centres on a tentative four-year deal reached on July 11 between the OMA and the provincial government on everything from increases in funding for physician services to giving doctors a stronger voice in managing and reforming the health-care system. The tentative agreement came after two years of bitter fighting between the OMA and Ontario Health Minister Eric Hoskins and his senior bureaucrats.
  • Under the deal, the overall budget for physician services, in other words their pay, would increase by 2.5 per cent a year, rising to $12.8 billion in 2019-20 from the current level of $11.9 billion. But a recently formed group calling itself the Coalition of Ontario Doctors and alleging it speaks for thousands of OMA members wants the tentative deal scrapped, arguing that if approved it would result in fewer doctors, fewer health clinics, less patient care - and even lead to the death of patients.
  • Like Trump in the U.S. with his anti-Muslim, anti-immigrant rhetoric, such claims by these dissident doctors are meant to scare Ontario patients. At the same time, the coalition, suggesting the deal's approval method was rigged, hired high-priced lawyers and went to court to force the OMA to hold a general meeting, now set for Sunday in Toronto, where doctors will vote in person on the deal rather than cast ballots online.
  • In addition, some angry doctors have taken to social media to bully, silence and question the motives of physicians who back the agreement. Combined, these tactics are irresponsible, reprehensible and unworthy of doctors who claim their first priority is care of their patients. Leading the charge against the OMA is the Ontario Association of Radiologists, which has about 1,000 members and is bankrolling the court challenges and ad campaigns against the OMA and the tentative deal.
  • As a group, radiologists are among the highest-paid doctors in Ontario, earning an average of more than $600,000 a year, with some topping $1 million. In recent years they have benefitted from new technologies that allow them to perform medical procedures quicker, thus allowing them to see more patients and send more bills to the government. Despite all their gloom-and-doom rhetoric about pending deaths brought about by the deal, what the dissidents are really upset about is - what else? - their own wallets.
  • Think of it as a rich man's self-pity. They won't say it openly, but these rich radiologists, along with some ophthalmologists and cardiologists, are most furious because their fees will be cut more than those other physician services. What the deal tries to do is level the pay structure so doctors with similar training receive the same net incomes.
  • For its part, the OMA concedes that many doctors who support the agreement aren't completely happy with it. But they believe the main benefit is that the deal establishes a period of peace and a better relationship between doctors and the government, one that has been very destructive over the past few years.
  • Regardless of the outcome of Sunday's vote, the OMA will never be the same, much as the Republican Party will never be the same after Donald Trump's candidacy and the emergence of the Tea Party. Within the OMA, many conservative doctors who hate the Liberal government at Queen's Park, dislike government interference in their profession and want to run the health-care system as they did 30 or 40 years ago are on the move.
  • The physicians' deal is the first target in their sights. Next up is the leadership of the OMA, its bargaining team and its specialty sections. Yes, it's time to feel some sympathy for the OMA. Bob Hepburn's column appears Thursday. bhepburn@thestar.ca
  • The Ontario Medical Association deserves public sympathy as it takes on dissident doctors, Bob Hepburn writes.
Irene Jansen

Francesca Grosso and Michael Decter. Canada 2020. We can save money and improve health ... - 0 views

www.ottawacitizen.com/...story.html

specialty clinics lean accord ems mergers home care

shared by Irene Jansen on 10 May 12 - No Cached
  • Confounding expectations, in December 2011, Finance Minister Jim Flaherty announced a unilateral renewal of federal health funding.
  • This unanticipated federal generosity leaves the provinces with the ability to manage federal health care dollars as they choose.
  • It also deprives them of the federal government as a convenient scapegoat.
  • ...10 more annotations...
  • The recent Ontario Health Action Plan highlights aggressive bargaining with doctors and health care unions as well as lowered drug costs as key cost-saving strategies. However, even if real zeros can be achieved in these areas, such strategies will yield only about half the required savings.
  • What other cost-cutting measures might the provinces consider that could improve patient care?
  • Use health care professionals more effectively
  • Fewer health organizations
  • In Saskatchewan, Premier Brad Wall is implementing the Toyota Corporation “lean” philosophy as a way of removing unnecessary and inefficient processes from health care delivery. Significant savings are being achieved.
  • Reduce unnecessary readmissions to hospitals
  • Get rid of processes that are unnecessary orredundant
  • extended care paramedic
  • Move services out of hospitals
  • we are still conducting surgeries in the most expensive setting — one constructed to house infrastructures required for complex care and in which labour costs and staffing levels are very high
Irene Jansen

Eliminating Waste in US Health Care - - JAMA - 1 views

jama.ama-assn.org/...jama.2012.362.full

sustainability spending us coordination overutilization

shared by Irene Jansen on 19 Mar 12 - No Cached
  • In just 6 categories of waste—overtreatment, failures of care coordination, failures in execution of care processes, administrative complexity, pricing failures, and fraud and abuse—the sum of the lowest available estimates exceeds 20% of total health care expenditures.
  • Obtaining savings directly—by simply lowering payments or paying for fewer services—seems the most obvious remedy.
  • Here is a better idea: cut waste.
  • ...16 more annotations...
  • The literature in this area identifies many potential sources of waste and provides a broad range of estimates of the magnitude of excess spending.
  • The Table shows estimates of the total cost of waste in each of these 6 categories both for Medicare and Medicaid and for all payers.
  • Failures of Care Delivery: the waste that comes with poor execution or lack of widespread adoption of known best care processes
  • this category represented between $102 billion and $154 billion in wasteful spending
  • Failures of Care Coordination: the waste that comes when patients fall through the slats in fragmented care.
  • represented between $25 billion and $45 billion in wasteful spending
  • Overtreatment: the waste that comes from subjecting patients to care that, according to sound science and the patients' own preferences, cannot possibly help them
  • represented between $158 billion and $226 billion in wasteful spending
  • Administrative Complexity
  • represented between $107 billion and $389 billion in wasteful spending
  • Pricing Failures: the waste that comes as prices migrate far from those expected in well-functioning markets, that is, the actual costs of production plus a fair profit.
  • US prices for diagnostic procedures such as MRI and CT scans are several times more than identical procedures in other countries.
  • represented between $84 billion and $178 billion in wasteful spending
  • Fraud and Abuse
  • represented between $82 billion and $272 billion in wasteful spending
  • Addressing the wedge designated “overtreatment,” for example, would require identifying specific clinical procedures, tests, medications, and other services that do not benefit patients and using a range of levers in policy, payment, training, and management to reduce their use in appropriate cases. The National Priorities Partnership program at the National Quality Forum has produced precisely such a list in cooperation with and with the endorsement of relevant medical specialty societies.
Irene Jansen

Walkom: The dangerous myths about medicare - thestar.com - 0 views

www.thestar.com/...dangerous-myths-about-medicare

accord demographics privatization sustainability

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Canadian Institute for Health Information (CIHI)
  • the aging population has only a “modest” effect on medicare spending — in large part because, thanks to social programs like old age security, Canadians over 65 are healthier than they used to be
  • The institute doesn’t dismiss out of hand the role of aging. It just points out that other things — such as wages paid doctors and overall population growth — are far more important in determining health-care costs.
  • ...5 more annotations...
  • medicare costs in general aren’t spinning out of control
  • governments cut back health-care spending growth severely during the recession of the early 1990s, then — because of public pressure — reversed themselves later on
  • No government is likely to attack medicare head on. They’ve learned that this is political suicide.
  • My guess is that governments will be looking at ways to privatize even more — from hospitals to specialty clinics — all within the medicare umbrella.
  • In theory, this could work out. Or, as in Britain today, it could undermine the very nature of the public health-care system. The devil will be in the details.
1 - 20 of 23 Next ›
Showing 20▼ items per page