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Walkom: Canada's never-ending medicare fight - thestar.com - 0 views

www.thestar.com/...-s-never-ending-medicare-fight manning insurance medicare user fees comparisons social programs sustainability
shared by Irene Jansen on 23 Jan 12 - No Cached
  • The most depressing element of Canada’s on-again, off-again medicare debate is its repetitiveness. The country is forced to fight the same battle again and again. It’s as if our political elites learn nothing. I was reminded of that this weekend when Reform Party founder Preston Manning showed up on CTV’s Question Period to — again — make his pitch for two-tier health care.
  • Manning has been pushing two-tier medicine since 2005. That’s when he and former Ontario premier Mike Harris wrote that Canada’s medicare system should be replaced by a narrowly defined scheme focused on catastrophic illness and financed, in part, by user fees. All other health care would be paid for privately.
  • Any number of studies have demonstrated that so-called single payer public insurance systems like Canadian medicare are more efficient than two-tier schemes
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  • And user fees? Even a Senate committee that had been warm to the idea of charging patients each time they saw a doctor changed its mind when faced with the evidence.
  • But the real problem with two-tier medicine, as former Saskatchewan premier Roy Romanow noted on the same CTV show, is that it simply shifts costs.
  • Manning made much of the fact that Quebec’s government devotes proportionally less of it provincial budget to health —30 per cent of program spending as opposed to about 40 per cent in Ontario. He appeared to attribute this to the fact that Quebec, unlike Ontario, allows physicians to opt out of medicare and bill patients privately. But the real reason why the Quebec government spends less in proportional terms on health care is that it spends more in absolute terms on everything else. Provincial government program spending per capita in Quebec is $11,457. In Ontario, the figure is $9,223.
  • total health spending in Ontario represents 11.9 per cent of the province’s gross domestic product. In Quebec, the comparable figure is 12.4 per cent
  • The Germans, Dutch and French, all of whom are praised by two-tier fans, spend more of their gross domestic product on health care than we do.
  • Surely it’s more productive to build on what we have — a successful, publicly funded, universal health insurance system that covers doctors and hospitals. It could be improved or even expanded. But it works. That’s why Canadians keep fighting for it. Over and over and over again.
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Trudeau and two-tier health-care system - Infomart - 0 views

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  • Ottawa Citizen Sat Sep 26 2015
  • Liberal Leader Justin Trudeau wasted no time to brandish the Canadian Charter of Rights and Freedoms in support of a covering one's face during a citizenship ceremony. Is he as keen to put an end to a two-tier health-care system?
  • During his recent visit to Ottawa, Trudeau answered without hesitation "Absolutely not" to my question, "Should public funds be used to subsidized two-tier health-care services and benefits?" In his view, this would contravene the Charter, which guarantees equal treatment for all Canadians. However, he refused to answer the second part of my question, no doubt for fear of alienating some of his supporters.
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  • It is a fact that public sector employees, MPPs, MPs and senators can access health-care services and benefits above and beyond what is available through their provincial health plans. In his words, a form of two-tier health care plan. Premiums to these complementary health plans are subsidized in part by government, in other words by public funds. My question to the Liberal leader is simple: "If you form the next government, will you maintain the present two-tier health-care system for public sector employees including MPs and senators, or will you direct Treasury Board to stop the partial payment of the premiums and direct participants to absorb the full cost of the plan, or will you subsidize access to such plans for all Canadians?"
  • A reminder for Trudeau, the Charter is not a buffet where one chooses the articles that suit his or her agenda. Canadians, public sector employees and non public sector employees, deserve equal treatment. In his own words, it is a question of rights. Pierre Drouin Ottawa
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Evidence shows private MRI tests won't cut the wait - Winnipeg Free Press - 0 views

www.winnipegfreepress.com/...nt-cut-the-wait-404701236.html MRI privatization Manitoba two-tier
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  • Last week, Health Minister Kelvin Goertzen suggested he was "willing to look" at copying a Saskatchewan initiative that allows people to pay for MRI tests at private clinics to relieve pressure on the public system. In exchange for being able to charge directly for a scan, private MRI clinics have to provide one free scan to someone on the public waiting list.
  • In question period Friday, the NDP lashed out at Goertzen for his interest in a program the federal government has deemed illegal under the Canada Health Act. Two-tier health care remains a flashpoint between the right and left wings of the Canadian political spectrum, as was witnessed in the Manitoba legislature last week.
  • NDP critic Matt Wiebe put it bluntly. "This is the first step in (the Tory government’s) plan to create a two-tier health system, where the size of your wallet determines your care."
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  • Many within the system believe allowing private, for-profit options is a potential solution. Government has always relied on private facilities such as walk-in clinics, X-ray clinics and laboratories to provide insured services within the public system. Perhaps it’s time to allow Canadians to purchase medical services on the open market.
  • Although a province may have an oversupply of surgeons, it has a shortage of the other disciplines. The hours nurses and anesthesiologists work in the private system would come at the expense of the hours they can devote to the public system.This is a key caveat on the argument in favour of allowing more private, for-profit health care options: it is difficult to create a private tier that does not ultimately weaken the public tier. In fact, it is tough to find examples where increased private options relieve pressure on the public system and reduce wait times.
  • There is some evidence of this in Saskatchewan, where the government has been allowing private, for-profit MRIs for about 10 months. To date, Saskatchewan claims it has taken 2,200 patients off public wait lists for MRIs. And yet, its wait times in the public system have not gone down.
  • In fact, during the first six months Saskatchewan allowed residents to purchase their own MRI tests, the government’s own website shows wait times went up.
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Modernize, not privatize, medicare - Infomart - 0 views

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  • Winnipeg Free Press Mon Dec 14 2015
  • National Medicare Week has just passed, buoyed with optimism as a fresh-faced government takes the reins in Ottawa -- elected partly on a promise of renewed federal leadership on health care. Yet, these "sunny ways" are overcast by recent developments at the provincial level that entrench and legitimize two-tier care. Saskatchewan has just enacted a licensing regime for private magnetic resonance imaging (MRI) clinics, allowing those who can afford the fees -- which may range into the thousands of dollars -- to speed along diagnosis and return to the public system for treatment. Quebec has just passed legislation that will allow private clinics to extra-bill for "accessory fees" accompanying medically necessary care -- for things such as bandages and anesthetics.
  • Once upon a time, these moves would have been roundly condemned as violating the Canada Health Act's principles of universality and accessibility. These days, two-tier care and extra-billing are sold to the public as strategies for saving medicare. Under Saskatchewan's new legislation, private MRI clinics are required to provide a kind of two-for-one deal: for every MRI sold privately, a second must be provided to a patient on the public wait list, at no charge to the patient or the public insurer. Quebec's legislation is touted as reining in a practice of extra-billing that had already grown widespread.
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  • Underlying both reforms is a quiet resignation to the idea that two-tiered health care is inevitable. This sense of resignation is understandable, coming as it does on the heels of a decade-long void in federal leadership on health care. Throughout the Harper government's time in office, the Canada Health Act went substantially unenforced as private clinics popped up across the country. Even in its reduced role as a cheque-writer, the federal government took steps that undermined national unity on health care, switching the Canada Health Transfer to a strict per capita formula, which takes no account of a province's income level or health-care needs. If Canadians hope to reverse this trend, we cannot simply wage a rearguard battle for the enforcement of the Canada Health Act as it was enacted in 1984. Even if properly enforced, the act protects universal access only for medically necessary hospital and physician services. This is not the blueprint of a 21st-century public health-care system.
  • We desperately need universal coverage for a full array of health-care goods and services -- pharmaceuticals, mental-health services, home care and out-of-hospital diagnostics. Canada is unique among Organization for Economic Co-operation and Development countries in the paucity of what it covers on a universal basis despite falling in the top quartile of countries in levels of per capita health spending. Far from being our saviour, the Canada Health Act in its current incarnation is partly to blame -- not because of its restrictions on queue-jumping and private payment, but because it doesn't protect important modern needs, such as access to prescription drugs.
  • There are limits on what a public health system can provide, of course -- particularly as many provinces now spend nearly half of their budgets on health care. But fairness requires these limits be drawn on a reasoned basis, targeting public coverage at the most effective treatments. Under the current system, surgical removal of a bunion falls under universal coverage, while self-administered but life-saving insulin shots for diabetics do not. A modernized Canada Health Act would hold the provinces accountable for reasonable rationing decisions across the full spectrum of medically necessary care.
  • Instead of modernizing medicare, Saskatchewan and Quebec are looking to further privatize it. Experience to date suggests allowing two-tiered care will not alleviate wait times in the public system. Alberta has reversed course on its experiment with private-pay MRIs after the province's wait times surged to some of the longest in the country.
  • The current wisdom is long wait times are better addressed by reducing unnecessary tests. A 2013 study of two hospitals (one in Alberta, one in Ontario) found more than half of lower-back MRIs ordered were unnecessary. Skirmishes over privatization have to be fought, but they should not distract us from the bigger challenge of creating a modern and publicly accountable health system -- one that provides people the care they need, while avoiding unnecessary care.
  • Achieving that will make National Medicare Week a true cause for celebration. Bryan Thomas is a research associate and Colleen M. Flood is a professor at the University of Ottawa's Centre for Health Law, Policy and Ethics. Flood is also an adviser with EvidenceNetwork.ca.
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Alberta health care can be better, but not through lawsuits and a two-tier sy... - 0 views

medicinehatnews.com/...lawsuits-and-a-two-tier-system from heather Alberta two tier privatization
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  • By Medicine Hat News Opinon on April 11, 2014.
  • On April 2, Justice P. R. Jeffrey of Alberta’s Court of Queen’s Bench rejected the claim put forward by lawyer John Carpay on behalf of Darcy Allen that prohibition on private health insurance in Alberta infringes on Mr. Allen’s Charter Rights. Mr. Carpay based his court argument on the Supreme Court of Canada ruling in the Chaouilli case that a ban on private health insurance under Quebec law infringed Mr. Chaoulli’s Charter right to security of the person. This claim was not a rejection of access to health care but rather recognition that allowing private insurance to determine Albertans’ access to health care is not a solution to the problems in our public health care system. The Alberta Court found Chaoulli didn’t apply. That’s no surprise. The Supreme Court clearly stated Chaoulli applied only to the specifics of the Quebec case. This Alberta case was simply political grandstanding. We can’t build the health system we want through the courts. A small, angry minority of Albertans wants a two-tier health system where a few people get whatever they want while everyone else waits. The great majority of us want good health care based on need, not ability to pay. The minority just can’t seem to live with losing this argument. Or do Mr. Carpay et al believe in democracy and the rule of law only when they win?
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Medicare threatens to put Justin Trudeau to the test: Walkom - 0 views

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  • Cheryl Stadnichuk on 04 Apr 16
     
    Moves in Quebec and Saskatchewan toward two-tier health care will force the new Liberal government to act, one way or another. their health systems toward two-tier medicine. Quebec's reforms in particular could end up violating the Canada Health Act, a federal statute that prohibits physicians from charging extra fees for medically necessary services. That province has long allowed physicians to extra-bill patients for "medication and anesthesia agents." The idea, presumably, was that doctors couldn't charge patients out-of-pocket for, say, looking at a sore finger. But they could charge for the cost of a bandage. .... Saskatchewan presents Ottawa with a murkier problem. In November, Premier Brad Wall's government passed a law allowing private MRI clinics to operate in the province, charge whatever fee they choose and bill patients directly for the service.
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Overlapping health system just helps to 'jump queue' - 1 views

www.smh.com.au/...jump-queue-20140420-36yoj.html from heather Australia privatization two tier
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  • April 20, 2014
  • Private insurance, public resources Hospital waiting times are growing longer because Australia's "two-tier" health system is pushing resources from the public to the private system, experts say. Nearly 90 per cent of private health insurance coverage here duplicates public services, meaning private patients get the same treatment but faster access, an international analysis has shown.
  • Sam Taylor's children were just 6 and 14 when she was asked to make a choice no woman ever wants to make. Diagnosed with an aggressive form of breast cancer in May last year, Taylor tested positive for the BRCA1 gene mutation that greatly increases the lifetime risk of developing cancer. Doctors said she had two options: wait up to three years in the public system for the double mastectomy that might save her life or spend thousands of dollars going through private insurance.
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  • A tale of two systems and one public purse Jeff Richardson, foundation director of the Centre for Health Economics at Monash University, says duplication has created two medical systems, both funded primarily through the public purse. "We run a two-tier health system now. There's no point in calling it other than that," he said. "Both systems offer a number of similar services for the same complaint … [But] private health funds are not funding medicine, by and large. They're simply giving people access to private hospitals."
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The creeping spread of two-tier health care - Infomart - 0 views

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  • Peterborough Examiner Wed Nov 2 2016
  • In 2014,when members of the Peterborough Health Coalition met with the newly appointed health minister at Queen's Park, he gave assurances that he would not allow the province to drift into a two-tier healthcare system. Since that time the following ominous symptoms have emerged:
  • 1. Increasingly (as in measurements preceding cataract surgery) patients are being offered freebie OHIP procedures or a higher calibre pay-for-service alternative. 2. Increasingly medications (including some highly effective antibiotics) are being removed from drug card coverage. 3. Many doctors now charge fees for a range of services including providing letters. 4. Benefits in areas such as special diet supplements are being revoked of reduced
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  • 5. Most physio clinics are now fee-for-service. The two local clinics which accept patients under OHIP coverage have waiting lists of up to nine months. 6. Patients are denied day surgery unless they have (or can hire) someone to spend the first night post-surgery with them. 7. Costs of equipment and supports have skyrocketed and the government no longer funds a local lending cupboard where people used to be able to pay a refundable deposit for the loan of a walker, cane, wheelchair, bath seat etc. Crutches are now $40 and the cost of an air cast is a minimum of $140 plus tax.
  • Back in 2014 the health minister urged us to report any indications of creeping two-tier coverage. Over the past two years letters and e-mails to his office have not earned the courtesy of a reply. But one recent letter, forwarded to the minister by our local MPP, did elicit a prompt response. After salutations the minister's assistant courteously and concisely advised that "the ministry receives correspondence from people all over Ontario who offer advice and insights on various issues. Hearing those views is essential to help shape a province that reflects the needs and concerns of all Ontarians. Thank you for writing."
  • In bureaucratese this can be interpreted as meaning "The ministry has received your correspondence and appropriately filed your letter in the colossal, specially designated parliamentary shredder." Christmas is approaching. It appears that, unless the Health Minister is visited by Three Spirits, we may soon have many more Tiny Tims in our neighbourhoods --people who could have been fit, healthy and often employable had they been able to afford prosthetics or medications or therapies to strengthen and heal their traumatized bodies.
  • And the priceless legacy of free universal health care, so courageously fought for and won for all of us by the incomparable champion of the disadvantaged Tommy Douglas, will be lost forever. Carol Winter McDonnel St.
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Wait-list limbo - Infomart - 0 views

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  • National Post Tue Mar 3 2015
  • It offends some Canadians that there is a lawsuit afoot in British Columbia seeking to establish patients' rights to seek health-care outside the provincial government system. These critics say that the constitutional challenge - which is being waged by a private surgery clinic and four individuals who suffered real harm while sitting on health-care waiting lists - is an attack on universal care. The case "could set a dangerous precedent for the rest of the country, and move Canada toward a U.S.-style two-tier health-care system," claims a website set up by Canadian Doctors for Medicare and the B.C. Health Coalition.
  • Borello hasn't even had her first appointment with an orthopedic surgeon yet. That's not scheduled until next month. These women are hardly alone. There are more than 3,000 patients currently waiting for hip surgery in British Columbia. Wait times vary wildly depending on where a patient happens to live, which hospital he's referred to, and simply his luck. Having connections in and knowledge of the medical community makes a big difference, too. And despite the common refrain that allowing patients the option to seek private care in B.C. would exhaust the province's supply of doctors, the province itself has admitted that it has surfeit of orthopedic surgeons.
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  • One of them, 55-year-old Julie Bennett, explains to CBC that she's relying on narcotic pain killers to get her through while she awaits her surgery. She is told it won't happen until 2016, even though she was referred for the procedure in 2013, and she worries she will end up in a wheelchair before then. The other patient, 85-year-old Chiara Borello, spent two weeks in hospital while doctors experimented with medication to try to control her pain, according to her daughter Renata Borello. "If I drop dead, that's fine," the elder Borello tells CBC. "But I won't take any more of that poison [the debilitating painkillers]. That's too much poison."
  • As the executive director of the Canadian Constitution Foundation, which is supporting the plaintiffs' challenge, I endorse the ideal of ensuring that quality health care is readily available to every Canadian. But the belief that a two-tier system undermines that ideal is wrong. It's as wrong as the assumption that "two-tier" equals "U.S.-style" (most of the rest of the world operates with mixed public and private health-care systems). And it's as wrong as pretending that we have a "onetier" system as it is. A couple of recent happenings, both as frustrating as they are telling, serve to underline the point rather nicely. On Monday, CBC News British Columbia published a story called "Patients' 'lives ruined' as hip surgery waits grow." The piece focuses on two B.C. osteoarthritis sufferers who are experiencing intolerable pain while they wait for the hip operations they need.
  • Rather, what we're seeing is that government is simply incapable of delivering timely health care through its centrally planned monopoly. It insists, though, on legally confining Julie Bennett and Chiara Borello to wait-lists by banning them from purchasing private health insurance that could cover the cost of their needed surgery, or allowing that aforementioned oversupply of orthopedic surgeons to spend some of their time in the private system, working through some of those 3,000 cases that are causing such a bottleneck. We're supposed to just keep hanging in there and waiting until the government can get its act together.
  • Interestingly enough, that's exactly the message being sent by the second recent happening I referenced at the start of the column. The trial in the constitutional challenge to B.C.'s health care monopoly was supposed to begin this week, on March 2. It has now been delayed because six days before trial, the government lawyers informed the plaintiffs that the B.C. Ministry of Health had suddenly discovered "thousands of documents" that could be relevant to the case and must be turned over for review. Why these thousands of documents did not turn up at any point in the previous six years of litigation is unclear. It's tempting to read impure motives into the last-minute disclosure - an attempt to exhaust the funds and patience of the plaintiffs who can't rely on unlimited taxpayer-funded coffers and staff, perhaps. But it's every bit as possible that this is simply more evidence of the government's general inability to handle something as challenging as the healthcare file, which requires the nimbleness and efficiency that a bureaucracy is inherently illequipped to provide.
  • Either way, the plaintiffs will be back in court in six to eight weeks, ready to fight for their rights to make their own health-care decisions.
  • Marni Soupcoff is executive director of the Canadian Constitution Foundation (theccf.ca).
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Two-tiered wage system announced by Tories - thestar.com - 0 views

www.thestar.com/...age-system-announced-by-tories migrant workers wages regulation two tier federal
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  • Immigration Minister Jason Kenney has always vehemently denied bringing cheap foreign labour into Canada. Employers had to pay foreign temporary workers “the prevailing wage,” he pointed out.
  • That indeed is what the rules said – until Wednesday, when Human Resources Minister Diane Finley quietly changed them. Employers will now be allowed to pay foreign temp workers 15 per cent less than the average wage.
  • Under the new rules, foreign temporary workers will still covered by provincial employment standards, meaning they must be paid the minimum wage. But in booming Alberta, the minimum wage ($9.40) is a far cry from the average wage ($26.03).
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  • Since Prime Minister Stephen Harper assumed power in 2006, the number of foreign temporary workers admitted into Canada has grown by 40 per cent. The temporary worker stream is now larger than the stream of permanent workers intending to set down roots and become citizens.
  • When Canada introduced its temporary foreign worker program in 2002, the governing Liberals vowed never to adopt the European model route in which “guest workers” are paid less than nationals and treated as second-class residents. But under Harper, the country is now moving in that direction.
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Ontario moving to two-tier health care: protest - 1 views

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  • Mar 11, 2014
  • Ontario moving to two-tier health care: protest
  • A London group has joined a province-wide movement opposed to new rules that will allow the contracting out of more health care services.
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Health care inching closer to two-tier - Infomart - 0 views

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  • The Barrie Examiner Tue Nov 26 2013
  • I am concerned with the way our health care is becoming a two-tier system. Why is it that the government can stop OHIP coverage for certain medical care, while government employees are all covered for them 100% of the time with their group benefits? Both myself and a close friend of mine need surgery. I have an unstable shoulder and he has a torn ACL in his knee.
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Two-tier health care? | Chatham Daily News - 0 views

www.chathamdailynews.ca/...pov-two-tier-health-care from heather two tier accord Ontario coalition
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  • By Peter Epp, QMI Agency Tuesday, April 29, 2014 1:19:40 EDT PM
  • For the better part of the last 50 years, Canadians have been justifiably proud of a public health care system that promises universal health care to all citizens, the cost of which is borne entirely by a public treasury. Although the system has been challenged and placed under much stress, it has also functioned much as designed.
  • Some of those solutions aren't sitting well with the Ontario Health Coalition, whose mission it is to uphold and make sure that community hospitals are financially sustained in the same fashion as they have in the past. The Health Coalition is upset with the funding cuts that local hospitals have had to adjust to, and are further worried with the transfer of some health care functions to private clinics.
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Privatization in health care will leave poor out in the cold - Infomart - 0 views

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  • Windsor Star Mon May 4 2015
  • A long-running dispute between Dr. Brian Day, the co-owner of Cambie Surgeries Corp., and the British Columbia government may finally be resolved in the BC Supreme Court this year - and the ruling could transform the Canadian health system from coast to coast. The case emerged in response to an audit of Cambie Surgeries, a private for-profit corporation, by the BC Medical Services Commission. The audit found from a sample of Cambie's billing that it (and another private clinic) had charged patients hundreds of thousands of dollars more for health services covered by medicare than is permitted by law. Day and Cambie Surgeries claim the law preventing a doctor charging patients more is unconstitutional.
  • Day's challenge builds on the legacy of a 2005 decision by the Supreme Court of Canada overturning a Quebec ban on private health insurance for medically necessary care. But this case goes much further, not only challenging the ban on private health insurance to cover medically necessary care, but also the limits on extra-billing and the prohibition against doctors working for both the public and private health systems at the same time. A trial date was set to begin in 2012, but was adjourned until March 2015 so that the parties could resolve their dispute out of court and reach a settlement. It now appears such a resolution has not been reached and the court proceedings may resume in November. Here's why this case matters.
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  • Legal precedent: Whatever way the case is decided at trial, it is likely to be appealed and eventually reviewed by the Supreme Court of Canada. A decision from this level will mean all provincial and territorial governments will have to revisit equivalent laws. The foundational pillars of Canadian medicare - equitable access and preventing twotier care - could well be vanquished in the process. Wait times: Day will likely argue that Canada performs poorly on wait times compared to other countries, and that other countries allow two-tier care; thus, if Canada is allowed two-tier care, our wait times would improve. But this approach is too simplistic. Comparisons to the British health system, fail to recall that, despite having two-tiers, it has in the past suffered horrendously long-wait times. Recent efforts to tackle wait times have come from within the public system, with initiatives like wait time guarantees and tying payment for public officials to wait times targets.
  • By looking to Britain, we are comparing apples to oranges. British doctors are generally full-time salaried employees while most Canadian physicians bill medicare on a fee-forservice basis. Consequently, the repercussions of permitting extra billing in Canada could eviscerate our publiclyfunded system, whereas this is not the case in Britain. Imagine if most doctors in Canada could bill, as those at the Cambie clinic have done, whatever they want in addition to what they are paid by governments?
  • Conflict-of-interest incentives: Evidence suggests there is a danger in providing a perverse incentive for physicians who are permitted to work in both public and private health systems at the same time. Wait times may grow for patients left in the public system as specialists drive traffic to their more lucrative private practice. Sound improbable? Academic studies have noted this trend in specific clinics that permit simultaneous private-public practice. And recent U.K. news reports have profiled a case where a surgeon bumped a public patient in need of a transplant for his private-pay patient.
  • Competition: Proponents of privatized health services often claim it would add a healthy dose of competition, jolting the "monopoly" of public health care from its apathy. But free markets don't work well in health care. Why? Because public providers and private providers won't truly compete if the laws Day challenges are struck down. Instead, those with means and/or private insurance will buy their way to the front of queues. Public coverage for the poor will likely suffer, as is clearly evident in the U.S., with doctors refusing to provide care to low-income patients in preference for those covered by higher-paying private insurance.
  • Of course, this is all based on an outcome that is not yet known. It may be that the charter challenge in B.C. will be unsuccessful, but clearly the stakes for ordinary Canadians are high. Sadly Dr. Day is not bringing a challenge for all Canadians. Isn't it past time our governments and doctors work to ensure all Canadians - and not just those who can afford to pay - receive timely care? Colleen Flood is Professor and University Research Chair in Health Law Policy at the University of Ottawa. Kathleen O'Grady is a Research Associate at the Simone de Beauvoir Institute, Concordia University and Managing Editor of EvidenceNetwork. ca
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TheSpec - Home care's 'race to the bottom' - 1 views

www.thespec.com/...home-care-s-race-to-the-bottom home care on two tier wages union competitive bidding substitution integration
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  • St. Joseph's Home Care is ready to compete for a flood of opportunity believed to be coming this fall when the province is expected to overhaul how contracts are awarded.
  • The home care agency — run by the same organization as St. Joseph's Hospital and Villa — cut wages by up to 15 per cent in all new contracts it wins.
  • The $13.96 starting hourly rate is now below Hamilton's living wage of $14.95. It takes five years to reach the top rate of $15.31.
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  • That's also below the starting wage of $16.07 for personal support workers, dietary aides, health aides and home cleaners.
  • Kim Ciavarella, president of St. Joseph's Home Care. “We introduced this new tier so we'd be able to bid on those contracts. It positions us very nicely.”
  • The 190 workers came close to striking over the two-tier system that sees lower wages go to staff working on any new contracts
  • “We feel it's a race to the bottom,” said Bill Hulme, community care lead for the Service Employees International Union Local 1 Canada, which represents 10,000 home care workers including those at St. Joseph's.
  • The low wages, combined with a lack of job security, have made home care the most unstable sector of the health care system and the hardest in which to retain staff, says Jane Aronson, a home care researcher and director of McMaster's school of social work.
  • “I find it unfathomable that at the same time the provincial and federal governments keep saying home care is very important, it's organized so those who are its front line staff won't have security and in this instance won't even have a living wage,” she said. “It's not a field people can afford to work in very long so we lose people with skills.
  • home care workers make far less than the hourly wage because they're often not paid for their transportation time between clients
  • The province halted competitive bidding in January 2008 to try to resolve some of these issues. It's expected something new will be in place this fall.
  • St. Joseph's Health System is testing what it calls “bundled care,” which involves the province giving a set amount of money to provide diagnostic, hospital, long term care and home care to patients with a co-ordinator overseeing it all and acting as a point of contact.
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User fees threatened for patients across Canada if court challenge negotiations fail to... - 0 views

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  • Canada Newswire Mon Sep 29 2014
  • TORONTO, Sept. 29, 2014 /CNW/ - As Ontario's new Health Minister Dr. Eric Hoskins sits down with provincial and territorial Health Ministers for their fall meeting this week, experts and patient advocates hope that he'll carry a strong message. Across Canada advocates are calling on the B.C. Health Minister to hang tough on the Medicare court challenge which threatens open season on patient user fees for surgeries, diagnostics and other procedures. The case was scheduled to begin on September 8, but lawyers for both Brian Day, owner of one of the largest private clinics in Canada, and the B.C. government asked the court for a delay in order to negotiate a settlement. Negotiations are now happening behind closed doors and the court date is delayed until March 2015.
  • Following a provincial audit in 2012 which revealed that Day was charging hundreds of thousands of dollars in unlawful user fees to patients, Day filed a Charter Challenge to nullify the laws that he was violating. His case aims to bring down the laws that protect single-tier Medicare and forbid clinics like his from extra-billing patients and charging user fees for care that currently must be provided without charge under the public health care system. The litigation has far-reaching implications for the entire country. Day's clinics were first exposed by patients who complained they were unlawfully billed for medical procedures. The B.C. government responded by trying to audit the clinics. Day refused to let in auditors until forced by a court order, and even then the clinics did not fully comply with auditors. Auditors had access to only a portion of the clinics' billings and only one month's worth of data. Nevertheless, what they found was astonishing. In a period of about 30 days, patients were subject to almost half a million dollars in user charges. The five patients who brought the initial legal petition have had their trial delayed while Day's Charter Challenge to the laws upholding single-tier Medicare is heard. They are still waiting for redress.
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  • "In order to protect patients, the B.C. government must hold private clinic owners and operators accountable when they break the laws prohibiting extra-billing and user fees," said lawyer Steven Shrybman, a partner at Sack Goldblatt Mitchell who is acting for the B.C. Health Coalition and Canadian Doctors for Medicare, intervenors in the court challenge. Shrybman is well-known for his successful Supreme Court challenge against Ontario's attempted sale of Hydro One and the recent election fraud cases in Federal Court. "Though the challenge was launched in British Columbia, it has the potential to bring two-tier care to Canadians across the country," he warned. "Advocates of public health care from Ontario and across the country are calling on the B.C. government to take a tough stand in these negotiations. These are the laws that uphold Medicare and defend patients," said Dr. Ryan Meili, Vice-Chair of Canadian Doctors for Medicare. "A simple slap on the wrist encourages more violations in provinces from coast to coast."
  • The problem is already creeping into Ontario, according to Natalie Mehra, executive director of the Ontario Health Coalition, where the government is proposing to expand private clinics. "Patients are being confused by private clinic operators who are manipulating them into paying thousands of dollars for health care services that they have already paid for in their taxes," she warned. "The public should know that you cannot be charged by a doctor or private clinic operator for surgery, diagnostic tests or any other medically necessary hospital or physician service. Extra user fees charged to sick and elderly patients are unlawful and immoral and governments should be delivering that message." Advocates warned that this court case should also raise alarm bells in Ontario's government about the dangers of private clinics. At risk is our public health system in which access to health care is based on need, not wealth. SOURCE Ontario Health Coalition
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Two-tiered health care is already in B.C - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|vitc|20150912|229114975 from heather bc private clinics privatization court Day
shared by Govind Rao on 14 Sep 15 - No Cached
  • Times Colonist (Victoria) Sat Sep 12 2015
  • Re: "Private surgery is troubling," editorial, Sept. 6. I agree that the B.C. Liberal government's policy to direct ever more public health-care funds to private clinics is troubling, but not unexpected. The editorial, however, did not mention the elephant in the room that is playing the biggest part in this government's every worsening healthcare crisis - fixation on lowering taxes. The inaptly named B.C. Liberals are of conservative ideology and therefore believe that the private sector and market forces, combined with ever-decreasing taxation, will somehow solve society's everincreasing complex problems.
  • Canada's health care is dependent on both federal and provincial policy. B.C. citizens are currently reliant on two governments with the same ideology - keep lowering taxes. Make no mistake about two-tiered health care coming to B.C. - it is virtually here. I'm sure you all know of someone who has paid a private clinic to get a procedure done more quickly rather than wait in line for that same surgeon in the public system. I believe that the B.C. Liberals expect Dr. Brian Day will win his court case this fall challenging the ban on private health care by the provincial Medicare Protection Act. Haven't the B.C. Liberals already violated that same act by the several instances of farming out surgical procedures to private clinics? Larry Jacobi Victoria
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Why a two-tiered system won't solve our health care woes - The Globe and Mail - 1 views

m.theglobeandmail.com/...article17691727 from heather two tier privatization medicare accord
shared by Govind Rao on 27 Mar 14 - No Cached
  • Mar. 27 2014
  • Canada is about to face its second court challenge over restrictions on private health insurance when Dr. Brian Day’s case appears before the courts in September. It is true that there are examples of jurisdictions that value universal health insurance coverage and also allow private insurance – the U.K. and Sweden would be two examples. But it is important to note that although these countries, among others, may allow for private insurance, they still have many of the same problems with their health care system that Canada does.
  • A recent review of the economic evidence on the effects of private insurance on public health care systems that I wrote with Matt Townsend for the Encyclopedia of Health Economics suggests that there is little evidence for many of the benefits that advocates of private insurance claim will occur for those who do not make use of the private system, such as shorter wait times or lower public costs.
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Private MRIs wrong prescription - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|relp|20151026|232213388 from heather diagnostics private clinics privatization Saskatchewan
shared by Govind Rao on 26 Oct 15 - No Cached
  • The Leader-Post (Regina) Mon Oct 26 2015
  • In the final sitting of the legislature before the spring election, Premier Brad Wall's government plans to pass Bill 179 to facilitate private user-pay MRIs in Saskatchewan. As a longtime family doctor, I see this as a cynical political move that caters to public fears about long wait lists for imaging, but which will actually work to make things worse for patients who truly need an MRI.
  • There is very clear evidence that, far from relieving pressures in the public system, offering a separate stream for the wealthy to jump the queue actually lengthens public wait lists. This has been shown over and over again, whether it be with cataract surgery, diagnostic imaging or surgical procedures. MRI is no different.
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  • In Alberta, where private MRI facilities advertise and operate, the median wait time for an MRI is much longer (80 days) than in Saskatchewan (28 days). Furthermore, the wait has lengthened in the public system in Alberta since privatized facilities came on the scene. The explanations are complex, but siphoning human capacity (doctors and technologists), as well as other resources, from the public system into the private and more lucrative stream plays a big role. So does the market generation of increased demand by deceptive advertising and promotion of privatized services.
  • Medical tests should be ordered in accordance with evidence-based guidelines about their usefulness and indications. Patient access to MRI is currently prioritized in Saskatchewan health-care facilities on the basis of medical need, from Level I (a life-threatening diagnosis or treatment requiring MRI within 24 hours) to a Level IV (stable patients needing long range diagnosis or management allowing for delay of 30-90 days).
  • This system works and prioritizes appropriately. While patients sometimes feel that an urgent MRI will make a difference to their outcome, this is rarely the case. When it is the case, patients are prioritized and get urgent access. Allowing private MRI's based on ability to pay and jump the queue will trample this well-developed, equitable system. It will allow the wealthy or anxious to bypass this system and result in two-tiered care.
  • And the queue-jumping is not just limited to getting an MRI. It will extend to preferential and quicker access to treatment options, such as specialist care and surgery based on the MRI results if positive.
  • The Wall government and the private MRI operators that will profit from this legislation have proposed a two-for-one deal, suggesting that one public MRI scan will be done for every private MRI performed. Don't be fooled. This will not get around the problem of prolonging public wait lists since it will siphon resources from the public system. If we really need more MRIs, why not increase capacity in the public system instead?
  • While MRI can be a useful tool, when inappropriately used it can lead to overdiagnosis or "false positives." This then triggers a costly cascade of subsequent investigations or interventions to reassure either physician or patient MRI technology has important limitations, and frequently finds unrelated non-significant abnormalities that frighten patients. For example, 90 per cent of healthy individuals over 60 years of age with no symptoms of back pain show degenerative abnormalities on MRI. Similarly, the vast majority of adults over 50 show knee damage on MRI and only clinical assessment by a doctor identifies whether or not these findings are significant. Early MRI has not been shown to improve outcomes in low back pain and may actually make for worse outcomes. A doctor examining for red flag symptoms can identify the very small number of patients for whom an MRI is useful.
  • Many MRI scans are therefore unnecessary. Allowing patients to purchase an investigation they don't need wastes resources, bypasses the role of an informed health-care provider, and may in the end actually harm patients with needless investigations and interventions. Physicians are engaged in initiatives to "choose wisely" in testing. Throwing the door open to investigations based on ability to pay, rather than medical need, flies in the face of sensible approaches to health resources.
  • We live in a society obsessed with health. Selling fear of sickness is profitable. But access to MRIs is not our most urgent health-care need. To suggest otherwise is to obscure the social and economic determinants that define who is healthy and who is not, and to further shift resources away from the sick towards the worried well.
  • Let's promote greater equity, not less, and preserve health care based on need, not two-tiered care based on ability to pay. Let's trust health-care providers to counsel patients about the right test at the right time and to prioritize patients appropriately. The marketplace has no role in these decisions.
  • Dr. Sally Mahood is a Regina family doctor and an associate professor, Family Medicine, University of Saskatchewan.
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Top A&E doctors warn: 'We cannot guarantee safe care for patients anymore' - UK Politic... - 0 views

www.independent.co.uk/...-patients-anymore-8624513.html UK safety ER
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  • // div.slideshow img { display: none; } 1 / 2Top A&E doctors have warned 'We cannot guarantee safe care for patients anymore'Rex //
  • A combination of “toxic overcrowding” and “institutional exhaustion” is putting lives at risk, according to the letter to senior NHS managers from the leaders of 18 emergency departments.
  • Last week, figures showed that the number of patients attending casualty units in England has increased by a million in the 12 months leading up to January 2013.
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  • Speaking before his appearance at the Health Select Committee, he conceded that urgent care services were “getting closer to the cliff edge,” with A&E admission increasing by 51 per cent over the past 10 years
  • The letter from the 20 A&E leaders talks of the “institutional exhaustion” of the nursing, medical and even clerical staff who being pushed ever harder by the growing volume of work with little outside support
  • . It also describes how doctors and nurses are being forced to work in what are verging on dangerous environments
  • They further warn that overcrowding is likely to lead to more deaths in hospitals and reveal that standards of care are deteriorating as serious clinical incidents and delays are rising.
  • The letter states: “The aforementioned issues have led to us routinely substituting quality care with merely safe care; while this is not acceptable to us, what is entirely unacceptable is the delivery of unsafe care; but this is now the prospect we find ourselves facing on too frequent a basis
  • Recent developments such as the introduction of 111 and financial penalties for holding ambulance crews in ED are touted as solutions to the crisis: however we as ED physicians recognise that these measures will actually make the problem worse instead of better, and evidence is already emerging to support our opinions.
  • Furthermore, we firmly believe and strongly recommend that ED leads should be intimately involved with and consulted on the commissioning of Emergency services in the region, as well as other related emergency care changes-such as 111.
  • There is toxic ED overcrowding, the likes of which we have never seen before.
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