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Doug Allan

Reforming private drug coverage in Canada: Inefficient drug benefit design and the barr... - 0 views

www.healthpolicyjrnl.com/...fulltext

drugs benefits

shared by Doug Allan on 04 Feb 15 - No Cached
  • Reforming private drug coverage in Canada: Inefficient drug benefit design and the barriers to change in unionized settings
  • The Canadian Life and Health Insurance Association, concerned about the sustainability of private drug coverage in Canada, has asked for government help to reduce costs [11x[11]Canadian Life and Health Insurance Association, Inc. CLHIA report on prescription drug policy; ensuring the accessibility, affordability and sustainability of prescription drugs in Canada. Canadian Life and Health Insurance Association Inc., ; 2013See all References][11]. Growing administrative costs of private health plans continues to put additional financial pressures on the capacity to offer private health benefits [12x[12]Law, M., Kratzer, J., and Dhalla, I.A. The increasing inefficiency of private health insurance in Canada. Canadian Medical Association Journal. 2014; 186See all References][12].
  • Most Canadians are covered through private drug plans offered mostly by employers through supplemental health benefits: 51% of Canadian workers have supplemental medical benefits [2x[2]Morgan, S., Daw, J., and Law, M. Rethinking pharmacare in Canada. CD Howe Institute, ; 2013 (Commentary 384)See all References][2], and since work-related health insurance also covers dependents of employees with coverage, as many as two-thirds of Canadians are covered by health insurance plans.
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  • Prescription drug spending in Canada's private sector has increased nearly fivefold in 20 years, from $3.6 billion in 1993 to $15.9 billion in 2013 [3x[3]Express Script Canada. 2013 Drug trend report. ESI, Mississauga; 2014 (http://www.express-scripts.ca/sites/default/files/uploads/FINAL_executive%20summary_FINAL.pdf [accessed 01.06.14])See all References][3].
  • Private drug plans in Canada are often considered wasteful because they accept paying for higher priced drugs that do not improve health outcomes for users and use costly sub-optimal dispensing intervals for maintenance medications. As a consequence, it is estimated that private drug plans in Canada wasted $5.1 billion in 2012, which is money spent without receiving therapeutic benefits in return [4x[4]Express Scripts Canada. Poor patient decisions waste up to $5.1 billion annually, according to express script Canada. (June)Press release, ; 2013 (http://www.express-scripts.ca/about/canadian-press/poor-patient-decisions-waste-51-billion-annually-according-express-scripts [accessed 01.06.14])See all References][4]. This amount represented 52% of the total expenditures of $9.8 billion by private insurers on prescription drugs for that year [5x[5]Canadian Institute for Health Information. Drug Expenditure in Canada 1985 to 2012. CIHI, Ottawa; 2013See all References][5].
  • Respondents from all categories mentioned that, in contrast to employers, the over-riding objective of unions is to maximize their benefits with minimal co-payments for their employees.
  • The study focused on large unionized workplaces that had Administrative Services Only (ASO) plans, where the employer is responsible for the costs of benefit plans and bears the risks associated with it, while insurers are just hired to manage claims.
  • This study focused on ASO arrangements because they are the most common insurance option chosen by large private-sector firms [16x[16]Sanofi. Sanofi Canada healthcare survey. Rogers Publishing, Laval; 2012See all References][16]. Those organizations whose activities resided solely in the province of Québec, where the regulation of private drug plans differs [17x[17]Commissaire de la santé et du bien être du, Québec., Les médicaments d’ordonnance: État de la situation au Québec. Gouvernement du Québec, Québec; 2014See all References][17], were excluded.
  • Respondents from all categories indicated that consistency of benefits with other market players is of significance to employers.
  • Sean O’BradyxSean O’BradySearch for articles by this authorAffiliationsÉcole de relations industrielles, Université de Montréal, Montreal, Quebec, CanadaInteruniversity Research Centre on Globalization and Work (CRIMT), Montreal, Quebec, Canada, Marc-André GagnonxMarc-André GagnonSearch for articles by this authorAffiliationsSchool of Public Policy and Administration, Carleton University, Ottawa, Ontario, CanadaCorrespondenceCorresponding author at: School of Public Policy and Administration, Carleton University (RB 5224), 1125 Colonel By Drive, Ottawa, Ontario, Canada K1S 5B6. Tel.: +1 613 520 2600.xMarc-André GagnonSearch for articles by this authorAffiliationsSchool of Public Policy and Administration, Carleton University, Ottawa, Ontario, CanadaCorrespondenceCorresponding author at: School of Public Policy and Administration, Carleton University (RB 5224), 1125 Colonel By Drive, Ottawa, Ontario, Canada K1S 5B6. Tel.: +1 613 520 2600., Alan Cassels
  • Finally, employers were most concerned with the government's role in distributing the costs associated with drug coverage among public and private players in the system. In fact, each employer expressed concern over this. Three of the four employers expressed concern over the government's role as a plan sponsor and how governments shift costs to the private sector. As described by one employer, “the government is a very big consumer of drugs” and if the drug companies “start losing money on the government side, they pass it on to private insurance”. Thus, government regulations that help employers contain costs are desired.
  • the employer always has the advantage in this stuff because they have all of the information with respect to the reports and the costs from the insurer or the advisor”
  • According to one consultant, “no one knows the cost of drug benefit plans.” This respondent was arguing that few involved in benefit design, either in private firms, unions, or insurers, are sufficiently competent to undertake proper analyses of claims data so they do not really know how proposed plan changes could affect them. This lack of expertise has ramifications for the education of stakeholders on the outcomes of benefit design.
  • However, when speaking of for-profit insurers, participants from all groups argued that insurers have no financial incentives to cut costs for employers, as indicated by one employer saying: “from my experience on the committees, I don’t get the impression that the insurers are there to save costs for the employers. I haven’t seen it. It's always been the other direction.” This claim was also corroborated by a benefits consultant, who argued that “there has been a fair bit of inertia, you know, amongst the providers out there in actually doing something too radical, too leading edge” because “there's no direct financial incentive for insurance companies or pharmacy benefit managers to actually help employers save money”.
  • Expanding on this, another consultant argued that an insurer's commission structure, which is based on volumes of claims expressed in a dollar value, may in fact discourage insurance companies from proposing plan designs that reduce the volumes of claims, as doing so would adversely affect company profits. Furthermore, another benefits consultant indicated that insurers are experts who calculate risk and thereby have no aptitude for the creation of formularies. According to this respondent, the impact is that insurance companies excel at managing risk, yet fare poorly in designing cost-effective plans that rely on the design and implementation of formularies.
  • An interesting finding from the interview data was that respondents from all interviewed groups declared being in favor of introducing some sort of arrangement for a national drug plan. Some favored having a universal pharmacare program which would apply to all drugs, while others favored programs tailored for catastrophic drug coverage. Two of the insurers that responded to this question explicitly favored some form of universal catastrophic drug coverage while the other favored universal pharmacare.
  • Each of the union representatives and one employer interviewed for this study expressed their support for universal pharmacare. Three out of five consultants argued in favor of a national pharmacare plan while the other two favored some other form of national risk pooling or formulary management to address costs.
  • While a majority of interviewees favored some form of universal coverage, a few respondents from the insurer and employer sides expressed concerns that universal pharmacare is not feasible.
  • The employers indicated that their over-riding strategy is to maintain cost-neutrality in providing drug benefits – in the context of overall compensation – to employees: any increases in the costs of a particular benefits area must be off-set by cost-savings elsewhere. Controlling knowledge was also frequently reported by the union-side respondents (and by one consultant that services employers) as a strategy to achieve greater control over negotiations and plan design by firms. According to one union representative, “
  • Marc-Andre Gagnon has received research funding by the Canadian Federation of Nurses’ Unions for a different research project related to drug coverage in Canada. Alan Cassels is co-director of DECA (Drug Evaluation Consulting and Analysis). The authors would like to acknowledge the financial contribution of the Canadian Health Coalition in order to pay for the transcription of interviews.
Irene Jansen

Health Care Law to Allow States to Pick Benefits - NYTimes.com - 0 views

www.nytimes.com/...w-states-to-pick-benefits.html

insurance reforms us

shared by Irene Jansen on 23 Jan 12 - No Cached
  • In a major surprise on the politically charged new health care law, the Obama administration said Friday that it would not define a single uniform set of “essential health benefits” that must be provided by insurers
  • it will allow each state to specify the benefits within broad categories
  • Opponents say that the federal government is forcing a one-size-fits-all standard for health insurance and usurping state authority to regulate the industry.
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  • The new law lists 10 categories of “essential health benefits” that must be provided by insurance offered in the individual and small-group markets, starting in January 2014. These include preventive care, emergency services, maternity care, hospital and doctors’ services, and prescription drugs.
  • The announcement by the administration follows its decision this year to jettison a program created in the law to provide long-term care insurance
  • This criticism has inspired legal challenges to the new law — with the Supreme Court set to decide next year whether the government can require Americans to buy health insurance — and helps explain why public opinion of the law remains deeply divided.
  • Under this approach, each state would designate an existing health insurance plan as a benchmark. The benefits provided by that plan would be deemed essential, and all insurers would have to provide benefits of the same or greater value.
  • Each state would choose one of the following health insurance plans as a benchmark: ¶ One of the three largest small-group plans in the state. ¶ One of the three largest health plans for state employees. ¶ One of the three largest national health insurance options for federal employees. ¶ The largest health maintenance organization operating in the state’s commercial insurance market.
  • the administration’s approach “builds off the experience of today’s marketplace and will minimize disruption to it.”
  • Several states have received temporary waivers from tough new federal standards that require insurers to spend more of each premium dollar for the benefit of consumers. Federal officials have also provided temporary exemptions from some provisions of the law for some employers and labor unions offering bare-bones coverage.
  • The law also says that the definition of essential benefits must not “discriminate against individuals because of their age, disability or expected length of life.” Sara Rosenbaum, a professor of health law and policy at George Washington University, said the new bulletin “does not offer any guidance on this crucial part of the law.”
Govind Rao

The rise of health care's 'three amigos'; Demand for massage, physio and chiropractic t... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20150414|218434815

from heather benefits costs

shared by Govind Rao on 14 Apr 15 - No Cached
  • Toronto Star Tue Apr 14 2015
  • Parents are taking their babies to chiropractors to cure colic and ear infections. Teens and young women are having "spa days." Young adults are taking antidepressants for anxiety. According to a study of claims and costs commissioned by Green Shield Canada, a rise in what it calls the "three amigos" of massage, physio and chiropractic treatments is changing how the drug and health benefits pie is being dished out. Where it was once 70 per cent on drugs and 30 on benefits, it is now 60-40.
  • Coming at a time when more drugs are available to manage chronic illness - but at a higher price - the new balance raises questions about finding the money to pay for them. The fourth annual report by Green Shield, a non-profit and the fourth-largest Canadian insurer of these benefits, shows how age and stage influences demand. Use of paramedical services, the so-called laying on of hands, is starting at younger ages. Parents are taking their babies under the age of 1 to chiropractors based on the Internet-based wisdom that moving their baby's back and spine will lessen colic and ear infections.
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  • Massages have become a lifestyle rather than health choice. Some children under the age of 10 are getting them. Massage allowances are mostly used by girls and women. Women at all ages use benefits at a much higher rate than men, with one exception, which is 10 years old and under. In this age group, boys tend to need speech therapy more than girls. Mental-health claims for drugs and therapy that treat depression and anxiety are starting at ever- younger ages. David Willows, vice-president of strategic market solutions at Green Shield, said spas were once considered something for the wealthy. The rest of us might manage a massage once in a while as a special treat. Not so now.
  • Ross Cristiano, who heads the Toronto health and benefits team for HR consultant Towers Watson, agreed payments for soft benefits are rising, but these paramedical costs are about 10 per cent of all spending. He agreed that high-cost drugs, which account for 20 per cent of all spending, are getting pricier and there's going to be a reckoning. "If you look at high-cost drugs over the last four years, the cost of providing them has increased by about 60 per cent," he said. "Given that a lot more of these drugs are hitting the market, that's probably going to increase." Adam Mayers writes about investing and personal finance on Tuesdays and Thursdays. Reach him at amayers@thestar.ca.
Heather Farrow

New Canada Child Benefit could serve as model for health-care reform: report - The Glob... - 0 views

www.theglobeandmail.com/...article31019422

medicare accord privatization

shared by Heather Farrow on 25 Jul 16 - No Cached
  • Jul. 20, 2016 3
  • The launch of new family benefits that take from the well-off in order to give more to lower and middle-income Canadians is stirring debate over whether the same approach should apply to health care.Millions of Canadian parents will receive new monthly payments from Ottawa starting this month as the government officially launches the new Canada Child Benefit.
  • A report this week by Sean Speer and Ian Lee for the Macdonald-Laurier Institute argued that income testing for family benefits could serve as a model for health-care reform.The report notes that while Canadians are universally covered for doctor and hospital visits, Canadians without private coverage must pay out of pocket for a large number of other services like prescription drugs and vision care.
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  • Some critics view income testing as a threat to the universal nature of health-care funding in Canada. There is also debate over how income or means testing should be measured. For instance, nursing-home fees in New Brunswick are based on net annual income. The seniors advocacy group CARP campaigned strongly against a 2015 provincial budget change that added savings and investments into the calculations.
  • Natasha Mistry, CARP’s director of stakeholder relations, said internal polling of members found a solid majority oppose income testing of health-care benefits.
Govind Rao

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

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

from heather mental health privatization

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

Public-sector plan goes above and beyond for its pensioners - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|tost|20150305|215759083

from heather pensions Ontario cupe

shared by Govind Rao on 05 Mar 15 - No Cached
  • Toronto Star Thu Mar 5 2015
  • Ontario's nurses, social workers, lab technicians and other hospital staff have a lot of reasons to smile today. At a time when most pension plans are cutting benefits, their Healthcare of Ontario Pension Plan (HOOPP) has just increased inflation protection for its 295,000 members. Instead of covering 75 per cent of the annual increases in the cost of living, HOOPP is raising the bar to 100 per cent. While many plans struggle with underfunding, Ontario's third-largest pension fund has $1.15 on hand for every $1 it must spend. Stocks on the Toronto market returned 7.4 per cent on average in 2014, while HOOPP returned a record 17.71 per cent. The plan's average return in each of the last 10 years is 10.27 per cent.
  • CEO Jim Keohane seemed almost embarrassed Wednesday as he discussed his annual results. He noted sombrely, "We have the highest 10-year return of any global pension plan." Hey, let me in. Where can I get a pension plan like that? Well, in the private sector, nowhere. The surest way to rouse readers from slumber to red hot anger is to suggest that anything in the public sector can be better than the same thing done privately. The profit motive is the only way to breed efficiency, some say. Let the market decide. Government and quasi-government agencies are fat, wasteful and largely corrupt. You can add lazy, unproductive and incompetent.
  • ...5 more annotations...
  • But when it comes to pensions, that's not true. Ontario's big public-sector funds are the top of their class. While companies want 110 per cent of our effort, they've largely rewarded workers by abandoning the sort of pension plans that provide security and let people sleep easy in retirement. Some 76 per cent of private-sector employees don't have a pension of any kind. Of those who do have a pension, less than half have defined benefit plans. When you do the math, only about one in 10 people working in the private sector has a defined benefit plan. Such plans pay a monthly amount for life, putting the onus on companies to come up with the money. Corporate Canada doesn't like that idea and has been bailing out, moving to defined contribution (DC) plans where they can throw some money in the pot to match workers' contributions (if they're lucky) and then wash their hands. That leaves workers with all the risks and stress of investing and managing the money on retirement. These are skills most people don't have.
  • The public sector still believes that collective effort can give a better outcome. So, 86 per cent of workers for provincial and local governments - people such as firefighters and police, those at universities and colleges and workers in health care - are covered by pension plans, mostly the defined benefit kind. Pensions provide a broader social benefit beyond the cash in a pensioner's pocket. According to HOOPP, 7 per cent of all income in Ontario comes from defined benefit pensions, which pay out about $27 billion a year, money that supports the communities where people live. Keohane says 20 per cent of all income in Collingwood, for example, comes from pensions. He says it's a myth that taxpayers are footing the bill. In HOOPP's case, 80 cents of every dollar in the $61-billion fund come from investment returns.
  • There are several reasons why an individual can't hope to match the performance of a big fund with an RRSP. Big funds bring investing expertise and economies of scale to bear in a way that individuals cannot. It is precisely because they lack a "for-profit" motive that such funds can keep fees low and returns high. Think of how many fees you might pay along the way when investing - for advisers, buying and selling stocks and funds, trailer fees, management expense ratios, fees you can't see. Big funds are also "patient money," which means they can weather market ups and downs and not be forced to sell. The next "quarter" for HOOPP is 25 years, not three months.
  • OMERS, Ontario's largest pension plan, also reported strong results last week. OMERS manages the assets of 450,000 municipal employees and earned a 10-per-cent investment return in 2014. The fund stumbled during the financial collapse of 2008 and has been working its way out of a hole. In 2014, OMERS made more progress, increasing its funding level to 91 cents per dollar needed, up from 88 cents a year ago. There's still a long way to go to catch HOOPP, but it's going the right way. Our frayed faith and anger with our public institutions is well-deserved, and that general discontent spills over to public pension envy. But a better target would be private-sector employers who have been abandoning their workers because it's expedient, leaving them to make financial decisions in retirement they are often ill-equipped to make.
  • Adam Mayers writes about investing and personal finance. Reach him at amayers@thestar.ca. What is HOOPP? Healthcare of Ontario Pension Plan is the eighth-largest pension fund in Canada. It cover 295,000 people who work at hospitals, community care facilities, labs, clinics and addiction centres. Nurses are its largest membership group. Fifty of its pensioners are over 100 years old. HOOPP earned a 17.71-per-cent return in 2014, adding $9.1 billion to its assets, which now stand at $60.8 billion. Its average annual return over the past 10 years is 10.27 per cent. Source: HOOPP
Govind Rao

One-third of Ontario workers lack medical/dental benefits, study says | Toronto Star - 0 views

www.thestar.com/...ental-benefits-study-says.html

from heather benefits Ontario

shared by Govind Rao on 17 Feb 15 - No Cached
  • Wellesley Institute report finds the working poor and women are least likely to get workplace health benefits; it proposes universal drug coverage and expanded dental programs.
  • One-third of Ontario employees receive no medical and dental benefits through their workplace, with low-income workers and women most likely to be excluded, according to a report to be released Tuesday. The study by the Wellesley Institute, a Toronto-based health policy think-tank, shows that the vast majority of those in precarious or low-wage jobs do not have employer-provided health plans. The report notes that those workers are not often eligible for government-funded benefits either, leaving a significant gap in health coverage.
Govind Rao

Right-wingers singing same song - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|cbpo|20150327|217280838

from heather NS cupe

shared by Govind Rao on 27 Mar 15 - No Cached
  • Cape Breton Post Fri Mar 27 2015
  • Every spring, we seem to get the same old song from the usual right-wing groups, such as the Canadian Federation of Independent Business, the Canadian Taxpayers Federation, and the Fraser Institute. They always look to play the blame game, pitting the public sector and its unions and the private sector against one another just in time for the spring budgets. The spin seems to be that people making a decent living with benefits in the public sector is a bad thing, and that those workers' wages should be brought down and their benefits and pensions slashed.
  • They completely ignore the real reason that wages are higher in the public sector - namely, that historical wage and benefit inequities for women and other equality seeking groups have been addressed much more thoroughly in the public sector. That's the real news story here: Equality seeking groups - including 51 per cent of the population (women) - continue to be dramatically underpaid and undervalued in the private sector. The other important questions they never seem to address are: What actually happens to the people who don't have those benefits, who don't have a pension? What happens when they retire, when they get sick, when they need dental work, have vision problems or other major health issues that are not covered by public health care? What happens to the folks who don't have a drug plan and can't afford their medication? Shouldn't we be having a conversation about how to ensure all workers make a decent wage, have a job with benefits and a pension they can retire on with some dignity ... in both the private and public sector?
  • ...1 more annotation...
  • Let's be honest: The real purpose of these right-wing groups is to try to keep wages and benefits low for businesses small and large. Danny Cavanagh, president CUPE Nova Scotia
Govind Rao

Does your benefits plan discriminate against some of your members? | Canadian Union of ... - 0 views

cupe.ca/nate-against-some-your-members

from heather cupe benefits equity

shared by Govind Rao on 28 May 15 - No Cached
  • May 11, 2015
  • More than three-quarters of CUPE members have access to some level of workplace benefits like extended health, dental or vision coverage, but 22 per cent of our members still don’t have any plan at all. The percentage of CUPE members in equality-seeking groups (women, racialized workers, Aboriginal workers, LGBTTI workers, and workers with disabilities) without access is greater than the overall percentage.
  • If there are groups of workers that don’t have access (part-time or casual workers, for instance) bargain to include them.
  • ...1 more annotation...
  • Overall we see more small gains than losses in benefit plans across Canada. It’s an area where we can continue to improve, and where we can do our part to reduce inequality in our workplaces.
Irene Jansen

Cuts to refugee health insurance dangerous, inhumane, doctors say | News | National Post - 0 views

news.nationalpost.com/...dangerous-inhumane-doctors-say

immigration federal budget cuts

shared by Irene Jansen on 08 May 12 - No Cached
  • Looming cuts to refugee health benefits are inhumane, unethical and won’t save the government money, say some Ottawa doctors.
  • A program providing temporary health insurance to refugee applicants who aren’t eligible for provincial or territorial coverage will be pared back starting June 30
  • The Interim Federal Health Program will no longer include vision, dental or supplemental health benefits for current and future asylum seekers. Most pharmaceutical benefits will also dry up.
  • ...3 more annotations...
  • “If we are only allowed to offer care to someone when they are spitting up blood in the emergency room, they will most certainly have already infected others (with tuberculosis),”
  • The program cost $84.6 million in 2010-11 fiscal year, with approximately 96,000 people receiving at least one benefit, according to a spokesman from Citizenship and Immigration Canada. But Tyndall said the cuts will actually cost money, not save it.
  • the changes will create emergency room visits and hospitalizations that could have been avoided — all at a cost to the government.
Irene Jansen

Still No Relief in Sight for Long-Term Needs | HeraldTribune.com - 0 views

www.heraldtribune.com/...news03

insurance ltc us

shared by Irene Jansen on 23 Jan 12 - No Cached
  • the cost of nursing home care averages $72,000 a year
  • an attempt by President Ronald Reagan and a Democratic Congress to protect the elderly from catastrophic medical expenses and provide a modest prescription drug benefit and somewhat improved nursing home care
  • That law, the Medicare Catastrophic Coverage Act of 1988, was repealed within months of enactment after a furious response by elderly voters angry that they had to pay for the benefits themselves through a tax mostly paid by the wealthy.
  • ...6 more annotations...
  • The repeal legislation created a commission to examine the issue of long-term care, but it ended the appetite of many in Congress to resolve the issue. The Clinton health plan made another attempt at improving long-term care, but the bill failed.
  • The program’s end is a blow to middle-class hopes, though its modest benefit would have covered only about a quarter of nursing home care.
  • Senator Judd Gregg, Republican of New Hampshire, succeeded in adding an amendment requiring the administration to certify that the program would be self-sustaining for 75 years before enacting it. The administration concluded that it could not make that certification, killing the program.
  • Less than 3 percent of Americans now buy private long-term care insurance. The government’s version of long-term care insurance shared a basic flaw with commercial options: It was voluntary, with benefits to be paid entirely by premiums.
  • Senator Edward M. Kennedy made passing the Class Act one of his last priorities
  • “I was middle class, but I’ll be impoverished eventually,” he said.
Irene Jansen

Allison Williams et al. 2010. Evaluation of Canada's Compassionate Care Benefit from a ... - 0 views

www.coag.uvic.ca/...luation_compassionate_care.htm

caregivers ei

shared by Irene Jansen on 23 Jan 12 - No Cached
  • An Evaluation of Canada’s Compassionate Care Benefit from a Family Caregiver’s Perspective
  • Canada’s Compassionate Care Benefit (CCB) was initiated by the federal government in January 2004 and provides eligible workers 6 weeks of employment insurance (EI) benefits for those who take time off work to care for a gravely ill or dying family member at home.  At the same time, employers are compelled, via an amended Canadian Labour Code, to grant such leaves and protect the jobs of employees who take them. 
  • The primary objective of this study is to evaluate the CCB from a FCGs perspective.
  • ...1 more annotation...
  • The final report is now available. The report is available in both English and French.
  • Irene Jansen on 23 Jan 12
     
    From across all three stakeholder groups, five common suggestions for improving the CCB have been identified: 1. Implement a CCB awareness campaign that targets all stakeholder groups and the Canadian public simultaneously through a range of formats; 2. Improve the application process to be quicker, simpler, and more sensitive to the stressful and emotional realities of CCB applicants; 3. Eliminate the required two-week unpaid waiting period; 4. Lengthen the period of support to allow for: flexibility because of the challenges in prognosticating death, a more reflective and not rushed palliative process, and caregivers to extend the paid leave after death to include time for bereavement; and 5. Increase the financial assistance to more adequately reflect the 'real' costs endured by family caregivers when taking time off work to provide end-of-life care.
Govind Rao

New deal | Benefits Canada - 0 views

www.benefitscanada.com/...new-deal-2-48656

from heather benefits drugs pharmacare patents

shared by Govind Rao on 07 Feb 14 - No Cached
  • Stephen Frank | January 22, 2014 To save workplace drug plans, Canada needs to change its drug pricing strategy
  • According to the Organisation for Economic Co-operation and Development (OECD), Canada has the second highest per capita spending on prescription drugs in the OECD.
  • threatening the sustainability of private plans.
  • ...4 more annotations...
  • preferred provider networks, mandatory generic substitution, agreements between pharmacies and insurers (which stipulate that a pharmacy will lower its costs for the clients of a certain insurer if that insurer directs its clients to the pharmacy in question), and step therapy (which requires plan members to try certain drugs first before switching to more costly medications). Add to that the new high-cost drug pooling agreement for fully insured plans—which shelters firms from the full expense of any high-cost and recurring drug claims—and it’s clear that the pace of change in the insurance market has been unprecedented.
  • The overall mission of the PMPRB needs to change so that it strives for the lowest possible prescription drug prices for all Canadians.
  • one that recognizes and rewards truly breakthrough drugs
  • Stephen Frank is vice-president, policy development and health, with the Canadian Life and Health Insurance Association. sfrank@clhia.ca
Govind Rao

The Enabling Society - 0 views

irpp.org/...policy-horizons-essay-2015

from heather privatization medical savings accounts

shared by Govind Rao on 23 Apr 15 - No Cached
  • Peter Hicks April 9, 2015
  • According to Hicks, the welfare state’s approach of addressing the broadly defined needs of broadly defined groups of beneficiaries in a broadly uniform manner at a single point in time is simply no longer adequate.
  • The evidence base generated by the system of big statistics
  • ...8 more annotations...
  • individualization of programs and services, the adoption of a life-course perspective, and the ongoing use of evidence-based information in designing and adapting policy.
  • Moreover, with citizens having direct access to the same information, they will be better equipped and able to make their own choices or decisions on courses of action.
  • A major restructuring of Canada’s income security system will likely be required in order to follow through on these principles. Here, Hicks recommends reconfiguring the system around three pillars: guaranteed annual income, social insurance and lifetime accounts.
  • The first pillar would ensure that every Canadian has access to a relatively modest minimum income so that no one falls through the cracks. As Hicks notes, governments are not far away from achieving this objective thanks to programs such as the National Child Benefit Supplement/Canada Child Tax Benefit, the Working Income Tax Benefit and the Guaranteed Income Supplement/Old Age Security.
  • reduce the disincentive to work in older age.
  • In recent years these two objectives have become intermingled as programs such as employment insurance (EI) have taken on new roles and responsibilities (parental, sickness and care leave, for example). This has created unintended disparities within the labour market between those who qualify for assistance and those who do not, making it difficult for many people to manage key transitions in life.
  • integrated lifetime accounts
  • These lifetime accounts would operate in a similar way to retirement and other tax-preferred savings accounts (RRSPs, TFSAs, RESPs), which allow accumulation of capital through direct contributions over time and follow individuals through life. The pillar would incorporate lifetime accounts that already exist (such as public pension and education saving programs), while extending the model to a number of other areas including the many special benefits programs currently administered within EI, as well as various tax credit and loan programs for individuals. There are a range of options for how such accounts could be used, financed and managed.
Govind Rao

Low Earnings, Unfilled Prescriptions | Wellesley Institute - 0 views

www.wellesleyinstitute.com/...arnings-unfilled-prescriptions

from heather drugs research

shared by Govind Rao on 24 Jul 15 - No Cached
  • July 20, 2015
  • by Steve Barnes
  • The assumption that working age Canadians receive health benefits through their employers is based on outdated beliefs about the labour market. Our study Low Wages, No Benefits showed that one-third of working Ontarians do not have employer-provided health benefits.
Govind Rao

Provinces dismantle the first stage of pharmacare - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|tost|20150304|215681715

from heather pharmacare drugs

shared by Govind Rao on 04 Mar 15 - No Cached
  • Toronto Star Wed Mar 4 2015
  • British Columbia struck the first blow. Saskatchewan, Manitoba, Newfoundland and New Brunswick followed suit. Ontario is poised to join them.
  • Fifteen years ago, Canada had a working model of a national pharmacare plan. Seniors in every province, regardless of income, were entitled to public coverage for all prescription drugs. Their only out-of-pocket expense was a small co-payment.
  • ...12 more annotations...
  • Today, the program is partially dismantled. Half of the provinces have scaled back their seniors' drug benefits. The rest of the system looks shaky. There has been no nationwide analysis and very little public commentary, just snippets from individual provinces. Now a Montreal think-tank has pulled it all together. The Institute for Research on Public Policy has just released an informative study, "Are Income-Based Public Drug Programs Fit for an Aging Population?"
  • The institute commissioned three health-care specialists - two from the University of British Columbia and one from Harvard - to track the retrenchment, analyze its impact and offer advice to the provinces that haven't ratcheted back seniors' drug benefits. The authors acknowledge that financial pressures the provinces face are real. Canada's population is aging, drug expenditures are escalating and the economy is no longer robust enough to accommodate rising costs.
  • What they question is the wisdom of restricting access to medicine for the highest-needs segment of the population
  • Former B.C. premier Gordon Campbell was the first Canadian politician to curtail drug coverage for seniors. Shortly after taking power in 2001 he imposed a three-year budget freeze on his province's health ministry. The following year, he raised the co-payment on seniors' prescriptions to $25. In 2003, he implemented an income-tested plan - "Fair PharmaCare" - requiring better-off seniors to contribute up to 3 per cent of their annual income to the cost of their medications.
  • It penalizes Canadians over 65 with chronic conditions or serious disabilities. "In effect the deductibles under income-based programs are tantamount to imposing a specific income tax on people with the highest medical needs," the authors say. This violates the spirit of medicare. And it is financially inefficient. By unloading the cost of medications on seniors and private insurers, governments reduce their leverage in the pharmaceutical marketplace. The fewer citizens they buy for, the less bargaining power they have.
  • The appeal of eliminating universal drug coverage is obvious. It reduces the burden on the public purse. It makes medicare more sustainable. It targets benefits to those who really need them. What's not to like? Three things, the authors say:
  • It is detrimental to the health of seniors. The more financial barriers governments put in front of elderly residents, the less likely they are to fill their prescriptions. Seniors in B.C. forgo drug treatment at twice the rate of their Ontario counterparts. Although they pay the highest price, taxpayers lose, too. Providing older people with medically necessary drugs is much cheaper than paying their hospital bills when their conditions become unmanageable.
  • Over the next decade, four of his counterparts followed his lead, imposing restrictions on seniors' drug benefits. In 2012, former Ontario premier Dalton McGuinty went part-way. He reduced public drug coverage for seniors with incomes over $100,000. They are now required to pay the first $100 of their annual drug bill and a $6.11 co-payment (triple the standard seniors' fee of $2) for each prescription. In 2013, Alberta indicated it was considering the B.C. model. That is where things now stand.
  • There is a fourth drawback the authors don't mention. The premiers are pushing a full-fledged pharmacare plan out of reach, in defiance of the will of their citizens. Public opinion polls consistently show that 75 to 90 per cent of Canadians want medically necessary drugs brought into medicare. That was part of the vision forged by Saskatchewan premier Tommy Douglas and chief justice Emmett Hall, chair of the Royal Commission on Health Services half a century ago. They recommended that the cost of hospitalization be lifted from families' shoulders first; physicians' fees would be covered next; and finally prescription drugs would be publicly insured.
  • Today Canada is the only country in the developed world with a universal public health-care system that excludes coverage of prescription drugs. Policy-makers were inching in the right direction until the turn of the millennium. As of 2000, seniors, social assistance recipients and aboriginal people had full drug coverage.
  • Now the premiers are moving backward, creating an inequitable patchwork of drug coverage for seniors and lowering the likelihood of pharmacare for everyone else. The short-term savings may look appealing. The long-term costs will add up in ways Canadians haven't begun to contemplate.
  • Carol Goar'
Govind Rao

Extended Health and Dental Plan Improvements - 0 views

www.cupesaskhcc.ca/...h-and-dental-plan-improvements

from heather Saskatchewan bargaining benefits

shared by Govind Rao on 09 Feb 15 - No Cached
  • 07 February 2015
  • Vision care – the maximum reimbursement for the purchase of prescription eyewear has been increased to $300 every two years (pro-rated for other than full-time employees) Eligibility for benefits has been improved as follows: If you work: 40-49% FTE 50% coverage 50-59% FTE 60% coverage 60-69% FTE 70% coverage 70-79% FTE 80% coverage 80% to Full time 100% coverage If you qualify for this “Better Than” benefit, your coverage will automatically be increased. Ex: If you work 85% of full time hours, you are now eligible for full-time benefit coverage.
Govind Rao

Time to Demand Medicare for All and Social Security Benefits We Can Live On! ... - 0 views

www.counterpunch.org/...curity-benefits-we-can-live-on

from heather US medicare US-Canada privatization

shared by Govind Rao on 23 Mar 15 - No Cached
  • March 23, 2015
  • by DAVE LINDORFF
  • it’s time for an aggressive mass movement built around defending and expanding both those critical public funding programs.
  • ...10 more annotations...
  • Fighting to improve Social Security and to expand Medicare to all is to benefit people of all ages. After all, what child or grandchild complains about the size of a grandparent’s Social Security check, and what grandparent wants to short change a child or grandchild? And expanding Medicare helps everyone.
  • the Boomer generation, once all at retirement age, will be a colossal force in defense of Social Security and Medicare, and that they will also be demanding an expansion of those programs, making them both more generous and also broader in reach.
  • That means we Americans, old and young, need to organize and fight like hell now to defend both programs, and to demand that they be expanded.
  • Germany, France, Belgium, Netherlands, Denmark and the Scandinavian countries — national pension systems provide people with benefits that replace 60 percent or more of final working income, allowing them to retire without taking a hit in their living standard (lower-income workers actually get even more in retirement and may actually see their living standards rise when they retire).
  • Compare this to the US, where the replacement rate is only about 37% of working income in retirement.
  • European countries all have excellent national health programs that make health care essentially free.
  • The US stands almost alone in the developed world in not having a national health program of one kind or another. Not incidentally, it also has the most expensive health care in the world, gobbling up almost 18 percent of GDP. No country approaches that level of resources spent on health care for its citizens.
  • Clearly, Obamacare (the so-called Affordable Care Act), is not the answer, as it costs a fortune and still leaves some 30 million without access to affordable health care.
  • Dr. Robert Zarr, the head of Physicians for a National Health Program (PNHP) points out in an interview on PRN.fm’s “This Can’t Be Happening” program [1], the US could easily move to a national health program like what all these above countries have by simply lowering the age for being eligible for Medicare — currently at 65.
  • Why don’t we do this, creating what is essentially a Canadian-model health plan (it’s actually called Medicare in Canada, and has been working since the early 1970s, and has been backed by conservative national and provincial governments consistently through most of the intervening years because Canadian’s love it)?
Govind Rao

Banker's budget benefits Bay Street - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=ar|7598780|wccn|20160225|241144723

from heather cupe Ontario privatization p3 cuts budget

shared by Govind Rao on 08 Mar 16 - No Cached
  • Thu Feb 25 2016
  • TORONTO, ONTARIO--(Marketwired - Feb. 25, 2016) - The provincial budget tabled today at Queen's Park looks like it was written by former TD Bank Executive Ed Clark for the benefit of Bay Street, not for the people of Ontario, says the president of Ontario's largest union. "On every major file, given the choice between benefiting Ontarians and benefiting Bay Street, the Liberals have chosen Bay Street," said CUPE Ontario President Fred Hahn. "It's not what Kathleen Wynne campaigned on; it's not what the people of Ontario need." This year's budget will hurt communities across the province as programs and services are cut in order to balance the budget by an arbitrary date.
  • "Maybe the Liberals missed the memo. Both their federal cousins and the people of Ontario clearly are less concerned about deficit than they are about investing in the economy to create the good jobs and public services we all need," said Hahn. Successive austerity budgets have left Ontario with the lowest per-capita program spending in Canada and serious cuts to front-line public services such as health care, schools, universities and social services. North Bay has seen more than 300 jobs cut from its hospital, Hamilton lost more than 70 child protection workers and the Toronto Catholic District School Board is looking at eliminating 100 educational assistants - cuts similar to those being seen in every community across the province. To make matters worse, he said, the budget continues the Liberal plan to privatize services and sell assets we all own in common. This includes the sale of 60 percent of Hydro One, which government watchdogs and economists warn will ultimately cost Ontario hundreds of millions of dollars annually. Continuing the privatization agenda flies in the face of AG's finding that P3 schemes have needlessly funnelled more than $8 billion into the pockets of private corporations.
  • ...2 more annotations...
  • This government needs to stop letting bankers like Ed Clark drive the bus. They don't have the best interest of Ontarians at heart," said Hahn. Instead, he said, the government should restore corporate tax cuts, which former Premier Dalton McGuinty bragged amount to $8 billion a year. They should invest in public services that create good jobs and stimulate the economy in every community across the province. "The Liberals have a choice to make," said Hahn. "Stop the cuts that are dragging our economy down, or face the thousands of people they've left unemployed during the next election." CUPE is Ontario's community union, with more than 250,000 members providing quality public services we all rely on, in every part of the province, every day. CUPE Ontario members are proud to work in social services, health care, municipalities, school boards, universities and airlines.
  • Craig Saunders (416) 576-7316
Doug Allan

Newsroom : More Physiotherapy, Exercise and Falls Prevention for Seniors - 0 views

news.ontario.ca/...ls-prevention-for-seniors.html

physiotherapy homecare

shared by Doug Allan on 19 Apr 13 - No Cached
  • Starting on August 1, 2013, community-based physiotherapy, exercise classes and falls prevention services will be offered in more locations across Ontario. In total, 218,000 more people, mostly seniors, will benefit from the additional services.
  • Each Local Health Integration Network (LHIN) will receive funding to provide falls prevention and exercise classes for 68,000 more seniors across the province, benefitting 130,000 seniors in total.
  • Long-term care homes will receive $68.5 million in funding for physiotherapy and exercise directly.  All residents who have an assessed need for physiotherapy in their care plan will receive appropriate one-on-one physiotherapy to help them restore their mobility.
  • ...3 more annotations...
  • Community Care Access Centres will receive $33 million in additional funding to reduce the waitlist for in-home physiotherapy services, which will help to keep more seniors and eligible patients healthy and at home longer. Up to 60,000 more people, mostly seniors, will receive physiotherapy in the comfort of their own homes, benefitting 150,000 people in total.
  • Over the coming months, the Ministry of Health and Long-term Care and the LHINs will engage physiotherapy providers and community partners interested in delivering these services in communities across Ontario.
  • Until now, a small number of for-profit companies have had almost exclusive control over the delivery of publicly-funded physiotherapy.
  • Doug Allan on 19 Apr 13
     
    Physiotherapy restructuring  -- more home care?
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