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International Centre for Health Innovation at the Richard Ivey School of Business

“Strengthening Health Systems Through Innovation: Lessons Learned”

“We must transform the current, traditional, highly ‘prescriptive’ approach to health care into one that places consumers at the centre of service delivery models,” said Dr. Anne Snowdon, Chair of the Centre, and lead author of the study. “This means redesigning health service environments to create consumer choice, and engaging consumers directly in the choice of providers to select health services that meet their personal health and wellness goals.” 

TORONTO, CANADA--(Marketwired - Feb. 25, 2014) - A new study published by the Canadian Health Policy Institute (CHPI) provides hard evidence from Canadian experience that private competition and choice in drug insurance plans has been good for patients and that a government-run Pharmacare monopoly will reduce access to new medicines.

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.

The Telegram (St. John's) Tue Jun 23 2015

With oil prices down, an aging population and high unemployment, the conservative government of Newfoundland and Labrador is looking for a silver bullet to cut costs for public services and infrastructure. Their sights are settling on privatization to be that silver bullet. What is privatization? In its most narrow sense, privatization is the whole or partial sale of public services and/or infrastructure. It can include the sale of assets, functions or the entire institution.

With privatization, the service or infrastructure becomes funded and/or run by a private corporation. Privatization usually includes not only a change in ownership but also a change in the priorities, responsibilities and role of the state. Advocates of privatization offer free-market competition as the path to economic and social success, with promises of cost savings, lower risk, greater efficiency and more individual choice. Privatization takes several forms in Canada, including:

Jun 10, 2015

HALIFAX – CUPE Nova Scotia is concerned about the memo “Exploring Home Care Options” from the Continuing Care Branch of the Health and Wellness Department that sends conflicting messages about the province’s plans to privatize home care. CUPE Home Support Coordinator Marianne Welsh says, “While the government appears to be back-tracking on its plans for so-called ‘competitive bidding,’ the idea still hasn’t been rejected outright.” “In fact,” says Welsh, “the memo which was sent to all home care agencies in the province makes it clear that the Department is reserving the option to privatize services. The memo states, ‘Depending on the outcome of this initiative, home care services may still need to be tendered for some, or all, regions in the province’,” says Welsh. CUPE represents 462 home support workers in the province and has called upon the government to reject the competitive bidding model for home care.

Friday, June 26, 2015

How Insurers Competed in the Affordable Care Act's First Year By Katherine Swartz, Mark Hall, Timothy S. JostThe Commonwealth Fund, June 24, 2015

by Will Falk (Show all posts by Will Falk) May 27, 2015

This is the “sharing economy”.

An under-appreciated feature of the return of sharing, however, is the impact on government— not only as regulator, but also as a deliverer of public services. Though a strict definition of the sharing economy does not translate perfectly into publicly provided programming, its key principles— creating trust through feedback, community collaboration, scheduling efficiency, asset optimization, and payment settlement— are well-suited to entrepreneurialism in public sector delivery models, including in healthcare.

National Post Sat Jul 4 2015

Aetna Inc.'s US$37-billion deal to buy smaller health insurer Humana Inc. will face rigorous scrutiny from U.S. regulators, which antitrust experts said could also make other large-scale mergers in the sector more difficult. The Aetna-Humana tie-up would be the largest such deal among health insurers. Friday's announcement starts the clock on an examination by regulators of whether consumers will be hurt by diminished competition. The deal follows weeks of intense discussions about potential combinations among the five biggest U.S. health insurers: Aetna, Humana, Cigna Corp., Anthem Inc. and UnitedHealth Group.

Insurers want more leverage in a health-care system that has seen major consolidation among hospitals and doctor practices, as well as mergers between medical device makers and other suppliers. The cost of new drugs has soared, and President Barack Obama's health-care law has made it harder for insurers to pass on higher costs to customers. Last month, Anthem offered to buy Cigna for US$47 billion. Cigna, which had also considered purchasing Humana, has so far rejected the buyout approach. Some industry watchers expect a potential buyout of Cigna to be revived.

07/10/2015

If there ever were evidence that competition does not work to drive down prices in the healthcare marketplace, look at the hospitals. A new report in Health Affairs by Gerard Anderson and Ge Bai reveals the failure of market forces to drive hospital prices down. There are 4,050 hospitals in America, and some prices are inexplicably high. What makes matters worse, try comparing hospitals based on their prices; they're often not transparent.

Until Congress regulates hospital prices, it's likely they'll keep rising. As with the drug companies, which often can charge what they will for their patented drugs--(check out this post on the cost of cancer drugs) -- hospitals generally have the power to set prices however they see fit. In most states, no one is regulating their charges. Only Maryland and West Virginia have laws regulating hospital prices.Unreasonably high hospital prices drive up health care costs for everyone, if not directly, then indirectly. The 30 million Americans without insurance get stuck with the biggest bills and likely are least able to afford the charges. But, anyone with insurance who's getting out-of-network care can get hit with huge bills. All of these people often end up dunned by collection agencies and saddled with tremendous debt and bad credit ratings. Workers compensation and auto insurance rates are higher as well in states with unregulated prices.

January 26th, 2015

by Julie Brill

In this post, I want to focus on the key role economic analysis plays in the Federal Trade Commission (FTC)’s health care enforcement program. I use this lens to look first at how the FTC has become more successful in challenging hospital mergers, and then to rebut the notion that the Affordable Care Act is somehow a “free pass” for health care industry consolidation. After the federal antitrust agencies successfully challenged a number of hospital mergers in the 1980s and early 1990s,[1] we suffered a string of court losses in the mid- and late-1990s, even in cases involving highly concentrated hospital markets.[2] In 2002, the FTC decided to take a step back and examine the reasons for our losses, and whether our analysis of hospital markets was correct.

Times Colonist (Victoria) Sat Feb 28 2015

A growing number of health professionals, patients, community groups and even politicians are calling for national pharmacare. But many Canadians likely wonder what pharmacare is and whether Canada is ready for it. Let's start at the beginning. Affordable access to safe and properly prescribed prescription medicines is so critical to patient health that the World Health Organization has declared governments are obligated to ensure such access for all of their citizens.

Unfortunately, Canada is the only developed country with a universal health-care system that does not include universal coverage of prescription drugs. The negative consequences for our health and economic well-being are significant. Without universal coverage of prescription drugs, one in 10 Canadians cannot afford to fill the prescriptions their doctors prescribe. When patients don't fill prescriptions they need, it hurts them and our economy because they end up needing more health care in the long run.

National Post Mon Mar 16 2015

Last week, behind closed doors in a hotel in Hawaii, negotiators from a dozen countries met to continue negotiations on a trade agreement that will affect an estimated 800 million people and 40% of the global economy: the Trans-Pacific Partnership (TPP). The negotiations, which began in 2010 between Canada, the United States and 10 other Pacific Rim countries, are being conducted without opportunity for public scrutiny. Currently, U.S. President Barack Obama is asking Congress to grant him the authority to fasttrack the TPP without amendments from lawmakers. Of the many issues at stake, the implications are especially critical for ensuring affordable health care and access to medicines for the millions of people in developing countries where Doctors Without Borders works and also for Canadians.

We know from leaks of the TPP draft text that some governments are attempting to dismantle public-health safeguards enshrined in international law by extending the length of time that brand-name medicines are protected by patents to create new types of monopolistic protection. As a result, pharmaceutical companies will be able to charge unduly high prices for several more years, thereby restricting access to affordable life-saving generic medicines. This will disproportionately affect those who can least afford to pay. Currently, in the poorest countries and even at the lowest global price available, the cost of immunizing a child using World Health Organization recommended vaccines has risen a colossal 6,700% since 2001. The stricter intellectual property rules under negotiation in the TPP will only further limit competition, keep prices artificially high and keep vaccines out of reach.

Essays October 2014

Problems at clinics should prompt rethink on competitions for hospital services Rick Janson

The media is applauding Health Minister Dr. Eric Hoskins this week for promising greater transparency around private clinic inspections that had previously been kept secret by Toronto Public Health and The College of Physicians and Surgeons of Ontario (TCPSO).

National Post Tue Apr 14 2015

I magine having to choose between putting food on the table or buying necessary medication. Research suggests this is the case for one in 10 Canadians who can't afford to fill their prescriptions. Canada is the only country with universal health care that does not also have universal drug coverage. Even for those who do have private or public drug coverage, there are discrepancies in what and who is covered from province to province. Canadians also pay more for drugs than citizens in almost any other Western nation. These are just a few of the arguments that have reignited calls for a national pharmacare program. It is not a new concept, but one that is gaining traction as leaders are turning over every stone to "bend the cost curve" in health care downward. In a recently published study in the Canadian Medical Association Journal (CMAJ), health economists and researchers concluded a universal drug program could actually save Canadians billions of dollars. Great savings are achieved by pooling provincial and territorial needs and resources to increase buying power, eliminate duplication and establish a platform for collaboration and cost-sharing. If health-care leaders are looking for proof that provinces and territories can do more together than they can on their own when it comes to the provision of life-saving and enhancing drug therapies, they need look no further than the blood system they created close to 20 years ago.

Many are aware that since its creation in 1998, Canadian Blood Services has been in the business of collecting, processing and distributing blood components in all provinces and territories outside Quebec. But few realize we have also been running a national formulary of biological drugs, providing universal and equitable access to plasma-derived medicine at no cost to patients for nearly two decades. Our organization has sole responsibility for managing a national portfolio of plasma-derived products and their synthetic alternatives worth about $500 million a year. These life-saving pharmaceuticals are used to treat people with hemophilia and other bleeding disorders, patients with inherited and acquired immune disorders, burn and trauma victims, and many others. A national, scalable, cost-shared infrastructure and logistics network ensures the right product gets to the right patient, at the right time.

The Chronicle-Herald Sat Apr 18 2015

Health and Wellness Minister Leo Glavine recently announced plans to seriously consider opening home care and support services to competitive bidding. This would allow private, for-profit corporations to bid on contracts currently provided by government and not-for-profit agencies. This competitive bidding process will award home-care contracts based on the lowest bid, not on who will provide the best quality of care. To date, Mr. Glavine has refused to hold consultations or allow for public input. Seniors' care is too important to leave to partisan political interest. In response, the Nova Scotia Citizens' Health Care Network is hosting a series of town hall meetings across the province. The next three will be in Sydney on April 21, in Amherst on April 30, and in Halifax on May 4. Details can be found online at www.nshealthcoalition.ca. We are deeply concerned by this move. The wait list for home care in Nova Scotia has been rapidly expanding. Over a six-month period in 2014, the wait list increased by 80 per cent, from 422 to 760 patients needing care. With the oldest population in the country, and some of the highest rates of chronic illness, this trend is sure to continue.

The StarPhoenix (Saskatoon) Mon Nov 23 2015

There is nothing novel about providing some medical services in a private practice setting in Saskatchewan. Imaging services, such as X-rays and ultrasound, are already provided that way. What is novel is to legislate that these services will be privately paid for.

The Canada Health Act requires that medicare finance all "medically necessary" physician services. The intent of the act is that services be distributed on the basis of medical necessity rather than ability to pay. There is no doubt that the new Saskatchewan legislation will restrict access to services if private MRIs are not covered by medicare. Of course, enforcement of the federal Health Act is subject to ministerial discretion. The Saskatchewan government, when it drafted its legislation, was probably confident that the former federal minister would be discreet. It is highly doubtful that the new federal Liberal government will take the same view

The Globe and Mail Mon Dec 7 2015

The intellectual-property provisions in the Trans-Pacific Partnership agreement will drive up global drug prices and make it harder to treat diseases in developing countries, Medecins sans Frontieres (Doctors Without Borders) says. A month after the final text of the TPP was released, the medical humanitarian organization has completed its analysis of the portions of the massive trade pact that will affect drug costs.

Despite changes from earlier leaked versions of the text, there are still serious problems, Judit Rius, MSF's U.S. legal policy adviser, said. "This is catastrophic. This is very negative. The impact is going to be at multiple levels," Ms. Rius said in an interview. "First of all, it is going to delay access to generic competition [for brand-name drugs], which is a proven intervention to reduce the price of medicines."

The Globe and Mail Tue Dec 1 2015

The Victorian Order of Nurses was, for more than a century, the primary provider of home and community-based care in Canada. Now it is teetering on the verge of bankruptcy. Late last week, theVON shut down operations in six provinces - Alberta, Saskatchewan, Manitoba, New Brunswick, Prince Edward Island, and Newfoundland and Labrador - and filed for protection under the Companies' Creditors Arrangement Act.

It will continue to operate in Ontario and Nova Scotia - at least for now. The collapse of the iconic organization, founded in 1897 by Lady Aberdeen, was swift and brutal. It also serves as a cautionary tale about Canadians' tortured relationship with medicare, in particular the conflicting desires to cling to our history of charitable provision of care and achieving efficiencies with unforgiving business models.

CMAJ March 15, 2016 vol. 188 no. 5 First published February 8, 2016, doi: 10.1503/cmaj.109-5232

Laura Eggertson

Aboriginal health projects received less than 1% of the funding awarded by the Canadian Institutes of Health Research (CIHR) in its first major competition since restructuring — an outcome Aboriginal researchers say illustrates the need to reconcile the new system with the vast inequities in Indigenous health.