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"The priority of the Medical Services Commission and the Ministry of Health is to uphold the Medicare Protection Act and the benefits it safeguards for patients in this province," B.C. Health Minister Terry Lake said in a statement on Tuesday. "We expect and require these clinics to come into full compliance with the law, and we remain fully committed to seeing out this case to its resolution." The ministry said it could not comment further because the case is before the courts. But the federal government is also watching the proceedings closely and has sought intervenor status in the case. In a statement from Ottawa, Health Canada said many provisions of the B.C. legislation mirror those of the Canada Health Act, "making this case of significant importance not only to British Columbians, but to all Canadians."

Given that Canadians "overwhelmingly" support universally accessible health care, "any challenge to a principle so fundamental to our health-care system is of significant concern to the Government of Canada." During a federal Liberal caucus retreat in Saguenay, Que., last week, Health Minister Jane Philpott said the case and the prospect of health-care privatization are a cause of "concern" for her. "I think I have made it very clear on repeated occasions that our government is committed to firmly upholding the Canada Health Act. The Cambie case deals specifically with that, with the provision of services," she told reporters. "It's fundamentally important to the health-care system in the entire country, not just in British Columbia, that we make sure that medically necessary services are universally insured and there are no barriers to access of those services." Ms. Philpott acknowledged that some health-care services in Canada are delivered privately, citing physiotherapy, which is largely carried out in private clinics because it is not included under the Canada Health Act.

But she said anything similar to a user fee is a barrier to people being able to receive medically necessary care. Ultimately, Dr. Day said, the law, facts and evidence are on the side of his argument that Canadians would best be served by a "hybrid" health-care system. "I kind of hope the judge doesn't hear that, and our lawyers would be nervous to hear that, but that's what I believe," he said. Within that system, public hospitals would offer private services and private hospitals would offer public services. He said he also wants to see competition between and within the systems. "Competition breeds excellence," Dr. Day said. © 2016 The Globe and Mail Inc. All Rights Reserved.

In response to the 2011 C. difficile outbreak in the Niagara Health System, Mehra said they are "trying to find out the details of the cleaning contracts and whether the private companies were allowed to dramatically reduce the number of cleaners. "These are things that intrinsically affect patient care."

And, he said, closing a nursing home would come with enormous severance costs.

They also suggested consolidating Upper Canada Lodge in Niagara-on-the-Lake, Gilmore Lodge in Fort Erie and Linhaven Home for the Aged in St. Catharines, three homes up for redevelopment in the next decade.

Seniors services director Henri Koning said the region's system has 957 beds. But even with 30% turnover in a year, she said, waiting lists are lengthy. She said closing a home would involve five years' notice to the province and a long consultation process.

Niagara Falls Coun. Barbara Greenwood, who co-chairs council's public health and social services committee, said centralizing down to one nursing home would leave residents' care lacking. She said Niagara is so vast, only local nursing homes can meet residents' needs.

The region is mandated by the province to run at least one long-term care home. At the moment, the region runs eight

Personal support workers in the home care sector can be paid as little as $12.50/hour compared to hourly rates of $18 to $23 for their hospital-based colleagues.

Similar disparities have also been observed for other care workers, including registered nurses.

In addition, home care workers often do not get steady hours

According to Stella Yeadon, a representative for the Canadian Union of Public Employees, this is largely because union organizing is very challenging in the home care sector. Unlike the hospital environment where workers are in a single building, home care workers rarely meet one another.

support for family caregivers was notably absent from both Ontario’s Action Plan for Healthcare and the year-one update released last month. Support for caregivers is part of Ontario’s new Seniors Strategy, but it remains to be seen how much of this strategy will translate into action.

According to a report from the Ontario Health Coalition, another contributor to lower wages is the Ontario government’s procurement policy for Community Care Access Centres (CCAC), which requires CCACs to contract out home care services. While competitive bidding for contracts has been somewhat successful in keeping costs down for CCACs, it has done so largely by “driving down wages,”

Low wages and limited benefits across an entire sector raise concerns about the possibility of recruiting skilled care workers. “

low wages could pose real barriers to recruiting and retaining staff.

Health care workers face substantial health risks as part of their work, due to their exposure to infectious diseases, violence from patients/residents with dementia, allergic reactions from chemical agents, and injuries resulting from lifting patients.

There is currently limited data on the occupational health risks of delivering care in the home. However, some care may be riskier in the home, where workers are more likely to be without either backup from other staff or mechanical assistance (such as patient lifts), as compared to workers in a hospital or a long-term care facility.

turnover as workers leave home care for higher paying jobs at hospitals is bad for patients

patients who need home care do not have families to care for them

there’s no one to care for them but me and they need more help.”

lower wages and riskier environments raise the possibility that the quality of care may be negatively affected as services are moved from hospital to community settings.

choices than British Columbians or Quebecers do," answered Kenney. Health Minister Sarah Hoffman has an answer: if Kenney wants a policy brawl over the injection of more private options, he's welcome to it. "I'm not surprised that he's trying to find ways to expand privatization in the health-care system," she said in an interview. "Certainly, that's unfortunate." As you'd expect from a federal Conservative, Kenney blames centralized decision-making. "I just believe that local management of resources is a lot more sensible than hyper-centralized control," he told the Herald. "You know, when hospitals are given a limited budget for a limited number of hours they can service people, that gets out of alignment with the actual local demand."

But Hoffman figures Albertans don't want another major shift in how health care is run, after watching a pack of failed experiments in the PCs' waning years. She has doctors and officials working on two related problems - how to get more use out of the city's publicly owned MRI machines, and how to make sure everyone on the list really needs the test. I asked if she eventually plans to fold the province's vast array of private clinics, including imaging centres, under the government wing through public ownership.

We're not planning on doing a full overhaul," she said. "In general, Albertans are proud of what we've got. I don't have any drastic plans for changing the way those programs are administered." As often happens, when you sift through the rhetoric the opponents are quite close together. Most New Democrats would agree with another Kenney statement (as long as they're weren't aware who said it): "We need to ensure our health care has adequate funding, that it's publicly administered, that it's universally available, that it complies with the Canada Health Act." The key point is not who owns the assets, but who pays the bill. If health care pays, it hardly matters whether you get the test in a public hospital or a private clinic.

The MRI dispute is a good example of how the public-private debate has become so futile and misleading. Nine MRI machines in Calgary are publicly owned. They perform the tests for people on the waiting list. But there are also three MRIs in privately owned clinics.

The province doesn't fund MRI tests in those private clinics. The PCs wouldn't, and now the NDP won't either. And yet, health care funds virtually every other imaging test, including X-rays, ultrasounds and mammograms. Those exams are done every day in the very same clinics that own the private MRIs. The cost of a private test is $750, which probably explains why those machines are underused despite the long public wait.

Simple answer, right? The province should just start funding tests on the private MRIs. Asked why she doesn't do that, Hoffman says, "Why would you pay to rent something when you already own it and you're only using it half the time?" OK then, why not use what you've got? Why does that have to be so ridiculously difficult? Health care in Alberta is extraordinarily complex, and because of that, far beyond the reach of simplistic rhetoric about private and public delivery. That debate is just a distraction from the real issue - making the system work. Do that, please. Don Braid's column appears regularly in the Herald dbraid@postmedia.com

After leaving that hospital in July, 2005, Mr. Georgiou took a top position with the province's procurement agency, Infrastructure Ontario. But outside of his day job, the former executive began working for a private family construction business, Toronto Engineering Company (TECO). By March, 2006 - and until December, 2007 - TECO was working for St. Joseph's hospital. During this period, Mr. Georgiou became involved in a scheme to defraud York University with bogus construction invoices.

Mr. Georgiou used two family businesses, including TECO, to invoice the university for $64,800 worth of renovation work he acknowledges his company never performed. (Mr. Georgiou was not charged criminally and reached a settlement with the university.) When The Globe presented evidence to St. Joseph's last September that the hospital had also done business with TECO, the health centre hired Deloitte to investigate. The firm completed its probe this past spring. Deloitte found that over the course of nearly two years, St. Joseph's Health Centre processed 18 TECO invoices worth about $223,000 for repairs, painting and project management. The report shows Ms. Bahl approved all but five. (The hospital's thenproject manager of redevelopment, Doug Wilson, signed off on the rest.)

Deloitte found no evidence that Mr. Georgiou declared his TECO ties to the hospital, although internal hospital e-mails suggest Ms. Bahl was aware of his connection, the review states. Through their lawyers, Mr. Georgiou and Ms. Bahl criticized the fairness of the reviews. The report was not a full-blown audit and drew no conclusions. Deloitte did not interview Mr. Georgiou, Ms. Bahl or any other former hospital employees or vendors.

In a letter to The Globe, Mr. Georgiou's lawyer, Gavin Tighe, said TECO's dealings with St. Joseph's began after Mr. Georgiou left, so there was no conflict, but that, regardless, his client disclosed those ties. "TECO competitively bid on work at St. Joseph's Health Centre," Mr. Tighe wrote, adding that "TECO did not at any time contract or pay BJ Quality Flooring or Darwin Fisher Flooring to perform work." Deloitte also determined that there "may also have been an attempt to conceal" the involvement of Ms. Bahl's husband in the renovation projects.

Travis Walker, a lawyer representing Ms. Bahl, wrote to The Globe that Ms. Bahl "denies any impropriety" and that "any potential conflict of interest was disclosed to senior management" and "no concerns were ever raised." It is not clear exactly what policies Mr. Georgiou and Ms. Bahl may have violated, because St. Joseph's has refused to comment on the rules it had in 2007. A hospital spokesperson said "gaps in the procurement process at the time are historical and have since been mitigated" and that Deloitte unearthed "no substantive findings that indicate any further exploration is required." St. Joseph's would not answer questions on the report. When Mr. Georgiou left St. Joseph's Health Centre, he was one of the most powerful and connected members of the hospital, having served as vice-president for five years and interim CEO for 10 months.

About a month before he began working for Infrastructure Ontario in January, 2006, Mr. Georgiou's family members registered TECO in Ontario. Mr. Georgiou's wife, Helen Saoulli, and her parents were listed as directors. Mr. Georgiou acted as a project manager for TECO, according to a statement he made during the York investigation. Over the next two years, TECO invoiced St. Joseph's for work that included installing a new security gate for the emergency department, wall patching and painting, and disposal of chemical waste, documents obtained through a Freedom of Information request show. BJ Quality Flooring, the company owned by Ms. Bahl's husband, Bojidar Danef, was listed as a subcontractor on seven of the quotes, the Deloitte review found.

The auditing firm noted there may have been an attempt to conceal Mr. Danef's involvement because, at some point in the process, BJ Quality Flooring was changed to "Darwin and Fisher" [sic] - except that the contact name, telephone number and price stayed the same. Doug McDonald, owner of Darwin Fisher, a commercial flooring company in Mississauga, says his company has never done business with TECO and he has no idea why TECO invoices would include it. Mr. McDonald noted that during that period, Darwin was doing extensive work for St. Joseph's, and that on some occasions, he hired Mr. Danef as a subcontractor. Last November, Mr. Georgiou's employment as vice-president of St. Michael's Hospital was terminated after The Globe revealed his involvement in the York fraud, and later the fact that he had private business ties to the president of a construction company that won a $300-million contract with the hospital that Mr. Georgiou had overseen and helped award. After those stories were published, Markham Stouffville Hospital - where Ms. Bahl was then a senior executive overseeing a redevelopment project - launched an internal probe when a whistleblower came forward with concerns. The findings brought a wave of departures, including those of Ms. Bahl and Mr. Wilson, who had left St. Joseph's and was working with Ms. Bahl in Markham. Mr. Wilson could not be reached for comment.

The Markham Stouffville review, which Deloitte also conducted, found that Ms. Bahl hired five of the hospital's contractors to renovate her 6,480-square-foot home, received favourable pricing from some and awarded renovation contracts at Markham Stouffville to her husband's flooring company and her late uncle's window-covering business. It appears Ms. Bahl also mixed her professional connections with her personal life when she was at St. Joseph's hospital. Deloitte found evidence that one of the hospital's furniture vendors "assisted Ms. Bahl in procuring office furniture for her home at a 50-per-cent discount from the list price," the report said. In another instance, Deloitte noted Ms. Bahl may have tried to circumvent hospital procurement policy by counselling an art supplier to invoice through a company that was already doing work for the hospital, rather than submit a payment request directly.

"This is the only way I can cover the cost," Ms. Bahl wrote to the art supplier in an e-mail obtained by Deloitte.

Just now in Ontario this arrangement would appear to have hit a wall. Having negotiated a four-year deal offering average annual fee increases of 2.5 per cent, the Ontario Medical Association executive was dismayed to find it rejected by nearly two-thirds of its members, who complain it does not make up for cuts in fees imposed last year. How things should have broken down to this extent need not detain us here. But it does perhaps point to the need to find another way.

Because doctors' fees, as such, are not the issue. To be sure, they are part of the puzzle: at $11.5 billion annually, they are roughly one-fifth of Ontario's health-care budget. But all the hard bargaining in the world isn't going to rescue Canada's health-care system from the fiscal cliff to which it is headed. Much more important than doctors' fees are doctors' decisions, as the gatekeepers dictating how resources are allocated within the system: how many tests are ordered, what procedures are done, and so on.

The problem is that decisions about treatment are too often divorced from decisions about budgets. Governments set a budget constraint at the macro level, which filters down through the various regional health authorities and local health networks the provinces have seen fit to establish. But doctors typically do not: they make whatever they can bill. And the incentives of feefor-service are to perform as many surgeries and other treatments as they can. Absent changes in those incentives, simply capping fees isn't going to change much.

You can see why doctors felt the need to organize. Governments had set themselves up as sole purchasers of medical services. The idea was supposed to be that they could exploit that monopoly power to drive down costs. But it didn't quite work out that way: politicians in need of re-election, it seems, do not make terribly tough negotiators (who knew?). It was always easier to pass the problem on to the next government, or the next generation - or, as federal governments got in on the act, Ottawa. In consequence, health-care spending skyrocketed through much of the 1970s and 1980s.

Traditionally, doctors have been paid per service, while hospitals have been funded on a block grant basis. The key to reform is to turn this around: giving groups of doctors a fixed amount per patient, with which to purchase services from hospitals, clinics and other providers, that is on a per-treatment basis. Paying doctors a lump sum localizes the budget constraint, forcing doctors to take account of costs in decisions on treatment; paying hospitals per service makes it possible for lower-cost competitors to undercut them.

Even in the more recent wave of cuts following the last recession, these have been largely untouched. As documented in a new study by the C. D. Howe Institute

("Hold the Applause: Why Provincial Restraint on Healthcare Spending Might Not Last"), governments have largely resorted to the familiar public-sector strategy of starving the capital account to feed the operating account: while capital spending has been sharply curtailed, physicians' fees have not.

This is not sustainable in the long run - as new doctors enter the profession, and most of all, as the population ages. As it is, provinces are now spending more than 40 per cent of their budgets on health care; by 2030, a recent Fraser Institute paper projects the number will have risen to nearly 50 per cent. Yet wait times continue to mount: at more than 18 weeks, on average, from GP referral to treatment, they are nearly twice what they were 20 years ago.

Clearly the answer does not lie in more money, least of all more federal money: for every additional dollar in federal transfers the Howe study's authors find that provincial health spending increases by 36 cents. But neither is the answer ever stricter doses of austerity - any more than one would improve a car's mileage by putting less gas in the tank. Rather, what's needed is systemic reform, altering the way that public funds flow through the system, and how the different players within it are remunerated.

Only with the onset of the early 1990s recession, and particularly the sharp cut in federal transfers as Ottawa tried to stabilize its finances, was there the first serious effort at retrenchment. But as the fiscal crisis eased, and particularly after the 2004 health-care accord, with its massive 10-year increase in federal transfers, whatever impetus for reform there might have been dissipated. Rather than "buying change," most of the new money went to increases in provider compensation.

In sum, rather than doctors and governments negotiating with each other at one gigantic bargaining table, what we need are lots of little bargaining tables, at which providers can haggle with each other.

We recognize that the future of health care is digital and this strategic investment will make us a better health and wellness partner to patients and providers," said Loblaw spokesperson Tammy Smitham. "QHR brings complementary talent and technology to our organization, providing opportunities to establish new business partnerships and drive improved care co-ordination for Canadians." Smitham said that Loblaw has no short-term plans to change the way its pharmacy business operates - but that the company is hopeful the acquisition will in the long term make its patient care more efficient, and allow it to work with more health care providers beyond the pharmacy niche. In recent years, retailers including Shoppers have added medical services, notably dispensing flu shots and prescription renewal services, as governments have sought to regulate the professional allowances pharmacies receive from drugmakers. RBC Dominion Securities analyst Irene Nattel said in a note that the QHR acquisition will have negligible impact on Loblaw's results but should fit alongside the company's existing pharmacy and health care operations.

QHR's shares climbed 22 per cent to close at $3.10 on the TSX Venture Exchange Monday. Loblaw shares were up one per cent, closing at $71.81 in Toronto. Loblaw has looked to its Shoppers division to deliver new avenues for earnings growth, as competition for sales volume in its grocery business has expanded beyond traditional competitors like Metro Inc. and Sobey's to include big-box retailers Costco Wholesale Corp. and Walmart Canada.

The Shoppers acquisition in 2014 gave Loblaw access to smaller sized stores in high-density urban neighbourhoods. Following the introduction of increased food and grocery offerings at its drugstores, revenue growth at Shoppers Drug Mart outpaced other parts of the company's business in the second quarter.

That question dominated the recent Public Health 2016 conference in Toronto. Speakers described persistent inequity and inaction across the health system, from research to medical training to hospital care. “The common response is to deny that the problem lies in the structures,” said Charlotte Loppie, director of the Centre for Indigenous Research and Community-led Engagement at the University of Victoria in British Columbia.

She argued that it’s a mistake to see “colonization” as something that happened in the past. “It’s about the control that some people have over other people, which obviously continues today in the health policies and programs that are developed and expanded on indigenous communities, rather than with those communities.”

Research Loppie spoke at a panel hosted by the Canadian Institutes of Health Research (CIHR), which faced criticism in February for awarding less than 1% of funding to Aboriginal health projects in its first major competition since restructuring. “We know we have to work to get this right and get this better and I think we’re learning as we go,” said Nancy Edwards, scientific director of the Institute of Population and Public Health at CIHR.

According to Edwards, Aboriginal health is now a “standing item” at science council meetings, which bring together CIHR top brass every four to six weeks. There has also been “a lot of consultation” with indigenous researchers and communities. There isn’t a single barrier standing in the way. “It’s not that simple,” she said.

Speakers at the Canadian Public Health Association’s annual conference urged structural change to improve indigenous health.

Loppie said she considers Edwards an ally, but noted that CIHR has “a long way to go” to correct the disadvantage to Aboriginal health research under the new funding structure. “Change is a difficult point,” particularly at the most senior levels of administration, she said.

Medical education Australia’s experience integrating indi genous health education into medical training shows how change at that level can help transform a system. Australia’s version of a Truth and Reconciliation Commission recommended compulsory courses for all health professionals in 1989. But this didn’t become reality for doctors until 2006, when the Australian Medical Council set standards that the indigenous health training schools must provide.

With accreditation on the line, change was rapid and meaningful, said Janie Smith, a professor of innovations in medical education at Bond University in Australia. “If you don’t meet the standards, you can’t run your program, so it’s very powerful.” Bond’s medical program overhauled its case-based curriculum to include indigenous examples to teach core concepts. Students also complete a two-day cultural immersion workshop in first year and a remote clinical placement in fifth year.

“It’s a really important principle that this is the normal program and it’s funded out of the normal budget,” Smith said. Integration in core curriculum teaches students that cultural sensitivity is fundamental to being a good doctor, like understanding anatomy. It also protects indigenous health education from “toe cutters” when budgets are tight. Although Canadian medical schools are expanding their indigenous health content, some educators noted that it’s still peripheral to core training.

Lloy Wylie teaches medical students as an assistant professor of public health at Western University in London, Ontario. She recalled one indigenous health session that only a third of students attended. “When it’s voluntary, only the people who don’t need the training show up.”

Hospital care Wylie said she encountered the same indifference among some medical colleagues at Victoria Hospital in London, Ont., where she is appointed to the psychiatry department. “There are still some very unsettling things that I see going on in our hospital system.” She shared stories of “huge jurisdictional gaps” between the hospital and reserve, of patients with cancer denied adequate pain medication because of assumptions about addiction, and of health workers “woefully unaware” of indigenous culture and services.

People in the hospital weren’t even aware of the Aboriginal patient liaison that was in the hospital,” Wylie said. There are some recent bright spots; for example, British Columbia and Ontario are boosting cultural sensitivity training for health workers. But Wylie noted that the same workers “go back to institutions that are very culturally unsafe, so we need to look at changing those institutions as a whole.”

Brock Pitawanakwat, an assistant professor of indigenous studies at the University of Sudbury in Ontario, cited the importance of creating space for traditional healing alongside clinical care. In some cases, it’s a physical space: Health Sciences North in Sudbury has an on-site medicine lodge that provides traditional ceremonies and medicines.

These services are as much about healing mistrust as any physical remedy, Pitawanakwat said. “Going into a hospital after attending a residential school, there’s still that negative emotion,” he explained. “If you look at these buildings in archival photos, they’re almost identical.”

Wylie suggested that the fee-for-service model could also be changed to support physicians building better relationships with patients. “Anything we do to make our hospitals more welcoming places for Aboriginal people will be good for everybody,” she said. “Right now, they’re really alienating for everybody.”

it costs $21,780 to get a hip replacement done in a private clinic in Alberta, according to stats released by the Canadian Health Coalition. A hip replacement in a non-profit hospital in Alberta costs just $10,000.

that Albertan, pockets flush with $20,000, will indeed have to be rich because of the airfare, lodging and food for the several weeks post-operative that the patient must remain near the medical facility where the surgery is done

the $20,000 is just another twist on queue-jumping — the public purse will pay double what the surgery would cost so the rich can get their boo-boos taken care of ahead of the great unwashed who can’t afford any such thing.

The real solution, of course, is exactly what Sherman, a doctor himself, proposes: “Let’s run operating rooms at 95 per cent here. Why run ORs at 25 per cent and contract (surgery) out?”

Seniors in need, caregivers in distress: What are the home care priorities for seniors in Canada? explores the growing issue of home care in Canada. The report takes a deeper look at the seniors who are receiving home care, the family caregivers that are lending support, as well as the challenges of home care in Canada.

In the US medical care has become a huge, competitive industry with many private investors, but with relatively little government regulation. Involving more than $2.7 trillion (£1.7 trillion; €2 trillion), the US healthcare industry now constitutes nearly 18% of our entire economy and it continues to expand.

No more than half of the US health economy involves investor owned organisations and institutions, but most of the others (so called not-for-profits) also see themselves as businesses competing for market share, so they act very much like their for-profit, investor owned competitors. Virtually all organisations and many physicians seek to maximise their income.

dependence of the US system on private for-profit insurance plans. Numbering in the hundreds, but increasingly being consolidated within a relatively few giant corporations

about a quarter of those over 65 have opted to have Medicare pay for their care through private plans

private insurance plans comprise a huge and growing industry, with a gross income of more than $800bn. Their profits and business overheads vary considerably but average between 15% and 25% of their premiums.

private insurance plans added over $150bn to the cost of healthcare in 2011.6 (The overhead expenses of Medicare are less than 5% of total expenditures.)

The recent movement of US physicians into large multispecialty groups suggests that this reorganisation of medical care may already be under way. If this trend continues, it could not only facilitate the enactment of legislation, but also help to make our medical care much more affordable and efficient.

bill, the Affordable Care Act (ACA) was passed by the Democratic controlled Congress in March of 2010

many liberals, like me, have reservations.9

The law does contain major advances but, despite its name, it has no provisions that will reliably control rising costs.

group practices can deliver care more efficiently than unorganised physicians in solo or small, single specialty partnership practices who compete for income and depend on fee for service payment.11

substantial savings, as well as improved care, can be anticipated when primary care physicians collaborate with specialists in well organised groups

With so many physicians employed in multispecialty practices it would be much easier to institute new payment methods that replace insurance based reimbursement for itemised services with tax supported prepaid access to comprehensive care.

↵Angell ME. The epidemic of mental illness: Why? The New York Review, June 23, 2011:20-2.

↵Relman AS. In dire health. The American Prospect2012;23:34-7.

Drug costs were rising by as much as 15 to 20 per cent annually in Manitoba a decade ago, Oswald said. But through improved procurement policies -- recognized in 2008 by the federal Competition Bureau -- and bulk purchasing, its costs have risen by only two to five per cent annually in recent years, she said.

The Manitoba Centre for Health Policy recently completed a study comparing the total health costs of people with chronic diseases and those who didn't have one.

Greg Finlayson, lead author of the study, was careful, though, not to condemn nor admonish individuals with chronic illnesses. He said disease prevention is a broader societal issue. "It is not the individual that is costing money. We don't want to blame people," he said.

Last fall, in what was described as a win for the province's doctors, the Selinger government committed to paying physicians comparable fees to those received by MDs in richer neighbouring provinces. On Oct. 4, the province's 2,400 doctors ratified a four-year deal that assured they'd be paid, on average, the same as those in Alberta, Ontario and Saskatchewan. The docs got a 10.6 per cent fee boost over four years -- which kicks in mainly in the last two years -- and other financial incentives.

The heads of the Canadian Medical Association and Canadian Nurses Association, responding moments after the announcement, said they were pleased to have a role in the looming assessment in health care.

In 2004, the Ontario Liberals passed legislation called 'The Commitment to the Future of Medicare Act' reaffirming the commitment of "the people of Ontario and their government," to the Canada Health Act. "It begs the question, are the McGuinty Liberals on the verge of breaking their promise to defend Medicare?

Chicago-based BrightStar Care’s franchise foray into Canada as a master franchisee

BrightStar expanded from its 229 U.S. locations north of the border this past summer

Mr. Evans handles Eastern Canada, while Jim Jacoboni is the master franchisee for Western Canada.

huge potential in a burgeoning industry that some estimates peg at 18% annual growth

BrightStar plans to open about 50 franchises in the next three to five years, with 22 in Alberta and British Columbia, and 25 in Eastern Canada

Although provincial governments are delivering some home care services directly, the private sector is moving quickly to fill in gaps in service and could even be contracted out by governments.

Vancouver-based Nurse Next Door, which has 50 locations across Canada

The industry is moving from a “task-based” model of service delivery to a “caring” model that focuses on quality of life

Two of the largest sources of referrals come from hospitals and assisted living centres

Mr. DeHart is adamant he is changing perceptions of aging from a view of depression, loneliness and fear “to one of celebration.”

“It’s time to ditch the denture cream and start living life,” Mr. DeHart says.

Nurse Next Door is expanding into the United States with the opening of a location in each of Colorado and Oregon by the end of this year.

Anne Rockingham, director of international operations for BrightStar, says Canada is the first step in the company’s global expansion into other markets, such as the United Kingdom and Australia.

Franchising has become the established method of expansion in the industry. Mr. Evans and Mr. Jacoboni will each be responsible for recruiting new franchisees to run single-or multi-unit franchise operations within their respective territories.

“The gaps are just going to get wider,” Mr. Jacoboni says. “It’s becoming more acceptable to have a combination [of public and private sector services].”

the Canada Health Act is being held hostage

the False Creek Surgical Clinic in British Columbia

it has only

MG: We treat our employees based on merit. Whether they receive perks and raises and also enjoy job satisfaction is very much geared towards their productivity. They get paid really well, so it is a very pleasant working environment for all of us.

three operating rooms and uses the labour force from the public system in their off-times

From the perspective of the Workers Compensation Board, it’s quite hard for them not to send patients to us when you consider that it has been such a success story in provinces. In British Columbia, it is the norm for patients from the Workers Compensation Board to receive care in private facilities.

FC: It is said that one of the reasons the public healthcare establishment is resisting competition is that private clinics are typically not unionized, which means no union dues for public sector union bosses. Your view?

MG: I would say that is true.

performs over 3,000 procedures a year

Seniority and the advancement of an individual because of seniority is simply never going to occur in our system.

FC: The Maples Clinic has become synonymous in Manitoba with a single piece of equipment, your MRI machine.

FC: One of the government’s arguments is that they can produce an MRI scan for $300, compared to your price near $700.

MG: The Workers Compensation Board came up with a plan where they are willing to pay a premium in order to get patients back into the workforce faster. The prerequisite was that patients would be treated within a very short time frame—ten days from the time of consultation to surgery within 21 days—to get people back into the workforce faster. That has resulted in huge savings in lost wages, and that savings was actually expanded to businesses and corporations in the form of lower premiums

How much did they actually save in B.C. by using the False Creek clinic?

over two million dollars

In most other developed countries with universal access, the purchaser of health services is a different entity than the providers.

we should open up Medicare services to private insurers