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Irene Jansen

Healthcare Policy, 7(1) 2011: 68-79 Population Aging and the Determinants of Healthcar... - 0 views

www.longwoods.com/...22525

demographics spending

shared by Irene Jansen on 23 Jan 12 - No Cached
    • Irene Jansen
      Irene Jansen on 23 Jan 12
       
      Rising hospital expenses, use of specialists threaten system; Aging population accounts for one third of increase, says UBC study Vancouver Sun Tue Aug 30 2011 Page: A4 Section: Westcoast News Byline: Matthew Robinson 
  • We found that population aging contributed less than 1% per year to spending on medical, hospital and pharmaceutical care. Moreover, changes in age-specific mortality rates actually reduced hospital expenditure by –0.3% per year. Based on forecasts through 2036, we found that the future effects of population aging on healthcare spending will continue to be small. We therefore conclude that population aging has exerted, and will continue to exert, only modest pressures on medical, hospital and pharmaceutical costs in Canada. As indicated by the specific non-demographic cost drivers computed in our study, the critical determinants of expenditure on healthcare stem from non-demographic factors over which practitioners, policy makers and patients have discretion.
  • research dating back 30 years illustrates that population aging exerts modest pressure on health system costs in Canada (Denton and Spencer 1983; Barer et al. 1987, 1995; Roos et al. 1987; Marzouk 1991; Evans et al. 2001; McGrail et al. 2001; Denton et al. 2009)
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  • To shed new empirical light on this old debate, we quantified the impacts of demographic and non-demographic determinants of healthcare expenditure using data for British Columbia (BC) over the period 1996 to 2006. Using linked administrative healthcare data, we quantified the trends in and the determinants of expenditures on hospital care, physician services and pharmaceuticals. To our knowledge, this is the first time that all three of these major components of healthcare costs have been analyzed in a single Canadian study.
  • our study cohort included 3,159,900 residents in 1996 and 3,662,148 residents in 2006
  • We found that population aging in British Columbia contributed less than 1% per year to total growth of expenditures on hospital, medical and pharmaceutical care from 1996 to 2006. We also found that changes in age-specific mortality rates reduced (albeit modestly) per capita healthcare costs over time, confirming what other researchers have suggested (Fries 1980; Breyer and Felder 2006). With rigorous analysis of recent healthcare data, we can therefore confirm what studies spanning earlier decades for British Columbia, elsewhere in Canada and other comparable health systems have found: the net impact of demographic factors on major components of the healthcare system is moderate (Denton and Spencer 1983; Fuchs 1984; Barer et al. 1987, 1995; Gerdtham 1993; Evans et al. 2001; McGrail et al. 2001). Moreover, when we forecasted the effects of expected demographic changes in British Columbia through 2036, we found that the future effects of population aging on healthcare spending will continue to be modest (1% or less per year).
  • Our findings also indicated that average payment per unit of hospital care increased over the period. The increase in hospital unit costs may have been an appropriate policy response to increases in age-adjusted clinical complexity per patient remaining in care following reductions in the average length of stay
  • After taking into account population aging, the average number of days of prescription drug therapy received by British Columbia residents grew more than 5% per year during the first half of our study period and plateaued in the latter half of the period (data not shown)
  • Despite popular claims about population aging and the sustainability of healthcare in Canada, demographic changes exert steady, predictable and modest forces on the cost of major components of our healthcare system. This is likely to remain true for the foreseeable future.
  • Irene Jansen on 23 Jan 12
     
    Despite popular claims about population aging and the sustainability of healthcare in Canada, demographic changes exert steady, predictable and modest forces on the cost of major components of our healthcare system. This is likely to remain true for the foreseeable future. Changes in the age-specific profile of healthcare costs, by contrast, can exert and have exerted significant pressures on health system costs. Clinicians, policy makers and patients have some discretion over the non-demographic sources of healthcare cost increases - unlike population aging. Though these results are largely confirmations of studies from past decades, it is nevertheless important to update the scientific basis for policy debates. Moreover, close attention to recent trends and cost drivers - such as the price of prescription drugs that drove pharmaceutical expenditures in the past decade - also helps to illuminate the non-demographic forces that seem most amenable to policy intervention. Ultimately, then, research of this nature is a reminder that the healthcare system is as sustainable as we want it to be.
Irene Jansen

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

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

sustainability demographics privatization neoliberalism

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

How To Defuse The Baby Boomer 'Demographic Bomb' And Save Health Care - 0 views

www.huffingtonpost.ca/...ction-eldercare_n_8260078.html

from heather seniors ltc continuing care

shared by Govind Rao on 14 Oct 15 - No Cached
  • 10/13/2015
  • In fact, it was just revealed that seniors outnumber kids under 15 for the first time ever.
  • Seniors will hit 20 per cent of Canada's population by 2024, and 25 per cent by 2036, at which point they will account for 62 per cent of health costs according to the Canadian Medical Association (CMA).
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  • "It costs $1,000 a day in a hospital bed, or $150 a day for a long-term care facility, or $50 bucks for home care," Simpson explains. "It’s a simple economic argument. And it just happens to be the right thing to do, as well. It’s just pushing through that complacency and notion that we can't change things. This is a real sticking point; it’s a home-run economic argument as far as I’m concerned."
  • No wonder NDP leader Thomas Mulcair has dubbed this a "demographic bomb."
  • What we see in New Brunswick are things like 25 per cent of all acute care hospital beds are taken up with patients that should be in nursing homes or at home with enhanced home care support. And it is paralyzing their health-care system.
Govind Rao

Health care makes way into election - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246200|ntnp|20150819|227385788

from heather federal election

shared by Govind Rao on 19 Aug 15 - No Cached
  • National Post Wed Aug 19 2015
  • Frustration at the way the general election campaign is unfolding for the Conservatives bubbled over at a campaign event in the Toronto suburb of Etobicoke Tuesday. One angry Conservative left his porch long enough to berate the CBC's Hannah Thibedeau and CTV's Laurie Graham for daring to ask the party's leader about the Mike Duffy trial.
  • You are a piece of s-t," shouted the supporter, an outburst that will confirm for many the impression Stephen Harper leads a nasty party, backed by a zombie army of the unthinking. But everyone should take a deep breath and let the temperature drop by a few degrees. We are in mid-August. It's no wonder, in George Bernard Shaw's words, the media can't distinguish between a bicycle accident and the collapse of civilization.
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  • The Duffy trial is sucking up all the oxygen because there's nothing else happening. The leaders all have significant policy announcements up their sleeves, but they are saving them for next month, when more people are paying attention. One Conservative candidate may be indulging in wishful thinking when he said "absolutely no one cares about Duffy - it's an Ottawa story."
  • I'm not sure that's true. The Duffy trial testimony has simultaneously undermined Harper's "strong leadership" pitch and bolstered the case for change. But it is clear the caravan will move on after the trial goes on hiatus at the end of next week. We will be celebrating Thanksgiving one week before election day. The odds are when the mornings are as crisp and golden as an apple, Nigel Wright's testimony will be a vague recollection for most folks. As a memory experiment, who remembers the details of Justin Trudeau's "32-point plan to restore democracy in Canada," unveiled exactly two months ago? Other issues will come to the fore and one battleground that Quebec Premier Philippe Couillard is keen to highlight is the way Ottawa funds health-care.
  • The case for a demographic funding formula received a boost last month in a paper by the Parliamentary Budget Office that suggested the demographics of an aging population are set to defeat all attempts by provinces at containing healthcare costs. The phrase was not used, but the implication was that a genuine fiscal imbalance is emerging.
  • Health-care is always high on the agenda of concerns when voters are asked by pollsters. Yet, the Harper Conservatives have neutralized the issue in recent elections by closely shadowing the policies of their opponents.
  • This time will be different. The Conservatives have long promised that in 2017, the CHT will grow at the rate of general growth plus inflation - about three per cent to 3.5 per cent. Provinces have been used to six-per-cent increases since Paul Martin signed his "fix for a generation" in 2004.
  • The NDP has said it will maintain that six-per-cent escalator, while the Liberal Party says it will be focused on preparing the system for the wave of baby-boomer retirements in a new health accord.
  • Couillard wrote to the leaders of all federal parties late last week, renewing calls for them to take into account aging populations when calculating the $32-billion Canada Health Transfer. Backed by the Canadian Medical Association, Couillard issued a challenge to the party leaders to top up the CHT to take account of changing demographics.
  • The report pointed out that the ratio of people aged 15-64, compared with those over 65, will fall from 4.3:1 in 2014 to 2.6:1 by 2034. The PBO suggested that provincial governments need to find savings or revenue increases of 1.4 per cent of gross domestic product, about $28 billion annually, to put themselves on a sustainable footing. At the same time, the federal government will have a similar amount of money to spare, as a result of falling public debt levels.
  • The wrinkle for both the NDP and Liberals is that they can commit extra billions of dollars to health-care or pledge to balance the budget. It stretches credulity to suggest they could do both, alongside the commitments they have already made. The Conservatives have already made their choice, committing themselves to reducing debt levels and ensuring the budget is balanced.
  • Contrasting policy positions on one of the subjects that Canadians say they really care about could provide some relief from the inertia afflicting the 42nd general election campaign. When temperatures, and tempers, cool, the leaves will cascade, the seasons will turn and so will the concerns of many voters.
Govind Rao

Can Quebec handle the demographic shift? - Policy Options - 0 views

policyoptions.irpp.org/...c-handle-the-demographic-shift

from heather pensions quebec

shared by Govind Rao on 22 Dec 15 - No Cached
  • Nicole F. Bernier November 26, 2015 
  • There is plenty of support for renegotiating retirement plans in the name of demographics, balanced budgets and intergenerational equity. Recently the International Monetary Fund urged the provinces to continue containing budgetary expenses related to the aging of the population. The Conseil du patronat (Quebec’s employers’ council) has expressed concern about Quebecers’ quality of life, saying it is threatened by population aging, global competition, and the heavy footprint of an increasingly indebted government. Some commentators even applauded the “shock therapy” of the last provincial budget. As Paul Journet of La Presse said, “Let’s not forget that the real sickness that needs to be cured is the structural deficit, and we know that it is caused by population aging.”
Irene Jansen

Health ministers look to cut back on pricey diagnostic tests - The Globe and Mail - 0 views

www.theglobeandmail.com/...article9820161

cof innovation guidelines drugs home care

shared by Irene Jansen on 20 Mar 13 - No Cached
  • Ontario, for instance, is pumping money into providing more home care. Manitoba is looking toward preventive medicine. Saskatchewan is reviewing ways to improve long-term care. Nova Scotia has a system where paramedics treat some ailments in long-term care facilities to avoid tying up hospital beds.
    • Irene Jansen
      Irene Jansen on 20 Mar 13
       
      For truth re. Ontario home care, see: as http://ochuleftwords.blogspot.ca/search/label/homecare Wall's vision of "improving LTC" in Saskatchewan involves expanding retirement homes (largely private for-profit, lesser-regulated).
  • Mr. Ghiz said they could use more help from Ottawa.“Hopefully, some day, the federal government will be at the table with dollars and with ideas – we're open
    • Irene Jansen
      Irene Jansen on 20 Mar 13
       
      "Hopefully, some day, the federal government will be at the table with dollars and with ideas - we're open". This is not a battle cry.
  • finding ways to keep seniors out of hospital. Ontario, for instance, is pumping money into providing more home care. Manitoba is looking toward preventive medicine. Saskatchewan is reviewing ways to improve long-term care. Nova Scotia has a system where paramedics treat some ailments in long-term care facilities to avoid tying up hospital beds.
    • Irene Jansen
      Irene Jansen on 20 Mar 13
       
      For the truth on Ontario home care, see http://ochuleftwords.blogspot.ca/search/label/homecare Wall's vision of "improving LTC" in Saskatchewan involves expanding retirement homes (lesser-regulated, largely for-profit).
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  • The greatest cost pressure on the system, however, may be the demographic shift and the steady rise in the number of senior citizens requiring chronic care.
  • The provinces will look to expand a collective drug-purchasing plan, set new guidelines to cut the number of unnecessary medical procedures and improve home care for senior citizens. These strategies were on the table Friday as provincial health ministers hunkered down in Toronto for two meetings on overhauling the nation's universal health-care system and wrestling down its cost.
  • The second, chaired by Ontario Health Minister Deb Matthews, focused on dealing with the nation's aging population.
  • The provinces are also looking at ways to cut back on pricey diagnostic tests and surgeries such as MRIs, knee replacements and cataract removals. After consulting with health-care professionals, they hope to draw up a series of voluntary guidelines, to be presented this summer, on when such procedures are necessary and when they can be skipped.
  • The provinces will look to expand a collective drug-purchasing plan, set new guidelines to cut the number of unnecessary medical procedures and improve home care for senior citizens. These strategies were on the table Friday as provincial health ministers hunkered down in Toronto for two meetings on overhauling the nation's universal health-care system and wrestling down its cost.
  • The first session was part of the Health Care Innovation Working Group
  • The first session was part of the Health Care Innovation Working Group
  • The second, chaired by Ontario Health Minister Deb Matthews, focused on dealing with the nation's aging population.
  • Last year, the working group produced a deal that saw the provinces and territories, with the exception of Quebec, team up to purchase six generic drugs in bulk, which resulted in savings of $100-million annually.They want to take a similar approach to buying name-brand medicines. Mr. Ghiz estimated such a plan could save $25-million to $100-million more.
  • Last year, the working group produced a deal that saw the provinces and territories, with the exception of Quebec, team up to purchase six generic drugs in bulk
  • They want to take a similar approach to buying name-brand medicines. Mr. Ghiz estimated such a plan could save $25-million to $100-million more.
  • The provinces are also looking at ways to cut back on pricey diagnostic tests and surgeries such as MRIs, knee replacements and cataract removals. After consulting with health-care professionals, they hope to draw up a series of voluntary guidelines, to be presented this summer, on when such procedures are necessary and when they can be skipped.
  • The greatest cost pressure on the system, however, may be the demographic shift and the steady rise in the number of senior citizens requiring chronic care.
  • finding ways to keep seniors out of hospital.
  • For all the provinces' innovations, however, Mr. Ghiz said they could use more help from Ottawa.
  • “Hopefully, some day, the federal government will be at the table with dollars and with ideas – we're open
Irene Jansen

Health ministers mull more home care | The Chronicle Herald - 0 views

thechronicleherald.ca/...-ministers-mull-more-home-care

Council of the Federation innovation home care drugs purchasing

shared by Irene Jansen on 18 Mar 13 - No Cached
  • TORONTO — Provinces and territories will likely have to expand home care as a way to deal with the demographic deluge of aging Canadians, two premiers said Friday during a gathering of provincial health ministers.
  • Provinces and territories will likely have to expand home care as a way to deal with the demographic deluge of aging Canadians, two premiers said Friday during a gathering of provincial health ministers.
  • An aging population was at the top of the working group’s agenda as a major concern because it’s consuming more health-care dollars, said P.E.I. Premier Robert Ghiz.
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  • There aren’t enough nursing home beds to accommodate the surge of seniors needing care, so home care may be the solution, said Saskatchewan Premier Brad Wall.
  • The working group, which Ghiz and Wall both lead, is also making progress on lowering the cost of prescription drugs, they said.
  • Several provinces and territories reached a deal in January to team up when purchasing six widely used generic drugs, which will collectively save them about $100 million a year, Wall said.
  • They’re also looking at brand-name drugs and will have more to say about it in July at the Council of the Federation meeting in Niagara-on-the-Lake
  • The provinces have agreements for seven brand-name drugs and they’re negotiating prices for 13 others, said Ontario Health Minister Deb Matthews.
    • Irene Jansen
      Irene Jansen on 25 Mar 13
       
      bulk purchasing agreement among the provinces covering 27 prescription drugs. There are approximately 6500 prescription drugs on the Canadian market, with about 80 new drugs coming on to the market each year. So only about 6475 drugs to go - this year. CF
  • The working group also talked about “appropriateness of care” — ways to make the health-care system more efficient and cut down on soaring costs. “The radiologists in this country have said 10 to 20 per cent of diagnostic imaging is probably not required,” Wall said.
  • There might be other suggestions from providers, in terms of cataracts
Heather Farrow

Make senior care a priority; New health accord - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20160827|254784412

accord seniors ltc

shared by Heather Farrow on 29 Aug 16 - No Cached
  • Toronto Star Sat Aug 27 2016
  • Canadian health care faces a rare opportunity - and a daunting challenge. Officials at the federal and provincial level are quietly working toward a new national accord with potential to reshape medicare in this country. If properly done, the process will produce a stronger, more efficient health-care system better serving the needs of both the sick and the healthy. Expect the opposite if turf wars prevail; if inadequate funding leaves vital parts of the system starved of cash and if established interests use this opportunity to give themselves a raise instead of investing in better patient care.
  • With negotiations expected to last for several more months, the outcome of this process remains far from clear. But provincial and territorial officials are, at least, talking with a Liberal government in Ottawa elected on a pledge to negotiate a new health pact. That, in itself, marks a welcome change from years of intransigence under former prime minister Stephen Harper. Under his misguided leadership, the federal level disavowed any responsibility for shaping the health-care system. When an earlier $41-billion health accord, negotiated by Paul Martin's Liberals, expired in 2014, Harper refused to do the hard work of negotiating a new deal.
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  • Instead, he simply continued existing transfers of money, with annual increases of 6 per cent, to be followed by a reduction, to about 3 per cent, as of 2017. That formula was issued unilaterally, without consulting the provinces. And transfers came with no strings attached, meaning the federal government effectively abandoned leadership in the realm of Canadian health care. It's vital for Ottawa to oversee the evolution of medicare. That's the best way to set shared national priorities and establish universal standards suited to Canadians' 21st-century needs.
  • Prime Minister Justin Trudeau appears to understand this, with his party campaigning on a pledge to "provide the collaborative federal leadership that has been missing during the Harper decade." Key to this is negotiating a new health accord, including a long-term agreement on funding. Now comes the hard part: actually hammering out a deal. The only immediate commitment made by the Liberals was an investment of $3 billion, over four years, "to deliver more and better home care services for all Canadians." But there was no mention of that in the federal budget this spring, a document notable for its lack of attention to expanding Canada's health-care system.
  • Health Minister Jane Philpott explained that promised changes to home care are part of ongoing talks toward a health accord. Fair enough. But it's essential for the federal contribution, in any new deal, to go beyond just this. Ottawa's health-care transfers to the provinces and territories totalled $34 billion last year, about 22 per cent of public spending in this area. At one time it was a 50-50 split. And Canada's provincial premiers, as recently as July, have urged the federal government to cover at least 25 per cent. That seems reasonable to expect from a new accord, especially given growing pressure on Canada's health-care system from an expanding, and rapidly aging, population.
  • One worthwhile change, forcefully advocated by the Canadian Medical Association earlier his week, would be for Ottawa to deliver additional health-care funding through a special "top-up" based on each province's population of seniors. Health transfers are currently issued on a per-capita basis, failing to take into account far heavier costs associated with caring for the aged. This gives provinces with a younger population, such as Alberta, a break while failing to adequately compensate those with more old people, including British Columbia and Ontario.
  • The Conference Board of Canada made a compelling case for a demographic top-up in a report last fall, calculating that it would cost Ottawa about $8.6 billion over five years. Currently, "there are large discrepancies across the country when it comes to the health-care services available to seniors, particularly in pharmacare, home care, long-term care and palliative care," warn authors of the report. "As Canada's population continues to age, this situation is likely to worsen."
  • One goal of a national accord is to eliminate, or at least ease, such discrepancies. To that end, it would make a great deal of sense to introduce some form of demographic top-up. This represents just one opportunity inherent in negotiating a new health accord. It remains to be seen if it will actually be delivered. © 2016 Torstar Corporation
Irene Jansen

Heated health care debate ahead for premiers as each defends their own interests - The ... - 0 views

www.theglobeandmail.com/...article2302548

accord demographics cht

shared by Irene Jansen on 23 Jan 12 - No Cached
  • “I think the consequences of the new model, unintended as they are, are going to be severe for seniors all across the country,” Ms. Clark said. “The decision to go to straight per capita regardless of age represents a massive shift in health-care dollars away from senior citizens. We can’t sustain a health-care system across the country under those circumstances.”
  • “So in B.C. where a lot of people move as they age we’re going to see a growth in our allocation under the Canadian Health Transfer (CHT) of .05 per cent. In Alberta, they’re going to see a growth in CHT of about 50 per cent.”
  • Officials in the B.C. Ministry of Health have run numbers of what a new health funding formula might look like if it was weighted for demographics. Not surprisingly, B.C. (along with Quebec and New Brunswick, among others) would do much better, and provinces such as Ontario and Alberta would be worse off.
Irene Jansen

Continuing Care: A Pan-Canadian Approach CHA August 2011 - 0 views

www.cha.ca/...Care_Synthesis_Aug_2011_EN.pdf

continuing care home care ltc

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Irene Jansen on 23 Jan 12
     
    Canadians expect their healthcare system to be effective, sustainable, accountable, and, above all, to deliver high-quality health services across the country. As demographics shift and the demand for services across the continuum of care increases, sustainable solutions for evolving health needs must be identified. Within the continuum of care, home, long term, palliative and respite care have progressively taken on an importance that was not anticipated when medicare began; that is, when healthcare only included care provided in hospitals or by physicians.
Irene Jansen

Is B.C.'s social system up to handling the wave of aging baby boomers? - 0 views

www.theprovince.com/...story.html

demographics sustainability bc

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Most importantly, McGrail says, we have to rebuild the health system. That means reducing hospital infrastructure and acutecare spending to focus on investments in home care, with doctors making house calls, and building more long-term-care nursing homes.
  • The only real answer is to face the "inconvenient truth" of coming austerity -- either spending programs are reduced or eliminated, or taxes are raised, or a mixture of both, Ragan argues in his new report, Canada's Looming Demographic Squeeze.
  • In a recent paper, McGrail said the cost impact of aging is small and predictable, but the most recent research shows increases in utilization (how many and how often Canadians use health services) are twice as important as aging in increasing costs year by year.
Govind Rao

Canadian Medical Association Journal: New CMA president tackles demographic issues - 0 views

www.cmaj.ca/...hic-issues-cmaj.109-5127.xhtml

from heather cma

shared by Govind Rao on 01 Sep 15 - No Cached
  • August 26, 2015
  • As a runner and competitive paddler, the 56-year-old family physician from Waverley, Nova Scotia, knows about endurance.
  • First up on her agenda is making the strategy for seniors' health care a pivotal election issue
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  • Over-65ers already account for nearly half of health spending; by 2031, their number will double and the load will threaten the entire system.
  • federal government to get back into the health care."
  • plus the branding of NewCo, CMA's new subsidiary of for-profit enterprises, including CMAJ.
Heather Farrow

Pharmacare won't come soon: minister; Warns CMA meeting in Vancouver that indigenous he... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|vasn|20160824|254542102

pharmacare

shared by Heather Farrow on 24 Aug 16 - No Cached
  • Vancouver Sun Wed Aug 24 2016
  • "Most seniors prefer care in the comfort of their home and not in hospitals." Doctors of B.C. president Dr. Alan Ruddiman told Philpott that the "harsh reality" is that certain provinces like B.C. are struggling to meet the health-care needs of aging populations, so the CMA is advocating in favour of federal demographic-based "top ups." But Philpott wouldn't reveal where negotiations will go on that point and said there are 14 health ministers, including herself, who have to hammer out an agreement.
  • "National pharmacare, you know if you've seen my mandate letter (from Prime Minister Justin Trudeau), does have to do with the cost of drugs and there's impressive work we can do in the next few years to drive down costs," she said. Philpott suggested the government will, for now, focus on bulk buying, price regulations and negotiations with pharmaceutical companies, rather than a full program covering the costs of drugs for those who can't afford them. While Philpott, a doctor, said she "gets" how a pharmacare program would be beneficial, but there are other problems like "horrendous and unacceptable gaps in care for indigenous people and we need frank conversation about where our priorities should be."
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  • Philpott said one of the misconceptions about the future of health care is that demographics - a silver tsunami related to an aging population - is going to bankrupt government coffers. While she acknowledged that seven per cent of $1,000-a-day hospital beds are taken up by seniors and 14 per cent of beds are occupied by patients who should be in alternate levels of care, Philpott threw cold water on the "doom and gloom" forecasts that an aging population means "massive infusions of cash" are needed to sustain public health care. Sticking to the federal government's commitment to inject another $3 million over four years into home care, she noted it's not only cost effective but preferred by patients and their families.
  • Federal health minister Jane Philpott said Tuesday a national pharmacare program is likely years away because of more pressing priorities like primary care, improved health for indigenous people, better care for those with mental illness, and more home care for seniors. "I do not want to promise anything I don't know I can deliver on," she told about 600 delegates and observers at the annual Canadian Medical Association meeting in Vancouver.
  • The reality is I don't know how this is going to end up. A lot of this will come down to basic principles of fairness." While Canada spends more per capita than many other countries, Philpott said she's concerned about international rating systems that show Canada gets poorer outcomes compared to countries such as Australia, the United Kingdom, France and Germany. During a press scrum, a journalist noted that all those other countries have parallel public/private systems. But Philpott insisted the federal government is only interested in how those other countries deliver care within the publicly funded realm. "Our government is firmly committed to upholding the Canada Health Act. That act has principles around accessibility and universality and it means Canadians have access to care based on need, not on ability to pay," she said. "You cannot have a growing, thriving middle class unless you have a publicly funded universal health care system."
  • Philpott attempted to dissuade doctors of the notion that the federal role is merely to transfer money to the provinces ($36 billion this year), maintaining that the government and "this minister of health" is determined to be engaged in health system transformation. The provinces have begun the slow process of negotiations with the federal government on a renewal of the Canada Health Accord to be signed sometime next year. But some health ministers have complained that the feds have given no indication about how much money they can expect. It's been more than a decade since the provinces and the federal government negotiated transfer payments and Philpott said that while the last round led to improvements like shorter waiting times in some surgical areas, "it did not buy change. So we should use this opportunity to trigger innovation."
  • Philpott said real change will incorporate digital health records and the banishment of anachronisms like fax machines. Patients should be seamlessly connected, in real time, to their health care providers, hospital, home care, pharmacy and lab. "What is it going to take to get there? Pragmatism, persistence and partnership. Changes require courage and practicality." Doctors gave her enthusiastic applause for stating that low socioeconomic status represents one of the greatest barriers to good health and "that is why this government believes that the economy and jobs and a stronger middle class will reduce social inequity." She said in 2016, the federal government has earmarked $8.4 billion in spending on social and economic conditions for indigenous communities. Earlier Tuesday, on the second day of the three-day annual meeting, doctors passed numerous motions that will now go to their board for further discussion before becoming official policy.
  • Delegates passed a motion introduced by Ontario doctor Stephen Singh of the Canadian Society of Palliative Care Physicians that aims to distinguish between palliative care ("neither to hasten or postpone death") and medical assistance in dying. Most palliative care doctors don't want to serve as gatekeepers to doctor-assisted dying, but they do want to consult with patients who have life-limiting illnesses in order to help mitigate their suffering.
Irene Jansen

Jeffrey Simpson touts more privatization in health-care system - Winnipeg Free Press - 0 views

www.winnipegfreepress.com/...lth-care-system-170806996.html

privatization excellent

shared by Irene Jansen on 24 Sep 12 - No Cached
  • Simpson writes with a clear ideological bias. He favours increased privatization. With frequent criticisms of those he calls "unreconstructed defenders of medicare" and the Supreme Court justices who ruled on the landmark Chaoulli case and whom he calls "gifted health policy amateurs," he spares no rhetorical disdain. Unfortunately, Simpson practises much of the same behaviours he criticizes in others.
  • His superficial analyses of multiple complex systems that function within different geographical and demographic realities do not help us understand the Canadian system.
  • privatization of health care is his solution to medicare's problems
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  • Simpson repeatedly refers to the consequences of poverty and social inequity on the health of the population and their impact on health-care costs, but he does not include this fundamental issue in his remedies for our current problems.
  • "social insurance for drugs"
  • Alan Katz is a Winnipeg family physician and health-policy research scientist.
Irene Jansen

M. McGregor and D. Martin. 2012. Testing 1, 2, 3. Is overtesting undermining patient an... - 0 views

www.cfp.ca/...1191.full

overtreatment diagnostics

shared by Irene Jansen on 19 Nov 12 - No Cached
  • the guideline committees that make recommendations do not appear to consider cost-effectiveness, opportunity costs, and the potential harms of decisions to broaden screening guidelines
  • Not only are we screening with widespread laboratory testing at younger ages, but our definition of disease is also shifting.
  • In BC, there has been a 13.9% increase per year in treatment rates for 8 chronic diseases, beyond what would be expected for the changing demographic characteristics of the population
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  • Either British Columbians are rapidly becoming much sicker, or this increase in prevalence is a reflection of what Welch and colleagues describe as “looking harder” and “changing the rules.”
  • about one-third of the increasing cost of testing is related to physician adherence to guidelines
  • patients now often request particular tests
  • Earlier diagnoses and more aggressive treatments appeal to our self-definition as fighters of illness—and we all shudder at the successful lawsuit against the physician who did not screen
  • we use them as therapy of a sort, giving hope to the patient that we will find an explanation for the symptoms instead of admitting that we do not know and might never know the exact cause of the problem
  • At the highest level, there needs to be a broader evaluation of guidelines. Such evaluation needs to have representation from policy thinkers and health economists in addition to family doctors, other specialists, patients, and the public.
  • the opportunity costs of deciding to implement widespread laboratory testing for healthy people, compared with adopting population-based policies, such as 24-hours-a-day, 7-days-a-week access to community recreation facilities and social housing, or free access to smoking cessation supports, should be debated.
  • Tests and repeat tests that are deemed to be of less benefit or not worth the opportunity-cost trade-off should be delisted.
Heather Farrow

Hurry up and wait - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|tidp|20160824|254534355

day privatization private clinics court

shared by Heather Farrow on 24 Aug 16 - No Cached
  • The Timmins Daily Press Wed Aug 24 2016
  • How did it ever come to this? How did supposedly intelligent men and women, given the responsibility for running our health-care system, allow things to deteriorate so badly? More importantly, how did we-the public-allow ourselves to be duped all these years by spineless, self-serving politicians?
  • Earlier this year, an Ontario teenager, Laura Hillier, died while waiting for a stem-cell transplant. She was only 18 years old, and had her whole life ahead of her. Unfortunately for Laura, she made the mistake of getting sick in Ontario, a province where-like most of the rest of Canada- we've had our heads buried in the sand for far too long when it comes to how we fund our health-care system. This young girl died, not because they couldn't find a donor-there actually was one-but because those in charge couldn't find a way to fund the procedure that would have saved her life.
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  • Then there's little Meghan Arnott, age 12, who's waiting for surgery in British Columbia to correct a complication brought on by Crohn's disease. Unfortunately for Meghan, she's been told her surgery may have to be postponed eight or nine months due to a severe shortage of nurses in B.C., caused by-you guessed it-chronic underfunding of our health-care system by the government. Meanwhile, this young girl waits in excruciating pain and discomfort, yet another invisible victim of Medicare.
  • Or how about 16-year-old Walid Khalfallah, who hails from Kelowna, British Columbia? Walid is now a paraplegic thanks to his encounter with our health-care system. All because those running the show felt it was a reasonable risk for a young boy of 13 to wait 27 months-that's right, folks, I said 27 months-for surgery on his spine. By the time Walid had the surgery in 2012, at Shriners Hospital in Spokane, Washington, it was too late.
  • Still think we have the best health-care system in the world? Not by a long shot. Despite statements by elected officials to the contrary, Canada's health-care system is no longer something we Canadians can-or should-be proud of. Stories like those of Laura, Meghan and Walid, while admittedly anecdotal, point to inadequacies in how Medicare is funded and how decisions are made when it comes to deciding on what programs receive funding and which don't.
  • It's sort of like winning the lottery. If you belong to a demographic that is older and more inclined to vote-baby boomers, for example, in need of cataract surgery or hip replacements-then you might very well be in luck. If you happen to be a child, however, or suffering from some less-than-"sexy" disease, then good luck, you're on your own.
  • No one's life should have to depend on the roll of the dice. That's crazy. Fortunately, after years of delays and legal maneuvering by the B.C. Government, Dr. Brian Day's charter challenge is finally about to get under way this coming September in Vancouver. The case, which will be argued before the Supreme Court of British Columbia, will include six other plaintiffs, including Walid Khalfallah, in addition to Dr. Day. Sadly, two of the six plaintiffs have died as a result of delayed access to care. The irony of that should be lost on no one.
  • In 2005, the Supreme Court of Canada ruled that those living in the province of Quebec should have the right to purchase private health-care insurance under the Quebec Charter. This was known as the Chaoulli case. Dr. Jacques Chaoulli successfully convinced all seven judges hearing the case that patients were suffering and, in some cases, dying while waiting to access care. Dr. Day and his fellow plaintiffs will be arguing that those living outside Quebec should have similar protection under the Canadian Charter of Rights and Freedoms.
  • Not surprisingly, the B.C. Government and Government of Canada will be arguing the opposite, as will a number of special interest groups, including representatives of the B.C. Health Coalition and Canadian Doctors for Medicare, who have applied for and been granted intervener status. While I have no doubt that Dr. Day will ultimately win his charter challenge-after all, Dr. Day and those representing the more than two million Canadians currently suffering on waiting lists, including Walid and the other five plaintiffs, are on the side of the angels. As for all those bureaucrats, lawyers and elected officials-armed with an endless supply of "lies, damn lies, and statistics," desperately trying to justify maintaining the status quo-I'm not really sure whose side they're on.
  • Certainly not yours or mine. Because if they were, they'd come clean and admit the truth. Canada's health-care system is not sustainable and on the verge of complete and total collapse. Spending millions of dollars to defend the indefensible is not only wrong, it's obscene. Just ask Laura, Meghan, Walid and the friends and relatives of the two plaintiffs who died after waiting for both care and justice. Access to a waiting list is not access to care, as the judges in the Chaoulli case so rightly pointed out 11 years ago. Hopefully, when the decision is handed down, once all the arguments have been heard this fall in British Columbia, we'll finally be able to have that "adult" conversation we've been avoiding for the past 20 years and actually do something to fix the mess we find ourselves in. One can only hope. Stephen Skyvington
Cheryl Stadnichuk

Regina Qu'Appelle Health Region is missing surgical, emergency and fiscal targets | Reg... - 0 views

leaderpost.com/...l-emergency-and-fiscal-targets

deficits wait times surgeries

shared by Cheryl Stadnichuk on 17 Nov 16 - No Cached
  • The Regina Qu’Appelle Health Region (RQHR) is missing surgical, emergency room and financial targets, according to its second quarter report released Wednesday evening at the Regina Qu’Appelle Regional Health Authority’s board meeting.
  • The emergency department length of stay continues to be on an upward trend with the average patient staying for 13 hours instead of the 2016-17 target of 7.75 hours
  • The region’s population has grown by 47,000 people over the past decade and the population is aging — both contributing to longer ER waits, said Keith Dewar, CEO of the RQHR. “The growth in demand has resulted in significant volume pressures that have not been directly funded,” he said. “About a third of that growth and demand — both by population increase and by demographic changes — is funded.”
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  • As of Sept. 25, 2,859 patients had waited longer than three months for surgery — failing to meet the target of less than 1,934 waiting longer than three months. Based on the “current mismatch” between funded volumes and increasing demand, the region projects a minimum of 3,500 patients will wait longer than three months for surgery by the end of the fiscal year.
  • As of September, the region had a $6.6-million deficit. The overall deficit is projected to grow to around $13 million, but Dewar said the region continues to work hard to reduce that projection. The issues: In September, staff on the adult mental health unit at the General Hospital received layoff notices to align staffing with the needs of the unit. There will be more layoffs in the future, Dewar said.   Other measures to reduce the deficit include reducing sick time and overtime. That is hard to do if there continues to be overcapacity issues — when there are more patients waiting to be admitted than there
Irene Jansen

Health vow may leave Tories ill - 0 views

www.financialpost.com/...story.html

accord equalization

shared by Irene Jansen on 23 Jan 12 - No Cached
  • In the mid-election fog of March, Jim Flaherty appeared on CBC's The House and made a commitment he may yet live to regret.
  • "We need to negotiate with the provinces and say, 'How long an agreement do you want? A five-year agreement? A 10-year agreement? A two-year agreement?' ... We will keep it at 6% for whatever the duration of the agreement is," he said.
  • At first blush, it looks like the feds have given away the farm before they have even sat down with the provinces. But what Ottawa gives with one hand, it may take away with the other
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  • The bulk of transfers from Ottawa are for health but Ottawa also sends the provinces $11.5billion for social policy (mainly education) and $14.6-billion in equalization payments. Social transfers have been rising at a rate of 3% a year, while equalization increases have been linked to GDP growth. Both of those deals are up for re-negotiation at the same time as the health accord and the feds have made no similar commitments to increase spending. The government could say it intends to put its emphasis on the growing seniors demographic and healthcare, rather than on the education, leaving the provinces little room to complain, since their transfers would be rising overall.
  • Josh Hjartarson, policy director at the Mowat Centre, said he would not be surprised if Ottawa is considering ways of clawing back some of the money it is set to send to the provinces for health care.
  • The Premiers are set to meet in January to come up with a common front to take into the meetings with the feds. Ottawa's advantage is that the provinces are easy to divide and conquer, particularly when it comes to equalization.
  • The McGuinty government has previously called on the federal government to transfer tax points - for example, Ottawa would hand over sales tax revenue and in return it would receive all corporate income tax revenues.
  • People familiar with the government position say redesignating tax powers are not on the government's radar screen right now.
  • "The entire suite of fiscal federalism is up for negotiation," said Mr. Hjartarson.
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