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Heather Farrow

Workers at Diagnostic Services of Manitoba begin strike vote | National Union of Public... - 0 views

nupge.ca/...ces-manitoba-begin-strike-vote

Manitoba union bargaining diagnostics

shared by Heather Farrow on 10 Aug 16 - No Cached
  • "A major issue for our rural diagnostic health care professionals is recruitment and retention, and being understaffed because jobs are not being filled. These professionals are having to work too much overtime and then have to be on call — it’s exhausting and isn’t sustainable.” — Michelle Gawronsky, President MGEU Winnipeg (9 Aug 2016) — Starting today for the next 2 weeks, workers at Diagnostic Services of Manitoba (DSM) — members of the Manitoba Government and General Employees' Union (MGEU/NUPGE) Locals 388–390, 392 and 393 — will take a strike vote at meetings across the province.
  • Employer's final offer didn't address workload and staffing issues
Irene Jansen

Robert Evans on doctor shortage Healthcare Policy Vol. 7 No. 2 :: Longwoods.com - 3 views

www.longwoods.com/22659

doctors hhr ally excellent

shared by Irene Jansen on 06 Sep 12 - No Cached
  • And second, a lid must be placed on APP program payments. Funding for benefit and incentive programs should be folded into the negotiation of fee schedules, recognizing that they are, like fees, simply part of the average prices physicians receive for their services.
    • Irene Jansen
      Irene Jansen on 06 Sep 12
       
      Alternative payments program (app) is the term used to describe the funding of physician services through means other than the fee-for-service method.
  • the coming increases in numbers have, once again, foreclosed for decades the possibilities for exploiting the full competence of complementary and substitute health personnel, expanding interprofessional team practice and in general, shifting the mix
  • Including rapid growth in net immigration, the annual "crop" has nearly doubled.
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  • Canadian medical schools have expanded their annual enrolment by 80% over the last 13 years
  • it is politically extremely difficult, almost impossible, to cut back on medical school places once they have been opened.2
  • In the last decade, medical expenditure per physician has also risen, by nearly 35% above general inflation.
  • Each of these waves of expansion responded to widespread perceptions of a looming "physician shortage." How accurate were those perceptions? In the case of the first wave, they rested on assumptions that were simply wrong, and by a wide margin. Medical schools were built to serve people who never arrived.
  • major increase in physician supply per capita, from 1970 to 1990, did not result in underemployed physicians. Utilization of physicians' services adapted to the increased supply. Whether the additional physicians were "needed," and what impact their activities might have had on the health of Canadians, are good and debatable questions
  • Does all this increased diagnostic activity among the very elderly actually generate health benefits?
  • As in the case of the previous major expansion, the impact on the total supply of physicians will unfold slowly, but relentlessly, over decades.
  • Table 1. Canadian health spending, percentage increase per capita, inflation-adjusted   1999–2004 2004–2009 1999–2009 Hospitals 19.1 11.7 33.0 Physicians 16.4 24.4 44.8 Rx drugs 46.1 19.0 73.7 Total health 22.2 16.5 42.3 Provincial governments 21.2 17.7 42.6  
  • Over the nine-year period, there were very large increases in the per capita volume of diagnostic services – imaging and laboratory tests. Adjusting for fee changes, per capita expenditures on these rose by 28.4% and 42.1%, respectively.
  • much greater among the older age groups – 59.4% and 64.4%, respectively, for those over 75
  • money has been poured into reimbursing diagnostic services for the elderly and very elderly, but access to primary care for the non-elderly appears to have been constrained
  • insofar as more recently trained physicians tend to be more reliant on the ever-expanding arsenal of diagnostic technology, overall expenditures per physician will continue to rise as their numbers grow
  • (Population has grown by about 14%.)
  • a lot of money is going out the door and no one has a clear picture of what it is buying
  • The question of Canadian physician supply is now moot. The new doctors are on their way, and whether or not we will need them all is no longer relevant. It may be that as cost containment efforts begin to bite we will again see renewed limits on the inflow of foreign-trained physicians, but we will not be able to turn down the domestic taps as supply increases.
  • Growth in diagnostic testing has to be brought under control, both in how ordering decisions are made and in how tests are paid for.
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).
  • ...16 more annotations...
  • 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
Govind Rao

Three quarters of guideline panellists have ties to the drug industry BMJ 2013; 347 doi... - 0 views

www.bmj.com/bmj.f4998

from heather drugs privatization

shared by Govind Rao on 14 Aug 13 - No Cached
  • Govind Rao on 14 Aug 13
     
    Ingrid Torjesen Author Affiliations The majority of health professionals in the United States who sit on guideline panels deciding the definitions or diagnostic criteria for common conditions have financial ties to pharmaceutical and medical device companies, a study has found.1 The researchers identified 16 publications by national and international guideline panels that had been published between 2000 and 2013 on the diagnosis of 14 common conditions. Of these, 10 proposed changes widening diagnostic definitions, one narrowing definitions, and the impact of the other five was unclear. Conditions that had their definitions expanded included high blood pressure, Alzheimer's disease, and rheumatoid arthritis. Panels widened definitions …
Govind Rao

Health Professions Regulatory Advisory Council (HPRAC) - Diagnostic Sonographers - 0 views

www.hprac.org/...Diagnostic_Sonographers.asp

from heather regulation Ontario

shared by Govind Rao on 19 Nov 13 - No Cached
  • Regulation of Diagnostic Sonography under the Regulated Health Professions Act, 1991  The Minister's Question On March 26, 2010, the Minister of Health and Long-Term Care, the Hon. Deb Matthews directed HPRAC to reference a previous HPRAC report and "make recommendations on the currency of, and any additions to, advice provided in relation to the regulation of Diagnostic Sonographers". On May 7, 2013, the Minister noted that there may be additional considerations related to the regulation of the profession; and further directed HPRAC to "conduct a broad public consultation with key groups and stakeholders within the diagnostic sonographer community who may not have been included in the original review." The minister extended the timeline for this referral and requested that HPRAC submit its advice by June 30, 2014.
Govind Rao

A look at the MRI plan - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|relp|20151019|231698836

from heather diagnostics Saskatchewan private clinics privatization

shared by Govind Rao on 19 Oct 15 - No Cached
  • The Leader-Post (Regina) Mon Oct 19 2015
  • The government announced changes to Saskatchewan's MRI process in the spring, and Premier Brad Wall has made it a priority to push the legislation through the house. The new system will allow people to pay a private clinic for an MRI, effectively skipping to the front of the queue. In return, the clinic will have to provide a second, free, MRI to the public system. Health Minister Dustin Duncan says it will chip away at ballooning wait times and provide more options to patients, but critics say the plan will create a two-tier health system and won't lessen waits at all. Here's a look at the government's plan.
  • The business case One of the biggest questions around the legislation is this: Will any private clinics bite? As Bryan Salte from the College of Physicians and Surgeons of Saskatchewan points out, between the investment in people and equipment, setting up a private clinic is "an expensive proposition," and he's "not sure it's a guaranteed way to make money." Duncan says government is "not going to force anybody to do this." At the end of the day, Duncan says, private clinics are "going to have to determine for themselves whether ... from their point of view, it's a sound business idea."
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  • Wait times Currently, MRI wait time trends are hard to figure out. Because there has been no consistent record-keeping, requests for data are met with several caveats. Looking at raw numbers, waits in 2014 were anywhere from within 24 hours for a Level 1 priority patient, to 287 days for a Level 4 patient. Current wait times also differ markedly between health regions - bad news if you're in Saskatoon, where for the past few years, average waits for all but Level 1 patients have been longer than in Regina. In 2014, for example, patients waited 10 days for a Level 2 scan in the Regina Qu'Appelle Health Region, compared with 19 days in the Saskatoon Health Region. Level 3 waits were 58 days in Regina and 86 in Saskatoon, and Level 4 waits were 96 and 120 days respectively. Duncan admits part of that might come down to overuse of diagnostic imaging - something the Saskatchewan Medical Association and government are working on.
  • That's backed up by the fact that in the past eight years, the number of publicly funded scans in Saskatchewan has more than doubled and there are more MRI machines, but it hasn't made a dent in wait times. Health policy analyst Steven Lewis can't see the new approach reducing waits, because the only way you do so "is if demand stays constant while you're increasing capacity - and that never happens." Duncan is convinced the new approach "will help toward wait times," but Dr. Ryan Meili, a family physician in Saskatoon and vicechair of Canadian Doctors for Medicare, disagrees. As evidence, Meili points to Alberta. It has private MRIs, he says, yet it "has the longest wait times for MRIs in the country." Erosion of public health?
  • You would expect Meili to be ideologically opposed to the privatization of MRIs - after all, he ran for NDP leadership and is a vocal opponent of privatizing any aspect of health care - but he also has "evidence-based" objections. "It starts to just further reinforce this idea that we need to privatize care, piece by piece, and it erodes confidence in the system," he says. Duncan argues that paying out of pocket for MRIs already "happens in Saskatchewan today" when people head to Alberta or the U.S. for a scan. The provincial health system doesn't stop them, he says, but "we don't get any benefit from people doing that." Duncan says at least this way, "the public system will get a scan for each one paid for out of pocket."
  • Because MRIs are generally a diagnostic tool, Lewis says the biggest risk in the change is that people who need a scan and pay out of pocket will end up getting treatment sooner than those who don't pony up the cash. "It's troublesome on so many levels," he says. egraney@leaderpost.com Twitter/LP_EmmaGraney
Irene Jansen

Private 3T MRI clinic spurs concerns: New Brunswick Telegraph-Journal - 0 views

www.evernote.com/...a5402c65e183bcbdf0e5f1b2fc4d2b

nb private clinics diagnostics

shared by Irene Jansen on 18 Oct 12 - No Cached
  • There are concerns among New Brunswick physicians that a soon-to-be-operational private MRI clinic is opening the door to queue-jumpers with deep pockets.
  • roughly $900 fee
  • "There are certainly some concerns," Anthony Knight, CEO of the New Brunswick Medical Society
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  • Opposition Liberal health critic Bill Fraser said there are many questions about the private clinic, including what kind of oversight and safety practices the province will be enforcing.
  • "This is a major piece of equipment, and it is not without health concerns both in sighting, installation and use of the magnet," said Whelan, chief of diagnostic imaging at the Saint John Regional Hospital.
  • Knight said he's not sure there is much need in New Brunswick for the private service. The New Brunswick government has recently invested in the purchase of five smaller 1.5 MRI machines for hospitals across the province. As well, it is looking at buying 3T MRIs for the Saint John Regional and the Moncton Hospital.
  • Who OK'd the use of this in the province? Did the private operators have to jump through the same kind of hoops we have to go through in the hospital?"
  • "We have 70 per cent of patients who can get diagnostic imaging access within one month, according to data from the New Brunswick Health Council. We also know that patients who are the sickest get care immediately, including MRI scans. So it's the less urgent cases who will be pursuing this private service."
  • The clinic's clients must have a referral for a scan from a doctor.
  • will employ four full-time technicians and one nurse
  • It is a client's doctor who makes the final diagnosis and determines with the patient where to go from there.
  • A private MRI clinic has been operating in Nova Scotia for almost 10 years. Across Canada, there are at least 40 for-profit magnetic resonance imaging (MRI) and computed tomography (CT) clinics.
Govind Rao

Contracting out of surgical preparation and delivery - 2 views

www.ochu.on.ca/contracting_out.php

from heather cupe ontario hospital private clinics privatization

shared by Govind Rao on 24 Nov 14 - No Cached
  • Contracting Out Hospital Work to Private Clinics – Backgrounder For years CUPE has been concerned the Ontario government would transfer public hospital surgeries and diagnostic tests to private clinics. CUPE began campaigning in earnest against this possibility some years ago with a tour of the province by British Health Secretary Frank Dobson who talked about the disastrous British experience with private surgical clinics.Unfortunately, the provincial Liberal government has now moved in this direction. The door opened a few years ago with the introduction of fee for service hospital funding (sometimes called Activities Based Funding). Then in the fall of 2013 the government announced regulatory changes to facilitate this privatization, with the government finally announcing Request for Proposals for the summer of 2014.
  • Hospitals are the main focus of the government’s health care cuts. They do not see community hospitals as providing a broad range of services to the local ... [Read More]population, but instead wish to remove an untold range of services from local hospitals and transfer them to specialized private clinics. The proposal would remove the most lucrative, high volume and easiest procedures from community hospitals. The remaining community hospitals would be left with the most difficult services. If they chose to compete with the private clinics, they would have to specialize in a narrow range of services. The government’s plan is the opposite of one-stop, integrated public health care. This proposed privatization of surgeries and diagnostic tests is in addition to the aggressive attempts to remove non-acute care services from hospitals (e.g. outpatient clinics, complex continuing care, rehabilitation, long-term care, primary care, etc.). As acute care currently accounts for only about 1/3 of current hospital funding, these attacks are a grave threat to the viability of community hospitals, and in fact we are now seeing a wave of hospital shut-downs that is somewhat reminiscent of the Mike Harris era. Despite the government’s rhetoric about keeping care non-profit, services that are being cut from local hospitals now are being privatized to for-profit owned corporations. Even if the private clinics did start out as non-profit (which has not been the case so far) the whole system of private clinics could be privatized with a stroke of a pen.
  • Ontario Health Care Privatization: The push for health care privatization in Ontario picked up in 2001 when Ontario Health Minister Tony Clement announced two privatized P3 hospital projects, the Royal Ottawa and the Brampton Civic (part of William Osler Health Centre). Spirited community-based campaigns, including P3 plebiscites in many towns, forced the Liberal government to greatly narrow the scope of the privatization of support jobs (i.e. CUPE jobs) in subsequent P3 hospitals. Nevertheless privatization of the hospital financing continues, despite revelations by the provincial Auditor General that confirmed claims by CUPE and others that the Osler project cost hundreds of millions more due to the P3.
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  • MRI and CT Clinics: The PC government also tried to set up private MRI and CT clinics outside of hospitals. Community/labour campaigns however were able to stop this. A key factor was that, to increase their revenue, the private clinics were allowed to bill private patients for a certain number of hours each week (with the rest of the week dedicated to patients paid for by the public system). As the public insurance system must pay for all ‘medically necessary’ hospital services, the government was left to try to explain why any reputable clinic would allow patients to subject themselves to such tests for medically unnecessary reasons. Since this episode, private clinics have been in the news – but mostly for the wrong reasons. Private surgical and diagnostic clinics: Initially, the government let the emerging industry slip entirely free of public reporting and oversight. However, after the September 2007 death of Krista Stryland, a young mother who underwent liposuction at a Toronto cosmetic clinic, the government required the industry to face some modest oversight in 2010. Unfortunately this was not by a public authority, but through self-regulation by the doctors (even though the doctors themselves had lobbied to expand this private industry).
  • Then in the fall of 2011, following disclosure that 6,800 patients would have to be notified that faulty infection control procedures at a private clinic could have exposed them to HIV or hepatitis, the then Health Minister, Deb Matthews, declined to introduce oversight by a public authority, despite public pressure. Instead she comments, “Government can’t do everything. A professional (regulating body) like the College of Physicians and Surgeons, they take responsibility for their members....At this point I am delighted the College is taking that responsibility seriously and has found a problem that we need to fix.” Eventually the College of Physicians and Surgeons released a report on the private clinics that mentions that some 29% of the private clinics fall short in some way – but the College would not indicate which ones – or how they fell short. This caused public uproar, with the Toronto Star playing a leading role (as it would continue to do). Again, the government promised improvements. In the last two months however, the Star has followed up and revealed (after our urging) that the public reports from the College of Physicians and Surgeons fall far short. They also ran a series of often front page stories on serious quality problems at private clinics.
Cheryl Stadnichuk

More than 500 doctors billed Ontario for more than $1 million in fees last year, health... - 0 views

news.nationalpost.com/...fees-last-year-health-minister

physicians billing ontario

shared by Cheryl Stadnichuk on 25 Apr 16 - No Cached
  • The most expensive doctor in Ontario, an eye specialist, billed the province for $6.6 million last year. We don’t know his or her name or where he or she practices, but we know how much that work costs taxpayers each year thanks to a release Friday by the Ontario government of the billing information of the province’s most expensive doctors. Getty Images/ThinkstockThe Ontario Medical Association says physicians have already seen a 6.9 per cent cut over the last year, but the province wants to rein in fees for radiologists and other specialists. Over the 2014 to 2015 time period, more than 500 doctors billed the province for more than $1 million in fees. They represent just two per cent of all doctors, but cost $677 million a year, or over six per cent of the more than $11-billion Ontario spends each year on physician compensation. And many of them charge much more than $1 million, the government’s release shows. Thirty-six billed more than $2 million.
  • The release intends to debunk a recent ad campaign from the Ontario Medical Association (OMA) arguingthe province’s efforts to rein in certain types of doctors’ fees is hurting patient care. It’s all part of a years-long dispute over doctor fees that’s pitted MDs against the province in a war over patients’ (and voters) hearts and minds. Yet, it’s not family doctors’ fees and their practices that Health Minister Eric Hoskins wants to see reduced, but the most costly specialists’ billings.
  • “It’s not our neurosurgeons who are billing over $1 million,” Hoskins said, “It’s a very narrow category of specialists. The data released shows three specialties tend to bill the most of the 506 doctors who topped $1 million: 154 diagnostic radiologists made the list, 85 opthamologists (eye surgeons) and 57 cardiologists. Twenty-five of the highest billing doctors specialize in addictions and prescribing methadone. 
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  • He wants the OMA to return to the negotiating table and discuss lowering some of the 7,300 fees on the physicians’ pay schedule. He said the province has made no less than 80 offers since talks broke down two years ago — close to one a week — to no avail. If they don’t, he said he’s prepared to make another unilateral cut (even though the cuts imposed in 2015 have already sparked the second Charter challenge from the OMA this decade). “If necessary we will be forced to make those changes,” he said. Hoskins doesn’t want to cut back on all doctors’ pay, but create a more equal system that doesn’t go over budget every single years, as has historically been the case.
  • “The top biller, an ophthalmologist, billed more than $6.6 million last year. The top diagnostic radiologist billed more than $5.1 million and the top anesthesiologist billed more than $3.8 million,” a government fact-sheet states. That’s far above the average doctor’s gross payment of $368,000 a year. And though the OMA argues that often doesn’t account for overhead and staffing costs, the province also subsidizes pay in many indirect and direct ways, including allowing doctors to incorporate, which reduces tax and liability burdens. Ontario, unlike many provinces, covers 80 per cent of doctors’ liability insurance. Hoskins said the ministry even sometimes covers hardware costs like computers.
  • Hoskins says his goal is to make things more equal and better distribute the money going to certain specialists whose work has gotten easier. MRIs and CT scans used to take an hour, now they take 20 minutes. Same with cataract surgery — that’s why diagnostic radiologists and eye surgeons are so disproportionally represented on the list.
Irene Jansen

Medical scan mistakes: what's behind the problems? - Health - CBC News - 1 views

www.cbc.ca/...cal-scans-problems-review.html

diagnostics errors private clinics regulation

shared by Irene Jansen on 12 Apr 12 - No Cached
  • A review by the B.C. Patient Safety and Quality Council eventually showed that these four radiologists were not qualified to read the scans they were interpreting.
  • A similar problem surfaced in Quebec just a couple of weeks ago, when a review of thousands of mammograms flagged for possible errors found 109 breast cancers that were missed. Newfoundland, Saskatchewan and Alberta have also faced problems with potential misinterpretations of medical scans.
  • medical imaging has always been an inexact science, but part of the problem stems from rapid advances in diagnostic imaging technology in the last decade.
  • ...4 more annotations...
  • Not only is there more data, analyzing these scans is not as simple
  • another factor is the plethora of scans and images on record which make it easy to scrutinize the work of doctors after the fact.
  • But Jean-François Leroux, whose Montreal law firm represents nine women considering or already taking legal action against a Quebec radiologist who missed dozens of breast cancers, says these were not isolated incidents. "It was really the absence of any control of the quality of the procedures," he said.
  • The Quebec College of Physicians has recommended better oversight of radiologists, digitized mammograms to make them easier for others to consult and more uniform standards for private clinics.
Irene Jansen

Health Council of Canada / Conseil canadien de la santé - Decisions,Decisions... - 0 views

healthcouncilcanada.ca/...index.php

doctors prescribing guidelines diagnostics

shared by Irene Jansen on 07 Feb 12 - No Cached
  • Decisions, Decisions: Family Doctors as Gatekeepers to Prescription Drugs and Diagnostic Imaging in Canada, calls for better management of prescription drugs and diagnostic imaging services in this country. The report examines the increasingly complex role of family physicians and the effects of their decisions on usage of Canada's health care services.
Irene Jansen

Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Inc... - 1 views

www.plosmedicine.org/...10.1371%2Fjournal.pmed.1001244

privatization quality costs excellent

shared by Irene Jansen on 31 Mar 13 - No Cached
  • Studies evaluated in this systematic review do not support the claim that the private sector is usually more efficient, accountable, or medically effective than the public sector
  • Irene Jansen on 31 Mar 13
     
    Summary by Anna Marriott, Oxfam Access and responsiveness * Studies that measured utilization by income levels tended to find the private sector predominately serves the more affluent. In Colombo, Sri Lanka, where a universal public health service exists, the private sector provided 72% of childhood immunisations for the wealthiest, but only 3% for the poorest. * Waiting times are consistently reported to be shorter in private facilities and a number of studies found better hospitality, cleanliness and courtesy and availability of staff in the private sector. Quality * Available studies find diagnostic accuracy, adherence to medical management standards and prescription practices are worse in the private sector. * Prescribing subtherapeutic doses, failure to provide oral rehydration salts, and prescribing of unnecessary antibiotics were more likely in the private sector, although there were exceptions. * Higher rates of potentially unnecessary procedures, particularly C-sections, were reported at private facilities. In South Africa for example, 62% of women delivering in the private sector had C-sections, compared with 18% in the public sector. * Two country studies found a lack of drug availability and service provision at public facilities, while surveys of patients' perceptions on care quality in the public and private sector provided mixed results. Patient outcomes * Public sector provision was associated with higher rates of treatment success for tuberculosis and HIV as well as vaccination. In South Korea for example, TB treatment success rates were 52% in private and 80% in public clinics. Similar figures were found for HIV treatment in Botswana. Accountability, transparency and regulation * While national statistics collected from public sector clinics vary considerably in quality, private healthcare systems tended to lack published data on outcomes altogether. Public-private partnerships also lacked data. * Several reports ob
Cheryl Stadnichuk

Saskatchewan Health Minister Dustin Duncan's compelling case for private MRIs | Regina ... - 0 views

leaderpost.com/...se-for-private-mris-compelling

private clinics SK

shared by Cheryl Stadnichuk on 16 Jun 16 - No Cached
  • Comment Print When it comes to the numbers, the take-up for the Saskatchewan Party government’s privatized diagnostic imaging tests has not yet been what you would call overwhelming. In the two months since two Regina facilities were licensed to provide private-pay MRIs, the numbers show 258 patients used them. This includes 77 patients who paid for their own scans plus several organizations — yes, including the Saskatchewan Roughriders — that forked over cash for preferential treatment. These numbers are too small to point to to the success of the program, but, in turn, they sure don’t solidify
  • the worst fears of medicare purists that the rich would be leaping at the opportunity for early diagnosis just so they could jump the queue for surgery.
  • Most significant are the problems of keeping up with the demand for diagnostics and the cost of paying for it all. This is reflected in numbers showing that in an 11-month period ending in February, the number of people on Saskatchewan’s CT wait list increased by 29 per cent, to 3,823 from 2,954. Wait times for non-urgent CTs averaged 119 days. Moreover, the Regina Qu’Appelle Health Region’s contract with the private CT providers ($183.85 per exam) is significantly less than the in-hospital cost of $230 to $240. “It really has added to the capacity within the system without costing the taxpayers any dollars,” Duncan told reporters last week. “We’re just getting a better price when we go to the market.”
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  • At a time when the government is grappling with a 2016-17 budget deficit, an added $2.6 billion in debt in the past years and a desire to hold the line on spending in 2017-18, the practicality of reducing costs simply cannot be overlooked
Heather Farrow

Quebec plans to introduce 50 superclinics by 2018 | Montreal Gazette - 0 views

montrealgazette.com/...-to-ease-pressure-on-hospitals

Quebec private clinics legislation cma

shared by Heather Farrow on 02 May 16 - No Cached
  • April 25, 2016
  • Quebec Health Minister Gaétan Barrette has announced a plan to introduce 50 so-called superclinics in the province to offer front-line health services and ease the crush of cases in emergency rooms. “We are one step closer to strengthening and consolidating the organization of medical services for the entire population of Quebec,” Barrette said Monday. “Complementing services offered by family medicine groups, the superclinic model will reduce the waiting time for emergencies and provide faster access to primary care and specialized services.” Barrette, who is hoping to have the clinics operating by 2018, said those who’d benefit in particular are people still looking for a family doctor.
  • Heather Farrow on 02 May 16
     
    Quebec will open 50 "superclinics" by 2018 to reduce the pressure on emergency rooms from non-urgent medical cases and provide faster access to primary and specialty services. The clinics will be required to run at least 12 hours a day; offer blood-testing and diagnostic imaging; and provide 80% of services to people without a family doctor.
Irene Jansen

Senate Social Affairs Committee review of the health accord- Evidence - March 10, 2011 - 0 views

www.parl.gc.ca/...22evb-e.htm

accord senate

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Dr. Jack Kitts, Chair, Health Council of Canada
  • In 2008, we released a progress report on all the commitments in the 2003 Accord on Health Care Renewal, and the 10-year plan to strengthen health care. We found much to celebrate and much that fell short of what could and should have been achieved. This spring, three years later, we will be releasing a follow-up report on five of the health accord commitments.
  • We have made progress on wait times because governments set targets and provided the funding to tackle them. Buoyed by success in the initial five priority areas, governments have moved to address other wait times now. For example, in response to the Patients First review, the Saskatchewan government has promised that by 2014, no patient will wait longer than three months for any surgery. Wait times are a good example that progress can be made and sustained when health care leaders develop an action plan and stick with it.
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  • Canada has catching up to do compared to other OECD countries. Canadians have difficulty accessing primary care, particularly after hours and on weekends, and are more likely to use emergency rooms.
  • only 32 per cent of Canadians had access to more than one primary health care provider
  • In Peterborough, Ontario, for example, a region-wide shift to team-based care dropped emergency department visits by 15,000 patients annually and gave 17,000 more access to primary health care.
  • We believe that jurisdictions are now turning the corner on primary health care
  • Sustained federal funding and strong jurisdictional direction will be critical to ensuring that we can accelerate the update of electronic health records across the country.
  • The creation of a national pharmaceutical strategy was a critical part of the 10-year plan. In 2011, today, unfortunately, progress is slow.
  • Your committee has produced landmark reports on the importance of determinants of health and whole-of- government approaches. Likewise, the Health Council of Canada recently issued a report on taking a whole-of- government approach to health promotion.
  • there have also been improvements on our capacity to collect, interpret and use health information
  • Leading up to the next review, governments need to focus on health human resources planning, expanding and integrating home care, improved public reporting, and a continued focus on quality across the entire system.
  • John Wright, President and CEO, Canadian Institute for Health Information
  • While much of the progress since the 10-year plan has been generated by individual jurisdictions, real progress lies in having all governments work together in the interest of all Canadians.
  • the Canada Health Act
  • Since 2008, rather than repeat annual reporting on the whole, the Health Council has delved into specific topic areas under the 2003 accord and the 10-year plan to provide a more thorough analysis and reporting.
  • We have looked at issues around pharmaceuticals, primary health care and wait times. Currently, we are looking at the issues around home care.
  • John Abbott, Chief Executive Officer, Health Council of Canada
  • I have been a practicing physician for 23 years and a CEO for 10 years, and I would say, probably since 2005, people have been starting to get their heads around the fact that this is not sustainable and it is not good quality.
  • Much of the data you hear today is probably 18 months to two years old. It is aggregate data and it is looking at high levels. We need to get down to the health service provider level.
  • The strength of our ability to report is on the data that CIHI and Stats Canada has available, what the research community has completed and what the provinces, territories and Health Canada can provide to us.
  • We have a very good working relationship with the jurisdictions, and that has improved over time.
  • One of the strengths in the country is that at the provincial level we are seeing these quality councils taking on significant roles in their jurisdictions.
  • As I indicated in my remarks, dispute avoidance activity occurs all the time. That is the daily activity of the Canada Health Act division. We are constantly in communication with provinces and territories on issues that come to our attention. They may be raised by the province or territory, they may be raised in the form of a letter to the minister and they may be raised through the media. There are all kinds of occasions where issues come to our attention. As per our normal practice, that leads to a quite extensive interaction with the province or territory concerned. The dispute avoidance part is basically our daily work. There has never actually been a formal panel convened that has led to a report.
  • each year in the Canada Health Act annual report, is a report on deductions that have been made from the Canada Health Transfer payments to provinces in respect of the conditions, particularly those conditions related to extra billing and user fees set out in the act. That is an ongoing activity.
  • there has been progress. In some cases, there has been much more than in others.
  • How many government programs have been created as a result of the accord?
  • The other data set is on bypass surgery that is collected differently in Quebec. We have made great strides collectively, including Quebec, in developing the databases, but it takes longer because of the nature and the way in which they administer their systems.
  • I am a director of the foundation of St. Michael's Hospital in Toronto
  • Not everyone needs to have a family doctor; they need access to a family health team.
  • With all the family doctors we have now after a 47-per-cent-increase in medical school enrolment, we just need to change the way we do it.
  • The family doctors in our hospital feel like second-class citizens, and they should not. Unfortunately, although 25 years ago the family doctor was everything to everybody, today family doctors are being pushed into more of a triage role, and they are losing their ability.
  • The problem is that the family doctor is doing everything for everybody, and probably most of their work is on the social end as opposed to diagnostics.
  • At a time when all our emergency departments are facing 15,000 increases annually, Peterborough has gone down 15,000, so people can learn from that experience.
  • The family health care team should have strong family physicians who are focused on diagnosing, treating and controlling chronic disease. They should not have to deal with promotion, prevention and diet. Other health providers should provide all of that care and family doctors should get back to focus.
  • I have to be able to reach my doctor by phone.
  • They are busy doing all of the other things that, in my mind, can be done well by a team.
  • That is right.
  • if we are to move the yardsticks on improvement, sustainability and quality, we need that alignment right from the federal government to the provincial government to the front line providers and to the health service providers to say, "We will do this."
  • We want to share best practices.
  • it is not likely to happen without strong direction from above
  • Excellent Care for All Act
  • quality plans
  • with actual strategies, investments, tactics, targets and outcomes around a number of things
  • Canadian Hospital Reporting Project
  • by March of next year we hope to make it public
  • performance, outcomes, quality and financials
  • With respect to physicians, it is a different story
  • We do not collect data on outcomes associated with treatments.
  • which may not always be the most cost effective and have the better outcome.
  • We are looking at developing quality indicators that are not old data so that we can turn the results around within a month.
  • Substantive change in how we deliver health care will only be realized to its full extent when we are able to measure the cost and outcome at the individual patient and the individual physician levels.
  • In the absence of that, medicine remains very much an art.
  • Senator Eaton
  • There are different types of benchmarks. For example, there is an evidence-based benchmark, which is a research of the academic literature where evidence prevails and a benchmark is established.
  • The provinces and territories reported on that in December 2005. They could not find one for MRIs or CT scans. Another type of benchmark coming from the medical community might be a consensus-based benchmark.
  • universal screening
  • A year and a half later, we did an evaluation based on the data. Increased costs were $400 per patient — $1 million in my hospital. There was no reduction in outbreaks and no measurable effect.
  • For the vast majority of quality benchmarks, we do not have the evidence.
  • A thorough research of the literature simply found that there are no evidence-based benchmarks for CT scans, MRIs or PET scans.
  • We have to be careful when we start implementing best practices because if they are not based on evidence and outcomes, we might do more harm than good.
  • The evidence is pretty clear for the high acuity; however, for the lower acuity, I do not think we know what a reasonable wait time is
  • If you are told by an orthopaedic surgeon that there is a 99.5 per cent chance that that lump is not cancer, and the only way you will know for sure is through an MRI, how long will you wait for that?
  • Senator Cordy: Private diagnostic imaging clinics are springing up across all provinces; and public reaction is favourable. The public in Nova Scotia have accepted that if you want an MRI the next day, they will have to pay $500 at a private clinic. It was part of the accord, but it seems to be the area where we are veering into two-tiered health care.
  • colorectal screening
  • the next time they do the statistics, there will be a tremendous improvement, because there is a federal-provincial cancer care and front-line provider
  • adverse drug effects
  • over-prescribing
  • There are no drugs without a risk, but the benefits far outweigh the risks in most cases.
  • catastrophic drug coverage
  • a patchwork across the country
  • with respect to wait times
  • Having coordinated care for those people, those with chronic conditions and co-morbidity, is essential.
  • The interesting thing about Saskatchewan is that, on a three-year trending basis, it is showing positive improvement in each of the areas. It would be fair to say that Saskatchewan was a bit behind some of the other jurisdictions around 2004, but the trending data — and this will come out later this month — shows Saskatchewan making strides in all the areas.
  • In terms of the accord itself, the additional funds that were part of the accord for wait-times reduction were welcomed by all jurisdictions and resulted in improvements in wait times, certainly within the five areas that were identified as well as in other surgical areas.
  • We are working with the First Nations, Statistics Canada, and others to see what we can do in the future about identifiers.
  • Have we made progress?
  • I do not think we have the data to accurately answer the question. We can talk about proxies for data and proxies for outcome: Is it high on the government's agenda? Is it a directive? Is there alignment between the provincial government and the local health service providers? Is it a priority? Is it an act of legislation? The best way to answer, in my opinion, is that because of the accord, a lot of attention and focus has been put on trying to achieve it, or at least understanding that we need to achieve it. A lot of building blocks are being put in place. I cannot tell you exactly, but I can give you snippets of where it is happening. The Excellent Care For All Act in Ontario is the ultimate building block. The notion is that everyone, from the federal, to the provincial government, to the health service providers and to the CMA has rallied around a better health system. We are not far from giving you hard data which will show that we have moved yardsticks and that the quality is improving. For the most part, hundreds of thousands more Canadians have had at least one of the big five procedures since the accord. I cannot tell you if the outcomes were all good. However, volumes are up. Over the last six years, everybody has rallied around a focal point.
  • The transfer money is a huge sum. The provinces and territories are using the funds to roll out their programs and as they best see fit. To what extent are the provinces and territories accountable to not just the federal government but also Canadians in terms of how effectively they are using that money? In the accord, is there an opportunity to strengthen the accountability piece so that we can ensure that the progress is clear?
  • In health care, the good news is that you do not have to incent people to do anything. I do not know of any professionals more competitive than doctors or executives more competitive than executives of hospitals. Give us the data on how we are performing; make sure it is accurate, reliable, and reflective, and we will move mountains to jump over the next guy.
  • There have been tremendous developments in data collection. The accord played a key role in that, around wait times and other forms of data such as historic, home care, long term care and drug data that are comparable across the country. Without question, there are gaps. It is CIHI's job to fill in those gaps as resources permit.
  • The Health Council of Canada will give you the data as we get it from the service providers. There are many building blocks right now and not a lot of substance.
  • send him or her to the States
  • Are you including in the data the percentage of people who are getting their work done elsewhere and paying for it?
  • When we started to collect wait time data years back, we looked at the possibility of getting that number. It is difficult to do that in a survey sampling the population. It is, in fact, quite rare that that happens.
  • Do we have a leader in charge of this health accord? Do we have a business plan that is reviewed quarterly and weekly so that we are sure that the things we want worked on are being worked on? Is somebody in charge of the coordination of it in a proper fashion?
  • Dr. Kitts: We are without a leader.
  • Mr. Abbott: Governments came together and laid out a plan. That was good. Then they identified having a pharmaceutical strategy or a series of commitments to move forward. The system was working together. When the ministers and governments are joined, progress is made. When that starts to dissipate for whatever reason, then we are 14 individual organization systems, moving at our own pace.
  • You need a business plan to get there. I do not know how you do it any other way. You can have ideas, visions and things in place but how do you get there? You need somebody to manage it. Dr. Kitts: I think you have hit the nail on the head.
  • The Chair: If we had one company, we would not have needed an accord. However, we have 14 companies.
  • There was an objective of ensuring that 50 per cent of Canadians have 24/7 access to multidisciplinary teams by 2010. Dr. Kitts, in your submission in 2009, you talked about it being at 32 per cent.
  • there has been a tremendous focus for Ontario on creating family health teams, which are multidisciplinary primary health care teams. I believe that is the case in the other jurisdictions.
  • The primary health care teams, family health care teams, and inter-professional practice are all essentially talking about the same thing. We are seeing a lot of progress. Canadian Health Services Research Foundation is doing a lot of work in this area to help the various systems to embrace it and move forward.
  • The question then came up about whether 50 per cent of the population is the appropriate target
  • If you see, for instance, what the Ontario government promotes in terms of needing access, they give quite a comprehensive list of points of entry for service. Therefore, in terms of actual service, we are seeing that points of service have increased.
  • The key thing is how to get alignment from this accord in the jurisdictions, the agencies, the frontline health service providers and the docs. If you get that alignment, amazing things will happen. Right now, every one of those key stakeholders can opt out. They should not be allowed to opt out.
  • the national pharmaceutical strategy
  • in your presentation to us today, Dr. Kitts, you said it has stalled. I have read that costing was done and a few minor things have been achieved, but really nothing is coming forward.
  • The pharmacists' role in health care was good. Procurement and tendering are all good. However, I am not sure if it will positively impact the person on the front line who is paying for their drugs.
  • The national pharmaceutical strategy had identified costing around drugs and generics as an issue they wanted to tackle. Subsequently, Ontario tackled it and then other provinces followed suit. The question to ask is: Knowing that was an issue up front, why would not they, could not they, should not they have acted together sooner? That was the promise of the national pharmaceutical strategy, or NPS. I would say it was an opportunity lost, but I do not think it is lost forever.
  • Irene Jansen on 23 Jan 12
     
    CIHI Health Canada Statistics Canada
Irene Jansen

Senate Social Affairs Committee review of the health accord, Evidence, September 29, 2011 - 0 views

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accord waits senate

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  • Christine Power, Chair, Board of Directors, Association of Canadian Academic Healthcare Organizations
  • eight policy challenges that can be grouped across the headers of community-based and primary health care, health system capacity building and research and applied health system innovation
  • Given that we are seven plus years into the 2004 health accord, we believe it is time to open a dialogue on what a 2014 health accord might look like. Noting the recent comments by the Prime Minister and Minister of Health, how can we improve accountability in overall system performance in terms of value for money?
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  • While the access agenda has been the central focal point of the 2004 health accord, it is time to have the 2014 health accord focus on quality, of which access is one important dimension, with the others being effectiveness, safety, efficiency, appropriateness, provider competence and acceptability.
  • we also propose three specific funds that are strategically focused in areas that can contribute to improved access and wait time
  • Can the 2014 health accord act as a catalyst to ensure appropriate post-hospital supportive and preventive care strategies, facilitate integration of primary health care with the rest of the health care system and enable innovative approaches to health care delivery? Is there an opportunity to move forward with new models of primary health care that focus on personal accountability for health, encouraging citizens to work in partnership with their primary care providers and thereby alleviating some of the stress on emergency departments?
  • one in five hospital beds are being occupied by those who do not require hospital care — these are known as alternative level of care patients, or ALC patients
  • the creation of an issue-specific strategically targeted fund designed to move beyond pilot projects and accelerate the creation of primary health care teams — for example, team-based primary health care funds could be established — and the creation of an infrastructure fund, which we call a community-based health infrastructure fund to assist in the development of post-hospital care capacity, coupled with tax policies designed to defray expenses associated with home care
  • consider establishing a national health innovation fund, of which one of its stated objectives would be to promote the sharing of applied health system innovations across the country with the goal of improving the delivery of quality health services. This concept would be closely aligned with the work of the Canadian Institutes of Health Research in developing a strategy on patient oriented research.
  • focus the discussion on what is needed to ensure that Canada is a high performing system with an unshakable focus on quality
  • of the Wait Time Alliance
  • Dr. Simpson
  • the commitment of governments to improve timely access to care is far from being fulfilled. Canadians are still waiting too long to access necessary medical care.
  • Table 1 of our 2011 report card shows how provinces have performed in addressing wait times in the 10-year plan's five priority areas. Of note is the fact that we found no overall change in letter grades this year over last.
  • We believe that addressing the gap in long-term care is the single more important action that could be taken to improve timely access to specialty care for Canadians.
  • The WTA has developed benchmarks and targets for an additional seven specialties and uses them to grade progress.
  • the lack of attention given to timely access to care beyond the initial five priority areas
  • all indications are that wait times for most specialty areas beyond the five priority areas are well beyond the WTA benchmarks
  • we are somewhat encouraged by the progress towards standardized measuring and public reporting on wait times
  • how the wait times agenda could be supported by a new health accord
  • governments must improve timely access to care beyond the initial five priority areas, as a start, by adopting benchmarks for all areas of specialty care
  • look at the total wait time experience
  • The measurements we use now do not include the time it takes to see a family physician
  • a patient charter with access commitments
  • Efficiency strategies, such as the use of referral guidelines and computerized clinical support systems, can contribute significantly to improving access
  • In Ontario, for example, ALC patients occupy one in six hospital beds
  • Our biggest fear is government complacency in the mistaken belief that wait times in Canada largely have been addressed. It is time for our country to catch up to the other OECD countries with universal, publicly funded health care systems that have much timelier access to medical care than we do.
  • The progress that has been made varies by province and by region within provinces.
  • Dr. Michael Schull, Senior Scientist, Institute for Clinical Evaluative Sciences
  • Many provinces in Canada, and Ontario in particular, have made progress since the 2004 health accord following large investments in health system performance that targeted the following: linking more people with family doctors; organizational changes in primary care, such as the creation of inter-professional teams and important changes to remuneration models for physicians, for example, having a roster of patients; access to select key procedures like total hip replacement and better access to diagnostic tests like computer tomography. As well, we have seen progress in reducing waiting times in emergency departments in some jurisdictions in Canada and improving access to community-based alternatives like home care for seniors in place of long-term care. These have been achieved through new investments such as pay for performance incentives and policy change. They have had some important successes, but the work is incomplete.
  • Examples of the ongoing challenges that we face include substantial proportions of the population who do not have easy access to a family doctor when needed, even if they have a family doctor; little progress on improving rates of eligible patients receiving important preventive care measures such as pap smears and mammograms; continued high utilization of emergency departments and walk-in clinics compared to other countries; long waits, which remain a problem for many types of care. For example, in emergency departments, long waits have been shown to result in poor patient experience and increased risk of adverse outcomes, including deaths.
  • Another example is unclear accountability and antiquated mechanisms to ensure smooth transitions in care between providers and provider organizations. An example of a care transition problem is the frequent lack of adequate follow-up with a family doctor or a specialist after an emergency department visit because of exacerbation of a chronic disease.
  • A similar problem exists following discharge from hospital.
  • Poorly integrated and coordinated care leads to readmission to hospital
  • This happens despite having tools to predict which patients are at higher risk and could benefit from more intensive follow-up.
  • Perverse incentives and disincentives exist, such as no adjustment in primary care remuneration to care for the sickest patients, thereby disincenting doctors to roster patients with chronic illnesses.
  • Critical reforms needed to achieve health system integration include governance, information enablers and incentives.
  • we need an engaged federal government investing in the development and implementation of a national health system integration agenda
  • complete absence of any mention of Canada as a place where innovative health system reform was happening
  • Dr. Brian Postl, Dean of Medicine, University of Manitoba, as an individual
  • the five key areas of interest were hips and knees, radiology, cancer care, cataracts and cardiac
  • no one is quite sure where those five areas came from
  • There was no scientific base or evidence to support any of the benchmarks that were put in place.
  • I think there is much less than meets the eye when we talk about what appropriate benchmarks are.
  • The one issue that was added was hip fractures in the process, not just hip and knee replacement.
  • in some areas, when wait-lists were centralized and grasped systematically, the list was reduced by 30 per cent by the act of going through it with any rigour
  • When we started, wait-lists were used by most physicians as evidence that they were best of breed
  • That continues, not in all areas, but in many areas, to be a key issue.
  • The capacity of physicians to give up waiting lists into more of a pool was difficult because they saw it very much, understandably, as their future income.
  • There were almost no efforts in the country at the time to use basic queuing theory
  • We made a series of recommendations, including much more work on the research about benchmarks. Can we actually define a legitimate benchmark where, if missed, the evidence would be that morbidity or mortality is increasing? There remains very little work done in that area, and that becomes a major problem in moving forward into other benchmarks.
  • the whole process needed to be much more multidisciplinary in its focus and nature, much more team-based
  • the issue of appropriateness
  • Some research suggests the number of cataracts being performed in some jurisdictions is way beyond what would be expected to be needed
  • the accord did a very good job with what we do, but a much poorer job around how we do it
  • Most importantly, the use of single lists is needed. This is still not in place in most jurisdictions.
  • the accord has bought a large amount of volume and a little bit of change. I think any future accords need to lever any purchase of volume or anything else with some capacity to purchase change.
  • We have seen volumes increase substantially across all provinces, without major detriment to other surgical or health care areas. I think it is a mediocre performance. Volume has increased, but we have not changed how we do business very much. I think that has to be the focus of any future change.
  • with the last accord. Monies have gone into provinces and there has not really been accountability. Has it made a difference? We have not always been able to tell that.
  • There is no doubt that the 2004-14 health accord has had a positive influence on health care delivery across the country. It has not been an unqualified success, but nonetheless a positive force.
  • It is at these transition points, between the emergency room and being admitted to hospital or back to the family physician, where the efficiencies are lost and where the expectations are not met. That is where medical errors are generated. The target for improvement is at these transitions of care.
  • I am not saying to turn off the tap.
  • the government has announced, for example, a 6 per cent increase over the next two or three years. Is that a sufficient financial framework to deal with?
  • Canada currently spends about the same amount as OECD countries
  • All of those countries are increasing their spending annually above inflation, and Canada will have to continue to do that.
  • Many of our physicians are saying these five are not the most important anymore.
  • they are not our top five priority areas anymore and frankly never were
  • this group of surgeons became wealthy in a short period of time because of the $5.5 billion being spent, and the envy that caused in every other surgical group escalated the costs of paying physicians because they all went back to the market saying, "You have left us out," and that became the focus of negotiation and the next fee settlements across the country. It was an unintended consequence but a very real one.
  • if the focus were to shift more towards system integration and accountability, I believe we are not going to lose the focus on wait times. We have seen in some jurisdictions, like Ontario, that the attention to wait times has gone beyond those top five.
  • people in hospital beds who do not need to be there, because a hospital bed is so expensive compared to the alternatives
  • There has been a huge infusion of funds and nursing home beds in Ontario, Nova Scotia and many places.
  • Ontario is leading the way here with their home first program
  • There is a need for some nursing home beds, but I think our attention needs to switch to the community resources
  • they wind up coming to the emergency room for lack of anywhere else to go. We then admit them to hospital to get the test faster. The weekend goes by, and they are in bed. No one is getting them up because the physiotherapists are not working on the weekend. Before you know it, this person who is just functioning on the edge is now institutionalized. We have done this to them. Then they get C. difficile and, before you know, it is a one-way trip and they become ALC.
  • I was on the Kirby committee when we studied the health care system, and Canadians were not nearly as open to changes at that time as I think they are in 2011.
  • there is no accountability in terms of the long-term care home to take those patients in with any sort of performance metric
  • We are not all working on the same team
  • One thing I heard on the Aging Committee was that we should really have in place something like the Veterans Independence Program
  • some people just need someone to make a meal or, as someone mentioned earlier, shovel the driveway or mow the lawn, housekeeping types of things
  • I think the risks of trying to tie every change into innovation, if we know the change needs to happen — and there is lots of evidence to support it — it stops being an innovation at that point and it really is a change. The more we pretend everything is an innovation, the more we start pilot projects we test in one or two places and they stay as pilot projects.
  • the PATH program. It is meant to be palliative and therapeutic harmonization
  • has been wildly successful and has cut down incredibly on lengths of stay and inappropriate care
  • Where you see patient safety issues come to bear is often in transition points
  • When you are not patient focused, you are moving patients as entities, not as patients, between units, between activities or between functions. If we focus on the patient in that movement, in that journey they have through the health system, patient safety starts improving very dramatically.
  • If you require a lot of home care that is where the gap is
  • in terms of emergency room wait times, Quebec is certainly among the worst
  • Ontario has been quite successful over the past few years in terms of emergency wait times. Ontario’s target is that, on average, 90 per cent of patients with serious problems spend a maximum of eight hours in the emergency room.
  • One of the real opportunities, building up to the accord, are for governments to define the six or ten or twelve questions they want answered, and then ensure that research is done so that when we head into an accord, there is evidence to support potential change, that we actually have some ideas of what will work in moving forward future changes.
  • We are all trained in silos and then expected to work together after we are done training. We are now starting to train them together too.
  • The physician does not work for you. The physician does not work for the health system. The physician is a private practitioner who bills directly to the health care system. He does not work for the CEO of the hospital or for the local health region. Therefore, your control and the levers you have with that individual are limited.
  • the customer is always right, the person who is getting the health care
  • It is refreshing to hear something other than the usual "we need more money, we absolutely need more money for that". Without denying the fact that, since the population and the demographics are going to require it, we have to continue making significant investments in health, I think we have to be realistic and come up with new ways of doing things.
  • The cuts in the 1990s certainly had something to do with the decision to cut support staff because they were not a priority and cuts had to be made. I think we now know it was a mistake and we are starting to reinvest in those basic services.
  • How do you help patients navigate a system that is so complex? How do you coordinate appointments, ensure the appointments are necessary and make sure that the consultants are communicating with each other so one is not taking care of the renal problem and the other the cardiac problem, but they are not communicating about the patient? That is frankly a frequent issue in the health system.
  • There may be a patient who requires Test Y, X, and Z, and most patients require that package. It is possible to create a one-stop shop kind of model for patient convenience and to shorten overall wait times for a lot of patients that we do not see. There are some who are very complicated and who have to be navigated through the system. This is where patient navigators can perhaps assist.
  • There have been some good studies that have looked at CT and MRI utilization in Ontario and have found there are substantial portions where at least the decision to initiate the test was questionable, if not inappropriate, by virtue of the fact that the results are normal, it was a repeat of prior tests that have already been done or the clinical indication was not there.
  • Designing a system to implement gates, so to speak, so that you only perform tests when appropriate, is a challenge. We know that in some instances those sorts of systems, where you are dealing with limited access to, say, CT, and so someone has to review the requisition and decide on its appropriateness, actually acts as a further obstacle and can delay what are important tests.
  • The simple answer is that we do not have a good approach to determining the appropriateness of the tests that are done. This is a critical issue with respect to not just diagnostic tests but even operative procedures.
  • the federal government has very little information about how the provinces spend money, other than what the provinces report
  • should the money be conditional? I would say absolutely yes.
Govind Rao

Health Edition Online - Print Article - 0 views

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from heather Alberta privatization private clinics diagnostics

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  • September 6, 2013   |   Volume 17 Issue 34 Alberta considering ban on private scans
  • This Friday, the College of Physicians and Surgeons of Alberta will debate revised standards of practice which include a proposal to ban private diagnostic imagery.
Govind Rao

7 new things your pharmacist can do Starting in September Quebec pharmacists will take ... - 1 views

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from heather pharmacists Quebec

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  • Govind Rao on 14 Aug 13
     
    Starting Sept. 3, pharmacists across the province will expand their role and provide a bundle of new services. Quebec's association of pharmacist owners (AQPP) is meeting with the Ministry of Health today to determine which of the services will be covered by medicare. Here's the run-down of tasks your pharmacist will be able to perform after Labour Day: Extend a prescription. Adjust a prescription. Switch one medication for its equivalent in case of a shortage. Administer medication to show a patient its proper usage. Prescribe and interpret laboratory analyses. Prescribe medication for a mild condition when the diagnostic is known. Prescribe medication when a diagnosis is not required.
Govind Rao

ServiceOntario: Making It Easier - Government of Ontario, Canada - 0 views

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from heather Ontario private clinics privatization

shared by Govind Rao on 19 Aug 13 - No Cached
  • A Regulation under the Independent Health Facilities Act - Prescribed Persons Ministry: Ministry of Health and Long-Term Care
  • The Ministry of Health and Long-Term Care (Ministry) is proceeding to establish community-based specialty clinics as per Ontario's January 2012 Action Plan for Health Care. Shifting low-risk ambulatory services from a hospital to a community-based setting represents an opportunity to improve access and the patient experience, maintain quality and outcomes of services, and realize reductions in costs for routine services currently performed in a hospital setting.
  • August 12, 2013
  • Govind Rao on 19 Aug 13
     
    Ontario has started consultations on legislative changes which will see the creation of more specialty clinics - one of the elements of the Action Plan for Health Care announced in January 2012. The intent is to move low-risk ambulatory services from hospitals to community-based settings. These non-profit specialty clinics will operate as part of the Independent Health Facility (IHF) program. There are over 1,000 IHFs in Ontario, most of which provide diagnostic services although some offer surgical or other medical procedures. The changes the government has in mind will see the new clinics, as well as all IHFs, come under the planning and funding umbrella of the 14 Local Health Integration Networks. Cancer Care Ontario will also be able to fund the clinics should they provide cancer-related services.
Govind Rao

Ontario Council of Hospital Unions - defending healthcare in every community - 0 views

www.ochu.on.ca

from heather cupe Ontario private clinics privatization

shared by Govind Rao on 17 Sep 13 - No Cached
  • Request for an inquest was denied; Family sues hospital for son's death, Sept. 12 Toronto Star - Mon Sep 16 2013 Family sues hospital for son's death, Sept. 12
  • the Ontario Council of Hospital Unions (OCHU), which represents front-line staff at St. Joseph's in Hamilton where the death occurred, publicly called for an inquest.
  • Mandatory flu shot for health staff misdirected November 2, 2012To save lives, prevent thousands of needless deaths stop provincial policies that cause medical errors, bed sores and superbug ... [Read More]infections
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  • To target health care workers and take away their right to choose by making the flu shot mandatory, is misdirected in the face of recent evidence that 41 per cent of people who get a flu vaccine receive no protection against the flu,” says Michael Hurley the president of the Ontario Council of Hospital Unions (OCHU).
  • Mandatory Flu Vaccinations for Health Care Workers CUPE encourages health care workers to get an influenza vaccination if they can safely do so. But making flu shots mandatory for health care workers is a serious intrusion on the freedom and personal autonomy of health care workers that may sometimes have detrimental effects on their own health.Forcing people to take flu shots against their will may well undermine public confidence in vaccination programs, even vaccination programs with an excellent results and high safety standards.
  • Govind Rao on 16 Oct 13
     
    Union calls for halt to move procedures from hospitals to private clinics Submission by the Ontario Council of Hospital Unions / CUPE on the Proposed amendment to O. Reg. 264/07 made under the Local Health System Integration Act, 2006 and A Regulation under the Independent Health Facilities Act - Prescribed Persons .  The Ontario Council of Hospital Unions / CUPE represents 30,000 workers in hospitals across the province, including Registered Practical Nurses, service workers, and administrative workers. We are opposed to the government’s plan to move surgical, diagnostic, and other work from public hospitals to private clinics. Our objections can be summarized as falling within seven distinct areas: 1] Quality • Even minor operations can go wrong. We believe that, in contrast with hospitals, it is unlikely private clinics will be able to handle emergencies and that they will likely simply call EMS. Will ambulances be able to move patients to hospitals when things go wrong? (We say “when” advisably, as sooner or later there will be problems.) Indeed, private surgical clinics first came to public attention when a patient died and the paramedics arrived to find a patient with no vital signs. Is it appropriate to establish a system that inherently requires extra time to effectively treat patients who fall into emergency situations? This is particularly troubling as underfunding and restructuring have challenged EMS response times. The government and government officials must be prepared to accept responsibility for such deaths if this plan is approved. 
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