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Govind Rao

Publication Launch: Economic Evaluation of Complex Interventions - A new discussion pap... - 0 views

www.cihr-irsc.gc.ca/48612.html

from heather integration continuing care

shared by Govind Rao on 22 Sep 14 - No Cached
  • integrated systems of care for the frail elderly, eHealth innovations for individuals with high needs, and models of care that link upstream prevention with healthcare delivery. These types of interventions have been described as complex as they have multiple components, are directed at populations and may affect multiple outcomes and be affected by feedback loops. Overall, the discussion paper guidance is intended to promote understanding and consistency in how economic evaluations of complex interventions are conducted, with the ultimate goal of contributing to improved research and evidence-informed health care decision-making.
Govind Rao

Look to Asia for a health-care policy for Canada; Japan spends proportionately less on ... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|otct|20150509|220126058

from heather Asia medicare privatization

shared by Govind Rao on 11 May 15 - No Cached
  • Ottawa Citizen Sat May 9 2015
  • Policy makers in North America are paying a lot of attention to Asia these days. Japanese Prime Minister Shinzo Abe recently became the first Japanese PM to address a joint meeting of the U.S. Congress. More broadly, U.S. and Canadian negotiators are deeply involved in moving the proposed Trans-Pacific Partnership (TPP) trade agreement forward. As 2015 began, the Canada-Korea Free Trade Agreement came into force. And a Canada-Japan Economic Partnership is beginning to take shape.
  • With Canada's pursuit of stronger Asia-Pacific economic links, we should look also to increasing the flow of policy ideas from the region, particularly those that can help us address important problems we share. One such issue is how to deliver health care services effectively and efficiently in the face of growing demands driven by new technologies, increased patient expectations, and population aging.
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  • Three countries we have written about in a new paper for the Macdonald-Laurier Institute - Japan, Korea and Taiwan - are not typically where Canadians look for public policy solutions. They are far away and have very different cultures and histories. But they, like other developed countries, face similar health care challenges.
  • apan, Korea and Taiwan are leading users of health-care technologies. Their overall health outcomes are comparable to, if not better than, those in Canada, and they do this spending a lower percentage of their GDP on health care than we do. These countries have universal public health care - something Canadians are justifiably proud of - though Japan achieved this about a decade before Canada. These countries' plans cover physician visits and hospitalization, but also dental care and outpatient prescription drugs.
  • What are the lessons for Canada? First, the countries' policy-makers actively learned from abroad. Japan looked to Germany as it started modernizing nearly 150 years ago; recently Korea and Taiwan studied what worked, or not, elsewhere as they developed their systems. More importantly, politicians and bureaucrats had the fortitude to implement necessary reforms. Changes were made often in the face of protests by entrenched stakeholders, including physicians. And programs were reviewed soon after implementation, making modifications when problems arose. This is in stark contrast to Canada's embrace of the status quo.
  • More specifically, the systems in Japan, Korea and Taiwan suggest that copayments may be useful to help moderate demand and help fund care. They can be applied and properly designed to recognize income disparities. In Canada's case, they could increase equity if used to help extend coverage to drugs and dental care for more people. Unlike in Canada, where most hospitals are de facto public, in these countries privately-owned hospitals, many of them non-profit, compete with public hospitals, creating dynamism in the sector.
  • Finally, and most significantly, these proactive governments have moved to introduce Long-Term Care Insurance (LTCI) to address a very predictable problem. Very few people buy LTCI on their own, mostly because they can't predict their future needs and expect long-term care be covered by public funds. However, estimates suggest that about 70 per cent of people who reach 65 will need LTC at some time. In Japan and Korea, and likely soon in Taiwan, LTCI creates distinct insurance funds devoted to supporting appropriate care at home and in institutions.
  • Asia deserves the attention it is getting. As we build economic links, we should also look for the good ideas of our new partners that can make our health and long-term-care systems better. Ito Peng is Director of the Centre for Global Social Policy at the University of Toronto. James Tiessen is director of the School of Health Services Management at the Ted Rogers School of Management at Ryerson University. They are co-authors of the MLI report An Asian Flavour for Medicare (macdonaldlaurier.ca).
Govind Rao

NDP aims to shake spendthrift image - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20150827|227972412

from heather ndp federal election

shared by Govind Rao on 27 Aug 15 - No Cached
  • Toronto Star Thu Aug 27 2015
  • Tom Mulcair has made the deficit fetish his own. The New Democratic Party leader has vowed that, no matter what happens, he will balance the federal budget if his party wins government. Even Conservative Leader Stephen Harper hasn't gone that far. He says governments may have to run deficits during recessions. Coming at a time of a wobbly world economy and falling oil prices, Mulcair's promise is almost certainly bad economics.
  • But for a party saddled with the (largely undeserved) reputation of wasting public money, it is probably good politics. The reason Mulcair's promise is bad economics is that deficits are sometimes necessary. In times of recession, for example, efforts to balance government budgets by raising taxes or cutting spending can make matters worse. The NDP understood this in late 2008 when, as part of an ill-fated coalition attempt, it said Ottawa should spend billions and endure at least four years of deficits in order to fight the worst economic slump since the 1930s.
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  • But with interest rates close to zero, Bank of Canada governor Stephen Poloz is running out of room. The other is to have Ottawa pump money into the economy, either by cutting taxes or spending more. This is not a radical idea. Mainstream economists say that in this low-inflation environment, the government can run deficits without putting the economy at risk. Writing in the Globe and Mail, former deputy minister of finance Kevin Lynch argues Ottawa should borrow money to fund necessary infrastructure projects even if this results in deficits. The NDP has already announced bold spending plans worth billions of dollars, ranging from daycare to health care. Given these commitments, it seems odd that the party would imprison itself in the balanced-budget straitjacket. At least it seems odd until the politics are taken into account.
  • Ultimately, Harper obliged. At the time, New Democrats didn't complain about the massive deficits that the Conservative stimulus plan would entail. Rather, as Mulcair told the Commons in early 2009, the NDP worried that Harper would renege on the billions in spending that he promised. Is Canada in a recession now? Experts differ, but Mulcair seems to think so. At least that was the impression he gave in a televised debate earlier this month. But even if the country is not technically in recession, an ironclad commitment to balanced budgets can be counterproductive. Governments have only two methods to steer a sluggish economy in the right direction. One is to have the central bank cut interest rates. The Bank of Canada has tried this.
  • Politically, the NDP faces a stereotype problem. Voters tend to believe that New Democrats are overly casual with public money. In fact, NDP provincial governments have pretty much the same fiscal record as those of other parties. They try to nickel and dime public servants in order to keep costs down. They fret about credit ratings. Their finances get whacked when the overall economy turns south. But New Democrats never get any fiscal respect. In Saskatchewan, former premier Allan Blakeney's NDP government regularly balanced the budget. His Conservative successor rarely did. Yet when polled, Saskatchewan voters tended to view Blakeney as the spendthrift. Mulcair's aim is to break the stereotype.
  • Hence the hard-line position on deficits. The New Democrats are even using lines from Conservative attack ads to bolster their case. Toronto NDP candidate Andrew Thomson, a former Saskatchewan finance minister, has taken to mocking Liberal Leader Justin Trudeau for saying that growth is more important than slavish attention to deficits and that, if the economy grows - and tax revenues grow with it - the budget will balance itself. The odd thing is that, in this instance, Trudeau was right. The odder thing is that the NDP used to take the same position. Thomas Walkom's column appears Wednesday, Thursday and Saturday.
Govind Rao

Economic platitudes not enough - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|kwrc|20150827|227972925

from heather federal election accord cuts

shared by Govind Rao on 27 Aug 15 - No Cached
  • Waterloo Region Record Thu Aug 27 2015
  • Canada's main political leaders have much to say about the ailing economy. None has yet produced a plausible plan to fix it. This week's stock market chaos served only to illustrate how ill-prepared the Conservatives, Liberals and New Democrats are when it comes to dealing with economic crisis. All responded with campaign bromides to the unsettling news that China, the world's No. 2 economy, is in trouble. Conservative Prime Minister Stephen Harper urged voters to stick with his recipe of tax cuts. Liberal Leader Justin Trudeau talked of the need to build the middle class.
  • New Democrat Leader Tom Mulcair, meanwhile, repeated his pledge to solve the crisis by lowering taxes for small business. These ideas aren't necessarily stupid. But in terms of dealing with an unusually stagnant economy, none of the parties' economic platforms - so far at least - is even remotely sufficient. First, look at where we are. The world economy has been weak since 2008. Europe and Japan are in trouble. The U.S. is only starting to pull out of its funk. For a while, China led the pack. But as this week's stock market scare demonstrated, China can be a slender reed to lean on. Former U.S. treasury secretary Larry Summers refers to what the world is going through now as "secular stagnation." It's as good a term as any.
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  • In practical terms, it means the economy is creating jobs - but not good ones. It means that consumers are relying on credit cards rather than wages to buy what they need. It means that entire sectors of the economy are out of whack. In Canada, this expresses itself as a reliance on notoriously volatile commodities such as oil. When oil and other commodity prices are up, Canada does OK. When they fall, as is happening now, the reverse occurs. In his stump speech, Mulcair rightly criticizes the Harper Conservatives for failing to pay enough attention to manufacturing. He is also correct when he says that too many of the jobs created are low wage and part time. But his solution to date - give tax breaks to small business and manufacturers - is singularly inadequate. Small businesses, almost by definition, require low-wage, part-time, non-union workers. Encouraging small business may create jobs. But most will be of the precarious variety that Mulcair decries.
  • Tax breaks to manufacturers, meanwhile, may encourage them to expand production - but only if they have customers willing to buy. As Mulcair correctly points out, too many corporations are refusing to reinvest their profits. Logically, that means government should take up the slack - even if this leads to fiscal deficits in the short term. But Mulcair pledged Tuesday that an NDP government would not run deficits. Trudeau is less categorical. He says a Liberal government would balance the books over the long haul. But, wisely, he has not ruled out deficit spending in the short run. Trudeau's real problem is that his solution to the crisis is also insufficient.
  • He says his Liberals would take money from the very-well-to-do and give it to those earning between roughly $50,000 and $200,000. Trudeau refers to this as helping the middle class. Making the rich pay is not a bad idea - although the economy would get more of a boost if the poor, who spend most of what they earn, received the money instead. But how would Trudeau lessen Canada's reliance on oil? How would he protect us from the kinds of shocks that roiled the world this week? How would he promote manufacturing or high-wage, new-technology industries? So far, the Liberals haven't said.
  • Finally, the Conservatives. Harper's party does not fit the cartoon stereotypes. It hasn't embraced the harsh austerity favoured in Europe. Rather, the Harper government has followed a kind of austerity-light regimen. It has penalized the unemployed but left welfare and medicare alone (although the Conservatives have said they will cut health spending if re-elected). Both opposition parties criticize the Conservatives for having run deficits since 2008. But given the weakness of the economy, it was the right thing to do. Arguably, Harper's real sin on this front was to move too quickly to balance the books. Still, the prime minister has much to answer for. One example: His government used the temporary worker program to suppress wages, relenting only when the politics became impossible. But his biggest mistake was to rely on oil. When petroleum prices were high and China booming, this was sufficient to hide the economy's fatal flaws. Now it is not. Thomas Walkom's columns appear in Torstar newspapers.
Govind Rao

Privatization: what it is, why it matters - Infomart - 0 views

www.fpinfomart.ca/...223358003

from heather NL privatization union

shared by Govind Rao on 23 Jun 15 - No Cached
  • The Telegram (St. John's) Tue Jun 23 2015
  • With oil prices down, an aging population and high unemployment, the conservative government of Newfoundland and Labrador is looking for a silver bullet to cut costs for public services and infrastructure. Their sights are settling on privatization to be that silver bullet. What is privatization? In its most narrow sense, privatization is the whole or partial sale of public services and/or infrastructure. It can include the sale of assets, functions or the entire institution.
  • With privatization, the service or infrastructure becomes funded and/or run by a private corporation. Privatization usually includes not only a change in ownership but also a change in the priorities, responsibilities and role of the state. Advocates of privatization offer free-market competition as the path to economic and social success, with promises of cost savings, lower risk, greater efficiency and more individual choice. Privatization takes several forms in Canada, including:
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  • ? full privatization: where a government enterprise is sold in full to private investors. ? publicly funded with services and management delivered privately, sometimes unknown to the consumer. ? public funding of private services: government provides vouchers to consumers for the purchase of goods and services from private providers.
  • ? public/private partnerships (P3s): full outside contracting, management and service delivery of traditionally delivered public services such as hospitals, roads, schools and prisons. This can include private finance, design, building, operation and possibly temporary ownership of an asset. Can privatization deliver? After decades of experimentation with privatization in different forms across Canada, the data is clear on the failure to deliver on its promises and the high cost society pays - multiple costs, not only in economic terms but also quality and access to services, quality and quantity of jobs, as well as transparency and accountability.
  • Public/private partnerships (P3s) are the fastest-growing model of privatization in Canada. The P3 models vary but all include the reliance on private sector borrowing to finance the development of public infrastructure projects in a long-term lease arrangement; it is effectively leasing rather than owning and sometimes that lease includes maintenance as well. P3s cost more. Governments have always been able to borrow money more cheaply than private corporations. According to a University of Toronto study of 28 P3 projects in Ontario, P3s cost, on average, 16 per cent more than a traditional public contract. A recent auditor general of Ontario report found that P3 projects cost the province $8 billion more than if they were done under the traditional model.
  • If they cost more, why do politicians promote them? Political expediency - in P3 lease agreements the debt stays off the books or is postponed for decades. P3s hide debt - which is a dream for politicians looking for easy wins in hard economic times. It is also ideological and it is about private sector lobbying and influence. Public services are a boon to private sector deliverers with guaranteed public payments and profit margins over the long term. Supporters of privatization claim that it leads to better pricing for the public as consumers. A comparison of privately owned Manitoba Telecom Services, privatized in 1997, to SaskTel, Saskatchewan's publicly owned telecommunications crown corporation shows this to not be true. Twenty years after privatization of MTS, the cost of a basic phone with SaskTel is $8 less per month than from MTS.
  • Private corporations demand a shroud of confidentiality in order to protect their competitive position. This means that privatization reduces both transparency and accountability. An example of this is the Ontario privatization of municipal water testing which has been linked to the May 2000 bacterial contamination of municipal water in Walkerton, Ont., led to the deaths of at least seven people and the serious illness of 2,300 more from water contaminated with E. coli. The absence of criteria governing quality of testing, and the lack of provisions made for notification of results to authorities contributed to the worst public health disaster involving municipal water in Canadian history.
  • Health care is a sector where there is huge pressure on government to control cost, particularly in Newfoundland and Labrador with the aging demographic. Private interests see great profit opportunities. But in health care, for-profit does not deliver. In Manitoba, living in a for-profit long-term care facility increased the odds of dying in hospital or being hospitalized.
  • In a metadata analysis of hospitals in the U.S., Dr. Philip Devereaux, a cardiologist at McMaster University, concluded that the death rate in for-profit hospitals was two per cent higher than in not-for-profit facilities. In Alberta, the Health Quality Council of Alberta's Long Term Care Family Experience Survey in 2012 found that, on average, private and volunteer operated facilities offered poorer quality in terms of staffing levels, care of residents' belongings, and assistance with daily living activities such as toileting, drinking and eating, than publicly operated ones.
  • The scathing Ontario auditor general report indicates that there needs to be extensive and comprehensive reviews of provincial privatization projects. Until proper cost-benefit analyses and public reviews and reform of private funding and procurement models occur, governments and public bodies should place moratoria on further public-private infrastructure contracts. The citizens pay either way, but they pay more in a privatized model - either as tax payers or out of pocket.
  • The government has alternatives. The Newfoundland and Labrador Federation of Labour has published a number of reports and fact sheets on the progressive revenue options open to the provincial government. There are a variety of progressive revenue options open to municipalities as well. There are no silver bullets. It is time to stop stigmatizing government and public services and recognize them for what they are: the way we pool our resources to buy services cheaper, control costs, and maintain accountability for quality.
  • his should be a debate based on evidence, not ideology. Mary Shortall, president, Unifor Local 597
Govind Rao

Health care costs to increase US - 0 views

www.fpinfomart.ca/...arrow_20140904_1536_oc0v_1.pdf

from from heather US costs spending

shared by Govind Rao on 04 Sep 14 - No Cached
  • Govind Rao on 04 Sep 14
     
    Thu Sep 4 2014 Section: Business Byline: Ricardo Alonso-Zaldivar WASHINGTON - The nation's respite from troublesome health care inflation is ending, the government said Wednesday in a report that renews a crucial budget challenge for lawmakers, taxpayers, businesses and patients. Economic recovery, an aging society, and more people insured under the new health care law are driving the long-term trend. Projections by nonpartisan experts with the Health and Human Services department indicate the pace of health care spending will pick up starting this year and beyond. The introduction of expensive new drugs for the liver-wasting disease hepatitis C also contributes to the speed-up in the short run. The report from the Office of the Actuary projects that spending will grow by an average of 6 per cent a year from 2015-2023. That's a notable acceleration after five consecutive years, through 2013, of annual growth below 4 per cent. Although the coming bout of health-cost inflation is not expected to be as aggressive as in the 1980s and 1990s, it will still pose a dilemma for President Barack Obama's successor. Long term, much of the growth comes from Medicare and Medicaid, two giant government programs now covering more than 100 million people.
  • Govind Rao on 04 Sep 14
     
    Thu Sep 4 2014 Section: Business Byline: Ricardo Alonso-Zaldivar WASHINGTON - The nation's respite from troublesome health care inflation is ending, the government said Wednesday in a report that renews a crucial budget challenge for lawmakers, taxpayers, businesses and patients. Economic recovery, an aging society, and more people insured under the new health care law are driving the long-term trend. Projections by nonpartisan experts with the Health and Human Services department indicate the pace of health care spending will pick up starting this year and beyond. The introduction of expensive new drugs for the liver-wasting disease hepatitis C also contributes to the speed-up in the short run. The report from the Office of the Actuary projects that spending will grow by an average of 6 per cent a year from 2015-2023. That's a notable acceleration after five consecutive years, through 2013, of annual growth below 4 per cent. Although the coming bout of health-cost inflation is not expected to be as aggressive as in the 1980s and 1990s, it will still pose a dilemma for President Barack Obama's successor. Long term, much of the growth comes from Medicare and Medicaid, two giant government programs now covering more than 100 million people.
Govind Rao

Canada's Premiers - Premiers' Task Force to support Chair's Initiative on Aging - 0 views

www.councilofthefederation.ca/...rt-chair-s-initiative-on-aging

from heather provinces Council of the Federation seniors

shared by Govind Rao on 02 Feb 15 - No Cached
  • August 28, 2014 – Charlottetown, Prince Edward Island – 55th Annual Premiers’ Conference
  • Today, under the leadership of Premier Robert Ghiz, Chair of the Council of the Federation for 2014-2015, Canada’s Premiers will launch a dialogue with Canadians and engage key stakeholders on aging, and create a Task Force to look at the impacts an aging population will have on Canada’s social and economic future. This work will raise awareness on the changing social and economic needs associated with an aging population and highlight work that provinces and territories are undertaking to address these issues. The Task Force work will build on existing work, notably that of the Health Care Innovation Working Group, and provide an opportunity for provinces and territories to share best practices, engage experts and provide evidence based information to Premiers on the social and economic impacts of aging.
Govind Rao

Canada's health-care system is financially unsustainable - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|kwrc|20150305|215760176

from heather privatization medicare

shared by Govind Rao on 05 Mar 15 - No Cached
  • Waterloo Region Record Thu Mar 5 2015
  • Here's a little thought quiz: Which of the following characteristics come to mind when you hear the term "monopoly service": efficient, customer-oriented, innovative, high quality, low cost? If you answered "none of the above," you probably recall the days when hooking up your telephone, sending a package or even travelling by air offered few or no choices. Today, we have a wide variety of competing providers that offer higher quality service at a lower cost.
  • But in health care, by far the most important and costly service, Canada is the only country that forbids competing with the public system. A 2014 Commonwealth Fund Report found the performance of Canada's monopoly health-care system ranked well behind Australia, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom. And a 2013 Organization for Economic Co-operation and Development (OECD) report found that, despite spending 36 per cent more per capita than the OECD average, Canada has the longest wait times for elective surgery.
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  • The 2012 government of Ontario-commissioned Drummond report projected that the cost of the province's health-care system, which already devours almost half of provincial spending, will rise to 80 per cent over the next two decades. The report states, "We challenge the government to open the door more widely for private sector involvement, not only to improve efficiencies, but also to capitalize on the huge economic potential in building a vibrant health care sector in Ontario".
  • The role of government is mainly funding and regulatory. The lesson here is that, as in virtually all other sectors, governments that try to be the deliverer and the regulator fail to do either well. That systems featuring competing private sector providers would prove superior to a bureaucratic government monopoly should come as no surprise. But that monopoly is also financially unsustainable. Ontario is the poster boy for this stark reality.
  • Recent Fraser Institute reports on the German and Dutch health-care systems found that just five per cent suffered elective surgery wait times longer than four months, compared with 25 per cent in Canada. Those assessments also pinpoint the key reasons for this superior performance. Germany provides universal access to high quality, timely health care through statutory social health insurance, along with an option to buy supplemental insurance. Since Germany's government monopoly health-care system was replaced in 1991, the proportion of care delivered by private hospitals and clinics has risen to 70 per cent. The result has been higher quality care and shorter wait times at a lower cost. Private hospitals and clinics also play a dominant role in the Netherlands. The Dutch system offers universal coverage while allowing the public to select providers competing on the basis of quality and timelines of care.
  • So what is that "economic potential"? A 2013 report commissioned by the Royal College of Physicians and Surgeons found that one out of six new medical specialists can't find work, while many others accept roles far below their qualifications. Even long-established specialists are only working part time because of severe shortages of operating room access. Allowing these highly qualified professionals to fill those empty hours treating paying patients in private facilities would not only reduce public system waiting lists and costs, but also foster the establishment of Canada as a "go-to" country for fee-paying international patients. This represents a huge opportunity to enhance the sustainability of our public health-care system, while creating a thriving private health care industry.
  • One would think such a compelling picture would have funding-stressed governments eager for change. But with the exception of Quebec, provinces have tried to stamp out the fragile green shoots of private patient care. The fate of private health care will soon rest with the Justices on the Supreme Court of British Columbia.
  • After the British Columbia Medical Services Commission ordered him to stop collecting fees at his Vancouver private clinics, Dr. Brian Day launched a lawsuit on behalf of four of his patients claiming a constitutional right to access timely private care. These patients had faced long waiting times that would have proven permanently debilitating or even fatal.
  • It's astounding that Day and his patients should be forced to fight an expensive court case aimed at winning Canadians the same freedom of choice that exists in every other country. Governments across Canada had better hope he wins, or they will see their citizens trapped in a downward spiral of ever-longer waiting lists and ravaged social programs. Gwyn Morgan is a retired Canadian business leader who has been a director of five global corporations. (troymedia.com)
Govind Rao

Privatization Hurts: Town hall meeting on privatization set to launch paper on economic... - 0 views

sk.cupe.ca/...mpact-of-laundry-privatization

from heather Saskatchewan cupe conference privatization laundry

shared by Govind Rao on 27 Jan 15 - No Cached
  • The Canadian Centre for Policy Alternatives and the Canadian Union of Public Employees are hosting a town hall meeting about the economic impact of laundry privatization.   Join us at the Town Hall Meeting! Wednesday, January 21, 2015 7:00 p.m. Prince Albert Inn (3680 – 2nd Avenue West)
Govind Rao

Submission to the Standing Committee on Finance & Economic Affairs - Ontario Health Coa... - 0 views

www.ontariohealthcoalition.ca/...ee-on-finance-economic-affairs

from heather Ontario coalition budget

shared by Govind Rao on 09 Feb 15 - No Cached
  • Submission to the Standing Committee on Finance & Economic AffairsPosted: January 29, 2015(January 29, 2015) OHC BUDGET SUBMISSION 
Govind Rao

MIT Press Journals - American Journal of Health Economics - Early Access - Abstract - 0 views

www.mitpressjournals.org/...AJHE_a_00041

from heather costs research spending

shared by Govind Rao on 05 Apr 16 - No Cached
  • Posted Online March 31, 2016.
  • Bradley RossenDepartment of Economics, Laurentian University
  • Akhter Faroque
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  • Department of Economics, Laurentian University
  • This paper uses a new (Hartwig-Colombier) method to decompose the growth rate of provincial per capita health-care spending in Canada over the period 1982–2011 into the contributions of the cost disease, traditional observable variables, and technological progress. Based on extensive robustness analysis across a variety of specifications, estimation methods, and two separate data sets, we find that the cost disease (rent extracting) is a relatively minor contributor, while technical progress in health care and growth in per capita incomes are by far the biggest contributors to the secular growth in health-care spending in Canada.
Govind Rao

Horizon plans to centralize health worker scheduling in province - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|mott|20151016|231504003

from heather NB admin cuts

shared by Govind Rao on 16 Oct 15 - No Cached
  • Times & Transcript (Moncton) Fri Oct 16 2015
  • Officials with the Horizon Health Network say plans to centralize staff scheduling for roughly 13,000 health-care professionals across New Brunswick will begin in January, when select employees at the Miramichi Regional Hospital will start using the new system. Currently, staff are scheduled by the managers of work units at hospitals and health clinics across the province. That's going to change, though, as the province's largest regional health authority takes steps to standardize its policies and protocols around shift-scheduling in the months ahead. Robin Doull, Horizon's regional director of workforce optimization, said work has been underway behind the scenes to prepare the new scheduling software that will be used by roughly 80 per cent of the health authority's staff, one site at a time, before the full implementation by March 2017.
  • The centralized scheduling team will work out of a provincially owned office on Charlotte Street in Saint John. "For all intents and purposes, we've built a call centre," he said. "We're working with the Miramichi Regional Hospital right now towards their implementation in January. There are going to be people at the Miramichi Regional Hospital in January who are calling us, emailing us, and using an information system that we've built to tell us about their scheduling requirements." For an organization that has close to 13,000 employees, some wonder how will it all work. Representatives from the Canadian Union of Public Employees say the move may make good business sense, but it will also come with a steep price for rural parts of the province by shifting dozens of good-paying jobs to a single urban centre. Doull said the team is taking steps to explain the plan to the employees who'll soon be using the new system. If a staff member wants to book five vacation days several months from now, the employee would log into a new software system and create an electronic request.
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  • The member of the scheduling team responsible for that work unit would receive the request along with a list of employees that have the skill-sets and availability to work in that vacationing staffer's place. "They assign that work according to the various union collective agreements," he said. However, if the matter is unfolding in a shorter period of time, such as if someone was calling in sick for a shift scheduled to start later today, there's a different protocol. "Obviously that needs more immediate attention. There's an actual telephone call from a manager or a supervisor at (the unit) to a dedicated line in the scheduling centre," he said. Together, the employee's manager would work with the scheduling team to sort out the appropriate person to be offered the shift. Why is Horizon making this change? The goal is to lighten the administrative load on health-care managers across the province so they can focus on the day-to-day delivery of care.
  • "We're taking that sort of task or transaction work out of the nursing units. Typically, it's done by ward clerks or, in many cases, the managers themselves. It consumes a lot of their time. But that's only part of their job. They have responsibilities for other operational requirements in their various units," he said. Doull said the health authority also sees value in managing schedules in a consistent way across the province. "What we want to do for all of the areas is standardize the processes and the application of the collective agreement rules. So instead of having (more than) 200 people in Horizon who have as some small part of their job (tried) to get by in doing scheduling work as best they can with no formal software support or training, we're going to bring that into a purpose-built department," he said. "And there are efficiency payoffs for that, both financial and operational, for us as an organization." He did acknowledge that there will still be room for personal interventions by managers, particularly if a quick conversation at the office door can resolve a pressing matter easily and effectively.
  • If a matter is of an urgent nature, the employee can contact their manager or appointed supervisor directly and have a conversation about the request for time off and the manager can figure out a specific way to handle the situation. "All the manager is going to do is simply call the centre in Saint John, or email the staffing team that they work with, and say, 'An employee has talked to me. This is what we're going to do and here's how I want you to deal with the shift on Saturday,'" he said. "The manager always has that direct-line option to deal with things that are of a more timely nature." Although, too much of that can be a problem, said Doull, explaining that in some units across the province managers can fall into routines where the easiest employee to reach, or the most willing employee to work, receives most of the overtime or sick-time shift offers. "Later on, one of the four or five people (ahead of the preferred employee) may very well come back and say, 'I have a grievance because I should have been offered that shift. What are you going to do for me?' And we may be in a situation of having to, in effect, pay twice for time that needs to be worked," he said.
  • "I wouldn't characterize it that it happens often, but it certainly happens often enough that we know about it and it's one of the problems that we're specifically trying to solve." Members of the scheduling team are working to determine which site will be the next to adopt this new staffing system. Ultimately, when the scheduling team is fully operational and slotting shifts for units across Horizon, a team of 21 staff members will be working at the Saint John centre between the hours of 5 a.m. and 11 p.m. "That's roughly 70 full-time equivalent (positions for our team)," he said.
  • Doull said he knows many employees are likely worried about this change, but the move is expected to create significant savings for Horizon. "What we're looking to do is return time to managers and clinical staff," he said. "We know patients have a better experience if they know who the manager is in their area and they're able to interact with them regularly ... We know staff are more satisfied at work if they're able to have access to their manager." There are also savings expected through reductions in payroll errors.
  • "If someone puts in the wrong code for a specific number of hours and an employee gets paid the wrong thing, we know how often we're going back and correcting these. What this system will do is take a lot of the manual data entry of our pay processes away," he said. "It'll be automated and driven by what the employee is scheduled to work." It should also help to highlight problems in specific units, he said. "If we have an area, for example, that is using a lot of overtime, we'll know who is not there, why they're not there, which positions are not actually filled because there's nobody to work them, and we'll be better able as an organization to identify where our recruiting issues are," he said.
  • Ralph McBride, CUPE Local 1252's provincial co-ordinator, said he's concerned about the economic impacts the move could have on communities across the province. "We're not overly impressed with centralizing services. We see this as taking away important jobs in rural New Brunswick and moving them to urban centres," he said. "We think there are economic hard times happening currently in the Miramichi. This won't help." There are no plans to integrate this system with scheduling protocols used by the Vitalité Health Network. The Daily Gleaner requested information from the Vitalité Health Network on how the province's other regional health authority schedules its staff and the paper is still waiting for a response.
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).
  • ...3 more annotations...
  • No wonder NDP leader Thomas Mulcair has dubbed this a "demographic bomb."
  • "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."
  • 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.
Heather Farrow

CEPR to Investigate Restructuring in the Health Industry and Implications for Less Skil... - 0 views

www.commondreams.org/...-and-implications-less-skilled

us medicare privatization research

shared by Heather Farrow on 16 Aug 16 - No Cached
  • Monday, August 15, 2016 -
  • WASHINGTON - The Center for Economic and Policy Research (CEPR) is launching a project to understand the impact of health care restructuring on the quality of jobs and economic security of low-paid health care workers. Of particular interest is how pay and working conditions change as jobs shift from hospitals to lower-cost outpatient facilities – and whether these changes differentially affect workers by gender, race, ethnicity, age, and education. The research will also address whether different management approaches lead to better or worse outcomes for these workers. 
  • This project is funded by a $250,000 grant from the W.K. Kellogg Foundation and will be completed by November 30, 2017. CEPR’s Senior Economist Eileen Appelbaum and Cornell University’s Rosemary Batt will lead the project. 
Heather Farrow

Undisciplined Economist, An | McGill-Queen's University Press - 0 views

www.mqup.ca/-an-products-9780773547162.php

economics medicare

shared by Heather Farrow on 15 Sep 16 - No Cached
  • An Undisciplined EconomistRobert G. Evans on Health Economics, Health Care Policy, and Population Health
Heather Farrow

N.S. tables budget with surplus - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|cbpo|20160420|245174210

NS budget

shared by Heather Farrow on 20 Apr 16 - No Cached
  • Cape Breton Post Wed Apr 20 2016
  • While severe cost-cutting measures aimed at reducing bloated deficits have dominated budgets in Atlantic Canada and elsewhere in the country, Nova Scotia's 2016-17 budget tabled Tuesday featured what's become a rarity - a razor-thin surplus of $17.1 million. The province's Liberal government was largely able to pull it off by holding the line on departmental spending while reaping the benefit of a $234 million increase in tax revenue collected mostly through personal income taxes, a 2.6 per cent jump in revenue over last year. In a budget with $10.1 billion in spending, the new surplus figure is an improvement on the $241.2 million deficit forecast in December. Finance Minister Randy Delorey highlighted the budgetary good fortune, but cautioned things could change quickly because the province is "not immune" to global economic slowdowns and shocks.
  • We know economic ups and downs will continue," Delorey said in his address to the legislature. "We also know we are not powerless. We can grow our surplus so we can become a source of stability in this region." Progressive Conservative Leader Jamie Baillie scoffed at the surplus, calling it "bogus" and the product of rosy projections for tax revenue. "It's like money is going to rain down into the pockets of Nova Scotians in the coming year and they can tax it," said Baillie. "This budget is going to fall apart the moment the day it hits the real world." Baillie said he doubts the surplus will grow given that employment has decreased over the last three years and added an opportunity was missed to lower the tax burden for Nova Scotians.
  • ...9 more annotations...
  • NDP Leader Gary Burrill called the budget a "surplus of words." In particular, Burrill was critical of the lack of help for post secondary students and said the government should have moved as New Brunswick did last week to provide more up-front financial assistance. When asked why there had been such a significant swing from deficit projections in December, when Delorey blamed softened government revenues on a drop in tax revenue and offshore royalties, the minister said it was because of a combination of things including more tax information from the federal government.
  • Revenue did soften within departments," he said. "What you will also see though is that through the decisions we made and good management we have reduced our expenses more than the revenue has softened, which has enabled us to improve our position." The budget promises include modest amounts for a series of spending initiatives, many of which were previously announced, while continuing promised multi-year spending in education.
  • There is $6.6 million to improve a childcare system which a recent report said employs the lowest paid early childhood educators in Canada. The government says the money would be used to improve wages and subsidies to parents, although the amount of the increases won't be released until Education Minister Karen Casey gives her official response to her department's report within the next week. Delorey didn't reveal any details either, but did say the funding would push pay for daycare workers "closer to the national average."
  • CUPE Nova Scotia president Dianne Frittenburg said the overall funding figure falls short of what workers in the sector expect. She compared the figure to the $10.2 million included to refloat the ferry from Yarmouth, N.S., to Portland, Maine. "I'm not saying the Yarmouth ferry isn't important but it (early childhood education) should have equal footing," said Frittenburg. In a completely new measure, the budget allocates $7.5 million towards increasing income assistance by $20 a month beginning May 1 for up to 25,000 eligible people.
  • Other spending measures include $3.6 million to help children with autism access specialized therapy and a 25 per cent refundable food bank tax credit for farmers that will cost $300,000. Education will get $21 million as part of a four-year $65 million government pledge. The money includes $6.4 million to cap class sizes up to Grade 6 and $7.5 million to help improve literacy and math skills.
  • The only tax increase in the budget hits smokers, with cigarettes going up two cents each or 50 cents a pack and the tax rate on cigars going up by four per cent at midnight. The moves are expected to bring $15.8 million to provincial coffers. Health spending, at $4.1 billion, takes up 40 per cent of the overall budget. It includes $14.4 million for home care, including home support and nursing. As previously announced there is $3.7 million earmarked for the redesign of the decrepit Victoria General Hospital in Halifax, but no money to replace it.
  • However, in an accounting measure, the government said it was taking a one-time $110 million payment from Ottawa and the Halifax Regional Municipality for the city's new convention centre and applying it to the debt.
  • Officials said the payment on the debt would free up money in the future to launch a multi-year redevelopment of the Queen Elizabeth II Health Sciences Centre.
  • HALIFAXHighlights of the Nova Scotia budget introduced Tuesday: ° Surplus of $17.1 million is projected on a spending program of about $10 billion. ° Net debt of $15.2 billion in 2016-17. ° Budget provides $6.6 million for childcare with money to increase the parent subsidy and to increase wages for early childhood educators. ° Education will get $21 million, with $6.4 million going toward class cap sizes extended up to Grade 6 and $7.5 million to help improve literacy and math skills. ° There will be $7.5 million for boosting income assistance by $20 a month for people eligible. ° Tobacco tax increased by two cents a cigarette or 50 cents a pack, $4 dollars per carton. ° Government will introduce a new 25 per cent refundable food bank tax credit for farmers at a cost of $300,000. ° $3.6 million for the Early Intensive Behavioural Intervention Program to ensure children with autism access a specialized therapy.
Irene Jansen

CUPE. Federal Budget 2012: Public health care under attack, women most affected | CUPE - 0 views

cupe.ca/...ederal-budget-2012-health-care

federal budget cupe accord cht

shared by Irene Jansen on 30 Apr 12 - No Cached
  • The 2012 federal budget confirmed Stephen Harper’s plan to cut federal health care funding, and it showed no leadership on pressing Medicare issues. Women, both as providers and recipients of health care, will suffer most from these gaps.
  • The budget confirms Harper’s decision, announced last November with no negotiations, to implement long-term cuts to health care funding. Starting in 2017, Canada Health Transfer increases will be tied to economic growth, with a three percent floor, down from six percent. How much is cut depends on economic growth; assuming the worst, it means a cut of $36 billion over seven years. Using the Parliamentary Budget Office's more optimistic outlook, it's a cut of $26 billion over seven years.
  • The federal government's cash share of provincial health spending was 50 percent at the start of Medicare; now it stands at 21 percent. Harper wants to drag the federal government back to the 10 percent level of the late 90s
  • ...6 more annotations...
  • This federal budget also cut Health Canada funding by 6.4 percent
  • The immediate federal cuts are already taking a toll on women’s and Aboriginal health groups.
  • One week after the Senate committee reviewing the health accord called for stronger federal leadership and new pan-Canadian programs (pharmacare and continuing care), the budget shows a federal government in retreat.
  • We need the federal government to negotiate with the provinces a new ten year health accord that will protect, strengthen and expand Medicare.
  • For more details on these recommendations and why they’re needed, see CUPE’s report on the health accord.
  • Support public health care: sign the Call to Care!
Irene Jansen

The faulty premise for the Drummond Commission (article based on Salima Valiani's paper... - 0 views

rabble.ca/...ty-premise-drummond-commission

union ontario economics rn drummond ltc

shared by Irene Jansen on 13 Feb 12 - No Cached
  • By not taxing the lenders and the wealthy, government lacks the base from which to uphold the common good. Government puts the common good in the pocket of the lenders, by both borrowing and cutting. Take for example, Ontario hospitals unable to meet the cost of fulfilling peoples' needs due to insufficient funding from the Ontario government which then cut registered nurse positions.
  • In 1999 the Ontario Ministry of Health and Long-Term Care created the Capital Renewal Program and began subsidizing private profits by granting money to companies to create desperately needed long-term care beds.
  • "Fixing the Fiscal House: Alternative macroeconomic solutions for Ontario," is a research paper recently released by the Ontario Nurses' Association
  • ...9 more annotations...
  • The Ontario government should bolster employment, and hence domestic demand in the economy, by increasing investment in public services and social programs
  • Drawing on post-2008 public investment measures adopted in China, Brazil, Australia and Kenya, the paper demonstrates how the Ontario government can be a leader in bringing the Ontario economy out of economic crisis for the common good, including eventually eliminating the deficit and debt.
  • the Ontario government should commit financial resources to create an additional 9,000 permanent full-time equivalent RN positions by the end of fiscal year 2014-2015 in order to begin addressing the particularly low RN-to-patient ratios in Ontario relative to other Canadian provinces.
  • mass construction of low-income housing in Ontario
  • In the long-term care sector, a minimum staffing standard should be funded and regulated at an average of 3.5 worked hours of nursing and personal care per resident, per day, including 0.68 RN hours per patient per day.
  • not substituting or replacing RNs with registered practical nurses
  • increase state revenue through taxation of corporations and the wealthy, beginning with cancelling the reduction of the corporate tax rate to 10 per cent.
  • work with the federal government to establish job creation targets in various areas. This should include job-intensive green job creation and fully subsidized skills training programs
  • For the full research paper see:http://www.ona.org/publications_forms/research_series.html
Irene Jansen

CHSRF Oct 2011 What if: A sliding scale were used to reimburse generic drugs to effecti... - 0 views

www.chsrf.ca/...atIfASlidingScaleWereUsed.aspx

pharma drugs

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Irene Jansen on 23 Jan 12
     
    Aidan Hollis, Department of Economics, University of Calgary Because generics offer no quality advantages over their branded counterparts, generic drugs compete for market share by offering low prices. The Ontario Drug Benefit (ODB) program, the largest drug plan in Canada, plays an important role in determining generic drug reimbursement prices. The ODB has set its generic drug reimbursement at 25% of the price of the reference branded drug. This has created unwanted consequences. In general, the price will be either too high or too low for any given drug, since this price-setting mechanism is arbitrary. If too high, payers are paying too much, and the excess profits will be divided between the pharmacies and the manufacturers. Excessive prices may also drive excessive
Irene Jansen

Institute of Health Economics - Research & Programs: Funding Models Conference - 0 views

www.ihe.ca/...funding-models-conference

funding conference canada

shared by Irene Jansen on 23 Jan 12 - No Cached
  • On November 25/26 2010 in Edmonton a national forum Funding Models to Support Quality and Sustainability-A Pan-Canadian Dialogue took place. Hosted by the Canadian Institute for Health Information (CIHI) in collaboration with the Institute of Health Economics (IHE) and the Canadian Health Services Research Foundation (CHSRF), this forum provided a unique opportunity for senior leaders to hear from national and international experts on funding models to support quality and sustainability. The forum is also designed to facilitate the sharing of information and ideas on approaches and tools being considered in Canadian jurisdictions.
  • Irene Jansen on 23 Jan 12
     
    November 2010 CHSRF
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