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Govind Rao

Lancaster House | Headlines | Arbitrator upholds mandatory flu shot policy for health... - 0 views

  • February 7, 2014
  • Dismissing a union policy grievance, a British Columbia arbitrator held that a provincial government policy requiring health care workers to get a flu shot or wear a mask while caring for patients during flu season was a reasonable and valid exercise of the employer's management rights.
  • Arbitrator upholds mandatory flu shot policy for health care workers
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  • The Facts: In 2012, the Health Employers' Association of British Columbia introduced an Influenza Control Program Policy requiring health care workers to get a flu shot or wear a mask while caring for patients during flu season, which the union grieved. The employer, representing six Health Authorities in B.C., implemented the policy in response to low vaccine coverage rates of health care workers and an inability to achieve target rates of vaccination through campaigns promoting voluntary vaccination commencing in 2000. Acting on the advice of Dr. Perry Kendall, B.C.'s Provincial Health Officer, and relying on evidence suggesting that health care worker vaccination and masking reduce transmission of influenza to patients, the employer moved towards a mandatory policy. Asserting that members had the right to make personal health care decisions, the B.C. Health Sciences Association filed a policy grievance, contending that the policy violated the collective agreement, the Human Rights Code of British Columbia, privacy legislation, and the Canadian Charter of Rights and Freedoms. Extensive expert medical evidence during the hearing indicated that immunization was beneficial for the health care workers themselves, but was divided as to whether immunization of health care workers reduced transmission to patients. The evidence was similarly divided as to the utility of masking.
  • Comment:
  • Having determined that the policy was reasonable under the KVP test, Diebolt turned to the Irving test applicable to policies that affect privacy interests, which he characterized as requiring an arbitrator to balance the employer's interest in the policy as a patient safety measure against the harm to the privacy interest of the health care workers with respect to their vaccination status. Determining that the medical privacy right at stake in the annual disclosure of one's immunization status did not rise to the level of the right considered in Irving, which involved "highly intrusive" seizures of bodily samples, Diebolt further held that the employer's interest in patient safety related to a "real and serious patient safety issue" and that "the policy [was] a helpful program to reduce patient risk." Diebolt also considered that the employer had chosen the least intrusive means to advance its interest in light of the unsuccessful voluntary programs and in providing the alternative of masking. To quote the arbitrator: "[W]eighing the employer's interest in the policy as a patient safety measure against the harm to the privacy interest of the health care workers and applying a proportionality test respecting intrusion, based on the considerations set out above I am unable to conclude that the policy is unreasonable."
  • Diebolt also upheld the masking component of the policy as reasonable, finding on the evidence that masking had a "patient safety purpose and effect" by inhibiting the transmission of the influenza virus, and an "accommodative purpose" for health care workers who conscientiously objected to immunization. Observing that mandatory programs have been accepted in New Brunswick and the United States, Diebolt also considered that regard should be paid to the precautionary principle in health care settings that "it can be prudent to do a thing even though there may be scientific uncertainty." Moreover, he held that the absence of a reference to accommodation did not make the policy unreasonable, noting that this duty was a free-standing legal obligation that was not required explicitly to be incorporated into the policy and that any such issue should be addressed in an individual grievance if made necessary by the policy's application. He also rejected the union's submission that the policy could potentially harm health care workers' mental and physical health, considering the evidence to fall short of "establishing a significant risk of harm, such that the policy should be considered unreasonable."
  • Turning first to the KVP test, specifically whether the policy was consistent with the collective agreement and was a reasonable exercise of the employer's management rights, Diebolt noted that the only possible inconsistency with the collective agreement would be with the non-discrimination clause, given his ruling regarding the scope of Article 6.01, and that he would address this issue in his reasons with respect to the Human Rights Code. Diebolt then turned to the reasonableness of the policy and found, after an extensive review of the conflicting medical evidence that: (1) the influenza virus is a serious, even fatal disease; (2) immunization reduces the probability of contracting the disease; and (3) immunization of health care workers reduces the transmission of influenza to patients. Accordingly, Diebolt reasoned that the facts militated "strongly in favour of a conclusion that an immunization program that increases the rate of health care immunization is a reasonable policy."
  • Diebolt instead regarded the policy as a unilaterally imposed set of rules, making it necessary to establish that they were a legitimate exercise of the employer's residual management rights under the collective agreement and met the test of reasonableness set out in Lumber & Sawmill Workers' Union, Local 2537 v. KVP Co., [1965] O.L.A.A. No. 2 (QL) (Robinson). In addition, given that the policy contained elements that touched on privacy rights, Diebolt held that the policy must also meet the test articulated in CEP, Local 30 v. Irving Pulp & Paper, Ltd., 2013 SCC 34 (CanLII) (reviewed in Lancaster's Disability & Accommodation, August 9, 2013, eAlert No. 182), in which the Supreme Court of Canada held that an employer cannot unilaterally subject employees to a policy of random alcohol testing without evidence of a general problem with alcohol abuse in the workplace, based on an approach of balancing the employer's interest in the safety of its operations against employees' privacy.
  • In a 115-page decision, Arbitrator Robert Diebolt denied the grievance and upheld the policy as lawful and a reasonable exercise of the employer's management rights.
  • The Decision:
  • As noted by the arbitrator, no Canadian decision has addressed a seasonal immunization policy similar to the policy in this case. However, a number of decisions have addressed, and generally upheld, outbreak policies mandating vaccination or exclusion on unpaid leave. B.C. Health Sciences Association President Val Avery expressed his disappointment in the arbitrator's ruling, stating: "Our members believed they had a right to make personal health care decisions, but this policy says that's not the case." Avery said the Association is studying the ruling and could appeal. On the other hand, Dr. Perry Kendall, B.C.'s chief medical officer of health, applauded the decision, calling it a "win for patients and residents of long-term care facilities."
  • In 2012, Public Health Ontario changed its guidelines to call for mandatory flu shots because not enough health care workers were getting them voluntarily. Other municipal public health units – led by Toronto Public Health – also called for mandatory shots. Ontario's chief medical officer of health, Dr. Arlene King, stated in November 2013 that, while the government wants to see a dramatic increase in the number of health care workers who get a flu shot, it is stopping short of making vaccinations compulsory, but has instead implemented a three-year strategy to "strongly encourage health care workers to be immunized every year." She acknowledged, however, that the number of health care workers getting inoculated remains at 51 percent for those employed in hospitals and 75 percent for those in long-term care homes. For further discussion of the validity of employer rules, see section 14.1 in Mitchnick & Etherington's Leading Cases on Labour Arbitration Online.
Doug Allan

The Caring Economy - Medium - 0 views

  • Home care, a growth area in Canada’s health care system, is an existing solution that helps make aging at home a reality. In fact, seniors who access home care support — privately or publicly—have a 40 percent reduced likelihood of admission to a nursing home facility.
  • In Ontario, more than 10,000 seniors are waiting- for 262 days, on average- to access home care services, which calls for the private sector to bridge the gap between the services available and the urgent need for home care.
  • In 2010, the private home care sector accounted for $1.48 billion and is expected to continue to grow as publicly available services become more restrictive and the senior population continues to grow. Though the volume of paid care reached 60 million hours per year in addition to 90 million hours of government subsidized care, the rising need for private care continues to grow, along with the aging population that it serves.
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  • To make aging at home a reality for all Canadians, we must redesign the delivery of home care to make it more accessible, accountable and affordable.
  • As government funding continues to decline, unpaid caregivers — typically a spouse or child — are having to fill the gap or pay out of pocket to hire care privately. In 2007, approximately 3.1 million Canadians, largely women between the ages of 45–64 years old (44%) (StatsCan 2012), were estimated to act as an informal caregiver to their loved ones, providing over 1.5 billion hours of care annually.
  • These caregivers provide 10 times the number of care hours by formal services, which is not only taxing on their personal well-being and their relationship with their recipient, but also on Canada’s economy — the cost to businesses from absenteeism and turnover related to unpaid care was estimated to be $1.28 billion in 2007.
  • The Caring Economy is made up of for-profit marketplaces that serve the needs of others. Like the Sharing Economy, it is a marketplace that empowers neighbours to care for neighbours— removing the need for corporations to intervene. Through the latest mobile technology, businesses in the caring economy connect the supply of care to the demand for care.
  • In the Caring Economy, there are two key end users: the demand side that needs to hire care and are willing to pay and the supply side that has time and is looking to help. Demand side users can build their own personalized team of care providers, communicate directly within the platform, and pay on demand via mobile payments — a seamless, convenient and transparent process. This is made possible through a peer-to-peer marketplace that uses mobile technology to efficiently manage the relationships between paid care-workers to primary caregivers and their loved ones — on demand. Simply put, it is Uber for home care.
  • At its core, this model redesigns how care is delivered to make ‘aging in place’ a reality. The model’s objective is threefold — to help seniors age with dignity, to unburden their family caregivers, and to turn compassionate people and Personal Support Workers (PSWs) into ‘micro-entrepreneurs’ — providing them with an opportunity to earn a 20–30% higher wage- a win, win, win.
  • The Uplift® smartphone platform delivers on-demand home care services — at the touch of a button. As a company, we are laser focused on harnessing the latest mobile technology and analytical problem solving to deliver a superior user experience that fulfills the aging population’s demand for higher quality care. We are setting the new standard.Our app is an affordable solution to expensive agency fees. We offer 30–50% lower fees than private agencies. We are also an innovative substitute to long-term care.As an organization, we are devoted to making a positive impact in the world. Moreover, we are a pioneer of the ‘caring economy’ — where neighbours can care for neighbours and caregivers are empowered.
Doug Allan

Reforming private drug coverage in Canada: Inefficient drug benefit design and the barr... - 0 views

  • Reforming private drug coverage in Canada: Inefficient drug benefit design and the barriers to change in unionized settings
  • The Canadian Life and Health Insurance Association, concerned about the sustainability of private drug coverage in Canada, has asked for government help to reduce costs [11x[11]Canadian Life and Health Insurance Association, Inc. CLHIA report on prescription drug policy; ensuring the accessibility, affordability and sustainability of prescription drugs in Canada. Canadian Life and Health Insurance Association Inc., ; 2013See all References][11]. Growing administrative costs of private health plans continues to put additional financial pressures on the capacity to offer private health benefits [12x[12]Law, M., Kratzer, J., and Dhalla, I.A. The increasing inefficiency of private health insurance in Canada. Canadian Medical Association Journal. 2014; 186See all References][12].
  • Most Canadians are covered through private drug plans offered mostly by employers through supplemental health benefits: 51% of Canadian workers have supplemental medical benefits [2x[2]Morgan, S., Daw, J., and Law, M. Rethinking pharmacare in Canada. CD Howe Institute, ; 2013 (Commentary 384)See all References][2], and since work-related health insurance also covers dependents of employees with coverage, as many as two-thirds of Canadians are covered by health insurance plans.
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  • Prescription drug spending in Canada's private sector has increased nearly fivefold in 20 years, from $3.6 billion in 1993 to $15.9 billion in 2013 [3x[3]Express Script Canada. 2013 Drug trend report. ESI, Mississauga; 2014 (http://www.express-scripts.ca/sites/default/files/uploads/FINAL_executive%20summary_FINAL.pdf [accessed 01.06.14])See all References][3].
  • Private drug plans in Canada are often considered wasteful because they accept paying for higher priced drugs that do not improve health outcomes for users and use costly sub-optimal dispensing intervals for maintenance medications. As a consequence, it is estimated that private drug plans in Canada wasted $5.1 billion in 2012, which is money spent without receiving therapeutic benefits in return [4x[4]Express Scripts Canada. Poor patient decisions waste up to $5.1 billion annually, according to express script Canada. (June)Press release, ; 2013 (http://www.express-scripts.ca/about/canadian-press/poor-patient-decisions-waste-51-billion-annually-according-express-scripts [accessed 01.06.14])See all References][4]. This amount represented 52% of the total expenditures of $9.8 billion by private insurers on prescription drugs for that year [5x[5]Canadian Institute for Health Information. Drug Expenditure in Canada 1985 to 2012. CIHI, Ottawa; 2013See all References][5].
  • Respondents from all categories mentioned that, in contrast to employers, the over-riding objective of unions is to maximize their benefits with minimal co-payments for their employees.
  • The study focused on large unionized workplaces that had Administrative Services Only (ASO) plans, where the employer is responsible for the costs of benefit plans and bears the risks associated with it, while insurers are just hired to manage claims.
  • This study focused on ASO arrangements because they are the most common insurance option chosen by large private-sector firms [16x[16]Sanofi. Sanofi Canada healthcare survey. Rogers Publishing, Laval; 2012See all References][16]. Those organizations whose activities resided solely in the province of Québec, where the regulation of private drug plans differs [17x[17]Commissaire de la santé et du bien être du, Québec., Les médicaments d’ordonnance: État de la situation au Québec. Gouvernement du Québec, Québec; 2014See all References][17], were excluded.
  • Respondents from all categories indicated that consistency of benefits with other market players is of significance to employers.
  • Sean O’BradyxSean O’BradySearch for articles by this authorAffiliationsÉcole de relations industrielles, Université de Montréal, Montreal, Quebec, CanadaInteruniversity Research Centre on Globalization and Work (CRIMT), Montreal, Quebec, Canada, Marc-André GagnonxMarc-André GagnonSearch for articles by this authorAffiliationsSchool of Public Policy and Administration, Carleton University, Ottawa, Ontario, CanadaCorrespondenceCorresponding author at: School of Public Policy and Administration, Carleton University (RB 5224), 1125 Colonel By Drive, Ottawa, Ontario, Canada K1S 5B6. Tel.: +1 613 520 2600.xMarc-André GagnonSearch for articles by this authorAffiliationsSchool of Public Policy and Administration, Carleton University, Ottawa, Ontario, CanadaCorrespondenceCorresponding author at: School of Public Policy and Administration, Carleton University (RB 5224), 1125 Colonel By Drive, Ottawa, Ontario, Canada K1S 5B6. Tel.: +1 613 520 2600., Alan Cassels
  • The employers indicated that their over-riding strategy is to maintain cost-neutrality in providing drug benefits – in the context of overall compensation – to employees: any increases in the costs of a particular benefits area must be off-set by cost-savings elsewhere. Controlling knowledge was also frequently reported by the union-side respondents (and by one consultant that services employers) as a strategy to achieve greater control over negotiations and plan design by firms. According to one union representative, “
  • the employer always has the advantage in this stuff because they have all of the information with respect to the reports and the costs from the insurer or the advisor”
  • According to one consultant, “no one knows the cost of drug benefit plans.” This respondent was arguing that few involved in benefit design, either in private firms, unions, or insurers, are sufficiently competent to undertake proper analyses of claims data so they do not really know how proposed plan changes could affect them. This lack of expertise has ramifications for the education of stakeholders on the outcomes of benefit design.
  • However, when speaking of for-profit insurers, participants from all groups argued that insurers have no financial incentives to cut costs for employers, as indicated by one employer saying: “from my experience on the committees, I don’t get the impression that the insurers are there to save costs for the employers. I haven’t seen it. It's always been the other direction.” This claim was also corroborated by a benefits consultant, who argued that “there has been a fair bit of inertia, you know, amongst the providers out there in actually doing something too radical, too leading edge” because “there's no direct financial incentive for insurance companies or pharmacy benefit managers to actually help employers save money”.
  • Expanding on this, another consultant argued that an insurer's commission structure, which is based on volumes of claims expressed in a dollar value, may in fact discourage insurance companies from proposing plan designs that reduce the volumes of claims, as doing so would adversely affect company profits. Furthermore, another benefits consultant indicated that insurers are experts who calculate risk and thereby have no aptitude for the creation of formularies. According to this respondent, the impact is that insurance companies excel at managing risk, yet fare poorly in designing cost-effective plans that rely on the design and implementation of formularies.
  • An interesting finding from the interview data was that respondents from all interviewed groups declared being in favor of introducing some sort of arrangement for a national drug plan. Some favored having a universal pharmacare program which would apply to all drugs, while others favored programs tailored for catastrophic drug coverage. Two of the insurers that responded to this question explicitly favored some form of universal catastrophic drug coverage while the other favored universal pharmacare.
  • Each of the union representatives and one employer interviewed for this study expressed their support for universal pharmacare. Three out of five consultants argued in favor of a national pharmacare plan while the other two favored some other form of national risk pooling or formulary management to address costs.
  • While a majority of interviewees favored some form of universal coverage, a few respondents from the insurer and employer sides expressed concerns that universal pharmacare is not feasible.
  • Finally, employers were most concerned with the government's role in distributing the costs associated with drug coverage among public and private players in the system. In fact, each employer expressed concern over this. Three of the four employers expressed concern over the government's role as a plan sponsor and how governments shift costs to the private sector. As described by one employer, “the government is a very big consumer of drugs” and if the drug companies “start losing money on the government side, they pass it on to private insurance”. Thus, government regulations that help employers contain costs are desired.
  • Marc-Andre Gagnon has received research funding by the Canadian Federation of Nurses’ Unions for a different research project related to drug coverage in Canada. Alan Cassels is co-director of DECA (Drug Evaluation Consulting and Analysis). The authors would like to acknowledge the financial contribution of the Canadian Health Coalition in order to pay for the transcription of interviews.
Irene Jansen

The village where people have dementia - and fun | Society | The Guardian - 2 views

  • small Dutch town of Weesp
  • Hogewey, where Jo Verhoeff lives, has developed an innovative, humane and apparently affordable way of caring for people with dementia.
  • a traditional nursing home for people with dementia – you know: six storeys, anonymous wards, locked doors, crowded dayrooms, non-stop TV, central kitchen, nurses in white coats, heavy medication
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  • 152 residents
  • A compact, self-contained model village on a four-acre site on the outskirts of town, half of it is open space: wide boulevards, cosy side-streets, squares, sheltered courtyards, well-tended gardens with ponds, reeds and a profusion of wild flowers. The rest is neat, two-storey, brick-built houses, as well as a cafe, restaurant, theatre, minimarket and hairdressing salon.
  • low, brick-built complex, completed in early 2010
  • suffering from severe or extreme dementia
  • 250-odd full- and part-time staff
  • six or seven to a house, plus one or two carers, in 23 different homes. Residents have their own spacious bedroom, but share the kitchen, lounge and dining room.
  • 25 clubs, from folksong to baking, literature to bingo, painting to cycling
  • encourages residents to keep up the day-to-day tasks they have always done: gardening, shopping, peeling potatoes, shelling the peas, doing the washing, folding the laundry, going to the hairdresser, popping to the cafe
  • seven different "lifestyle categories"
  • One is gooise, or Dutch upper class
  • a house in ambachtelijke style, for people who were once in trades and crafts: farmers, plumbers, carpenters
  • Huiselijke is for homemakers: neat, spotlessly clean, walls hung with wooden display cabinets for dozens of brass and porcelain ornaments
  • No doors – apart from the main entrance, with its hotel-like reception area – are locked in Hogewey; there are no cars or buses to worry about (just the occasional, sometimes rather erratically-ridden, bicycle) and residents are free to wander where they choose and visit whom they please. There's always someone to lead them home if needed.
  • Other houses are designated christelijke, for the more religious residents; culturele, for those who enjoy art, music, theatre (and, says Van Zuthem, "getting up late in the morning"); and indische, for residents from the former colony of Indonesia (rattan furniture, Indonesian stick puppets on the walls, heating two degrees higher in winter, and authentic cuisine).
  • urban, for residents who once led a somewhat livelier lifestyle
  • By the time Hogewey was finished, it had cost ¤19.3m (£15.1m). The Dutch state funded ¤17.8m, and the rest came from sponsors and local fundraising.
  • anyone can come and eat in the restaurant, local artists hold displays of their work in the gallery, schools use the theatre, businesses hire assorted rooms for client presentations
  • Nor is the cost per resident of this radically different approach to dementia care much higher than most regular care homes in Britain: ¤5,000 a month, paid directly to Hogewey by the Dutch public health insurance scheme
  • Some residents also pay a means-tested sum to their insurer. There is a very long waiting list.
  • You don't see people lying in their beds here. They're up and about, doing things. They're fitter. And they take less medication.
  • we've shown that even if it is cheaper to build the kind of care home neither you or I would ever want to live in, the kind of place where we've looked after people with dementia for the past 30 years or more, we perhaps shouldn't be doing that any more."
Govind Rao

With The ACA Secure, It's Time To Focus On Social Determinants - 0 views

  • Social Determinants Elizabeth Bradley and Lauren Taylor July 21, 2015
  • Editor’s note: This article is part of a series of blog posts by leaders in health and health care who participated in Spotlight Health from June 25-28, the opening segment of the Aspen Ideas Festival. This year’s theme was Smart Solutions to the World’s Toughest Challenges. Stayed tuned for more. While Medicaid expansion remains a dream for Americans in many states, the integrity of both the state and federal marketplaces for insurance remained intact following the June 25 Supreme Court decision to allow the federal government to provide nationwide tax subsidies to help people buy health insurance. The following morning, Kathleen Sebelius led a discussion at the Aspen Ideas Festival calling the Court’s action “The strongest possible decision. Definitive.” The judicial victory provided space for participants to commit to asking new questions about how to improve health at a reasonable cost. After months of uncertainty, many of the leading minds in US health policy began to ask: What’s next?
Cheryl Stadnichuk

Allen v Alberta: The Sound and Fury of Section 7 and Health Care - TheCourt.ca - 0 views

  • The pain became so disabling that Dr. Allen was forced to sell his dentistry practice in July 2009. In desperation, Dr. Allen underwent surgery at his own expense in December 2009. The surgery was successful, relieving his pain and signalling a return to health. The cost of the surgery was $77,000.
  • Dr. Allen argued that section 26(2) of the Alberta Health Care Insurance Act, RSA 2000, c A-20 prevented him from obtaining private health care insurance and covering the cost of his surgery. The section in question prohibits insurers from issuing private health care insurance for basic health care already covered under the Alberta Health Care Insurance Plan. It gives the public Plan a monopoly on health care insurance for basic health care services. Dr. Allen argued that this was unconstitutional, infringing his section 7 Charter rights
  • The chambers judge held that the unconstitutionality of section 26(2) was dependent on whether Dr. Allen could demonstrate that this particular restriction on private health insurance in this specific context offended section 7. In his view, the connection between state-caused effect and the harm suffered by Dr. Allen had not been satisfied. This was because there was no evidence indicating either that the prohibition caused Dr. Allen’s wait time in the Albertan health care system, or that private health care insurance would have been available for this type of surgery anyway.
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  • Justice Slatter clearly had issues with the majority judgment in Chaoulli. He highlighted that section 7 is a notoriously unsettled and controversial Charter provision, and the “drafters of the Charter never intended it to be applied to the review of social and economic policies” (para 33).
healthcare88

1 in 3 cancer patients turn to friends, family to pay for care - 0 views

  • By Scott D. Ramsey and Veena ShankaranNovember 2, 2016
  • What she didn’t anticipate was the financial toll his illness would take on the family
  • As Rafe’s medical needs intensified, caring for him became all-consuming and Maria quit her job. Although her husband was still employed, the family’s income fell to half of what it had been, and they were faced with mounting medical bills on top of the normal day-to-day expenses like groceries and gas.
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  • Neighbors held a fundraising drive, gathering nearly $10,000, but by then the bills were so great that the money was gone within a week.
  • Scott D. Ramsey, MD, is the director of the Hutchinson Institute for Cancer Outcomes Research7 in Seattle. Health economist Veena Shankaran, MD, is a medical oncologist and an associate member of the Hutchinson Institute for Cancer Outcomes Research.
Irene Jansen

Nursing home residents abused - thestar.com - 0 views

  • Seniors in Ontario nursing homes are being beaten, neglected and even raped by the people hired to care for them, a Star investigation has found.
  • Seniors advocates agree that cases of abuse in long-term care are under-reported. According to the reports the Star obtained, more than 10 residents in Ontario each month are punched, pushed, verbally abused or sexually assaulted. In the majority of the known cases, the abuser was a staff member. In others, the assault was resident on resident.
  • Eight years after Star stories documenting problems brought a provincial vow of improved care, the same problems exist.
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  • The problems continue because the nursing home system is taking increasingly sick and demented residents but lacks the money for increased staffing levels to provide a minimum amount of daily care.
  • Personal support workers who do the majority of hands on work are not regulated and have little training to manage residents with complex needs.
  • Just over a year ago the ministry rolled three confusing nursing home acts into one piece of legislation
  • The new inspection system — with a focus on resident complaints — is now uncovering hundreds of cases of assault and neglect.
  • The Star obtained more than 1,500 inspection reports carried out since the new rules began.
  • The system relies on homes volunteering negative information about themselves or residents speaking out, even though many fear repercussions.
  • Of 1,500 inspection reports (the Star obtained about 70 per cent of reports from the last year), serious problems were found in 900 cases. Of those, roughly 125 were abuse related, 350 revealed neglectful treatment of a senior and the remainder found other types of poor care. There are 627 homes in Ontario with 77,000 residents.
Govind Rao

NS health min likes Scotia Surgery. @capital_health quietly renewed $1M contract with h... - 0 views

  • Scotia Surgery's latest renewal is for 18 months. #cbcns # ... @capital_health quietly renewed $1M contract with health firm last March
Govind Rao

Doctors v. government: the first major fight over pay - 0 views

  • CMAJ March 17, 2015 vol. 187 no. 5 First published February 9, 2015, doi: 10.1503/cmaj.109-4990
  • Roger Collier
  • Part II: Today’s contentious negotiations echo those from the battle over medicare a half-century ago Doctors refuse to compromise, says one side. The government cares more about its budget than patients, says the other side. Doctors have rejected a “very fair offer,” says a provincial health minister. Patients can’t wait for the government to balance its books, says a medical association. You know, this all sounds mighty familiar.
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  • Much of the rhetoric thrown around today in scuffles between governments and physicians might ring a bell for students of medical history. More than 50 years ago, doctors were also accused of being too stubborn to accept changes to pay structure, and a provincial government was also charged with putting fiscal concerns before patient needs. Of course, if that old saying holds any merit — “Those who cannot remember the past are condemned to repeat it” — perhaps a refresher is in order. There seems, after all, to be a little bit of history repeating itself.
  • The origin of conflict between provincial governments and physicians can be summed up in one word: medicare. It therefore dates back to midnight of July 1, 1962, when the Saskatchewan Medical Care Insurance Act passed into law, introducing the first universal, government-run, single-payer health system to North America. All of one minute later, most of Saskatchewan’s doctors went on strike.
  • tually, to be precise, the fighting between the government and doctors in Saskatchewan began a couple of years earlier, during the 1960 provincial election. Premier Tommy Douglas had made universal health care the main peg of his re-election campaign. The College of Physicians and Surgeons of Saskatchewan fiercely opposed the idea, contending that government interference in medicine would do far more harm than good.
  • A public battle ensued, pitting doctors against politicians. Debates were held, pamphlets were circulated, pledges were signed. Did the whole affair stay civil and free of propaganda? Well, you could say that. But only if you enjoy being wrong.
  • Let’s start with some of the literature circulated by opponents of medicare. One pamphlet, Political Medicine is Bad Medicine, was chockablock with scary warnings and seasoned with a liberal sprinkling of words in all-caps for emphasis. Red Tape! Skyrocketing costs! Inferior care! The premier’s plan “proposes a PERMANENT INFLEXIBLE GOVERNMENT SCHEME at a high cost” that would subject medicine “to POLITICAL considerations bearing no relation to your NEEDS.”
  • Then there was the infamous flyer — later used by Premier Douglas to shame his opponents, according to Saturday Night magazine — that suggested many doctors would flee the province if the medicare bill passed. “They’ll have to fill up the profession with the garbage of Europe,” read one excerpt, a quote from an anonymous doctor taken from the Toronto Telegram. “Some of the European doctors who come out here are so bad we wonder if they ever practised medicine.”
  • Later, some in the anti-medicare camp acknowledged that mistakes were made, passion had trumped reason, and the medical profession had suffered for engaging in political mudslinging. “Many doctors concede privately that they went too far, that the campaign lost them prestige in their communities,” reported Saturday Night magazine.
  • Of course, the premier was no stranger to rhetoric himself. In fact, according to some political commenters of the time, he was a master of the form. He accused the province’s physicians of using “abominable” and “despicable” tactics and pedalling “scurrilous trash.”
  • In the end, Douglas and his party, the Co-operative Commonwealth Federation, won the election and pushed ahead with their health system plan. The doctors and government set aside their differences and all lived happily ever after. Yeah, right.
  • Medicare was coming to Saskatchewan — that battle was over — but physicians still weren’t cooperating with the government. They focused their efforts on changing sections of the proposed medicare act, specifically those that granted the government almost unlimited power to control the practice of medicine.
  • There was no provision for negotiation. The doctors would simply have to do what the government told them to do, and be paid what the government said they would be paid,” Dr. Marc Baltzan (1929–2005), a Saskatoon nephrologist and former president of the Canadian Medical Association, wrote in a 1984 article in Canadian Family Physician entitled, “Doctor/Government Fee Negotiations in Canada.”
  • After the act became law, unchanged, the province’s physicians closed their offices, though they still provided emergency services in hospitals. The standoff lasted 23 days, ending only after both sides compromised and signed the Saskatoon Agreement. The deal amended the act to ensure doctors would maintain their independence and could, if they wanted, opt out of medicare and bill patients directly.
  • The deal was brokered by Lord Stephen Taylor, a British doctor and politician who helped implement the National Health Service in the United Kingdom. Later, reflecting on his Saskatchewan adventure, Taylor wrote that much of the animosity between the two parties arose because they did not understand each other at all. The government did not anticipate how much their plan would threaten the autonomy of a proud profession. Physicians “could not believe that the government was composed of honest and responsible people.”
  • Taylor, a man of both medicine and government, chose to take a dispassionate view of the conflict. “I see honest men on both sides, well motivated but mystified by the actions of their opponents.”
  • Decades later, debate over another act — the Canada Health Act, federal legislation adopted in 1984 — again showed just how differently government and physicians can view a change to how doctors are paid. This time, the government was putting an end to extra billing by physicians. But according to Baltzan, as mentioned in his Canada Family Physician article cited above, this was merely a “political euphemism” for banning a patient’s right to be reimbursed by the government when billed directly by a doctor.
  • In his lament over the passing of the “deceitful bill,” Baltzan suggested that it was important to revisit the original fight over medicare in Saskatchewan because “it shows that there is nothing new under the sun: it contains all the elements of physician–government confrontation that have been replayed again and again during the Canada Health Act debate.”
  • Now, more than 30 years later, it might not be a stretch to say there is still nothing new under the sun regarding negotiations between doctors and government. When things go bad, as they have in Ontario, both sides sometimes resort to a little time-tested rhetoric. Then again, though some of the messages sound familiar, other elements of physician–government showdowns have changed since 1962. For one, doctors back then didn’t have Twitter accounts.
Govind Rao

e-Health - Program - 0 views

  • Tap into 100+ hour of education covering some of the hottest topics in digital health and patient care at e-Health 2015. Encompassing all sectors of care, the program offers something for everyone in the sector, whether you’re working at the coalface of healthcare as a clinician, designing systems behind the scenes, writing policy or involved with any other aspect of e-Health. This year, it’s is all about Making Connections: People to People (e.g., clinicians, First Nations, patients, caregivers, consumers) Sector to Sector (e.g., acute, primary, community & long-term care) Data & Information to Outcomes (e.g., benefits evaluation, health system use, analytics) Current & Future Technologies (e.g., standards, interoperability, implementation & adoption, innovation)
Heather Farrow

Angus, Bennett to fly to Attiwapiskat, MPs get emotional during late-night debate on su... - 0 views

  • More funds and youth involvement are crucial for a long-term solution for remote First Nations communities, says NDP MP Charlie Angus.
  • Monday, April 18, 2016
  • PARLIAMENT HILL—NDP MP Charlie Angus, who is flying to Attawapiskat First Nation on Monday with Indigenous Affairs Minister Carolyn Bennett to meet with Chief Bruce Shisheesh, is calling for immediate action to provide critical services to the 2,000 residents of this northern Ontario community located in his riding.
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  • We need to stabilize the situation in Attawapiskat in terms of making sure they have the health support they need,” Mr. Angus (Timmins-James-Bay, Ont.) told The Hill Times last week. “We need a plan to get people who are needing help in any of the communities to get that help.”
  • A rash of attempted suicides prompted Mr. Angus, who’s also the NDP critic for indigenous and northern affairs, to call for an emergency debate on the ongoing suicide crisis in the James Bay community of about 2,000. As a result, the House of Commons convened until midnight last Tuesday for an emotionally charged discussion on mental health services following a string of incidents in northern reserves in recent months. Several MPs choked up during their statements, recounting suicide incidents in their ridings and personal lives.
  • Sometimes partisan politics need to be put aside and members need to come together to find solutions to prevent another unnecessary loss of life,” Conservative MP Todd Doherty (Cariboo-Prince George, B.C.) said during the debate. NDP MP Georgina Jolibois (Desnethé-Missinippi-Churchill River, Sask.) said the suicide rate went up in her home community of La Loche in northern Saskatchewan after a shooting spree that killed four people last January.
  • Liberal MP Robert-Falcon Ouellette (Winnipeg Centre, Man.) recalled visiting the northern Manitoba Pimicikamak Cree Nation, which declared a state of emergency over a series of suicide attempts last month.
  • Mr. Angus made an emotional appeal to action in his opening remarks during the emergency debate. “We have to end the culture of deniability whereby children and young people are denied mental health services on a routine basis, as a matter of course, by the federal government,” he said. Eleven people attempted to take their lives in Attawapiskat two Saturdays ago, prompting the First Nation to declare a state of emergency—the fourth one since 2006. There has been more than 100 suicide attempts in the reserve since the month of September, many of which involved children. The community has been plagued by flooding and several housing crises in recent years.
  • Eighteen mental health workers were dispatched to Attawapiskat on Tuesday, including two counsellors, one crisis worker, two youth support workers, and one psychologist. While there is no set timeline, they’re not expected to leave for at least two weeks, said Health Canada assistant deputy minister Keith Conn during a teleconference last week.
  • Some of the people treated for mental health problems last week had previously been airlifted out of the community for assessment before being sent back after their examination, according to Mr. Conn. This past Tuesday, at least 13 people, including a nine-year-old child, had made plans to overdose on prescription pills as part of a suicide pact. The Nishnawbe-Aski Police Service apprehended them before sending them to the local hospital for a mental health assessment.
  • Mr. Conn said he’s heard criticism of the mental health assessment process from Attawapiskat First Nation Chief Bruce Shisheesh. Individuals who are identified as likely to commit suicide are typically sent to a hospital in Moose Factory, Ont., to be psychologically evaluated by a psychologist or psychiatrist. They are then discharged and sent back to the community, where some try to take their life again. Mr. Conn said Health Canada does not “control the process,” but he personally committed to review the mental health assessment effectiveness.
  • No federally funded psychiatrists were present in the region prior to the crisis, despite reserve health-care falling under the purview of the federal government. Mr. Conn said the Weeneebayko Area Health Authority (WAHA), a provincial health unit servicing communities on the James Bay coastline, is usually responsible for the Attawapiskat First Nation following an agreement struck with the federal government about 10 years ago.
  • A mental health worker position for the reserve has been vacant since last summer, in part because there’s a lack of housing for such staff. The community has been left without permanent, on-site mental health care services. Since then, the position has been filled by someone already living on reserve. During the emergency debate in the House last week, Health Minister Jane Philpott (Markham-Stouffville, Ont.) emphasized the need for short- and long-term responses to the crisis.
  • We need to address the socio-economic conditions that will improve indigenous people’s wellness in addition to ensuring that First Nations and Inuit have the health care they need and deserve,” she said. Ms. Philpott pointed to the Liberal government’s budget, which includes $8.4-billion for “better schools and housing, cleaner water, and improvements for nursing stations.”
  • “Our department and our government are ensuring that all the necessary services and programs are in place,” she said during the debate. “We are currently investing over $300-million per year in mental wellness programs in these communities.” Yet, Mr. Angus said the budget includes “no new mental health dollars” for First Nations communities. In addition to allocating more funds for mental health services to indigenous communities, Mr. Angus said there needs to be a concerted effort to bring in the aboriginal youth in the conversation.
  • We need to bring a special youth council together,” he told The Hill Times on Wednesday. “We need to have them be able to come and talk to Parliament about their concerns, so we’re looking at those options now.” Emotion was audible in Mr. Angus’ voice when he read letters he received from Aboriginal youth during the emergency debate, which expressed a desire to work with the federal government to solve the crisis.
  • The greatest resource we have in this country is not the gold and it is not the oil; it is the children,” he said. “The day we recognize that is the day that we will be the nation we were meant to be.” Mr. Angus met with Indigenous and Northern Affairs Minister Carolyn Bennett (Toronto—St. Paul’s, Ont.) earlier in the week to discuss potential long-term solutions to the suicide crisis. “I’ve always had an excellent relationship with Carolyn Bennett, and as minister we’re trying to find ways to work together on this, to take the tension down, to start finding solutions,” Mr. Angus said. Mr. Angus criticized “Band-Aid” solutions that have been thrown at First Nations issues over the years and said there needs to be a “transformative change” this time.
  • That’s where we have to move beyond the positive language to actually the brass tacks,” he said. During the emergency debate, Mr. Angus supported the idea of giving more resources to frontline workers such as on-reserve police, and health and treatment centres. 0eMr. Angus’ riding sprawls from shores of the Hudson Bay to the Timiskaming district on the border with Quebec, an area roughly equivalent in land size to that of Guinea. He holds two constituency offices in Timmins and Kirkland Lake.
Irene Jansen

Nursing home neglect - thestar.com - 0 views

  • A private nursing home chain enforced such strict rations on diapers that staff wrapped residents in towels and plastic garbage bags to keep their beds dry.
  • A resident at a Bradford home who was prone to falls was left alone on a toilet. The resident fell and sustained a head injury.
  • Residents in a Hamilton home had untreated bedsores and were famished from lack of food.
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  • An elderly woman with a broken thighbone in a Pickering nursing home suffered for days without treatment.
  • A Brantford home was so short staffed that residents frequently missed their weekly baths.
  • Eight years after an Ontario government promise to revolutionize nursing home care, the elderly are still suffering neglect and abuse.
  • The Star’s investigation draws from material uncovered by a new inspection system created by the Ministry of Health and Long-Term Care in July 2010. It has since investigated 2,993 complaints and critical incidents, like broken bones or assaults. We analyzed more than 1,500 of those inspection reports and found at least 350 cases of neglect where residents were left in soaking diapers, suffered untreated injuries, bedsores, dehydration, weight loss or were put at risk from outdated care plans that ignored changing medical needs. Other reports, scrutinized for Thursday’s story, focused on abuse. Today the Star probes the issue of neglectful treatment of home residents. The reports reveal that many families have no idea what their loved ones are subjected to. Inspectors found that some homes do not disclose problems to the ministry or police.
  • Diaper shortages can be found in many of Ontario’s 627 homes, said Sharleen Stewart president of the union representing front-line nursing home staff. “Our members tell us the shortages leave residents with rashes and sores,” said Stewart, of the Service Employees International Union, which represents 50,000 Ontario health care workers, including 22,000 nursing home employees.
  • Last November a ministry inspector wrote, “Five different nursing staff members working the day shift from all home areas… indicated they are only provided with one (diaper) per (eight hour) shift for the resident and frequently have to go to another home area to try and borrow products.”
  • The report also described a resident with an open sore whose diaper was soaked in the morning. Since staff could not find a replacement, the resident was only given a paper insert to keep urine from the senior’s wound.
  • Two months later, in January 2011, the ministry was back at the same home, this time investigating a complaint from a family who said their loved one was wearing the same diaper from the previous day and it was “heavily soiled.”
  • Ko dismissed allegations that a Revera home in north Etobicoke rations diapers. But one current and one former resident of Westside Long Term Care on Albion Rd. told the Star residents are only given one diaper per eight-hour shift.
  • She praised the staff, saying they scramble to find an extra diaper if one’s needed. “They’re embarrassed that I’m embarrassed.”
  • Two employees at Westside said the home locks up diapers and staff have to sign them out. The workers at Westside spoke on the condition of anonymity, saying they are afraid of being fired. One worker said she is so worried about leaving residents in wet diapers that she places towels and plastic garbage bags under them to prevent urine from soaking their bed sheets.
  • Revera was “shocked” to hear allegations that makeshift diapers were being used and she has both launched an investigation and is conducting educational sessions for staff
  • Westside workers say their bosses warn staff they will be fired if they tell residents’ families the home is rationing diapers. Whistleblower protection in Ontario homes only helps staff who divulge problems to their nursing home supervisors or the health ministry. It does not protect the jobs of workers who warn residents’ families that their relatives are being neglected, complain to their union or speak to the media.
  • The new inspection report system often hides bad care from public scrutiny. The public report is often stripped of details. A private version for the home’s management, on the other hand, gives precise information about each violation. It took Lorraine Henderson 11 months to obtain copies of these private reports through access to information legislation.
  • The Star’s analysis of inspection reports found more than 50 cases in which elderly residents fell and got injured, many times when they were left unassisted by caregivers or dropped from mechanical lifts.
Irene Jansen

Why the markets can't run hospitals - Science-ish - Macleans.ca - 0 views

  • In a seminal 2009 New Yorker piece, entitled ‘The Cost Conundrum,’ Dr. Atul Gawande used “the most expensive town in the most expensive country for health care in the world”—McAllen, Texas—to show that more spending and “overuse of medicine” does not equal better health care. In fact, U.S. states that spent more on health care tended to be near the bottom of national quality and patient-care rankings. Dr. Gawande suggested there is an essential conflict between the profit motive—with “physicians who see their practice primarily as a revenue stream”—and cost-effective, quality patient care.
  • Similarly, a robust systematic review of studies comparing health outcomes in Canada and the U.S. noted that while the Canadian model “has many well-publicized limitations. . . Canada’s single-payer system, which relies on not-for-profit delivery, achieves health outcomes that are at least equal to those in the United States at two-thirds the cost.”
  • As for cost, another systematic review, published in the CMAJ, looked at payments at private for-profit and private not-for-profit hospitals. Again, the not-for-profits outperformed the for-profit hospitals by costing less. Some explanations for this: For-profit hospitals are driven to generate revenue for investors and executive bonus incentives are over 20 per cent higher at for-profit hospitals. The data could also be interpreted to mean that for-profit institutions are providing superior care—but then the earlier review about mortality showed this isn’t the case.
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  • Evidence out of Canada supports a similar conclusion. McMaster University associate professor Dr. PJ Devereaux—who led almost all the systematic reviews (the highest form of evidence) around this debate—has studied death rates in private for-profit and private not-for-profit hospitals, as well as out-patient for-profit dialysis clinics compared to not-for-profit clinics. In both systematic reviews, for-profit ownership resulted in a statistically significant increase in the risk of death for patients. Dr. Devereaux found the same association between worse care and profit in his BMJ systematic review on the quality of care in for-profit and not-for-profit nursing homes.
  • Science-ish can only vouch for the best-available evidence on quality of care and cost. It suggests not-for-profit settings win.
  • health care isn’t like any other market
Irene Jansen

Ontario task force to tackle abuse in nursing homes - thestar.com - 0 views

  • Ontario nursing homes and seniors advocates have created a task force to stop abuse in their facilites after a Star investigation found vulnerable residents are beaten, neglected and even raped by staff.
  • They came up with the plan after being summoned to an emergency meeting on Friday with Health minister Deb Matthews who demanded changes to nursing home practices
  • Matthews said the task force will bring together residents, families, staff, owners and advocates to create a “real culture change.”
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  • Attending the meeting were representatives of two nursing home associations, representing private and not-for-profit homes, a seniors advocacy group and organizations for resident and family councils.
  • the task force will come up with strong recommendations for change within a few months
  • The Star stories examined the Health Ministry’s inspection reports and found that residents are routinely abused and neglected in many of the 627 Ontario-licensed nursing homes. The stories analyzed more than 1,500 inspection reports filed since the province rolled out a new system in July 2010, which itself was the result of a 2003 Star investigation into nursing home neglect. Serious problems were found in 900 cases. Of those, roughly 125 were abuse-related, 350 revealed neglect of a senior and the remainder found other types of poor care.
  • The Star also found that residents are limited to one diaper per eight-hour shift in some homes. That is “not acceptable care,” Matthews said.
  • After an hour inside a Ministry of Health boardroom, about 10 nursing home leaders left with a commitment to improve conditions inside the homes.
  • The fastest way to create change, Matthews said, is for families and staff to report every example of abuse or neglect to the ministry’s complaint line. The Star’s stories found many homes tried to cover up their problems by delaying or not reporting incidents to the ministry.
  • the association that represents Ontario’s 33,000 nurses sent a letter to its members on Friday saying they must report abuse
  • Grinspun said. “We are telling out members to report, report, report. We will stand by them in every instance where their voice is pushed to silence.”
Irene Jansen

Auditor General of Canada. September 2002 Stauts Report. Chapter 3-Health Canada-Federa... - 0 views

  • Chapter 3—Health Canada—Federal Support for Health Care Delivery
  • Health Canada has made only limited progress in addressing the weaknesses we identified in our 1999 audit. As a result, its monitoring still does not allow it to assess and report the extent of provincial and territorial compliance with the Canada Health Act. Resolving disputes over compliance with the Act remains slow.
  • Health Canada needs to continue to work with the provinces and territories because it still does not have adequate information to assess the extent of provincial and territorial compliance with the Canada Health Act criteria and conditions for health care funding.
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  • The Canada Health Act Annual Report
  • does not indicate the extent to which each provincial and territorial health care insurance plan has satisfied the Canada Health Act criteria and conditions.
  • Weaknesses we identified in 1999
  • 3.25 We noted several weaknesses in Health Canada's reporting, monitoring, and enforcement activities, such as the following: The federal contribution to health care was not being reported to either Parliament or the Canadian public. Health Canada did not have the information it needed for effective monitoring of provincial and territorial compliance with the Canada Health Act. The Department was not reporting the extent to which the provinces and territories were complying with the Act. It was not rigorously enforcing the Act.
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    2002 September Status Report of the Auditor General of Canada
Irene Jansen

Private rooms: A choice between infection and profit - 0 views

  • The Canadian Standards Association (CSA) argues that a move toward single patient rooms is vital as nosocomial infections are becoming a deadly concern, with more than 50% of hospital beds in Canada now on wards with four or more beds per room
  • There’s an 11% increase in the risk of Clostridium difficile infection, a 10% increase in the risk of methicillin-resistant Staphylococcus aureus, and an 11% higher risk of vancomycin-resistant Enterococcus infection with each exposure to a new hospital roommate, according to a recent study coauthored by Dr. Dick Zoutman, professor of microbiology at Queen’s University in Kingston, Ontario, and chief of staff at the Belleville General Hospital in Ontario (Am J Infect Control 2010;38:173–81).
  • While opting to align Canada’s guidelines with those of the United States, the United Kingdom and several Scandinavian nations, the CSA indicated there may be clinical circumstances in which patients would benefit from the social and psychological advantages of shared rooms
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  • But Roger Ulrich, professor of architecture at Chalmers University of Technology in Gothenburg, Sweden, and a worldwide expert in health care design, says that “it’s hard to cite any evidence anywhere that patients do better when they’re with other patients.”
  • “Social support comes from being with people who matter to you, not strangers,”
  • hospital wards should be redesigned to create more communal social spaces
  • a systematic review conducted by Dr. Roger Ulrich and colleagues which indicated that single-bed rooms consistently outperform multi-bed rooms (www.healthdesign.org/sites/default/files/Role%20Physical%20Environ%20in%20the%2021st%20Century%20Hospital_0.pdf). The advantages included reduced medical errors, fewer falls, improved patient confidentiality, privacy, sleep quality, doctor-patient communication and the ability to accommodate family members.
Govind Rao

Health Council Canada - 0 views

  • Where you live matters: Canadian views on health care quality Results from the 2013 Commonwealth Fund International Health Policy Survey of the General Public The Health Council of Canada released results from the 2013 Commonwealth Fund International Health Policy Survey of the General Public. Where You Live Matters: Canadian views on health care quality is the eighth and final bulletin in the Canadian Health Care Matters series.
Govind Rao

CFHI - Driving Quality, Lowering Costs 2014 - 0 views

  • Driving Quality, Lowering Costs workshop seminar 8-9 October 2014 Westin Bayshore Hotel Vancouver, British Columbia
Govind Rao

One hospital not enough - 0 views

  • FRI, JUL 10, 2015| 23°CSunny
  • Last night (July 3), many locals and cottagers witnessed a brilliant example of why Huntsville District Memorial Hospital must remain open. I arrived at the Huntsville Hospital at 6 p.m. Friday, July 3, and was surprised to see at least 20 persons already in the initial emergency waiting room. Being a 20-year cottager plus a five-year resident of Huntsville, this was a large amount of people sitting in the outside waiting room during the off-season (November - April), when I usually go there. What I didn't know until later, is that there were at least 50 people ahead of me waiting in the two additional waiting areas of emergency.
  • I grew-up in Wiarton (yes, the home of Groundhog Willie) with a better hospital for a mere population of 2,000. Also, nearby Owen Sound (30 minutes away), has a good hospital for its population of 21,688; similar to Huntsville's size. Therefore, the Ontario government should be aiding us to make the kilometers/population to hospital ratio more realistic.
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  • Conclusion: no way, can all of Muskoka (4,035 square kilometres with a combined population of 59,220 people (as per Census 2011), be served by only one hospital. Christina Synnott Huntsville
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