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A large portion of those profits are possible because of unregulated "hospitality" fees, and an operational funding model that does not require government funds for front-line staffto actually go toward staffpay. No regulation exists for staff-to-patient ratios or to ensure patient and family councils are welcomed at each facility. Contracts between these providers and the government are confidential, meaning Albertans do not have the right to know how much public money is being doled out or what the terms of the contract are, and whether or not care is the No. 1 priority in these arrangements. This "wild west" model of continuing care providers was set up by the previous PC government, but it remains in place under the NDP government. However, there is hope positive change is coming. While the PC government significantly expanded the role of for-profit corporations in continuing care, the new government has taken a different position. Responding to promises from the previous government to open new care beds in Alberta, on Nov. 19, 2014, then-opposition leader Rachel Notley said in the legislature, "We don't argue with the need for more spaces for seniors; we do think that they should be publicly funded, publicly delivered."

In the same spirit, the NDP's election platform promised to open 2,000 public long-term care beds and "end the PCs' costly experiments in privatization, and redirect the funds to publicly delivered services." The previous government not only stopped building new public beds, but also unnecessarily closed hundreds of functional public long-term care beds and often funded the construction of replacement beds owned by for-profit corporations. Some of the closed facilities are currently empty and could still be reopened for public use.

In light of the problems the previous government created by funding private, for-profit care, the new government should begin by standardizing and limiting fees charged to residents, disclosing the amounts these corporations are being given and spending on direct care and how much of the public money is going to their shareholders, and setting standards for staff-topatient ratios. The most meaningful sign the new government can send would be to make good on their promise to open 2,000 public long-term care spaces, where profit is not a factor and care is the No. 1 priority. Fulfilling that promise should be the government's first step to phasing out private, for-profit continuing care. Our public health care dollars should not be given to corporate shareholders; it should be spent on care for Albertans. Private, for-profit care facilities are no more acceptable than Ralph Klein's short-lived private, for-profit hospitals. Noel Somerville is the chair of Public Interest Alberta's Seniors Task Force. Sandra Azocar is the executive director of Friends of Medicare.

Stealth privatization of health care makes accountability worse As a result of increased contracting out, home care has seen more low and inconsistent wages among workers, as well as declining quality and availability of care. In a response to the Ministry of Health’s 2016 Patients First discussion paper, OPSEU/NUPGE indicated that there is a dire need for increased funding to hospitals and Local Health Integrated Networks (LHINS) that have not seen an increase in funding in more than 4 years, as well as a need for health care to stay public to ensure transparency and accountability.

activity-based funding of hospitals

It also makes the federal government fully responsible for funding and delivering “aged care;”

AU$20 billion boost in funding for public hospitals over the next decade

But the final agreement fell short on one of the key objectives identified at the start of the exercise — a blending of federal and state government services and funding

Australia’s constitution makes the federal government responsible for national health policy, subsidization of public hospitals and funding of medical services and pharmaceuticals under medicare. State and territorial governments are responsible for public health services, such as dental, maternal and child health care; all direct care, including most acute and psychiatric hospital services; as well as a portion of the funding of public hospitals.

Costs have been rising at about a 9% rate for the past five years, while the revenues of state and territorial government have grown by about 6%.

The agreement essentially trades an increase in federal funding in exchange for reforms to be undertaken by the states.

Sarah Gregory is a researcher in health policy at The King’s Fund.

Smaller hospitals, like Pembroke where five medical and two pediatric beds were cut recently, have been “harshly and disproportionately affected,” Hurley says.

The $7 million in funding for 56 hospitals amounts to $125,000 per hospital. That’s about 3 and a half one hundredth of one per cent increase in the overall (provincial) hospital spend.

Dr. Brendon Carr (president and CEO of Island Health) when asked at the Island Health Board meeting here in June stated that there will be a premium in cost for the surgeries at the private clinic. We know private, for profit, health care is more expensive. He said they have the information and would provide it, but when I wrote and asked what the difference in cost for the taxpayers between surgeries in public or private, for profit, operating rooms, Mr. Peters declined to answer the question.

It is extremely concerning that our provincial government is contracting up to 55,000 surgeries to a private surgery clinic Re: Deal with private contractor could reduce surgery wait times - J.R. Rardon. The above noted article was in the Aug. 26, Campbell River Mirror. Reading the headline I have to ask "but at what cost?"

I pointed out to Dr. Carr that we have a shortage of doctors in Canada and he agreed. He said it would be the same doctors doing the surgeries in the private, for profit, surgery clinics. I asked how they can usurp our doctors into the private system without straining our public system more. He just said they will be watching it. That doesn't bode well for our public operating rooms. I fear that our provincial government is seriously undermining our position in defending the Dr. Brian Day court case on behalf of all British Columbians. At the very least it looks like a huge conflict of interest when they are seeking to contract an enormous number of surgeries to private clinics.

Our provincial and federal governments seem determined to starve the public health care system in favour of private, for profit, health care. They have let the surgery wait lists increase substantially. Our federal government refused to renegotiate the Canada Health Accord and brought in a new funding formula. They are telling us they are "increasing"  funding of the transfer payments to the provinces by three per cent, tied to the cost of living. Currently they are paying six per cent annually so this actually is a massive cut to the provinces for public health care in the amount of $36 billion over the next 10 years. With the federal government's cuts to health care funding, the share of federal CHT cash payments in provincial-territorial health spending will decrease substantially from 20.4 per cent in 2010-11 to less than 12 per cent over the next 25 years. This, according to the Parliamentary Budget Office, will bring the level of federal cash support for health care to historical lows. National Medicare was implemented across Canada by provinces and territories on the understanding that the federal government would contribute roughly 50 percent of the spending on Medicare.

Canadians are vehemently opposed to private health care whether it is using our public tax dollars or not. Canadians should not have to suffer and wait a long time for surgery. Funds would be far better invested in the public health care system which is being starved by our governments. It is very difficult for Canadians to see our medicare in serious jeopardy. The Canadian Medical Assoc., Canadian Doctors for Medicare, Canadian Health Coalition, Council of Canadians, B.C. Health Coalition, HEU, CUPE, Citizens for Quality Health Care and many others are united to protect, strengthen and expand our public health care. Please check out their websites and get more information. Please vote in the next two elections and vote for health care for the benefit of all Canadians. Lois Jarvis Citizens for Quality Health Care Campbell River

The health care system was in crisis. It took nearly 15 years of incremental increases to bring the federal portion of health funding back to the level is was at before Paul Martin took his axe to it. Going through an exercise like that again would be devastating for the health services that Canadians depend on each and every day.

Adding fuel to the speculation that the Liberals are planning massive cuts to health funding is Trudeau’s September 2nd letter to the Council of the Federation that makes no firm commitments to health care or federal transfers. The only firm commitment was to improve the federal-provincial relationship. That’s pretty thin gruel considering the state of that relationship after 10 years of Stephen Harper!

All Canadians who are concerned with the future of health care in this country need to scratch below Trudeau’s soothing words and take a look at his hard numbers. When you break down their plan, 77 per cent of the value of their “new investments” are tax shifts and benefits (including others not listed under that category), 12 per cent is the catch-all of ‘infrastructure’ spending (though most Canadians don’t think of early learning and cultural facilities as ‘infrastructure’), and five per cent is EI (paid for through EI premiums).

That leaves only six per cent, or a little over two billion a year for everything else. How much of that available funding will go to public home care and long-term care? How much will go to the provinces for new hospital beds after years of cuts? On reading the Liberal plan, we have to conclude: not a penny.

Their plan also targets $6.5 billion in spending reductions from an expenditure review. Will health care be on the table for cuts, if they can’t meet that ambitious target? John McCallum said on Saturday that in the effort to balance their books before the next election, ‘everything was on the table.’ Contrast this with Tom Mulcair’s plan for health care under a federal NDP government, and the stark choice is brought in to focus. 

Mulcair has committed to reversing Harper’s $36 billion in health care transfer cuts to the provinces.  He has committed to investing $5.4 billion into new public health care programs, including a prescription drugs, a plan for 41,000 home care and 5,000 long-term care spots. Over five million more Canadians will have access to primary health care through his plan to build 200 Community Health Clinics. And there are practical policy initiatives on mental health for youth, Alzheimer’s and dementia care.

Canadians cherish their universal Medicare system as one of the things that makes Canada great. They want a federal government that will commit the necessary funding and leadership to build the public health care system of our collective futures, to meet the challenges of an aging population and increasing drug costs. The next party to lead the federal government should be judged by the real dollars and focused policy it has committed to meet Canadians’ health care needs.

On that measure, the Liberal plan is dead on arrival. Paul Moist is national president of the Canadian Union of Public Employees. Representing over 633,000 members, including over 153,000 working in the health care sector, it is Canada’s largest union.

were meeting the guideline, while 33 facilities were exceeding it. (Information is missing on another 10 for a variety of reasons. For example, some were new.) The directory's data shows that a quarter of seniors in the homes have a diagnosis of depression and nearly one-third are being given anti-psychotic medication without a diagnosis of psychosis.

Your questions show we have some work to do here," she said. "I will specifically be writing to each Health Authority and the government on this issue. We have a target of care hours and here's how many of your facilities are at that or under that." Mackenzie said her office will also analyze the Residential Care Facilities Quick Fact directory data to determine whether facilities with low staffing levels may also have more seniors who are depressed or who are prescribed antipsychotics medication. She also wants to study whether these homes offer fewer amenities to boost quality of life such as recreational and occupational therapy. Mackenzie said the Quick Facts Directory, available online, provides numbers to back anecdotal evidence that quality of care has declined in many B.C. seniors homes. The directory will be updated annually, but does not include data on private nursing homes that receive no government funding.

"Anecdotally, everyone was saying hours (for staff) were being cut, but now you have quantitive evidence. For policy shifts (in government), they want to know the magnitude of the issue. Let's have a discussion on how we can fix this. Before you can deal with what homes are not providing recreational therapy and OT (occupational therapy), for instance, you have to fix the hours of care first," said Mackenzie. Whiteside said the figures showing the vast majority of government-funded homes are below ministry staffing guidelines prove what HEU members have been saying for years - that they are rushed in trying to care for seniors in nursing homes and concerned that seniors are suffering and workers are placed in dangerous situations when a senior acts out violently.

A recent Vancouver Sun series on violence in nursing homes found more than 1,000 physical assaults by seniors in long-term care facilities last year. And in the past four years in B.C., 16 seniors in care have been killed by other seniors suffering from dementia. "There's simply not enough time for them (care aides) to do their job and provide the care seniors need. When we establish what the level of care needed is, it needs to be mandatory. Clearly, there needs to be more strenuous accountability in this system for seniors - many of whom are frail," said Whiteside. Nor was she surprised to find 74 per cent of the privately owned and operated businesses failed to meet ministry guidelines. "The system is set up so Health Authorities are contracting with private providers and some of those private providers are subcontracting out some of the care to other contractors and at each phase there needs to be a profit made. It's not the kind of system to have for frail seniors. It's quite shocking to think this is the system we have for them," said Whiteside.

A Vancouver Sun request to interview Health Minister Terry Lake was not granted. However, the ministry sent an email stating there are no plans to introduce mandatory staffing levels. The recommended 3.36 direct care hours is a number used "as a starting point for planning decisions," the email said. "The standard that we want care providers to meet is high quality care at whatever level is most appropriate for an individual patient," the ministry email states. "Direct care hours are dependent on the individual's needs and are determined through a comprehensive assessment process involving the client, their family and staff. Experts all agree that having a legislated or policy requirement for staffing ratios and staffing hours is not appropriate, because of the complexity of patient needs." Daniel Fontaine, the CEO of the B.C. Care Providers Association, whose members represent approximately 60 per cent of the government's contracted-out beds, said home operators would be happy to provide 3.36 direct care hours, but the government funding isn't enough to reach this level.

We can only do what we are funded to do," said Fontaine. "While the government and health authorities are trying to bring those on the lower (staffing) levels up, it's been a slow process." One of the solutions could be to take some of the money spent in the acute care system and shift it into continuing care so seniors in long-term care facilities benefit, Fontaine said. Lorri Chmilar, who retired from nursing last year after working mainly for the Interior Health Authority, said the most stressful place she worked during her career was nine months spent in geriatric care. "Anyone who has worked in public care facilities has seen a decrease in staffing, decrease in activities, and decrease in quality of meals. What has increased is the amount of time in recording statistics, and basically CYA (cover your ass)," she said. "Understaffing is also a result of the poor mix of residents. It only takes one or two residents with severe dementia or severe physical impairments to increase the workload significantly to the detriment of the rest. To increase staffat this point, or to transfer a resident to a different care area is a major undertaking that requires much justifying and time. Nurses are derided for asking for extra assistance, if there is any to be had, and roadblocks to transfers are numerous. I fear for my family, and others, and the grey wave of us to come."

THE NUMBERS DRUGS WITHOUT DIAGNOSIS In B.C. facilities, an average of 31 per cent of residents were given antipsychotics without a diagnosis of psychosis. 133 facilities were above this average. 11 were at the average.

136 were below the average, but just one reported zero cases of providing antipsychotics without a diagnosis of psychosis. DAILY PHYSICAL RESTRAINTS In B.C. facilities, an average of 11 per cent of residents have daily physical restraints placed upon them. 116 facilities are above the average.

9 are at the average. 155 are below the average, of which 27 made no use of physical restraints. Source: Office of the Seniors Advocate, Province of B.C. © 2016 Postmedia Network Inc. All rights reserved.

We appreciate any reduction of funding can create a pressure that must be managed. Therefore, staff from the Department of Health and Wellness met with sector representatives to discuss their concerns and possible solutions on how to address funding pressures individually and collectively. If operators decide to lay off employees or reduce hours that is a business decision, not one mandated by our government. Government has to make very difficult choices about where we spend taxpayers' money. We are focused on improving our health care system and finding new and improved ways to deliver the care Nova Scotians need. Thank you very much for your attention and remember my door is always open. David Wilton MLA, Cape Breton Centre

"What we're doing in Scarborough, in my personal opinion, and I stand by my personal opinion, that it's wrong. We need to review the service itself, cost it out and fund it."

Looking to cut costs, the Central East LHIN has asked The Scarborough Hospital and Rouge Valley Centenary to examine the possibility of a merger

Wong added she and Balkissoon are still waiting to hear from Ontario's Minister of Health about a letter the two penned asking the government to take control of The Scarborough Hospital, which the MPPs claim is without adequate leadership.

Balkissoon said he feels Scarborough isn't treated equally when it comes to healthcare funding, noting nearby North York has a similar sized population but more, and more modern, hospital services.

"Our hospitals are in terrible trouble ... When you have to raise your staff's pay, but you don't get increased funding, the only way you can balance your books is by cutting jobs and cutting services."

This is just the tip of the iceberg," Ting warned. "Going forward, we have to save another $60 million."

Duguid said the crunch being felt at Scarborough's hospitals is a necessary part of the provincial government's plan to decentralize healthcare by spreading out services within communities, and increasing home care services.

Increases to home care funding shouldn't come at the expense of hospitals, said Ting.

"A lot of things people still need to come to a hospital for," he said. "I feel like we're being constricted, cut by cut, and eventually we will have to say OK, we can't run this hospital anymore."

the impact of Liberal health-care policy in southern Ontario is "bad enough." The model Mehra said the province is using to centralize services into fewer communities is especially detrimental to the North. "That doesn't work for the south," she added. "It definitely, in no way, works for Northern Ontario." The state of Northern health care was brought to the floor of Queen's Park this week when, on Wednesday during Question Period, NDP health critic France Gélinas called on the government to stop continued cuts to care in the region. Funding based on volumes doesn't jibe with regional population distributions, Mehra said. "It just doesn't make any sense at all," she said, adding Northern Ontario has many common complaints with small, rural southern Ontario communities.

The coalition argues the entire Ontario system has received short shrift for years and is below the Canadian per capita average by about $350 per person. The provincial Liberals ended a four-year hospital base funding freeze in its latest budget, pledging to spend $60 million on hospital budgets, along with $75 million for palliative care and $130 million for cancer care. The Ontario Health Coalition - and Sault and Area Health Coalition - are not impressed. The local group argues on a regular bases, 22 admitted patients often wait in SAH's Emergency Department for inpatient beds and admitted patients stay in emergency for as long as five days. Patients are lined along hallways on the floors or put in areas that were designed to be stretcher storage areas or lounges with no call buttons, oxygen, out of the nurses' usual treatment areas. Late last month, the Ontario Health Coalition launched an Ontario-wide, unofficial referendum to raise awareness about what it contends is a system in critical condition. The unofficial referendum asks Ontarians if they're for or against the idea: "Ontario's government must stop the cuts to our community hospitals and restore services, funding and staffto meet our communities' needs for care." Ballot boxes will be distributed to businesses, workplaces and community

centres across the province before May 28, when votes will be tallied and presented to Premier Kathleen Wynne. "We have to make it so visible, and so impossible to ignore, the widespread public opposition to the cuts to local public hospitals so the province cannot continue to see all those cuts through," Mehra said. Similar public OHC-led lobbying helped limit and "significantly" change policy in a past Sault Area Hospital bid to usher in publicprivate partnerships (P3s), she added. "The referendum is a way to make that so visible, so impossible to ignore by the provincial government, that we actually stop the cuts," Mehra said. Other speakers Thursday included Sault coalition member Peter Deluca, who spoke of the many challenges his elderly parents have endured thanks to what he dubbed less-than-stellar hospital experiences. "We deserve the truth, we deserve answers, not just political talk," said Deluca, adding concerned citizens must band together in order to prompt change and halt healthcare cuts.

Sharon Richer, of Ontario Council of Hospital Unions/CUPE, said as a Health Sciences North employee, she's seen "first-hand" how cuts affect health care. "There won't be change if we don't make a ripple," she said. Laurie Lessard-Brown, president of Unifor Local 1359, told the meeting of how SAH's recent "wiping out" of the personal support worker classification is wreaking havoc on staff and patients, alike. Registered nurses and registered practical nurse must now pick up the slack, she added. "Morale is lowest I've ever seen," Lessard-Brown said. And, as recent as last Tuesday, Unifor learned of a further four full-time RPN positions being cut while supervisor positions were being added. "Cutting front-line workers is not acceptable," Lessard-Brown said. jougler@postmedia.com On Twitter: @JeffreyOugler © 2016 Postmedia Network Inc. All rights reserved.

Natalie Mehra, Ontario Health Coalition executive director, decries what she describes as the profound lack of funding being divvied out to Ontario hospitals during a town hall meeting Thursday evening, hosted by the Sault and Area Health Coalition at Royal Canadian Legion, Branch 25.

Ontario lost a lot of ground in publicly funded home health care during the last Progressive Conservative government.  

In the publicly funded home support category, Ontario continued to increase funding during that period, but still fell well short of the Canada-wide increase.  

According to Conference Board figures, home care fell as a percentage of total health care spending, falling from 5.82% in Ontario in 1999 to 4.65% in 2010 (and from 4.72% to 4.54% Canada-wide).  Again, in Ontario all of the decrease was during the Progressive Conservative years; there has been a small rebound during the Liberal years (from 4.51% to 4.65%).  

Alison Redford struck a cautious tone, saying she always believes that "dialogue really does contribute to the best public policy." However, she added that Alberta was very pleased with the new per-capita funding approach

In an interview with CBC broadcaster Peter Mansbridge, Harper was asked about the premiers' idea of a health innovation fund.

"What I think we all want to see now from the premiers who have the primary responsibility here is what their plan and their vision really is to innovate and to reform and to make sure the health-care system's going to be there for all of us. So I hope that we can put the funding issue aside, and they can concentrate on actually talking about health care."

Pressed by Mansbridge on whether that meant he was saying no, Harper replied: "I'm not looking to spend more money. I think we've been clear what we think is within the capacity of the federal government over a long period of time."

Jean Charest had particularly harsh words for Harper

Charest complained that when medicare was initiated in the 1950s and 1960s, the federal government "drew the provinces in" by picking up 50 per cent of the health-care tab."That was the deal."In 2004, a royal commission led by Roy Romanow proposed that the federal share should be 25 per cent. Currently, it stands at 20 per cent and in a recent report, parliamentary budget officer Kevin Page said that because of Harper's new funding formula, the federal share will continue to slip - perhaps to as low as 11.9 per cent.

"What I think we all want to see now from the premiers, who have the primary responsibility here, is what their plan and their vision really is to innovate and to reform and to make sure the health-care system's going to be there for all of us," Harper said

"So I hope that we can put the funding issue aside, and they can concentrate on actually talking about health care

The idea of a separate fund for the provinces to use for innovation in the delivery of health care got no support from the prime minister.'I'm not looking to spend more money. I think we've been clear what we think is within the capacity of the federal government over a long period of time.'—Prime Minister Stephen Harper"I'm not looking to spend more money. I think we've been clear what we think is within the capacity of the federal government over a long period of time."

as they headed into their talks, none of the premiers ruled out more private, for-profit health care, or the possibility Canadians may not get the same level of service in each and every province.

"The underlying principle is to offer comparable levels of service even if they are different, in such a way that it respects the overall framework of the Canada Health Act," Manitoba Premier Greg Selinger said.

Saskatchewan Premier Brad Wall said having room to experiment with health-care delivery isn't a bad thing.

"If it's tied to objectives, where we say we'd like to have everyone having a surgery within three months, and we identify that, in order to do that in the public system, we need to use private clinics, then I think there'll be public support for that," he said.

The speech, her first as Health Minister, was warmly received to the point where CMA president Anna Reid

She also expressed concern that Ms. Ambrose remained mum on the 2014 health accord. Ottawa has offered to increase transfer payments to the provinces by 6 per cent annually until 2017 and then 3 per cent subsequently, but otherwise has refused to negotiate.

Ms. Ambrose, for her part, said federal funding has reached unprecedented levels – $30.3-billion this year and growing. “Now that the funding is there, we need to have a conversation on what can be done to make the system more sustainable,” she said.

She said promoting health innovation is “worthy of federal leadership

The minister said she has already reached out to many of her counterparts, but discussions will begin in earnest at the federal-provincial-territorial meeting of health ministers in October.

She will also “reach out” to the working group on innovation that was created by the Council of the Federation.

She said another priority will be work with her provincial and territorial counterparts to improve health care for seniors,

The report concluded, “What the Canterbury experience demonstrates is that it is possible to provide better care for patients, reduce demand on the hospital, and flatten or reduce elements of the demand curve across health and social care by improved integration—particularly around the interface between the hospital, primary care and community services.”

On the contracting side, the report said that the abolition of the purchaser-provider split in the health system was important as it gave boards the autonomy to decide how to fund their hospitals.

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f5503 (Published 12 September 2013) Cite this as: BMJ 2013;347:f5503

Gareth Iacobucci

"The federal government's commitment to increase their transfer payment by 6 per cent this coming year has actually be been broken and rather than getting 6 per cent Ontario will be getting only 3.4 per cent," Matthews said, referring to the health increase.

As well, the 6-per-cent increase was a national average and not all provinces would receive the same rate.

According to Library of Parliament estimates from 2011-2012, Alberta is the only province to benefit from the change to equal-per-capita funding.

Sousa said Tuesday he was "infuriated" to learn from federal Finance Minister Jim Flaherty that Ottawa's funding to Ontario for 2014-15 would be $19.158 billion - down $641 million, or 3.24 per cent, from this year's $19.799-billion allotment

REGINA — With the expiration of the Canada Health Accord on Monday, organized labour in Saskatchewan says without a new deal with the federal government, the $1.1 billion that will be lost in federal funding after 2017 will compromise patient safety and possibly lead to privatization and inequality in the health care system.“The Canada Health Accord was designed to restore federal funding, provide stability and national standards, and to ensure universality in our health care system,” said Tom Graham, president of the Canadian Union of Public Employees Saskatchewan branch, at a news conference.Graham called on the provinces, territories and federal government to negotiate a new agreement. Without one, funding from the Canada Health Transfer will remain at six per cent annual increases until 2017. After that, for a decade, a new formula using three-per-cent annual increases plus economic and population growth will come into effect.That amounts to a loss of $1.1 billion for Saskatchewan and $36 billion overall after 2017.Graham suggested this loss in funding will have to be made up through funding cuts in other areas or by raising provincial taxes.Tracy Zambory, president of the Saskatchewan Union of Nurses (SUN), added that significant changes to the health care system could result from federal funding models tied to economic performance and population.

Some countries using this system, including the UK’s National Health Service, found a tendency to “cherry pick”

“Healthcare systems evolve within the context of a specific culture, economy, politics and history and what worked in one place or time won’t necessarily work in a different country, or now,”

To that point, the differences between German and Canadian public health care go far beyond funding mechanisms

It’s really the result of almost a century and a half of evolution, and it’s very organic to Germany.

is cost control particularly as it relates to salaries and access to new drugs and procedures.

The negotiations between hospitals, providers and funds are really the key to lower spending, rather than direct competition between the funds.