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Irene Jansen

CHSPR Health Policy Conference February 28-29, 2012 Vancouver - 0 views

www.chspr.ubc.ca/hpc

conference abf

shared by Irene Jansen on 23 Jan 12 - No Cached
  • increasing attention from provincial governments to so-called “funding arrangements” – the processes through which provincial health ministries (and increasingly regional health authorities) purchase or pay for services for their ‘constituents’
  • activity-based-funding, pay-for-performance, and so on
  • Is there really anything innovative in all of this? What is the evidence base supporting the ‘new’ approaches? And how is the public to understand the confusing array of fact and fiction regarding health system funding, particularly in the ramp-up to the expiry of the federal/provincial/territory health accord in 2014?
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  • These are some of the questions that CHSPR’s 2012 health policy conference will tackle.
  • Irene Jansen on 23 Jan 12
     
    Will paying the piper change the tune? Promise and pitfalls of health care funding reform
Irene Jansen

Health Care Funding - Evidence and perspectives for funding health care in Canada. - 0 views

www.hospitalfunding.ca

abf funding fromdelicious

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Irene Jansen on 23 Jan 12
     
    Health Care Funding is a website supported by the UBC Centre for Health Services and Policy Research, and the Canadian Institutes of Health Research which aims to be " A central, reliable and impartial resource for literature, news and discussion regardin
Irene Jansen

The provinces got what they asked for on health funding - The Globe and Mail - 0 views

www.theglobeandmail.com/...article2306965

equalization

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Alberta is suggesting that the funding shortcomings of provinces such as Quebec and Ontario be addressed through the back door using the federal equalization fund. I’m not sure how that helps provinces such as Saskatchewan and B.C., which also lose under the new funding formula but don’t receive equalization payments.
Irene Jansen

Patient-based funding breathes new life into hospitals - The Globe and Mail - 0 views

www.theglobeandmail.com/...singlepage

abf bc

shared by Irene Jansen on 23 Jan 12 - No Cached
  • For the first time on a large scale, a province is beginning to reimburse hospitals based on what they actually do, rather than simply providing them with huge dollops of dollars, no matter what.
  • Early results from B.C.’s bold new program are now in, and they are dramatic.
  • The number of procedures is up, waiting lists are down, and hospital emergency departments covered by the program are processing patients as never before.
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  • At Nanaimo Regional General Hospital, for instance, waiting times in emergency have been cut by 50 per cent, fuelled by incentives as high as $600 for each extra patient admitted to an acute-care bed within 10 hours and lesser amounts for other treatment targets.
  • In Prince George, the number of MRIs, rewarded by $275 per procedure beyond a set baseline total, is targeted to go up by a third this year, representing 1,250 additional screenings.
  • The volume of shoulder surgeries, bringing in nearly $3,000 a pop for added procedures, is scheduled to virtually double, from 63 to 123.
  • A government report on the program’s first year of operation estimates that the influx of only $53-million in new money resulted in 67,000 more emergency patients being treated on time at the 14 hospitals involved, and 36,000 additional procedures performed at B.C.’s 23 largest hospitals.
  • Other aspects of the multipronged program include additional sums going to hospitals for taking on difficult cases and financing the introduction of a surgical quality-care system for B.C. hospitals.
  • Les Vertesi, executive director of the B.C. Health Services Purchasing Organization, which is overseeing the radical shift
  • not all of the $250-million earmarked for the program’s first two years is being claimed, because hospitals continue to struggle to improve capacity
  • Overall, about 17 per cent of hospital funding in B.C. is covered in various ways by the new approach.
  • “Throwing money at the problem may work, but an unintended consequence is that you essentially say to people: You don’t have to perform, until we give you money,” Mr. Lewis said.
  • Dr. Butcher of the Northern Health Authority added there is a risk of hospitals becoming too attached to activity-based funding. “It can artificially change your focus to procedures that generate revenue,” he cautioned, rather than doing what the patient really needs.
  • Not performing up to snuff can result in penalties.
  • Overall, however, patient-focused funding mostly rewards rather than punishes.
Irene Jansen

On health-care funding, 2 + 2 probably does equal 4 - The Globe and Mail - 0 views

www.theglobeandmail.com/...article2270491

accord cht

shared by Irene Jansen on 23 Jan 12 - No Cached
  • In 1977 both sides agreed to an incredibly complex formula, the essence of which was that federal funding for health care would increase annually at the rate of the nominal increase in the gross domestic product averaged over the previous three years.
  • the rate of inflation, add the rate real of economic growth – which, combined, equals nominal GDP
  • John Wright is CEO of the Canadian Institute for Health Information
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  • He believes the 1977 formula is “the most logical” basis for a new agreement.
  • Federal government revenues generally increase at same rate as nominal GDP.
  • the Canadian economy could prove the cynics wrong, but an average of 3 per cent is as enthusiastic as anyone not waving pom-poms would predict. In that case, health-care funding would increase by 5 per cent – still well below the provincial demand of 6 per cent, at least.
  • we can already calculate the likely increase for 2017, the first year of the new agreement. The Bank of Canada is determined to limit inflation to 2 per cent annually. The spreading debt crisis that is imperiling the euro is suppressing growth projections for Canada going forward. Over the next three years, growth of 2 per cent annually is a reasonable guess. Two plus two equals four
  • the United States and Canada could be dragged into a recession along with Europe. If so, inflation could turn into deflation
  • But the Conservatives promise that the final agreement will contain a funding floor
  • the Harper government is adamant that any future deal be negotiated on a strictly per capita basis
  • The Harper government is firm in the belief that regional equalization subsidies should be restricted to the equalization program itself.
Irene Jansen

Ottawa shirks health funding: Oswald - Winnipeg Free Press - 0 views

www.winnipegfreepress.com/...-funding-oswald-135983493.html

accord diktat manitoba

shared by Irene Jansen on 23 Jan 12 - No Cached
  • THE Selinger government is worried it will shoulder a greater share of health care-funding in the future -- and angry Ottawa is imposing this on Manitoba and other provinces unilaterally.
  • looking for a 10-year funding commitment from Ottawa with six per cent annual increases as a negotiating starting point. It has also argued health transfers should not be discussed in isolation from equalization and other social transfers. The worry is that one sector will benefit at another's expense, which has occurred in the past.
  • Oswald said health ministers wanted to discuss funding at their meeting last month but Aglukkaq refused.
Irene Jansen

Home care needs to be a priority - 0 views

www.calgaryherald.com/story_print.html

home care vision

shared by Irene Jansen on 23 Jan 12 - No Cached
  • less than 15 per cent of public funds spent on long-term care are dedicated to home care services
  • Other Organization for Economic Cooperation and Development countries invest significantly more resources: the Netherlands, France and Denmark, for example, invest, respectively, 32 per cent, 43 per cent and 73 per cent of their public long-term care funding on home care.
  • According to OECD data, Canada dedicates 1.2 per cent of its gross domestic product (GDP) to long-term care. If nothing is done to transform the health care system, with the aging of the population this proportion will rise to 3.2 per cent by 2050.
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  • This growth could be significantly reduced to 2.3 per cent if a sizable investment (e.g., 0.4 per cent of GDP or $5 billion) is made in home care now.
  • We need to change the philosophy of home care: It should become a right and not a privilege as it is now.
  • a public long-term care insurance plan should be created
  • to cover the necessary services from public (“in kind”), private, social economy or voluntary organizations
  • We should not opt for “cash-for-care” allowances as in some European countries since this type of benefit has undesirable effects: the creation of a “grey market” with untrained and underpaid workers, risk of financial abuse, poor quality services, and keeping women in traditional roles.
  • To finance this universal publicly funded insurance plan, a specific fund should be created to which the current budget for long-term care would be transferred to ensure a clear separation of this money from the rest of the health care funding.
  • It is time for a Continuing Care Act in Canada that would prioritize integrated care and home care, and include the creation of a public long-term care insurance plan
  • Réjean Hébert is a geriatrician and professor at the Research Centre on Aging of the Université de Sherbrooke.
Irene Jansen

Health funding plan contains 'positives' - 0 views

www.thestarphoenix.com/...story.html

accord diktat sk

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Premier Brad Wall says the release of the federal government's new health-care funding plan is frustrating and the results aren't what he'd hoped for.
  • other types of federal financial support for health care, particularly innovative initiatives, might be possible.
  • "We're not talking about a cut," Wall said. "We're talking about a reduction in an increase."
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  • "There's a frustration with the process and a concern about post-2017, there's no question," Wall told reporters Monday. "But we asked for extension of the six per cent (past 2014). It's there - not as long, but it's there. We'd asked for a longer-term view. It's there - not the way we wanted it, but there's room for changes, especially when we're six years out."
  • there are opportunities for Saskatchewan to negotiate some additional funding for innovation ... That's what we'll be working toward."
  • The Saskatchewan government is preparing its own proposal around extra funding for innovation in health care, he noted, pointing out "we've seen flexibility from the federal government on other files." That's partly why he isn't joining other premiers in sounding the alarm, he said.
Govind Rao

When quality trumps service, patients lose out - Healthy Debate - 0 views

healthydebate.ca/...umps-service-patients-lose-out

from heather quality ontario funding

shared by Govind Rao on 27 Feb 14 - No Cached
  • by Shawn Whatley (Show all posts by Shawn Whatley) February 24, 2014
  • The Ontario government deserves applause for tackling global funding for hospitals. “Global budgets provide[d] little incentive for hospitals to focus on efficiency, innovation, improving access, coordinating care across facilities and sectors or improving quality.” In 2012, the Ontario Ministry of Health announced its commitment to patient-based funding. It promised to deliver patients: • Shorter wait times and better access to care in their communities • More services, where they are needed • Better quality care with less variation between hospitals
Govind Rao

Health Edition Online - Print Article - 1 views

www.healthedition.com/printArticle.cfm

from heather economics

shared by Govind Rao on 20 Sep 13 - No Cached
  • September 20, 2013   |   Volume 17 Issue 36 Actuaries predict health care system "collapse" The Canadian health care system is not sustainable, a report sponsored by the Canadian Institute of Actuaries and the Society of Actuaries says. The analysis covering a 25-year time horizon from 2012 to 2037 concludes that health care expenditures will rise from 44.3 per cent of total provincial-territorial revenues in 2012 to 69.3 per cent in 2037.
  • Colleen Fuller on 21 Sep 13
     
    Hmmmm... Let's see what the actuaries were saying way back when: The Financial Post (Toronto) February 23, 1996, Friday, DAILY EDITION Actuaries give Canada five years to fix health care BYLINE: BRUCE COHEN Canada's health-care system will become unaffordable unless needs and priorities are rethought over the next five years, a Canadian Institute of Actuaries task force warned yesterday. "Demographic and deficit pressures . . . dictate that the days of unrestricted access to unlimited health-care resources must soon end," the CIA report declared. The actuaries estimate that if the system was pre-funded, a little more than $1 trillion would now be needed to cover future benefits for retirees. That includes $369 billion for today's seniors. The bulk of the rest is for baby boomers who will start turning 55 in 2001. But the system is "pay as you go" -- retiree care is funded largely by younger Canadians. In this case, actuaries say, the workforce will have to become 60% more productive over the next 35 years to fund health care and social security. Otherwise, they warn, programs such as education and welfare will have to be cut or government borrowing will have to increase. Government now funds 72% of the system. The private sector, mainly employer-sponsored insurance, pays 28%. The panel urged the provinces to build better databases on health-care use and success so funding decisions can focus on what works best. "Broad-based cost reduction programs don't necessarily give us the optimum results," task force chairman John Fessenden told a Toronto news conference. Governments now lack the data to judge, for example, whether money is better spent on dietary education or medical machines, said University of Waterloo professor Robert Brown. The panel said universal access to "basic" health care should be maintained. But government should consider user fees, co-payments and deductibles that private insurers use to limit costs.
Govind Rao

Primary Care Initiative Funding | RPNAO - 0 views

www.rpnao.org/...rimary-care-initiative-funding

from heather pn nursing Ontario

shared by Govind Rao on 12 Dec 13 - No Cached
  • Date: Dec 11th, 2013 RPNAO is pleased to announce special education funding for RPNs working in Primary Care settings. Limited special funding is being provided by the Ministry of Health and Long term Care until March 31, 2014 for RPNs currently registered to practice in the province of Ontario and employed in Primary Care settings. RPNs and/ or their employers can apply for funding to reimburse up to $1,500.00 toward tuition for provincially recognized educational opportunities that enhance the eligible RPN’s ability to deliver quality primary nursing care.
Govind Rao

Health care providers warn of over $1 billion in federal funding cuts to Saskatchewan w... - 0 views

cupe.ca/...a5339cf9435d19

from heather Saskatchewan accord campaign coalition

shared by Govind Rao on 10 Apr 14 - No Cached
  • Mar 31, 2014
  • REGINA – Today marks the end to stable health care funding with the expiry of Canada’s Health Accord which will lead to cuts of $1.1 billion to Saskatchewan’s share of Federal Government funding over ten years beginning in 2017. “The end of Canada’s Health Accord marks the beginning of federal health care funding cuts to the province of Saskatchewan of $1.1 billion after the next Federal election,” says Tom Graham, President of the Canadian Union of Public Employees (CUPE) Saskatchewan. “The Federal Conservative Government is planning to take $1.1 billion away from Saskatchewan’s health care system – the equivalent to 3,349 hospital beds or over 73,000 joint replacement surgeries – and, in doing so, is making a political decision to undermine our public health care system and put it at risk of further privatization.” The Health Accord refers to legal agreements signed among federal, provincial and territorial governments in 2003 and 2004. It sets out a common vision for health care in Canada and guarantees stable federal health funding, escalating at 6% a year. The expiry of the Health Accord on March 31, 2014, means provinces and territories stand to lose a total of $36 billion over 10 years through cuts to the Canada Health Transfer.
Govind Rao

Problems implementing pay hike for PSWs undermine Liberal health plan in Ontario - Info... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|ntgm|20150511|220231744

from heather Ontario psw wages cupe ltc

shared by Govind Rao on 11 May 15 - No Cached
  • The Globe and Mail Mon May 11 2015
  • INTO THE HOME The cost of moving health care out of hospitals It was one of the showpiece promises that Ontario's Liberals made before their government fell last year: a $4-an-hour wage hike for the personal support workers who are critical to the government's plans to shift health care out of expensive hospitals and into the home. More than a year and an election victory later, the PSW "wage enhancement" program is beset by so many complexities that the government has delayed indefinitely the second phase of the pay hike - a $1.50-an-hour raise that was due April 1 - while it works to mop up the problems on the ground, a Globe and Mail investigation has found.
  • Twenty-seven mostly non-profit health-care agencies across the province are refusing to accept the government-funded increase and pass it on to their workers, while one of the largest privatesector employers of PSWs in Ontario cut what it pays in mileage and travel time just after the first phase of the raise kicked in last fall, leaving some employees worse off than they were before the wage-enhancement program began. The PSW raise was also more expensive than expected, costing the province at least $77.8-million in 2014-15, 56 per cent more than the $50-million earmarked for the first year of the pledge.
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  • Although Health Minister Eric Hoskins has vowed that this year's portion of the raise will eventually be doled out retroactively to April 1, the delay has caused "a lot of confusion, uncertainty and frustration," among PSWs in the home and community care field, according to Kelly O'Sullivan, the chair for CUPE Ontario's health-care workers. "It adds to the ongoing precarious nature of this work," she said. "You can't even depend on a wage increase that's been promised to you by the government."
  • The government's PSW Workforce Stabilization Strategy was designed to make home-care work less precarious, not more. PSWs deliver more than half of all home-care services, helping clients to dress, bathe, prepare meals, tidy up and manage medications, among other tasks. Yet their paycheques are traditionally smaller and their schedules more erratic than those of PSWs who work in hospitals and nursing homes, making it difficult to retain quality workers in home and community care. Persuading PSWs to choose the home-care field is essential to the Ontario government's efforts to keep people out of hospitals and nursing homes for as long as possible - a way to stretch increasingly scarce health-care dollars and respond to the public's desire to heal and age at home.
  • People interviewed for this story were quick to praise the Liberals for trying to improve the lot of home-care PSWs and their clients by raising their minimum wage to $16.50 an hour from $12.50 over three years. The intention was laudable, they said. The execution of the plan was not. "This should be the best news story ever," said Deborah Simon, the chief executive officer of the Ontario Community Support Association, which represents hundreds of non-profit agencies that help people at home. Instead, Ms. Simon said, the Byzantine rules around the pay hike have created an "administrative burden" for organizations.
  • At the heart of the problem is which workers - and which kinds of work - qualify for the government-funded pay bump. While the government set a wage floor of $16.50 an hour as of 2016-17, it delivered the public funds through a "wage enhancement" that only applies when PSWs are providing "personal support services" funded by Local Health Integrated Networks (LHINs), the province's regional health authorities.
  • That means time spent in training, travelling to clients' homes or performing tasks such as food preparation do not qualify for the higher rate. Initially, even statutory holidays were paid out without the increase, although that has been reversed. Jason Lye, national head of independent living services at March of Dimes, says his agency spent months clarifying provincial rules, only passing on the first phase of the raise retroactively to workers in February in the form of a "blended rate" that takes into account how they historically have divided their time.
  • "The way I like to interpret it is when you see the whites of the clients' eyes, you are paying the $1.50," Mr. Lye said. There were other complications. The raise goes to all PSWs doing work that qualifies, meaning the $4 increase goes to everyone, whether they are making a base wage of $12.50 or $22 an hour. That has put pressure on employers to give raises to others, such as registered practical nurses and supervisors.
  • The rules also exclude some PSWs because of where they work or because the provincial funds that pay for their services do not flow through the province's 14 LHINs. The result is that PSWs within the same organization can be treated differently. Kingsway Lodge Fairhill Residence in the southwestern Ontario town of St. Marys chose to reject the increase because it would create an untenable disparity in its already well-compensated PSW work force. Hourly wages there range from $17.73 to $20.44. The organization operates a nursing home with round-theclock care, a retirement home and six supportive-housing suites where residents receive a few hours of personal support per day. The wage enhancement would have applied only in the supportive apartments. "There would be no way to do it because our staff flow between the three levels of care," said Theresa Wakem, the facility's administrator. At Traverse Independence, an agency in Kitchener that serves adults with physical disabilities and acquired brain injuries, management had to find $27,000 in a $6-million budget to give eight PSWs working in a day program the same raise as their colleagues. "It was a hardship," said CEO Toby Harris. The agency eliminated half a supervisor's job to cover the increase.
  • The wage enhancement helped a little bit, but we're still on the losing side," said the PSW, who asked not to be named. The company's London employees are not unionized. The PSW said some workers in London are refusing to serve clients outside the city because they are paid so little to travel there. "If I drove six hours in the county, I'd be lucky to get paid for three hours," the PSW said. Dr. Hoskins said before the Liberals committed to the pay increase, "we didn't have a tremendous amount of information about our PSWs - who they're working for, how much they're being remunerated."
  • The ministry is gathering data so it can "fine-tune" the second year of the program, including whether future increases should apply to all PSWs, even those already earning much more than $16.50 an hour, he said. He added that nearly 500 health-service providers have passed the increase on to their PSWs and the government expects the 27 holdouts to follow suit. As for Revera's changes, "I find that unacceptable," Dr. Hoskins said. "The ministry would be looking into those circumstances if they were brought to our attention." Ms. O'Sullivan, the CUPE representative, called the program's rollout "a reflection of a broader problem" with home and community care in Ontario.
  • If we can't figure out - we as in the government, the agencies and the unions - how everyone should be getting something as simple as a wage increase in an equitable way, can you imagine if you are a family member or a patient needing care, what the system must be like?" This is the first article of a Globe investigation into the challenges of moving health care out of hospitals and into the home. If you have a personal story to tell, contact Elizabeth Church at echurch@globeandmail.com and Kelly Grant at kgrant@globeandmail.com.
Govind Rao

'We have the evidence ... Why aren't we providing evidence-based care?'; Mental illness... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150523|221089241

from heather mental health privatization

shared by Govind Rao on 26 May 15 - No Cached
  • The Globe and Mail Sat May 23 2015
  • It's 4:30 on a Friday afternoon at her Sherbrooke, Que., clinic and Marie Hayes takes a deep breath before opening the door to her final patient of the day, who has arrived without an appointment. The 32-year-old mother immediately lists her complaints: She feels dizzy. She has abdominal pain. "It is always physical and always catastrophic," Dr. Hayes will later tell me. In the exam room, she runs through the standard checkup, pressing on the patient's abdomen, recording her symptoms, just as she has done almost every week for months. "There's something wrong with me," the patient says, with a look of panic. Dr. Hayes tries to reassure her, to no avail. In any case, the doctor has already reached her diagnosis: severe anxiety. Dr. Hayes prescribed medication during a previous visit, but the woman stopped taking it after two days because it made her nauseated and dizzy. She needs structured psychotherapy - a licensed therapist trained to bring her anxiety under control. But the wait list for public care is about a year, says Dr. Hayes, and the patient can't afford the cost of private sessions.
  • Meanwhile, the woman is paying a steep personal price: At home, she says, she spends most days in bed. She is managing to care for her two young children - for now - but her husband also suffers from anxiety, and the situation is far from ideal. Dr. Hayes does her best, spending a full hour trying to calm her down, and the woman is less agitated when she leaves. But the doctor knows she will be back next week. And that their meeting will go much the same as it did today. In its broad strokes, this is a scene that repeats itself in thousands of doctors' offices every day, right across the country. It is part and parcel of a system that denies patients the best scientific-based care, and comes with a massive price tag, to the economy, families and the health care system. Canadian physicians bill provincial governments $1-billion a year for "counselling and psychotherapy" - one third of which goes to family doctors - a service many of them acknowledge they are not best suited to provide, and that doesn't come close to covering patient need. Meanwhile, psychologists and social workers are largely left out of the publicly funded health-care system, their expertise available only to Canadians with the resources to pay for them.
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  • Imagine if a Canadian diagnosed with cancer were told she could receive chemotherapy paid for by the health-care system, but would have to cough up the cash herself if she needed radiation. Or that she could have a few weeks of treatment, and then be sent home even if she needed more. That would never fly. If doctors, say, find a tumour in a patient's colon, the government kicks in and offers the mainstream treatment that is most effective. But for many Canadians diagnosed with a mental illness, the prescription is very different. The treatment they receive, and how much of it they get, will largely be decided not on evidence-based best practices but on their employment benefits and income level: Those who can afford it pay for it privately. Those who cannot are stuck on long wait lists, or have to fall back on prescription medications. Or get no help at all. But according to a large and growing body of research, psychotherapy is not simply a nice-to-have option; it should be a front-line treatment, particularly for the two most costly mental illnesses in Canada: anxiety and depression - which also constitute more than 80 per cent of all psychiatric diagnoses.
  • Why aren't we providing evidence-based care?" .. The case for psychotherapy Research has found that psychotherapy is as effective as medication - and in some cases works better. It also often does a better job of preventing or forestalling relapse, reducing doctor's appointments and emergency-room visits, and making it more cost-effective in the long run.
  • Therapy works, researchers say, because it engages the mind of the patient, requires active participation in treatment, and specifically targets the social and stress-related factors that contribute to poor mental health. There are a variety of therapies, but the evidence is strongest for cognitive behavioural therapy - an approach that focuses on changing negative thinking - in large part because CBT, which is timelimited and very structured, lends itself to clinical trials. (Similar support exists for interpersonal therapy, and it is emerging for mindfulness, with researchers trying to find out what works best for which disorders.) Research into the efficacy of therapy is increasing, but there is less of it overall than for drugs - as therapy doesn't have the advantage of well-heeled Big Pharma benefactors. In 2013, a team of European researchers collated the results of 67 studies comparing drugs to therapy; after adjusting for dropouts, there was no significant difference between the most often-used drugs - selective serotonin reuptake inhibitors (SSRIs) - and psychotherapy.
  • The issue is not one against the other," says Montreal psychiatrist Alain Lesage, director of research at the Douglas Mental Health University Institute. "I am a physician; whatever works, I am good. We know that when patients prefer one to another, they do better if they have choice." Several studies have backed up that notion. Many patients are reluctant to take medication for fear of side effects and the possibility of difficult withdrawal; research shows that more than half of patients receiving medication stop taking it after six months. A small collection of recent studies has found that therapy can cause changes in the brain similar to those brought about by medication. In people with depression, for instance, the amygdala (located deep within the brain, it processes basic memories and controls our instinctive fight-or-flight reaction) works in overdrive, while the prefrontal cortex (which regulates rational thought) is sluggish. Research shows that antidepressants calm the amygdala; therapy does the same, though to a lesser extent.
  • But psychotherapy also appears to tune up the prefrontal cortex more than does medication. This is why, researchers believe, therapy works especially well in preventing relapse - an important benefit, since extending the time between acute episodes of illnesses prevents them from becoming chronic and more debilitating. The theory, then, is that psychotherapy does a better job of helping patients consciously cope with their unconscious responses to stress.
  • According to treatment guidelines by leading international professional and scientific organizations - including Canada's own expert panel, the Canadian Network for Mood and Anxiety Treatments - psychotherapy should be considered as a first option in treatment, alone or in combination with medication. And it is "highly recommended" in maintaining recovery in the long term. Britain's independent, research-guided scientific body, the National Institute for Health and Care Excellence, has concluded that therapy should be tried before drugs in mild to moderate cases of depression and anxiety - a finding that led to the creation of a $760million public system, which now handles therapy referrals for nearly one million people a year.
  • In 2012, Canada's Mental Health Commission estimated that only about one in three adults and one in four children are receiving support and treatment when they need it. Ironically, anti-stigma campaigns designed to help people understand mental illness may only make those statistics worse. In Toronto, for instance, putting up posters in subway stations in 2010 had the unexpected effect of spiking the volume of walk-ins at nearby emergency rooms by as much as 45 per cent in 12 months. Dr. Kurdyak treated many of them at CAMH. The system, he says, "has been conveniently ignoring this unmet need. It functions as if two-thirds of the people suffering won't get help." What would happen if the healthcare system outright "ignored" two-third of tumour diagnoses?
  • Essentially, argues Dr. Lesage, adding therapy into the health-care system is like putting a new, highly effective drug on the table for doctors. "Think about it," he says. "We have a new antidepressant. It works as well as many others, and it may even have some advantages - it works better for remission - with fewer side effects. The patients may prefer it. And [in the long run] it doesn't cost more than what we have. How can it not be covered?" ..
  • A heavy price This isn't just a medical issue; it's an economic one. Mental illness accounts for roughly 50 per cent of family doctors' time, and more hospital-bed days than cancer. Nearly four million Canadians have a mood disorder: more than all cases of diabetes (2.2 million) and heart disease (1.4 million) combined.
  • Mental illness - and depression, in particular - is the leading cause of disability, accounting for 30 per cent of workplace-insurance claims, and 70 per cent of total compensation costs. In 2012, an Ontario study calculated that the burden of mental illness and addiction was 1.5 times that of all cancers, and more than seven times the cost of all infectious diseases. Mental illness is so debilitating because, unlike physical ailments, it often takes root in adolescence and peaks among Canadians in their 20s and 30s, just as they are heading into higher education, or building careers and families. Untreated, symptoms reverberate through all aspects of life, routinely trapping people in poverty and homelessness. More than one-third of Ontario residents receiving social assistance have a mental illness. The cost to society is clearly immense.
  • Yet, when family doctors were asked why they didn't refer more patients to therapy in a 2008 Canadian survey, the main reason they gave was cost. For many Canadians, private therapy is a luxury, especially if families are already wrestling with the economic fallout from mental illness. Costs vary across provinces, but psychologists in private practice may charge more than $200 an hour in major centres. And it's not just the uninsured who are affected.
  • Although about 60 per cent of Canadians have some form of private insurance, the amount available for therapy may cover only a handful of sessions. Those with the best benefits are more likely to be higherincome workers with stable employment. Federal public servants, notably, have one of the best plans in the country - their benefits were doubled in 2014 to $2,000 annually for psychotherapy. Many of those who can pay for therapy are doing so: A 2013 consultant's study commissioned by the Canadian Psychological Association found that $950-million is spent annually on private-practice psychologists by Canadians, insurance companies and workers compensation boards. The CPA estimates t
  • These are the patients that family doctors juggle, the ones who eat up appointment time, and never seem to get better, the ones caught on waiting lists. Sometimes, they have already been bounced in and out of the system, received little help, and have become wary of trying again. A 40-something mother recovering from breast cancer, suffering from chronic depression post-treatment, debilitated by fear her cancer will return. A university student, struggling with anxiety, who hasn't been to class for three weeks and may soon be kicked out of school. A teenager with bulimia removed from an eatingdisorder program because she couldn't follow the rules. They are the ones dangling on waiting lists in the public system for what often amounts to a handful of talk-therapy sessions, who don't have the money to pay for private therapy, or have too little coverage to get the full course of appointments they need.
  • Canada's investment does not match that burden. Only about 7 per cent of health-care spending goes to mental health. Even recent increases pale when compared to other countries: According to a study by the Canadian Mental Health Association, Canada increased per-capita funding by $5.22 in 2011. The British government, meanwhile, kicked in an extra 12 times that amount per citizen, and Australia added nearly 20 times as much as we did. Falling off a cliff, again and again
  • In Winnipeg, Dr. Stanley Szajkowski watched for months as his patient, a woman in her 80s, slowly declined. Her husband had died and she was spiralling into a severe depression. At every appointment, she looked thinner, more dishevelled. She wasn't sleeping, she admitted, often through tears. Sometimes she thought of suicide. She lived alone, with no family nearby, and no resources of her own to pay for therapy. "You do what you can," says Dr. Szajkowksi. "You provide some support and encouragement." He did his best, but he always had other patients waiting.
  • hat 30 per cent of private patients pay out-ofpocket themselves. When the afflicted don't seek help, the cost isn't restricted to their own pocketbook. People with mental-health problems are significantly more likely to abuse drugs and alcohol, and to become physically sick, further increasing health-care costs. A 2014 study by Oxford University researchers found that having a mental illness reduced life expectancy by 10 to 20 years, roughly the same as did smoking and obesity. A 2008 Statistics Canada study linked depression to new-onset heart disease in the general population. A 2014 U.S. study found that women under the age of 55 are twice as likely to suffer or die from a heart attack, or require heart surgery, if they have moderate to severe depression. The result: clogged-up doctors' offices, ERs, and operating rooms. And an inexorable burden for the patients' families forced to fill the gaps in caregiving - or carry on when they lose a loved one.
  • Patients refer to it as falling repeatedly off a cliff. And they can only manage the climb back up so many times. Family doctors interviewed for this story admitted that they are often "handholding" patients with nowhere else to go. "I am making them feel cared for, I am providing a supportive ear that they may not get anywhere else," says Dr. Batya Grundland, a physician who has been in family practice at Toronto's Women's College Hospital for almost a decade. "But do I think I am moving them forward with regard to their illness, and helping them cope better? I am going to say rarely." More senior doctors have told her that once in a while "a light bulb goes off" for the patients, but often only after many years. That's not an efficient use of health dollars, she points out - not when there are trained therapists who could do the job better. However, she says, "in some cases, I may be the only person they have."
  • Family doctors aren't the only ones struggling to find therapy for their patients. "I do a hundred consultations a year," says clinical psychiatrist Joel Paris, a professor at McGill University and research associate at the Montreal Jewish General, "and one of the most common situations is that the patient has tried a few anti-depressants, they have not responded very well, and from their story it is obvious they would benefit from psychotherapy. But where do they go? We have community clinics here in Montreal with six-to-12-month waiting lists even for brief therapy." A fractured, inefficient system
  • "You fall into the role that is handed to you," says Antoine Gagnon, a family doctor in Osgoode, on the outskirts of Ottawa. He tries to set aside 20-minute appointments before lunch or at the end of the day to provide "active listening" to his patients with anxiety and depression. Many of them are farmers or self-employed, without any private coverage for therapy. "Five of those minutes are spent talking about the weather," he says, "and then maybe you get into the meat of the problem, but the reality is we don't have the appropriate amount of time to give to therapy, even to listen, really." Often, he watches his patients' symptoms worsen over several months, until they meet the threshold of a clinical diagnosis. "The whole system could save on productivity and money if people were actually able to get the treatment they needed."
  • But these issues aren't insurmountable, as other countries have demonstrated. Britain, for instance, has trained thousands of university graduates to become therapists in its new public program, following research showing that, as long they have the proper skills, people don't need PhDs to be effective therapists. Australia, which has created a pay-for-service system, also makes wide use of online support to cost-effectively reach remote communities.
  • Except for a small fraction of GPs who specialize in psychotherapy, few family doctors have the training - or the time - to provide structured therapy. Saadia Hameed, a GP in a family-health team in London, Ont., has been researching access to psychotherapy for an advanced degree. Many of the doctors she has interviewed had trouble even producing a clear definition of therapy. One told her, "If a patient cries, than it's psychotherapy." Another described it as "listening to their woes." A 2007 survey of 163 family doctors in Ontario found that almost four out of five had not received training in cognitive behavioural therapy, and knew little about it. "Do family doctors really need to do that much psychotherapy," Dr. Hameed asks, "when there are other people trained - and better trained - to do it?"
  • What further frustrates treatment for physicians and patients is lack of access to specialists within the system. Across the country, family doctors describe the difficulty of reaching a psychiatrist to consult on a diagnosis or followup with their patients. In a telling 2011 study, published in the Canadian Journal of Psychiatry, researchers conducted a real-world experiment to see how easily a GP could locate a psychiatrist willing to see a patient with depression. Researchers called 297 psychiatrists in Vancouver, and reached 230. Of the 70 who said they would consider taking referrals, 64 required extensive written documentation, and could not give a wait-time estimate. Only six were willing to take the patient "immediately," but even then, their wait times ranged from four to 55 days. Psychiatrists are in increasingly short supply in Canada, and there's strong evidence that we're not making the best use of these highly trained specialists. They can - and often do - provide fee-for-service psychotherapy in a private setting, which limits their ability to meet the huge demand to consult with family doctors and treat the most severe cases.
  • A recent Ontario study by a team at CAMH found that while waiting lists exist in both urban and rural centres, the practices of psychiatrists in those locations tend to look very different. Among full-time psychiatrists in Toronto, 10 per cent saw fewer than 40 patients, and 40 per cent saw fewer than 100 - on average, their practices were half the size of psychiatrists in smaller centres. The patients for those urban psychiatrists with the smallest practices were also more likely to fall in the highest income bracket, and less likely to have been previously hospitalized for a mental illness than those in the smaller centres.
  • And those therapy sessions are being billed with no monitoring from a health-care system already scrimping on dollars, yet spending a lot on this care: On average, psychiatrists earn $216,000 a year. There is nothing to stop psychiatrists from seeing the same patients for years, and no system to ensure the patients with the greatest need get priority. In Australia, Britain and the United States, by contrast, billing for psychiatrists has been adjusted to encourage them to reduce psychotherapy sessions and serve more as consultants, particularly for the most severe cases, as other specialists do.
  • As the Canadian system exists now, says Benoit Mulsant, the physician-in-chief at CAMH and also a psychiatrist, the doctors in his specialty "can do whatever they please. If I wanted, I could have a roster of actor patients who tell me entertaining stories, and I would be paid the same as someone who is treating homeless people. ... By treating the rich and famous, there is zero risk of being punched in the face by a patient." Left out in all this, by and large, are other professionals who can provide therapy. It doesn't help that the rules are often murky around who can call themselves psychotherapists. While psychologists and social workers are licensed under their professional associations, in some provinces a person can call himself a marriage counsellor or music therapist with no one demanding they be certified. In 2007, Ontario passed a law to regulate psychotherapists, requiring them to register with a provincial college that would set standards and handle complaints. Currently, however, the law is in limbo, although the government has said it will finally bring it into force by December. The brain keeps many secrets
  • Science, however, has yet to find depression's equivalent of insulin. Despite being scanned, poked and stimulated over and over and over again, the brain keeps its secrets. The "chemical imbalance" theory is now viewed as simplistic at best. It may not do much for patients, either: A 2014 study published in the journal Behaviour Research and Therapy suggested that, rather than reassuring them, focusing on the biological explanation for depression actually made patients feel more pessimistic and lacking in control. SSRIs work by increasing the amount of serotonin, a chemical that helps deliver messages within the brain and is known to influence mood. But researchers aren't sure why the drugs help some patients and fail with others. "Basically, it's like we have a bucket of water and we pour it over the patient's head," says Dr. Georg Northoff, the University of Ottawa's Michael Smith chair of Neurosciences and Mental Health. "But you want a drug that injects the water in a very specific brain regions or brain system, which we don't have."
  • Critics of therapy have argued that it's basically "good listening" - comparable to having a sympathetic friend across the kitchen table - and that in the real world of mercurial patients and practitioners of varying abilities, a pill just works better. That's true in many cases, especially when the symptoms are severe and the patients is suicidal: a fast-acting medication is safer, and may even be necessary before starting talk therapy. The staunchest advocates of therapy do not suggest it should be the first course of treatment for psychosis, or debilitating chronic depression, or mania - although, in those cases, there is evidence that psychotherapy and medication work well in tandem. (A 2011 meta-analysis found that patients with severe depression who received a combination approach had higher recovery rates and were less likely to drop out of treatment.) But drugs also don't work as well as the manufacturers would like us to think. Roughly one-third of patients given a drug will see no benefit (although they often respond to a second or third medication). In randomly controlled trials, drugs often perform only marginally better than sugar pills.
  • Yet it's talk therapy that the public often views most skeptically. "Until you go to a therapist, or a member of your family has a serious psychological problem, people are unsympathetic [about therapy]," says Dr. Paris, the Montreal psychiatrist. "They are very skeptical, and they don't believe the research. It's amazing, because pharmaceutical trials will get approval for a drug on the basis of two clinical trials that they paid for. And we have 100 clinical trials and no one believes us."
  • Dr. Ajantha Jayabarathan, an assistant professor at Dalhousie University's medical school, spent her early years as a family doctor in Spryfield, N.S., trying to manage an overload of mental-health cases. Most of her patients had little insurance; there was one reduced-cost counselling service in town, but the waiting lists were long. In 2000, her group practice became a test site for a shared-care project, which gave the doctors access to a mental-health team, including weekly in-person consultations with a psychiatrist. "It was transformative," she says. "We looked after everything in-house.
  • Over time, Dr. Jayabarathan says, she learned how to properly assess mental illness in patients, and how to use medication more effectively. "I just made it my business to teach myself what to do." It's the kind of workaround GPs are increasingly experimenting with, waiting for the system to catch up. Who would pay - and how?
  • The case for expanding publicly funded access to therapy is gaining traction in Canada. In 2012, the health commissioner of Quebec recommended therapy be covered by the province; it is now being studied by Quebec's science-based health body (INESSS), which is expected to report back next year. A new Quebec-based organization of doctors, researchers and mental-health advocates called the Coalition for Access to Psychotherapy (CAP) is lobbying the government.
  • In Manitoba, the Liberal Party - albeit well behind in the polls - has made the public funding of psychologists one of its campaign platforms for the province's spring 2016 election. In Saskatchewan, the government commissioned, and has since endorsed, a mental-health action plan that includes providing online therapy - though politicians have given themselves 10 years to accomplish it. Michael Kirby, the former head of the Canadian Mental Health Commission, has been advocating for eight annual sessions of therapy to be covered for children and youth in need.
  • There are significant hurdles: Which practitioners would provide therapy, and how would they be paid? What therapies would be covered, and for how long? Complicating every aspect of major mentalhealth change in Canada is the question of who should shoulder the cost: the provinces or Ottawa. In a written statement in response to questions from The Globe and Mail, federal Health Minister Rona Ambrose lobbed the issue back at her provincial counterparts, pointing out that the Canada Health Act does not "preclude provinces and territories from extending public coverage to other services or providers such as psychologists."
  • One result can be overloaded family doctors minimizing mental-health problems. "If you have nothing to offer someone," asks Dr. Anderson, "how much are you going to dig around to find out what is going on?" Some doctors also admit that the lack of resources can lead to physicians cherry-picking patients who don't have mental illness. And yet family physicians alone bill about $361million a year for counselling or psychotherapy in Canada - 5.6 million visits of roughly 30 minutes each. This is a broad category, and not always specifically related to mental health (some of it includes drug counselling, and a certain amount of coaching is a necessary part of the patient-doctor relationship). When it is psychotherapy, however, doctors admit it's often more supportive listening than actual therapy.
  • So how would Canada pay for access to such therapy? It wouldn't be cheap, in the short term. The savings would come from what Canadians would not have to spend in the long term: in additional medical and drug costs, emergency-room visits and hospital stays, and in unnecessary disability payments, to say nothing of better long-term health outcomes for patients given good care earlier. Some of the figures being tossed around sound staggering. Rolling out a version of Britain's centre-based program across Canada would cost $950-million. Michael Kirby's plan would amount to $1,000 annually per patient. A 2013 report commissioned by the Canadian Psychological Association calculated that, based on predicted need, and assuming no coverage from private health-care plans, providing an average of six sessions of therapy a year would cost an estimated $2.8-billion annually.
  • But any of those figures would still be a fraction of the roughly $210-billion that Canada spends annually on health care. Figuring out how to make the system most costeffective is, according to sources, currently delaying the INESSS report to the Quebec government. "You need to facilitate the government," says Helen- Maria Vasiliadis, a professor of community health at the University of Sherbrooke. "You can't be going to policymakers and showing them billions and billions of dollars. People start having heart attacks. With evidence in hand, we have to present possible solutions."
  • An insurance-based plan is the proposal that has emerged from the Quebec-based CAP group, which sent its proposal to Quebec's health minister last month. In its design, the system would work much like Quebec's public drug plan - Quebeckers not covered through work plans would contribute to a provincial insurance program for therapy. That would be similar to the system that Germany has used for decades. One step forward, one step back
  • Last year, the Sherbrooke clinic where Marie Hayes works received provincial funding for a part-time psychologist and a full-time social worker. With a roster of 25,000 patients, the clinic team laid out clear guidelines for the psychologist, who would consult on cases and screen patients, and be limited to a mere four sessions of actual counselling with any one patient. "We wanted to be careful she didn't become a waiting list - like everything in the system," says Dr. Hayes. The social worker helps guide patients into services such as housing and addiction counselling. They have also offered group sessions for depression management at the clinic. As stretched as those new professionals are in such a large practice, Dr. Hayes says the addition of that mental-health team is improving the care she can provide patients. Recently, for instance, the 32- year-old mother with anxiety attended sessions with the psychologist. "She is making progress," says Dr. Hayes, "slowly."
  • At Women's College Hospital in Toronto, Dr. Grundland is not so lucky. Asked to describe a difficult case, the family-practice physician mentions a patient suffering from depression after a lifechanging accident. Every month, doctor and patient would repeat the same conversation they'd already had more than a dozen times - and make little real headway. Her patient, says Dr. Grundland, needs a trained therapist: someone she can see regularly, to help her move past her frustration, counsel her about addiction, and ease the burden on her family.
  • But there's no extra money in the patient's budget for a psychologist. "I do my best," Dr. Grundland says, "but it's not my area of expertise." Meanwhile, the patient isn't getting better, and in the time that it takes to make it through one appointment with her, Dr. Grundland could see three other people with problems she was actually trained to treat. "But," says Dr. Grundland, "she has nowhere else to go." Erin Anderssen is a feature writer at The Globe and Mail. OPEN MINDS How to build a better mental health care system
  • The Centre for Addiction and Mental Health has purchased advertisements to accompany this series. While CAMH professionals are quoted in this story, the organization had no involvement in the creation or production of this, or any other story in the series. $20.7-billion The cost, according to a 2012 Conference Board of Canada report, of lost productivity each year due to mental illness. What else does $20-billion represent?
  • $20B: Canadian spending on national defence, 2012-13 $20B: Market valuation of Airbnb, 2015 $21B: Kitchener-CambridgeWaterloo region's GDP, 2009 $21B: Amount food manufacturing contributed to the economy, 2012
Govind Rao

Why a health-care report was dead on arrival - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150722|225356574

from heather federal accord innovation government

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  • The Globe and Mail Wed Jul 22 2015
  • When the Harper government has something to brag about, we hear about it, endlessly. When the government has something to hide, the information comes out without ministerial comment on a Friday afternoon. So it was last week that the Prime Minister's Office buried a long, detailed report about federal innovation in health care that the government itself had commissioned.
  • The Advisory Panel on Healthcare Innovation, chaired by former University of Toronto president and dean of medicine David Naylor, was to have been released at a news conference in Toronto on July 14. The day before the news conference, however, the PMO cancelled it and decided to release the report without notice on the Health Canada website on July 17. Just as the PMO hoped, the report received little attention. Health Minister Rona Ambrose, who was to have spoken about the report, was gagged. The posting on her department's website was timed so that it appeared only after the provincial premiers had finished their final news conference in St. John's, in case the report gave any or all of them ammunition to embarrass the federal government. Such is the way this government works.
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  • It's not hard to figure out why the Naylor report displeased the government. The panel was given a difficult, bordering on impossible, job: recommend innovations without Ottawa spending any more money. The panel's mandate read that recommendations "must not imply either an increase or a decrease in the overall level of federal funding for current initiatives supporting innovation in health care."
  • The Naylor panel ignored the mandate, explaining in its report that "although it was not an easy decision, we did not follow this guidance." Later, it warned that "absent federal action and investment, and absent political resolve on the part of provinces and territories, Canada's healthcare systems are headed for continued slow decline in performance relative to peers." To that end, the panel recommends creating a health innovation fund with a $1-billion yearly budget to invest in changes to the health-care system in conjunction with willing provinces and health-care institutions.
  • Such a fund would be just about the last thing the Harper government desires. This government is running on balancing the budget. Adding $1-billion a year in spending would not be what the government wants. Such an investment fund would have little political profile - nothing as sexy as, say, national pharmacare (which the panel cursorily debunked). It would also run the risk of provoking premiers who screamed in St. John's for more cash transferred from Ottawa to them, without strings attached.
  • For 2017-18, the federal government has announced it will reduce the increase in Ottawa's annual health-care transfer to the provinces from 6 per cent to something in the range of 3 per cent to 3.5 per cent, depending on economic growth. The provinces would likely not appreciate losing money from Ottawa with one hand, and then getting some, but only some, of it back through the innovation fund. The Harper government was hoping for change-on-the-cheap from the panel: innovation that would cost nothing but improve the system. It certainly has no interest in an expanded, direct federal role in health care, having made it abundantly clear that health care is for the provinces, except for Ottawa's responsibility for aboriginal and veterans' health, public health and drug approvals.
  • Moreover, provincial health budgets are rising on average now by only 2 per cent a year, compared with 7 per cent a decade ago, far below the 6-per-cent increases in transfers still coming from Ottawa. The premiers would love the transfer to return to 6 per cent, as would the federal New Democrats. That would be the single dumbest move any federal government could make, given the lamentable experience of the 2004-11 period, when money gushed out of Ottawa but bought little improvement in the healthcare system. The Naylor panel noted, as have many observers, that the money improved things for providers, but not for many patients.
  • The Naylor report covers all the ground about the manifold weaknesses and sturdy strengths of the Canadian system compared with other countries. It hails, quite rightly, some aspects of the U.S. system, especially the coordinated care of the best health organizations such as Kaiser Permanente.
  • Its broad recommendations, however, are dead on arrival in Mr. Harper's Ottawa, which is why the report slid into the public domain with such little notice.
Govind Rao

Resist the silent war on Canadian medicare - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|wifp|20150724|225529832

from heather accord medicare union

shared by Govind Rao on 24 Jul 15 - No Cached
  • Winnipeg Free Press Fri Jul 24 2015
  • When universal health care was adopted in 1966 with the passage of the Medical Care Act, it signified a profound moment in Canadian political history. Rarely before had an alliance of ideologically opposed figures -- the socialist Tommy Douglas, Progressive Conservative John Diefenbaker and Liberal prime minister Lester Pearson -- delivered legislation that would enshrine in collective consciousness the universal values of health and dignity; touchstones that still define this country and its society today.
  • Indeed, medicare is a fundamental pillar of Canadian identity. It projects our national values onto the world stage, delivers positive outcomes to patients and supports a vast infrastructure of globally recognized caregivers, physicians, researchers and front-line workers. It is also a system that relies heavily on federal funding and cash transfers.
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  • In 2004, the Health Accord was established as an agreement between the government and each province and territory. It provided all regions with stable funding to deliver adequate medical care that met national standards. The $41-billion pact was a response to deep cuts throughout the 1990s and aimed to address issues around wait times, pharmaceuticals and term care. For much of the past 10 years, federal support hovered around 23 per cent.
  • The accord rightly placed the government in a position of leadership on health care, one from which it could co-ordinate medical delivery and uphold common principles for all Canadians. Under the Harper government, however, the agreement began to erode. In 2011, three years before its expiry, the Conservatives announced major cuts to the Canada Health Transfer of $36 billion over a decade beginning in 2017. Instead of the traditional annual rise of six per cent, funding would now be based on the rate of growth of Canada's GDP.
  • Then, in 2012, after agreeing to extend monopoly drug patents to European countries in a far-reaching trade agreement, the government increased pharmaceutical costs to Canadians by an estimated $1 billion. Two years later, the Health Accord was not renewed; every province and territory was left on its own to determine how it will fund growing and aging populations into the uncertain future.
  • The retreat of the federal government from its position of authority on national health care is a troubling trend, one made all the more distressing in light of recent projections outlined in a report compiled by the Canadian Federation of Nurses Unions. In the document, The Canada Health Transfer Disconnect, economist Hugh Mackenzie argues lower GDP growth estimates mean federal support for medicare will drop from 23 to 19 per cent by 2025. This represents a shortfall of $44 billion.
  • Based solely on GDP and distributed by population, the platform is "insensitive to the differences in the drivers of the costs of health care," Mackenzie writes. Most importantly, this includes an aging population. Within the next 25 years, the number of Canadians aged 65 and older will double, reaching a staggering 10 million.
  • The premiers want the Health Transfer increased to at least 25 per cent of all health-care spending. Without it, the provinces and territories will face insurmountable financial pressure. In real terms, this means fewer nurses, home care visits, primary care centres and long-term beds. Since the election of a Conservative majority government, taxes are at their lowest levels in more than half a century. In its myopic vision of deficit reduction and austerity, Ottawa now collects $45 billion less in revenue. It is no wonder the Canadian public is being told it cannot "afford" adequate levels of health-care funding.
  • Without negotiations in place to renew the Health Accord, Canada's most cherished public institution is at risk of crumbling at an inopportune historical moment of generational change. At worst, these changes signal the advent of a for-profit, two-tier system that favours the wealthy while driving up costs and delivering poorer outcomes for the rest. From the perspective of the private sector, after all, access to essential care is not based on need, but the ability to pay.
  • Hyper-partisanship is a symptom of an ailing democracy and should not be responsible for the erosion of an institution that protects basic human rights. It is therefore the responsibility of all Canadians to recall our shared history and uphold a just standard of public morality. Together we may continue to see our nation as Tommy Douglas envisaged it, "like a little jewel sitting at the top of the continent."
  • Harrison Samphir is an editor at Canadian Dimension Magazine and a graduate student preparing to study International Relations at the University of Sussex, Brighton, UK. hsamphir@gmail.com.
Govind Rao

FREE SPEECH; Speech therapy can prevent a lifetime of struggles, but an early start is ... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150831|228230903

from heather waits specialty clinics privatization private clinics

shared by Govind Rao on 01 Sep 15 - No Cached
  • The Globe and Mail Mon Aug 31 2015
  • Four-year-old Eddie Hopkins is focused on a game of I spy. The object of his attention is a tube of lipstick in a picture. Can he say what it is? "Lipstick," he says, but it sounds more like "lit-git." Maybe lipstick is too hard. Can he say stick?
  • "Sti-ck," he says, hesitating before the k sound. One more try. "Sti-ick!" he shouts confidently, dividing the word into two. It seems like a small accomplishment, but for Eddie, it's the first and major step toward speaking normally. Like tens of thousands of children in Ontario, Eddie is in need of speech therapy. He has problems pronouncing the hard k sound, known as an unvoiced velar stop. He often switches it with the voiced velar stop, which most people know as the soft g sound, bringing him from "stick" to "stig." He also switches his sh and s sounds, and has issues with pronouncing two consonants together, such as the "cl" in "clown."
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  • The average number of people on wait lists as of May, 2015, is 611. Some regions have shorter wait lists, such as Toronto Central, which currently has zero. Others are in the four digits, such as the Central East CCAC, which stretches east from Victoria Park Avenue in Scarborough and north to Algonquin Park, and has 1,516 children waiting for speech therapy. Waiting that long can have a large impact on a child's ability to do well in school, according to Anila Punnoose, a director of Speech-Language and Audiology Canada. During the months or years children are waiting to get speech services, they can quickly fall behind in school, she said. A 1996 study found children with language deficits are more likely to experience social difficulties including interacting with their peers, which impacts their behaviour. Other studies have shown that children who don't get speech therapy early are at a greater risk of problems in their academic performance and mental health.
  • A lot of speech problems carry over to literacy, because a knowledge of speech sounds is crucial when learning to read, Punnoose said. "It's all about what you hear in those sounds. ... Do you know the beginning sounds in that word? A child who doesn't have good phonological awareness doesn't understand any of that," she said. When looking at school performance, Punnoose said early struggles carry through to later years. A child with speech problems who has difficulties learning in the early years won't be able to build on those lessons in later years as effectively as their peers, she said. Early intervention can mitigate and prevent those problems, she said. "If children are having severe difficulties with speech in kindergarten, it's a predictor that there's going to be academic difficulties, and especially reading and writing difficulties, by Grade 3," she said.
  • Jocelyn Fedyczko, Eddie's speech pathologist, has worked in a range that includes children from preschool all the way to teenagers. She said early intervention is crucial with young children such as Eddie. "The earlier you can help a child out, the more progress you see," she said. When a child gets to the top of the wait list, they get assessed again, and receive a block of treatment, usually around 10 or 12 sessions, says Peggy Allen, president of the Ontario Association of Speech-Language Pathologists and Audiologists (OSLA). That's often not enough to treat even minor to moderate issues such as Eddie's. Fedyczko said she can get through two to three sounds in that time, depending on the child. Many children have problems with more sounds than that, she said. But when a child finishes their block of treatment and needs more, because they haven't worked through all the sounds, for example, they go back to the bottom of the wait list, Allen said.
  • A spokesperson for the Toronto Central CCAC said they do not have an upper limit to the number of sessions per block assigned by a speech-language pathologist. The pathologist determines three goals for a child to achieve and assigns the number of sessions according to that. If after these sessions more goals are identified, the child is re-referred to the program, the spokesperson said. Parents who are worried about the impact waiting can have on their child can go to private clinics, if they have coverage or can afford the sessions out of pocket. Trish Bentley, Eddie's mother, decided to go for private therapy with Eddie's older brother Oliver. He was put on a six-month wait list for speech problems slightly more acute than Eddie's.
  • B.C.: Children's speech therapy is organized through the Ministry of Health, Ministry of Children and Family Development (MCFD) and through the Ministry of Education by way of school districts. Children are divided between preschool and school age. Preschool children go through regional health authorities. School-age children go through the school boards, but the pathologists there will often offer consultative services, rather than oneon-one speech therapy. B.C. also has a "no-wait-list" policy for children with autism, which translates to parents getting around $22,000 a year for therapy until the age of six, and $6,000 a year after that. Alberta: Health Services is in charge of speech therapy in that province. It offers both a preschool and a school program. The school program, unlike Ontario's, is done completely through the schools, with no CCAC-type system to refer out to. Saskatchewan: The school districts are responsible for speech therapy. Each school district divides up services slightly differently, though they all differentiate between children under three years, from three to five years, and from six to 18 years.
  • But the problems go deeper than a lack of funding, according to Allen. She said many of the issues in Ontario stem back to a series of agreements in the 1980s between the provincial Ministry of Long-Term Care, the Ministry of Education and the Ministry of Community and Social Services. These agreements divided up who is in charge of different treatments, between the school boards and the CCACs. At the time of their creation, these agreements made sense, but times and needs have changed, she said. "It's difficult when ministries make agreements that are frozen in time. It's very difficult to provide the kind of services that we all expect and want Ontarians to receive," she said. Dividing up the services is necessary when trying to manage resources, but the fragmentation is hurting children more than it's helping, Punnoose said.
  • Dividing services by language issues and other issues doesn't make sense when treating a child, she said. "You shouldn't be splitting up the kid," she said. Punnoose said she wants to see speech therapy come together under one roof. It would mean co-operation from all three ministries, as well as a major reorganization of the funding, but she believes it would be a better model for children. "Students are in schools the better waking part of their lives. Why wouldn't we have the services right there in an authentic environment where it's totally accessible," she said. There are changes coming.
  • Last December, the Ontario government announced more funding for preschool speech and language programs, as well as efforts to integrate speech services better, through its Special Needs Strategy. Punnoose says it's a good step. "The government recognizes that the system was broken," she said. For now, the choice for parents in many CCACs will be between long wait lists and paying for private service. Hunter-Trottier said many parents, even those with coverage, don't know about the latter option. "We sometimes get parents here in tears, saying, 'Oh my goodness, the services here, I wish I had known about that a year ago,' " she said. Bentley said she won't be looking at public services for Eddie, as she's happy with the service she gets at Canoe. "I'd be open to it, but I'm not going to actively seek that out," she said.
  • For Eddie, what matters is the progress he makes. Within 10 minutes of his trouble saying "lipstick," he was opening up a treasure chest, with a key. With little prompting, he used the same technique as before, separating the sounds of the word. "Kuh-ey," he said. Could he try it all together? He pauses for a second. "Key," he says, almost flawlessly, beaming at his success. SPEECH THERAPY IN EACH PROVINCE
  • Speech therapy, like all healthcare matters, is regulated differently in each province and territory in Canada. Information on how each system works is difficult to come by. But generally, most provinces have very similar systems - and challenges - according to Joanne Charlebois, CEO of Speech-Language and Audiology Canada. Charlebois said Ontario's wait times are probably worse than those in other provinces, but she's spoken to people across Canada who tell her similar stories. Here's a breakdown of how it works across the country. Ontario: Speech therapy for children falls under the responsibility of three ministries: the Ministry of Long-Term Care, the Ministry of Education and the Ministry of Community and Social Services. Children in Ontario are divided by age and by the nature of their speech problem. Children under school age qualify for Ontario's preschool speech and language program. Once in school, those children with language problems - major problems speaking or understanding words or sentences - go to a school speech pathologist, while any other problems, such as pronunciation, stuttering, voice and articulation are referred to the Community Care Access Centres, which employ contract speech pathologists.
  • Rather than wait those six months, Bentley took him to Canoe. "As time went on, we said enough of this, he's going to be past the point of catching the problem," she said. For families who don't have coverage and who can't afford private services, though, the only option is to wait. Finding the cause of the long waits is hard, but one thing is certain: It's not due to a lack of speech pathologists, according to Shanda Hunter-Trottier, the owner of S.L. Hunter Speechworks, another private clinic in Toronto. She used to have problems finding qualified speech pathologists, but now she's facing the opposite problem. "I've been practising for 26 years. ... In the last five years, [I] have more resumes than I can keep track of," she said. Rather, she says, it's a large web of problems that slows down the system. First among these is a lack of public funding. "There's a lot of speech pathologists that don't have jobs, but these places aren't hiring. The cutbacks have been atrocious," she said.
  • Manitoba: School districts are also in charge here. The inschool speech-language pathologists offer services from classroom-based programming to individual therapy. Quebec: The system here is more like Ontario's. Speechtherapy services are offered through the local community service centres (CLSC), similar to Ontario's CCACs. The CLSCs are not obliged to provide speech therapy in English, though some, especially in areas with a large anglophone population, usually do. Nova Scotia: The province has 28 speech and hearing centres, with 35 pathologists in total. They assess and provide treatment for children and adults. School boards in the province also have speech-language pathologists who also have a teacher's certificate.
  • Prince Edward Island: The province provides free speech services for children until they enter school. Northwest Territories: Speech therapists are only able to visit some remote communities once or twice a year. Instead, the province offers a service called Telespeech, where pathologists can help people without having to be physically present. Nunavut: The territory had no speech pathologists in 2013, according to Statistics Canada.
Govind Rao

South East LHIN's announcement of $21 million budget cuts to area hospitals will endang... - 0 views

www.ochu.on.ca/...lhins_cutback_announcement.php

from heather hospital cuts cupe Ontario campaign

shared by Govind Rao on 08 Sep 15 - No Cached
  • 04/September/2015
  • Toronto ON- “The announcement by the South East LHIN that it plans to cut hospital budgets in the region of the province that includes Brockville, Perth/Smith’s Falls, Kingston, Quinte, Picton, Trenton and Belleville by $16 to $21 million dollars is staggering and will ultimately endanger patient care” said Michael Hurley, President of the Ontario Council of Hospital Unions/CUPE. “This announcement comes on top of 4 years of budget cuts, which have reduced these hospitals budgets by 24% in real terms,” Hurley explained.
  • Hospital across the South East LHIN are cutting services in the face of a 5-year funding freeze imposed by the provincial Liberal government. An Ontario’s Auditor General report quotes studies which estimated that hospitals need a 5.8% increase in funding each year just to keep pace with the costs of drugs, medical technologies and doctors’ salaries which are rising faster than the general rate of inflation. The freeze has cut hospital budgets by 24% in real terms. Ontario hospitals were already the most efficient hospitals in the country with the fewest beds and staff and the shortest lengths of stay going into the budget freeze. Ontario spends $350 less per capita than any other province in Canada.
  • ...2 more annotations...
  • We can predict that beds and services will close as a result of funding cuts of this magnitude. Access problems will intensify and quality of care will deteriorate further. Women and the elderly will be hit hardest. The hospital staff that we represent will plan a stiff resistance, including demonstrations, rallies, lobbying, advertising and public engagement,” said Hurley.
  • Ontario’s Liberals dropped the corporate income tax rate to one of the lowest in North America, and economists estimate that the province has lost nearly $20 billion in revenue. This drop in tax revenue triggered austerity in provincial expenditures including a 5-year funding freeze for Ontario hospitals, already the worst funded per capita in Canada. “ Ontario’s hospitals are the least expensive and most efficient in the country and they are starved of operating revenue. It’s time for the provincial government to reverse the deep cuts it has made in hospital budgets in Ontario. The announcement of budget cuts of $20,000,000 to hospitals in the South East LHIN is surely an indicator of how bad the situation has become,“ said Hurley.
Govind Rao

VIHA needs to be pushed for more beds - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|pavt|20150911|229047313

from heather bc ltc continuing care privatization

shared by Govind Rao on 11 Sep 15 - No Cached
  • Alberni Valley Times Fri Sep 11 2015
  • Re: 'Care facility in Tofino unlikely' AV Times Page 3, Sept. 4 The tone in the comments of VIHA spokesman Suzanne Germaine as quoted in the Friday edition of the AV Times (an article reprinted from the Westerly News), are enough to raise the hackles of anyone in the Alberni-Clayoquot Regional Health District. She says VIHA must "focus its limited budget on areas of greatest need." I guess we should not be surprised that, in VIHA's estimation, the needs of Nanaimo and Qualicum continue to trump the needs of Port Alberni and Tofino.
  • These remarks display their complete ignorance of the geographical, cultural and social differences between Nanaimo-Qualicum and Port Alberni-Tofino. It's easy to sit in an office in Victoria and figure that funding care beds in Nanaimo and Qualicum should pacify residents here. Ms. Germaine states that VIHA is funding services to "allow folks to live at home for longer." That's all well and good, but there comes a time when living at home is just too much strain for the family and outright dangerous for the patient, and that is when a care facility must be available. In Nanaimo and Qualicum the median income levels are higher than here, there are those who can afford private care beds at $5,000 to $7,000 per month, and private facilities are available. Private care homes do not exist here. The only care homes in this regional health district are those that VIHA will fund.
  • ...1 more annotation...
  • Unfortunately Tofino Mayor Osborne seems resigned to this arbitrary verdict that no care beds will be funded for Tofino. Rather than complaining that she's on a hamster wheel, she should stand up and fight VIHA for equitable health care for West Coast citizens. It's time that VIHA provide adequate levels of care for our area, and a good start would be to fund more care beds in this area, for citizens of this area. To alleviate overcrowding in our hospital, to serve our aging population -VIHA will you listen? Bev Denning Port Alberni
Govind Rao

Tories warn of cuts to balance budget; Kenney says Ottawa will consider 'spending restr... - 0 views

www.fpinfomart.ca/...212716476

from heather budget federal government cuts

shared by Govind Rao on 19 Jan 15 - No Cached
  • The Globe and Mail Mon Jan 19 2015
  • The Conservative government is warning for the first time that falling oil prices could trigger new spending cuts in order to deliver on a promised balanced budget. On the heels of the surprise decision to delay the federal budget until at least April, the government is putting Canadians on notice that it is prepared to cut spending further rather than abandon its goal of balancing the books.
  • "We'll have to certainly look at potentially continued spending restraint. For example, we've had an operating spending freeze. The Finance Minister may have to look at extending that," Mr. Kenney told CTV's Question Period in an interview broadcast Sunday. In a separate interview with Global's The West Block, Mr. Kenney ruled out using the annual $3-billion contingency fund to achieve balance: "We won't be using a contingency fund. A contingency fund is there for unforeseen circumstances like natural disasters." If a government is in surplus and has not spent the contingency, that money goes toward paying down the national debt. However, Mr. Oliver suggested last week that the government was not planning to do that and would instead "bring the surplus down to zero" in order to provide benefits to Canadians.
  • ...5 more annotations...
  • In a prebudget letter to Mr. Oliver, the NDP urges the Finance Minister not to delay the budget and to instead scrap the recent tax cut that allows parents with children under 18 to split their income for tax purposes. The NDP says Ottawa should cut spending on advertising, the Senate and corporate subsidies. The letter calls for more spending on health care, child care and pensions and the creation of a credit for small businesses that make new hires.
  • The government says it is taking a few extra weeks to release a budget in order to get a better understanding of the current changes in the economy. The price of oil has dropped by more than half since June, a development that will mean billions less in tax revenue for Ottawa than had been previously expected.
  • Federal Employment Minister Jason Kenney is also pledging that Ottawa can hit its target without dipping into a $3-billion contingency fund, a comment that is at odds with recent statements from Finance Minister Joe Oliver, as well as analysis from several private-sector economists. The messaging from the government is shifting quickly in the face of growing signs that current, dramatically lower oil prices will be around for some time. The Bank of Canada will release its quarterly Monetary Policy Report on Wednesday, which is expected to expand on recent warnings that prices could go lower, or remain low, "for a significant period." In a series of interviews broadcast over the weekend, Mr. Kenney said balancing the books has important symbolic value and that "it may take some additional spending restraint" in order for the government to deliver on its promise.
  • The 2014 federal budget reintroduced a two-year freeze on departmental operating budgets that runs through the 2015-16 fiscal year, which is when the Conservatives are promising a return to balance. The 2014 budget said this freeze would save the government $550-million in 2014-15 and $1.1-billion in 2015-16. Mr. Kenney did not explain how extending the freeze might help the government achieve its balanced-budget promise. "They spent the surplus before they had it and now they're scrambling to figure out how to make one plus one equal three," said NDP finance critic Nathan Cullen.
  • Economists say it makes no practical difference whether Ottawa posts a small surplus or a small deficit, given that federal finances are sound overall in terms of debt levels and longterm spending trends. But Mr. Kenney said balancing the books remains an important goal. "It's a commitment we made to Canadians in the last election," he told CTV. "It's important that, when possible, we no longer go back and borrow money to pay for government spending."
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