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Irene Jansen

Glazier et al. All the Right Intentions but Few of the Desired Results: Lessons on Acce... - 2 views

www.longwoods.com/...23041

ontario primary care doctors capitation payment methods chc p4p excellent

shared by Irene Jansen on 19 Sep 12 - No Cached
  • The common elements of reform include organizing physicians into groups with shared responsibilities, inter-professional teams, electronic health records, changes to physician reimbursement, incentive and bonus payments for certain services, after-hours coverage requirements, and telehealth and teletriage services.
  • Ontario's initiatives have been substantially different from those of other provinces in the scope, size of investment and structural changes that have been implemented.
  • These models have the same requirements for evening and weekend clinics, and for their physicians to be on call to an after-hours, nurse-led teletriage service.
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  • Despite this increased attachment, the chance of being seen in a timely way did not improve. Ontario's primary care models require evening and weekend clinics and on-call duties, and penalize practices for out-of-group primary care visits; therefore, these findings are unexpected. While many factors are likely involved, Ontario's auditor general noted two major faults: not establishing mechanisms for ongoing monitoring and evaluation, and not enforcing practices' contractual obligations, especially for after-hours care
  • The access bonus is reduced by outside primary care use but not by emergency department visits. Physicians responding rationally to such a financial incentive would logically direct their patients away from walk-in clinics and toward emergency departments. The access bonus also strongly discourages healthcare groups from working together to provide late evening and night coverage because all parties would lose financially. An incentive that costs more than $50 million annually should be structured to align better with health system needs.
  • A recent systematic review found insufficient evidence to support or not support the use of financial incentives to improve the quality of care (Scott et al. 2011).
  • Ontario's reforms occurred in the absence of routine measurement of primary care within practices, groups or communities and with limited accountability for how funds were spent.
  • Ontario adjusts capitation for only age and sex, whereas most other jurisdictions further adjust for expected healthcare needs, patient complexity and/or socioeconomic disparities (e.g., the Johns Hopkins Adjusted Clinical Groups http://www.acg.jhsph.org/). That may be why Ontario's primary care capitation models have attracted healthier and wealthier practices (Glazier et al. 2012).
  • Community health centres care for disadvantaged populations with superior outcomes (Glazier et al. 2012; Russell et al. 2009) and could play a larger role in Ontario's health system.
  • Unlike some other jurisdictions (National Health Service Information Centre for Health and Social Care 2012), Ontario has no routine measurement of primary care at the practice, group or community levels. It has no organized structures, such as the Divisions of General Practice in Australia (Australian Department of Health and Ageing 2012) or the Divisions of Family Practice in British Columbia (2010), that can help practices come together to improve care. It has also failed to hold practices accountable for their contractual obligations, including after-hours clinics.
  • In Ontario, there was little relationship between incentive payments and changes in diabetes care (Kiran et al. 2012), nor were there substantial improvements in most aspects of preventive care despite substantial incentives (Hurley et al. 2011). Similar cautionary tales about pay-for-performance can be found elsewhere in the health system (Jha et al. 2012).
  • Access to primary care has proven to be challenging in Canada, leaving it behind many developed countries in timely access and after-hours care, and more dependent than most on the use of emergency departments (Schoen et al. 2007).
  • A strong primary care system is consistently associated with better and more equitable health outcomes, higher patient satisfaction and lower costs (Starfield et al. 2005).
Irene Jansen

Bonuses for docs do little to improve diabetes care - 0 views

mobile.reuters.com/...idUSBRE83P14D20120426

p4p canada us

shared by Irene Jansen on 01 May 12 - No Cached
  • Small financial incentives aimed at getting physicians to make sure their diabetic patients receive recommended routine exams may not lead to changes in doctors' behavior, according to a new study
  • pay-for-performance arrangements
  • offer money to physicians who achieve certain goals that are known to improve patients' health, reduce errors or save money
  • ...6 more annotations...
  • Dr. Tara Kiran, the lead author of the study from St. Michael's Hospital and the University of Toronto.
  • "Rates of recommended testing increased gradually from 2006 to 2008, but it was not really associated with the incentive code,"
  • Her results showed that the number of people who met the guidelines for all routine exams rose from 16 percent in 2000 to 27 percent in 2008, but the annual increase after the incentive became available was similar to what it was before doctors could earn the bonus.
  • Pay-for-performance programs have not shown much success in other settings, either.For example, an incentive program involving 252 hospitals in the United States had no impact on patients' health (see Reuters report of March 28, 2012).
  • Shifting doctors' offices to a "medical home," which attempts to be more comprehensive and accessible in providing care for patients, seems to make a bigger difference
  • "We're nibbling around the edges with these kinds of small incentive payments when it comes to improving primary care delivery," he said. "We're not addressing the issue of: how do we redesign the way we provide primary care?"
Irene Jansen

Evidence is poor that financial incentives in primary care improve patients' wellbeing,... - 0 views

www.bmj.com/...bmj.d5682.full

incentives payment methods primary care

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Research evidence fails to show that providing financial incentives to primary care services improves patients’ wellbeing, concludes a Cochrane review
  • The schemes used a variety of payment mechanisms, including payments for reaching single thresholds, a fixed fee per patient achieving an outcome, payments based on the relative ranking of the group’s performance, and salary increases. Six of the seven studies used schemes that paid medical groups rather than individual doctors.
  • Irene Jansen on 23 Jan 12
     
    Research evidence fails to show that providing financial incentives to primary care services improves patients' wellbeing
Irene Jansen

Curing lengthy wait times in the public health system. Calgary Herald. April 29, 2012. - 1 views

umanitoba.ca/...4982

waits teams incentives innovation alberta surgery

shared by Irene Jansen on 30 Apr 12 - No Cached
  • many patients stay in hospital longer than the recommended four-day provincial benchmark for hip and knee surgeries
  • Alberta Health Services devised an experiment in 2010-11 using non-financial incentives to get frontline staff across the province engaged in applying the four-day benchmark.
  • Multidisciplinary teams – surgeons, nurses, therapists and managers – were formed at 12 hospitals in the province where hip and knee surgery is performed.  Each team set out to reduce patient stay to the benchmark while also striving for other creative ways to improve performance. 
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  • Teams tracked their progress on a scorecard, met monthly for review, and shared results with other teams
  • Patients were managed more closely to ensure that they had a plan for coping at home after surgery. Those not medically ready to leave hospital, but not at risk, were moved into sub-acute care.
  • The experiment produced an impressive annualized savings of almost 11,000 acute care bed-days and was quickly adopted by AHS as a permanent program.
  • preliminary results suggest more than 13,500 bed-days have been saved, opening up bed capacity to potentially perform an extra 3,375 hip and knee replacements.
  • The teams’ incentive: a portion of the savings in resources were pumped back into hip and knee replacement services where the teams could see the impact of their success first-hand.
  • Part of the success is rooted in giving frontline health care professionals the means and incentives to participate directly in meeting the four-day benchmark.
  • Public health care suffers from many ailments but, as Canada’s premiers recognized when they formed their Health Care Innovation Working Group in January, it also brims with opportunities if you look in the right places.
Irene Jansen

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

www.parl.gc.ca/...49055-e.htm

accord waits senate

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Christine Power, Chair, Board of Directors, Association of Canadian Academic Healthcare Organizations
  • eight policy challenges that can be grouped across the headers of community-based and primary health care, health system capacity building and research and applied health system innovation
  • Given that we are seven plus years into the 2004 health accord, we believe it is time to open a dialogue on what a 2014 health accord might look like. Noting the recent comments by the Prime Minister and Minister of Health, how can we improve accountability in overall system performance in terms of value for money?
  • ...97 more annotations...
  • While the access agenda has been the central focal point of the 2004 health accord, it is time to have the 2014 health accord focus on quality, of which access is one important dimension, with the others being effectiveness, safety, efficiency, appropriateness, provider competence and acceptability.
  • we also propose three specific funds that are strategically focused in areas that can contribute to improved access and wait time
  • Can the 2014 health accord act as a catalyst to ensure appropriate post-hospital supportive and preventive care strategies, facilitate integration of primary health care with the rest of the health care system and enable innovative approaches to health care delivery? Is there an opportunity to move forward with new models of primary health care that focus on personal accountability for health, encouraging citizens to work in partnership with their primary care providers and thereby alleviating some of the stress on emergency departments?
  • one in five hospital beds are being occupied by those who do not require hospital care — these are known as alternative level of care patients, or ALC patients
  • the creation of an issue-specific strategically targeted fund designed to move beyond pilot projects and accelerate the creation of primary health care teams — for example, team-based primary health care funds could be established — and the creation of an infrastructure fund, which we call a community-based health infrastructure fund to assist in the development of post-hospital care capacity, coupled with tax policies designed to defray expenses associated with home care
  • consider establishing a national health innovation fund, of which one of its stated objectives would be to promote the sharing of applied health system innovations across the country with the goal of improving the delivery of quality health services. This concept would be closely aligned with the work of the Canadian Institutes of Health Research in developing a strategy on patient oriented research.
  • focus the discussion on what is needed to ensure that Canada is a high performing system with an unshakable focus on quality
  • of the Wait Time Alliance
  • Dr. Simpson
  • the commitment of governments to improve timely access to care is far from being fulfilled. Canadians are still waiting too long to access necessary medical care.
  • Table 1 of our 2011 report card shows how provinces have performed in addressing wait times in the 10-year plan's five priority areas. Of note is the fact that we found no overall change in letter grades this year over last.
  • We believe that addressing the gap in long-term care is the single more important action that could be taken to improve timely access to specialty care for Canadians.
  • The WTA has developed benchmarks and targets for an additional seven specialties and uses them to grade progress.
  • the lack of attention given to timely access to care beyond the initial five priority areas
  • all indications are that wait times for most specialty areas beyond the five priority areas are well beyond the WTA benchmarks
  • we are somewhat encouraged by the progress towards standardized measuring and public reporting on wait times
  • how the wait times agenda could be supported by a new health accord
  • governments must improve timely access to care beyond the initial five priority areas, as a start, by adopting benchmarks for all areas of specialty care
  • look at the total wait time experience
  • The measurements we use now do not include the time it takes to see a family physician
  • a patient charter with access commitments
  • Efficiency strategies, such as the use of referral guidelines and computerized clinical support systems, can contribute significantly to improving access
  • In Ontario, for example, ALC patients occupy one in six hospital beds
  • Our biggest fear is government complacency in the mistaken belief that wait times in Canada largely have been addressed. It is time for our country to catch up to the other OECD countries with universal, publicly funded health care systems that have much timelier access to medical care than we do.
  • The progress that has been made varies by province and by region within provinces.
  • Dr. Michael Schull, Senior Scientist, Institute for Clinical Evaluative Sciences
  • Many provinces in Canada, and Ontario in particular, have made progress since the 2004 health accord following large investments in health system performance that targeted the following: linking more people with family doctors; organizational changes in primary care, such as the creation of inter-professional teams and important changes to remuneration models for physicians, for example, having a roster of patients; access to select key procedures like total hip replacement and better access to diagnostic tests like computer tomography. As well, we have seen progress in reducing waiting times in emergency departments in some jurisdictions in Canada and improving access to community-based alternatives like home care for seniors in place of long-term care. These have been achieved through new investments such as pay for performance incentives and policy change. They have had some important successes, but the work is incomplete.
  • Examples of the ongoing challenges that we face include substantial proportions of the population who do not have easy access to a family doctor when needed, even if they have a family doctor; little progress on improving rates of eligible patients receiving important preventive care measures such as pap smears and mammograms; continued high utilization of emergency departments and walk-in clinics compared to other countries; long waits, which remain a problem for many types of care. For example, in emergency departments, long waits have been shown to result in poor patient experience and increased risk of adverse outcomes, including deaths.
  • Another example is unclear accountability and antiquated mechanisms to ensure smooth transitions in care between providers and provider organizations. An example of a care transition problem is the frequent lack of adequate follow-up with a family doctor or a specialist after an emergency department visit because of exacerbation of a chronic disease.
  • A similar problem exists following discharge from hospital.
  • Poorly integrated and coordinated care leads to readmission to hospital
  • This happens despite having tools to predict which patients are at higher risk and could benefit from more intensive follow-up.
  • Perverse incentives and disincentives exist, such as no adjustment in primary care remuneration to care for the sickest patients, thereby disincenting doctors to roster patients with chronic illnesses.
  • Critical reforms needed to achieve health system integration include governance, information enablers and incentives.
  • we need an engaged federal government investing in the development and implementation of a national health system integration agenda
  • complete absence of any mention of Canada as a place where innovative health system reform was happening
  • Dr. Brian Postl, Dean of Medicine, University of Manitoba, as an individual
  • the five key areas of interest were hips and knees, radiology, cancer care, cataracts and cardiac
  • no one is quite sure where those five areas came from
  • There was no scientific base or evidence to support any of the benchmarks that were put in place.
  • I think there is much less than meets the eye when we talk about what appropriate benchmarks are.
  • The one issue that was added was hip fractures in the process, not just hip and knee replacement.
  • in some areas, when wait-lists were centralized and grasped systematically, the list was reduced by 30 per cent by the act of going through it with any rigour
  • When we started, wait-lists were used by most physicians as evidence that they were best of breed
  • That continues, not in all areas, but in many areas, to be a key issue.
  • The capacity of physicians to give up waiting lists into more of a pool was difficult because they saw it very much, understandably, as their future income.
  • There were almost no efforts in the country at the time to use basic queuing theory
  • We made a series of recommendations, including much more work on the research about benchmarks. Can we actually define a legitimate benchmark where, if missed, the evidence would be that morbidity or mortality is increasing? There remains very little work done in that area, and that becomes a major problem in moving forward into other benchmarks.
  • the whole process needed to be much more multidisciplinary in its focus and nature, much more team-based
  • the issue of appropriateness
  • Some research suggests the number of cataracts being performed in some jurisdictions is way beyond what would be expected to be needed
  • the accord did a very good job with what we do, but a much poorer job around how we do it
  • Most importantly, the use of single lists is needed. This is still not in place in most jurisdictions.
  • the accord has bought a large amount of volume and a little bit of change. I think any future accords need to lever any purchase of volume or anything else with some capacity to purchase change.
  • We have seen volumes increase substantially across all provinces, without major detriment to other surgical or health care areas. I think it is a mediocre performance. Volume has increased, but we have not changed how we do business very much. I think that has to be the focus of any future change.
  • with the last accord. Monies have gone into provinces and there has not really been accountability. Has it made a difference? We have not always been able to tell that.
  • There is no doubt that the 2004-14 health accord has had a positive influence on health care delivery across the country. It has not been an unqualified success, but nonetheless a positive force.
  • It is at these transition points, between the emergency room and being admitted to hospital or back to the family physician, where the efficiencies are lost and where the expectations are not met. That is where medical errors are generated. The target for improvement is at these transitions of care.
  • I am not saying to turn off the tap.
  • the government has announced, for example, a 6 per cent increase over the next two or three years. Is that a sufficient financial framework to deal with?
  • Canada currently spends about the same amount as OECD countries
  • All of those countries are increasing their spending annually above inflation, and Canada will have to continue to do that.
  • Many of our physicians are saying these five are not the most important anymore.
  • they are not our top five priority areas anymore and frankly never were
  • this group of surgeons became wealthy in a short period of time because of the $5.5 billion being spent, and the envy that caused in every other surgical group escalated the costs of paying physicians because they all went back to the market saying, "You have left us out," and that became the focus of negotiation and the next fee settlements across the country. It was an unintended consequence but a very real one.
  • if the focus were to shift more towards system integration and accountability, I believe we are not going to lose the focus on wait times. We have seen in some jurisdictions, like Ontario, that the attention to wait times has gone beyond those top five.
  • people in hospital beds who do not need to be there, because a hospital bed is so expensive compared to the alternatives
  • There has been a huge infusion of funds and nursing home beds in Ontario, Nova Scotia and many places.
  • Ontario is leading the way here with their home first program
  • There is a need for some nursing home beds, but I think our attention needs to switch to the community resources
  • they wind up coming to the emergency room for lack of anywhere else to go. We then admit them to hospital to get the test faster. The weekend goes by, and they are in bed. No one is getting them up because the physiotherapists are not working on the weekend. Before you know it, this person who is just functioning on the edge is now institutionalized. We have done this to them. Then they get C. difficile and, before you know, it is a one-way trip and they become ALC.
  • I was on the Kirby committee when we studied the health care system, and Canadians were not nearly as open to changes at that time as I think they are in 2011.
  • there is no accountability in terms of the long-term care home to take those patients in with any sort of performance metric
  • We are not all working on the same team
  • One thing I heard on the Aging Committee was that we should really have in place something like the Veterans Independence Program
  • some people just need someone to make a meal or, as someone mentioned earlier, shovel the driveway or mow the lawn, housekeeping types of things
  • I think the risks of trying to tie every change into innovation, if we know the change needs to happen — and there is lots of evidence to support it — it stops being an innovation at that point and it really is a change. The more we pretend everything is an innovation, the more we start pilot projects we test in one or two places and they stay as pilot projects.
  • the PATH program. It is meant to be palliative and therapeutic harmonization
  • has been wildly successful and has cut down incredibly on lengths of stay and inappropriate care
  • Where you see patient safety issues come to bear is often in transition points
  • When you are not patient focused, you are moving patients as entities, not as patients, between units, between activities or between functions. If we focus on the patient in that movement, in that journey they have through the health system, patient safety starts improving very dramatically.
  • If you require a lot of home care that is where the gap is
  • in terms of emergency room wait times, Quebec is certainly among the worst
  • Ontario has been quite successful over the past few years in terms of emergency wait times. Ontario’s target is that, on average, 90 per cent of patients with serious problems spend a maximum of eight hours in the emergency room.
  • One of the real opportunities, building up to the accord, are for governments to define the six or ten or twelve questions they want answered, and then ensure that research is done so that when we head into an accord, there is evidence to support potential change, that we actually have some ideas of what will work in moving forward future changes.
  • We are all trained in silos and then expected to work together after we are done training. We are now starting to train them together too.
  • The physician does not work for you. The physician does not work for the health system. The physician is a private practitioner who bills directly to the health care system. He does not work for the CEO of the hospital or for the local health region. Therefore, your control and the levers you have with that individual are limited.
  • the customer is always right, the person who is getting the health care
  • It is refreshing to hear something other than the usual "we need more money, we absolutely need more money for that". Without denying the fact that, since the population and the demographics are going to require it, we have to continue making significant investments in health, I think we have to be realistic and come up with new ways of doing things.
  • The cuts in the 1990s certainly had something to do with the decision to cut support staff because they were not a priority and cuts had to be made. I think we now know it was a mistake and we are starting to reinvest in those basic services.
  • How do you help patients navigate a system that is so complex? How do you coordinate appointments, ensure the appointments are necessary and make sure that the consultants are communicating with each other so one is not taking care of the renal problem and the other the cardiac problem, but they are not communicating about the patient? That is frankly a frequent issue in the health system.
  • There may be a patient who requires Test Y, X, and Z, and most patients require that package. It is possible to create a one-stop shop kind of model for patient convenience and to shorten overall wait times for a lot of patients that we do not see. There are some who are very complicated and who have to be navigated through the system. This is where patient navigators can perhaps assist.
  • There have been some good studies that have looked at CT and MRI utilization in Ontario and have found there are substantial portions where at least the decision to initiate the test was questionable, if not inappropriate, by virtue of the fact that the results are normal, it was a repeat of prior tests that have already been done or the clinical indication was not there.
  • Designing a system to implement gates, so to speak, so that you only perform tests when appropriate, is a challenge. We know that in some instances those sorts of systems, where you are dealing with limited access to, say, CT, and so someone has to review the requisition and decide on its appropriateness, actually acts as a further obstacle and can delay what are important tests.
  • The simple answer is that we do not have a good approach to determining the appropriateness of the tests that are done. This is a critical issue with respect to not just diagnostic tests but even operative procedures.
  • the federal government has very little information about how the provinces spend money, other than what the provinces report
  • should the money be conditional? I would say absolutely yes.
Govind Rao

A human face of lengthy waits for surgery; Reducing these times can be done - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|cahr|20150822|227618245

from heather waits Alberta bc privatization

shared by Govind Rao on 24 Aug 15 - No Cached
  • Calgary Herald Sat Aug 22 2015
  • Robert L. Brown
  • I spent my life teaching actuarial science at a university. As a result, I calculated lots of numbers: averages, expected values, variances. But, they were only numbers. What I didn't see was the individual human story behind each calculation. But now that I am the human face within one of these distributions, I see it all in a different light. The distribution I am now studying is the wide variability of Canadian health-care delivery relevant to hip replacements. Some background: I entered the official hip replacement list in Victoria, B.C., on July 23, 2014. I was told to expect a wait time of 12 to 18 months. But was that good or bad? Was it necessary? I investigated.
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  • Data show that for hip replacements, B.C. has the second longest wait times in Canada, with a median value of 70 weeks. But that is a median value, which means about half of all patients wait longer. That is twice the wait time in Ontario, which is actually the third best province in Canada, according to recent Canadian Institute for Health Information (CIHI) statistics. So, I waited and the hip deteriorated until painkillers seemed useless.
  • Finally, just short of a year, I got a call on June 10 to say that my hip surgery was scheduled for July 15, or week 51. I fought back tears of relief. It almost made me forget the absence of a vital life during the weeks I had waited. What happened next knocked the wind out of my sails. One week before my scheduled operation, I was told that I had been bumped for a situation that presented a "higher level of urgency." They had just added almost eight weeks to my wait time for reasons that were opaque, at best, and without logic to me. Why did this happen? In the end, I got no real answers.
  • So, beyond my personal experience, the real question is: "Are Canadian wait times for hip replacement justified or could they be shortened?" Turns out, the variability within Canada's health-care system is wide, and does not just exist across provincial borders. In most provinces, wait times vary significantly from city to city, region to region, hospital to hospital and doctor to doctor. The evidence tells us that having a "private" alternative actually makes wait times in publicly funded health care facilities worse. So that is not the solution.
  • One of the problems in answering this question is a lack of provincewide databases in many jurisdictions. Such databases would help minimize wait times because patients from a busy facility in one region within a province could be transferred to other facilities (or surgeons) with shorter waiting lists. Today, in most provinces, doctors and specialists work in silos and there is no real overarching management of the system. Health care decision-making in Canada is largely decentralized, with few standardized measures of "success." One doctor can have wait times measurably better or worse than the next, and the system cannot be expected to respond well by moving individual patients. The only real leverage many provincial ministries impose is to incent desired behaviour through macrobudgets.
  • We need more integrated management and measurement in the system - if not countrywide, then at least provincewide. Alberta is a good model. Most recent data show that providing incentives tied to provincial benchmarks based on a standardized care path has created savings of almost 12,600 hospital bed days (and $13 million) annually. The incentive? The non-monetary savings in resources are pumped back into hip and knee replacement services, where the medical teams see the impact of their success first-hand, rather than disappearing back into the system as a whole. Alberta now meets CIHI benchmarks for hip replacements 87 per cent of the time, versus a 67 per cent success rate in B.C. In fact, for 90 per cent of its hip replacement patients, Alberta now meets the maximum wait-time limit criterion of 14 weeks. Note that providing financial compensation is not necessarily the primary motivating factor.
  • Canadians consistently show strong support for their health-care system. However, wait times continue to drag the outcomes down. We can shorten wait times, but it will take political courage. Let's hope that courage can be found. Robert Brown is an expert adviser with EvidenceNetwork. ca, a retired professor of actuarial science at the University of Waterloo and immediate past president of the International Actuarial Association. He lives in Victoria, B.C.
Irene Jansen

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

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

privatization quality costs excellent

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

Health-care costs need more haggling; Must study how public funds flow through system -... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246200|ntnp|20160820|254271543

doctors privatization

shared by Heather Farrow on 22 Aug 16 - No Cached
  • National Post Sat Aug 20 2016
  • The whole idea of a doctors' union is, on its face, preposterous. Doctors are not typically to be found among society's downtrodden, lacking marketable skills or bargaining power: on the contrary, they are among the highest-paid professionals in the country, and would be with or without a medical association to negotiate on their behalf.
  • More to the point, doctors are not civil servants. While some are paid a salary or per-patient "capitation" fee, most are in private practice, and charge for each treatment they perform. They are small business operators, really. And yet they are entitled to bargain collectively, like coal miners or factory workers, their fees set not by competition in the marketplace but in marathon negotiations with the government.
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  • Just now in Ontario this arrangement would appear to have hit a wall. Having negotiated a four-year deal offering average annual fee increases of 2.5 per cent, the Ontario Medical Association executive was dismayed to find it rejected by nearly two-thirds of its members, who complain it does not make up for cuts in fees imposed last year. How things should have broken down to this extent need not detain us here. But it does perhaps point to the need to find another way.
  • Because doctors' fees, as such, are not the issue. To be sure, they are part of the puzzle: at $11.5 billion annually, they are roughly one-fifth of Ontario's health-care budget. But all the hard bargaining in the world isn't going to rescue Canada's health-care system from the fiscal cliff to which it is headed. Much more important than doctors' fees are doctors' decisions, as the gatekeepers dictating how resources are allocated within the system: how many tests are ordered, what procedures are done, and so on.
  • The problem is that decisions about treatment are too often divorced from decisions about budgets. Governments set a budget constraint at the macro level, which filters down through the various regional health authorities and local health networks the provinces have seen fit to establish. But doctors typically do not: they make whatever they can bill. And the incentives of feefor-service are to perform as many surgeries and other treatments as they can. Absent changes in those incentives, simply capping fees isn't going to change much.
  • You can see why doctors felt the need to organize. Governments had set themselves up as sole purchasers of medical services. The idea was supposed to be that they could exploit that monopoly power to drive down costs. But it didn't quite work out that way: politicians in need of re-election, it seems, do not make terribly tough negotiators (who knew?). It was always easier to pass the problem on to the next government, or the next generation - or, as federal governments got in on the act, Ottawa. In consequence, health-care spending skyrocketed through much of the 1970s and 1980s.
  • Traditionally, doctors have been paid per service, while hospitals have been funded on a block grant basis. The key to reform is to turn this around: giving groups of doctors a fixed amount per patient, with which to purchase services from hospitals, clinics and other providers, that is on a per-treatment basis. Paying doctors a lump sum localizes the budget constraint, forcing doctors to take account of costs in decisions on treatment; paying hospitals per service makes it possible for lower-cost competitors to undercut them.
  • Even in the more recent wave of cuts following the last recession, these have been largely untouched. As documented in a new study by the C. D. Howe Institute
  • ("Hold the Applause: Why Provincial Restraint on Healthcare Spending Might Not Last"), governments have largely resorted to the familiar public-sector strategy of starving the capital account to feed the operating account: while capital spending has been sharply curtailed, physicians' fees have not.
  • This is not sustainable in the long run - as new doctors enter the profession, and most of all, as the population ages. As it is, provinces are now spending more than 40 per cent of their budgets on health care; by 2030, a recent Fraser Institute paper projects the number will have risen to nearly 50 per cent. Yet wait times continue to mount: at more than 18 weeks, on average, from GP referral to treatment, they are nearly twice what they were 20 years ago.
  • Clearly the answer does not lie in more money, least of all more federal money: for every additional dollar in federal transfers the Howe study's authors find that provincial health spending increases by 36 cents. But neither is the answer ever stricter doses of austerity - any more than one would improve a car's mileage by putting less gas in the tank. Rather, what's needed is systemic reform, altering the way that public funds flow through the system, and how the different players within it are remunerated.
  • Only with the onset of the early 1990s recession, and particularly the sharp cut in federal transfers as Ottawa tried to stabilize its finances, was there the first serious effort at retrenchment. But as the fiscal crisis eased, and particularly after the 2004 health-care accord, with its massive 10-year increase in federal transfers, whatever impetus for reform there might have been dissipated. Rather than "buying change," most of the new money went to increases in provider compensation.
  • In sum, rather than doctors and governments negotiating with each other at one gigantic bargaining table, what we need are lots of little bargaining tables, at which providers can haggle with each other.
Irene Jansen

WHO | Managing health workforce migration - The Global Code of Practice - 0 views

www.who.int/...index.html

migrant workers who

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Irene Jansen on 23 Jan 12
     
    section 4.6: 4.6 Member States and other stakeholders should take measures to ensure that migrant health personnel enjoy opportunities and incentives to strengthen their professional education, qualifications and career progression, on the basis of equal treatment with the domestically trained health workforce subject to applicable laws. All migrant health personnel should be offered appropriate induction and orientation programmes that enable them to operate safely and effectively within the health system of the destination country.
Irene Jansen

Nursing homes take healthier residents over sicker ones, expert charges - Healthzone.ca - 0 views

www.healthzone.ca/...ver-sicker-ones-expert-charges

user fees ltc ontario

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Long-term care homes in Ontario are cherry-picking easy residents to care for, leaving more complex ones stuck in hospitals and contributing to backlogs there, says the expert the commissioned to find solutions to the problem.
  • Dr. David Walker, former dean of health sciences at Queen’s University
  • The incentive at the moment is that you fill up your nursing homes with the healthiest people
  • ...3 more annotations...
  • other cases of hospitalized seniors waiting for nursing homes who have been threatened with charges of up to $1,800 a day even though the health minister ordered a stop to the practice
  • A report by Walker, released last August, stated there are more than 4,500 seniors stuck in hospital even though they are in need of “alternate levels of care,” such as long-term care or intensive home care.
  • if there are some homes taking people who are on ventilators, surely to goodness we can create enough incentives for the long-term care sector to attend to the higher-needs patients
Irene Jansen

New hospital financing models not without risks - 1 views

www.vancouversun.com/...story.html

ABF

shared by Irene Jansen on 23 Jan 12 - No Cached
  • The provinces of British Columbia, Alberta and Ontario have each recently announced plans to tackle this problem by introducing what is referred to as activity-based funding (ABF)
  • If the objective of implementing ABF is to reduce waiting times, shortening the lengths of stay is a desirable outcome. Plus, ABF creates incentives for hospitals to take the initiative to discharge "bed blockers"
  • However, ABF creates its own set of problems: incentives for hospitals to provide the most "profitable" types of care by treating the least ill, and to centralize services, which may improve efficiency but reduces access for small and remote communities.
  • ...1 more annotation...
  • The biggest criticism of ABF is that while aiming for increased efficiency, hospitals may "skimp" on quality. Careful monitoring of hospital quality has helped to avoid this.
Govind Rao

6 reasons privatization often ends in disaster - Salon.com - 0 views

www.salon.com/...often_ends_in_disaster_partner

from heather privatization

shared by Govind Rao on 14 Nov 13 - No Cached
  • Thursday, Oct 24, 2013
  • 6 reasons privatization often ends in disaster Inequality is much more pervasive in the private sector. Just look at the median salary for US workers Paul Buchheit, AlterNet
  • 1. The Profit Motive Moves Most of the Money to the Top
  • ...5 more annotations...
  • 2. Privatization Serves People with Money, the Public Sector Serves Everyone
  • 3. Privatization Turns Essential Human Needs into Products
  • 4. Public Systems Promote a Strong Middle Class
  • 5. The Private Sector Has Incentive To Fail, or No Incentive At All
  • 6. With Public Systems, We Don’t Have to Listen To “Individual Initiative” Rantings
CPAS RECHERCHE

Looking abroad to cure Canada's healthcare ailments | Financial Post - 1 views

business.financialpost.com/...as-health-care-be-found-abroad

funding ABF

shared by CPAS RECHERCHE on 18 Jun 14 - No Cached
  • One of the hurdles to adopting ABF more widely is a lack of data about many dimensions of health care in Canada, including demographics and the specific costs of many aspects of delivering services, and the analytic capacity to develop an accurate funding formula based on those factors
  • Global budgets provide predictability, which is useful for planning purposes for providers as well as administrators,” she points out, “and it helps hospitals to live within their means, which is generally a good thing. But the downside is that this can affect access to care, because there are incentives to do less if the hospital faces going over budget.”
  • incentive to innovate or find efficiencies when funding levels are fixed by a global budget, rather than geared to delivery of services.
  • ...6 more annotations...
  • 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.
Govind Rao

Privatization in health care will leave poor out in the cold - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|wist|20150504|219760378

from heather privatization medicare poverty ally

shared by Govind Rao on 04 May 15 - No Cached
  • Windsor Star Mon May 4 2015
  • A long-running dispute between Dr. Brian Day, the co-owner of Cambie Surgeries Corp., and the British Columbia government may finally be resolved in the BC Supreme Court this year - and the ruling could transform the Canadian health system from coast to coast. The case emerged in response to an audit of Cambie Surgeries, a private for-profit corporation, by the BC Medical Services Commission. The audit found from a sample of Cambie's billing that it (and another private clinic) had charged patients hundreds of thousands of dollars more for health services covered by medicare than is permitted by law. Day and Cambie Surgeries claim the law preventing a doctor charging patients more is unconstitutional.
  • Day's challenge builds on the legacy of a 2005 decision by the Supreme Court of Canada overturning a Quebec ban on private health insurance for medically necessary care. But this case goes much further, not only challenging the ban on private health insurance to cover medically necessary care, but also the limits on extra-billing and the prohibition against doctors working for both the public and private health systems at the same time. A trial date was set to begin in 2012, but was adjourned until March 2015 so that the parties could resolve their dispute out of court and reach a settlement. It now appears such a resolution has not been reached and the court proceedings may resume in November. Here's why this case matters.
  • ...5 more annotations...
  • Legal precedent: Whatever way the case is decided at trial, it is likely to be appealed and eventually reviewed by the Supreme Court of Canada. A decision from this level will mean all provincial and territorial governments will have to revisit equivalent laws. The foundational pillars of Canadian medicare - equitable access and preventing twotier care - could well be vanquished in the process. Wait times: Day will likely argue that Canada performs poorly on wait times compared to other countries, and that other countries allow two-tier care; thus, if Canada is allowed two-tier care, our wait times would improve. But this approach is too simplistic. Comparisons to the British health system, fail to recall that, despite having two-tiers, it has in the past suffered horrendously long-wait times. Recent efforts to tackle wait times have come from within the public system, with initiatives like wait time guarantees and tying payment for public officials to wait times targets.
  • By looking to Britain, we are comparing apples to oranges. British doctors are generally full-time salaried employees while most Canadian physicians bill medicare on a fee-forservice basis. Consequently, the repercussions of permitting extra billing in Canada could eviscerate our publiclyfunded system, whereas this is not the case in Britain. Imagine if most doctors in Canada could bill, as those at the Cambie clinic have done, whatever they want in addition to what they are paid by governments?
  • Conflict-of-interest incentives: Evidence suggests there is a danger in providing a perverse incentive for physicians who are permitted to work in both public and private health systems at the same time. Wait times may grow for patients left in the public system as specialists drive traffic to their more lucrative private practice. Sound improbable? Academic studies have noted this trend in specific clinics that permit simultaneous private-public practice. And recent U.K. news reports have profiled a case where a surgeon bumped a public patient in need of a transplant for his private-pay patient.
  • Competition: Proponents of privatized health services often claim it would add a healthy dose of competition, jolting the "monopoly" of public health care from its apathy. But free markets don't work well in health care. Why? Because public providers and private providers won't truly compete if the laws Day challenges are struck down. Instead, those with means and/or private insurance will buy their way to the front of queues. Public coverage for the poor will likely suffer, as is clearly evident in the U.S., with doctors refusing to provide care to low-income patients in preference for those covered by higher-paying private insurance.
  • Of course, this is all based on an outcome that is not yet known. It may be that the charter challenge in B.C. will be unsuccessful, but clearly the stakes for ordinary Canadians are high. Sadly Dr. Day is not bringing a challenge for all Canadians. Isn't it past time our governments and doctors work to ensure all Canadians - and not just those who can afford to pay - receive timely care? Colleen Flood is Professor and University Research Chair in Health Law Policy at the University of Ottawa. Kathleen O'Grady is a Research Associate at the Simone de Beauvoir Institute, Concordia University and Managing Editor of EvidenceNetwork. ca
Govind Rao

Trade deal may add $1.65B to drug bill: study - 0 views

www.mississauga.com/...y-add-1-65b-to-drug-bill-study

from heather trade drugs

shared by Govind Rao on 31 Oct 13 - No Cached
  • Trade deal may add $1.65B to drug bill: study
  • OTTAWA - The recently announced free-trade deal with Europe will likely cost Canadians hundreds of millions of dollars more for prescription drugs, says a new analysis. The report, by two York University professors, says concessions by the federal government to cement the deal will delay the arrival cheap generic drugs by about a year, on average. And the delay will add between $850 million and $1.65 billion — or up to 13 per cent — to the total drug bill paid annually by Canadians, either directly, through insurance plans or by provinces.
  • The researchers are also skeptical of claims by brand-name manufacturers that extended patent life will be an incentive to the industry to invest more in Canada. "There is no incentive for them to invest more in Canada," said Marc-Andre Gagnon, one of the authors. "The question is: Are we getting bang for the buck? And the answer is No." The report warns that all Canadians will likely wind up paying more in taxes, or higher premiums for private drug plans — and Canadians who can least afford it will bear the biggest burden.
Govind Rao

Preparing for a 'grey tsunami' - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|tost|20150826|227890249

from heather seniors cma ltc continuing care

shared by Govind Rao on 26 Aug 15 - No Cached
  • Toronto Star Wed Aug 26 2015
  • Senior care is being called the most pressing public issue in Canada today, and for good reason. Those over 65 now account for about 15 per cent of the population but consume an estimated 45 per cent of public health care spending. Yet Canadian seniors typically wait longer than those in comparable countries to see a specialist. Home care services fall well short of what's needed in many parts of the country; palliative care is inadequate; and families struggle with the burden of caring for aged and ill relatives. Now the bad news: It's all poised to become a whole lot worse with the arrival of the coming "grey tsunami." The proportion of seniors in Canada is expected to hit about 25 per cent over the next two decades - that's one in four of us - with this group projected to consume more than 60 per cent of health care budgets. Canadian Medical Association president Dr. Chris Simpson wasn't exaggerating when he described senior care as "the paramount health-care issue of our time." Indeed, the sustainability of this country's medicare system very much depends on how it responds to the challenge.
  • That's why the medical association, meeting this week in Halifax, is calling for a national strategy to deal with the needs of Canadian seniors. It's essential to better co-ordinate existing services and bridge policy gaps that block so many seniors from receiving the care they require. Toward this end, the association has released a 33-page policy framework covering changes required in everything from home care to accessing a physician, and from end-of-life treatment to financial help for hard-pressed families. It's a timely report. Doctors, quite rightly, want a national seniors strategy to become an important issue in the current federal election.
  • ...2 more annotations...
  • Politicians are generally supportive on issues affecting seniors. "Their hearts are in the right place," Simpson said this week. "We want them to start talking about it in the context of an election campaign." Simpson told The Canadian Press that Liberal Leader Justin Trudeau has promised to call a first ministers' meeting on health care and seniors within six months of being elected. The Conservatives have talked of a national dementia strategy, and the New Democrats and Green party have both been "strongly supportive" of a national strategy on seniors. All that is fine, as far as it goes. But whichever party forms the next government will have to respond with more than just talk. Decisive steps are required to deliver an effective strategy. "What we need now is some action," Simpson said.
  • Pointing in the right direction, the medical association urged federal officials on Monday to make tax incentives and financial supports more available to people caring for elderly family members. Existing tax incentives, for example, are available only to caregivers who are actually living with an aged relative. More than 75 per cent of the care provided to older Canadians is supplied by unpaid, informal caregivers, according to the medical association. "A national seniors strategy," it says, "should take into consideration both the financial needs of individuals who provide this invaluable service and the stress and burnout they often feel." There's no doubt we've fallen behind on care for seniors. A crisis looms. How Canada handles the growing tide of elderly people, and the pressure of their immense medical needs, could well make - or break - this country's health care system. Crafting a bold national strategy to address the problem is a vital first step, not just in helping seniors, but in safeguarding medicare for all Canadians.
Govind Rao

A report that diagnoses health care's ills; David Naylor's examination of Canada's barr... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150723|225447148

from heather medicare accord federal government

shared by Govind Rao on 23 Jul 15 - No Cached
  • The Globe and Mail Thu Jul 23 2015
  • Just more than a year ago, Health Minister Rona Ambrose announced, with some fanfare, the creation of the Advisory Panel on Healthcare Innovation. The blue-ribbon group, led by Dr. David Naylor, former president of the University of Toronto, was asked to recommend the five most promising ways the federal government could support innovation in a manner that would both improve accessibility and reduce costs. The move was widely seen as a token gesture by Ottawa to show it was interested in health care when, in fact, it has disengaged to the point of doing little other than cutting cheques for everdiminishing transfers of health dollars to the provinces.
  • Critics assumed the right-leaning panel would behave Dragons' Den-like, embracing a handful of showy private sector innovations and deliver a kick in the pants to the proponents of socialist medicare. What it delivered was something else entirely - a nuanced examination of the barriers to innovation and a sharp rebuke of governments for their lack of commitment to keeping medicare current and relevant. This is not what the Harper government wanted to hear, so it released the report on a late Friday afternoon in summer, hoping it would be ignored. But the Naylor report is a must-read for anyone who cares about the future of Canada's health-care system. It is loaded with stinging truths, beginning with "medicare is aging badly" and a "major renovation is overdue," and stressing that despite our being blinded by pride, the publicly funded health-care system provides coverage that is inadequate, slow and costly; performance is middling at best.
  • ...3 more annotations...
  • The report also features a decent "to-do" list of where to begin the renovations, with its mandated five point list: Embrace patient engagement and empowerment; Integrate fragmented health systems and modernize the work force; Invest in technological transformation, namely digital health and personalized medicine; Get better value for money by improving procurement, reimbursement and regulation; Partner with industry as a catalyst for innovation. There's nothing new here, and that's not a knock on the panel. What needs to be done to modernize medicare is no secret; how to do it is the challenge. This is where the insight of Dr. Naylor and his cohorts is most evident and useful. The panel says, essentially, that you will never get meaningful innovation without real commitment, and lambastes governments - and Ottawa in particular - for its lack of engagement. Dr. Naylor and his team stress that Canada's health-care system is rife with innovation and creativity but initiatives worthy of emulation are not being embraced and scaled up by make-no-waves policy-makers.
  • By clinging to the status quo - the path of least political resistance - governments have created an outdated system that is ill-prepared to deal with fundamental shifts such as patients demanding more engagement and the impending arrival of personalized medicine. In the end, the panel states the problem - and the solution - in the stark language of business: There is no system-level innovation in health care because there is a lack of working capital, an absence of expert management and little incentive for or investment in improvement. In short, there is no business plan, no goals. The panel bemoans, quite rightly, the lack of federal-provincial co-operation, saying it is "chagrinized and puzzled by the inability of Canadian governments to join forces" in the best interests of patients. But it saves its most stinging indictment for the federal government.
  • In the quick reporting after the report's release late Friday, most attention was focused on the call to merge three existing federal funded groups to create a federal Healthcare Innovation Agency of Canada, with a budget of at least $1-billion annually. But what the Naylor report is proposing is not the old fallback position of simply spending more to do the same. In fact, it deliberately avoids saying anything about federal spending or health transfers. Rather, it calls for a new philosophy, one that involves Ottawa having ideas and taking action beyond cutting cheques; to quote: "... a different model for federal engagement in health care - one that depends on an ethos of partnership, and on a shared commitment to scale existing innovations and make fundamental changes in incentives, culture, accountabilities, and information systems." Stated more colloquially, if the next prime minister - whether his name is Harper, Mulcair or Trudeau - wants medicare to actually meet the needs and expectations of Canadians, he needs to put on his big-boy pants and lead, not lie down, and innovate, not just pontificate.
Govind Rao

Medicare study: House calls tailored to frailest patients cut costs by avoiding hospita... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|wcpa|20150619|223099323

from heather medicare US home care doctors research

shared by Govind Rao on 23 Jun 15 - No Cached
  • Canadian Press Fri Jun 19 2015
  • WASHINGTON - An X-ray in the living room. A rapid blood test. A peek into pill bottles and refrigerators. The humble house call can accomplish a lot - and now research suggests that tailoring it to some of Medicare's frailest patients can improve their care while cutting costs. Medicare announced Thursday that it saved more than $25 million in the first year of a three-year study to determine the value of home-based primary care for frail seniors with multiple chronic illnesses, by avoiding pricier hospital or emergency room care.
  • Dr. Patrick Conway, Medicare's chief medical officer, says the house call delivers "high-touch" co-ordinated care that allows doctors and nurses to spot brewing problems in a patient's everyday environment before he or she worsens. "If we can keep people as healthy as possible and at home, so they only go to the hospital or emergency room when they really need to, that both improves quality and lowers cost," he said.
  • ...5 more annotations...
  • House calls are starting to make a comeback amid a rapidly greying population, although they're still rare. The idea: A doctor or nurse-practitioner, sometimes bringing along a social worker, makes regular visits to frail or homebound patients whose needs are too complex for a typical 15-minute office visit - and who have a hard time even getting to a physician's office. "It helps you avoid the emergency situations," said Naomi Rasmussen, whose 83-year-old father in Portland, Oregon, is part of Medicare's Independence at Home study.
  • On Thursday, Medicare released its long-awaited analysis of the study's first year and said the project saved an average of $3,070 per participating beneficiary; Conway said all but five practices generated savings. Medicare will divide $11.7 million in incentive payments among the nine practices that met enough of the quality requirements for that financial bonus, including Portland's Housecall Providers. "We need to shift costs to this kind of intervention," said Dr. Pamela Miner of Housecall Providers.
  • It took extra primary care visits, but "he went from bouncing in and out of the hospital to one hospitalization in an entire year," said Housecall Providers nurse Mary Sayre. But this kind of care is hard to find, in part because of reimbursement. Medicare did pay for more than 2.6 million house call visits in 2013. But add in the travel time, and doctors can see - and get paid for - many more patients in a day in the office than they can see on the road. Enter Medicare's Independent at Home demonstration project, now in its third year of testing how well a house call approach really works and how to pay for it. About 8,400 frail seniors with multiple chronic conditions - Medicare's most expensive type of patient - are receiving customized home-based primary care from 17 programs around the country. The incentive for doctors: They could share in any government savings if they also meet enough quality-care goals.
  • Her father, stroke survivor Teodor Mal, is prone to frequent infections and unable to tell his wife or daughter whenever he starts to feel ill. Visits to multiple doctors left him so agitated that a good exam was difficult, and just getting him and his wheelchair there took several hours and a special van. Then Mal began getting his primary care from Portland-based Housecall Providers Inc. When family members see any worrisome changes in his behaviour or appearance, providers can make a quick visit to see if another urinary tract infection or case of pneumonia is beginning, in time to give at-home antibiotics a chance.
  • The Affordable Care Act created the Medicare study, and legislation is pending in Congress to extend the project another two years. The program is "bringing the house calls of yesteryear into the 21st century," said Sen. Edward J. Markey, D-Mass. He said Thursday's pilot results are promising enough to make the project permanent so that many more Medicare patients eventually could seek this kind of care.
Govind Rao

Should doctors own hospitals? | The BMJ - 0 views

www.bmj.com/...bmj.h4615

from heather privatization private clinics hospital UK

shared by Govind Rao on 08 Sep 15 - No Cached
  • BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h4615 (Published 02 September 2015) Cite this as: BMJ 2015;351:h4615
  • ohn A Romley, associate professor of research
  • Financial incentives for physician owners can work against patients’ best interests
  • ...2 more annotations...
  • In the United States, nearly four out of five hospitals are private. As of 2010, more than 200 of these private hospitals were owned by doctors. In that same year the US Congress passed and President Obama signed into law the Affordable Care Act, a comprehensive package of healthcare reforms that prohibited (with limited exceptions) further development of “physician owned hospitals” (POHs).
  • The American Hospital Association supported this prohibition, stating: “When a doctor self-refers a patient to a hospital in which he or she is invested, that is fundamentally the wrong incentive and leads to the wrong behavior.”1
Govind Rao

The lose-lose issue for politicians; Canadians love their medicare, and there's no poli... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20150916|229368214

from heather medicare federal election

shared by Govind Rao on 16 Sep 15 - No Cached
  • The Globe and Mail Wed Sep 16 2015
  • apicard@globeandmail.com While health care is consistently identified as the No. 1 concern of Canadians in opinion polls, the issue rarely arises on the campaign trail. Debates among the leaders - and questions from reporters on the campaign trail - will be dominated by talk of the economy, foreign policy, defence and the environment, but health care will barely merit more than a few jingoistic platitudes. This seeming paradox, which has been the norm for decades, is easy enough to explain. "I never had a conversation about health care that didn't lose me votes," Joey Smallwood, the legendary premier of Newfoundland and wily politician, is purported to have said. In other words, talking about health care tends to be a loselose for politicians. Why is that?
  • First, Canadians love medicare. Despite the fact that it is a public insurance program - and not a particularly well-designed or well-managed one - the public romanticizes and mythologizes medicare to the point where ridiculous statements such as "medicare is what defines us as Canadians" get bandied about, and Tommy Douglas is elevated to deity. Any politician worth her or his salt knows better than to challenge idolatry. What that means, practically speaking, is that there is no political incentive to challenge the status quo - on the contrary, it's best to perpetuate it. So, when politicians do talk about health care, they don't promise change, they promise more money. Another key reason that there is little debate about health care is that there are few fundamental differences in the policies of the major parties, especially on paper.
  • ...4 more annotations...
  • All of them - Conservatives, New Democrats, Liberals, Greens, Bloc Quebecois - support universal, publicly funded health insurance. All of them believe Ottawa should transfer significant amounts of federal tax dollars to the provinces for health care. And all of the parties conveniently ignore that Canada has the least universal, most expensive, and least cost-efficient universal health system in the world, and that the provinces have almost no accountability for the federal money they receive. There are some differences among the parties, of course, but they are largely philosophical, and revolve around interpretations of the constitutional divisions of power - not very good fodder for sound bites. The Conservatives (at least under Stephen Harper) believe health is strictly a provincial responsibility and Ottawa should transfer money with no strings attached. The separatist Bloc has the same position.
  • The New Democrats, Liberals and Greens believe that Ottawa's role should be to create a semblance of a national health plan and show moral leadership (for lack of a better term). But to do so they need to, among other things, earmark money, to demand it be spent on specific programs. But the leaders don't want to say so out loud because no federal leader wants to pick a fight with the provinces during an election. NDP Leader Thomas Mulcair has made a number of healthcare promises aimed at specific demographic groups - such as home care and long-term care for seniors and a mental health plan for teens - but has been fuzzy on the details and an overall plan. Similarly, both the Liberals and the NDP promise to renew the health accord by holding talks with the premiers, but offer no hard numbers. (To refresh memories, in 2004, the Liberals unveiled the health care "fix for a generation," which principally involved increasing health transfers to the provinces by 6 per cent a year for 10 years. The Conservatives extended the 6-percent escalator to 2017; after that it will be tied to inflation, and no less than 3 per cent per annum.)
  • Pharmacare - providing affordable access to prescription drugs for all Canadians - is another hot topic in health circles, but not on the hustings. The Greens have a firm plan to implement pharmacare, saying it will save up to $11-billion annually, but promising a national plan is easy when you have little chance of winning power. Other parties are more circumspect about a topic whose details really matter. In fact, that's the overriding reason health care is difficult to discuss on the campaign trail: It's a sprawling, complex topic, with many potential pitfalls.
  • Health care is not one issue, it's 1,000 issues. The politician who wades too deeply into the morass risks bleeding support, suffering the proverbial death by a thousand cuts.
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