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Dodgy drugs left on Canadian shelves - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20150209|214151069

from heather drugs safety pharmacare

shared by Govind Rao on 10 Feb 15 - No Cached

Toronto Star Mon Feb 9 2015
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Canada's biggest pharmacies are selling allergy pills made with ingredients from a drug facility in India that hid unfavourable test results showing excessive levels of impurities in their products, a Star investigation has found. Recently, the Star purchased packs of over-the-counter desloratadine tablets from Toronto-based Shoppers Drug Mart, Rexall, Walmart and Costco stores.
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One month before, on Dec. 23, Health Canada had announced these antihistamines - made by Pharmascience - were under quarantine after serious problems were unearthed during an inspection of the company's drug facility in India. Inspectors found unsanitary conditions at the facility, including high growth of bacteria and mould. Even though government inspectors discovered significant misconduct dating back to 2012, the December quarantine technically affects only new products made in the past month and a half - not ones already sitting on store shelves.
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"How can a medicine be too dangerous to import but safe enough to consume? This makes no sense," said Amir Attaran, a law professor and health policy expert at the University of Ottawa. By not ordering a recall, he said, "Health Canada is knowingly leaving adulterated medicines on the pharmacy shelves."
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Health Canada said it has restricted imports from the Indian plant as a "temporary precautionary measure," and, so far, a recall is unwarranted. "At this time, no specific safety issues have been identified with these products currently on the market," a government spokesman said in an email.
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"If at any time health or safety issues are detected, the department takes immediate action, including a recall, if necessary." Spokespeople for Shoppers, Rexall, Walmart and Costco emphasized that no recall has been made and the regulator has deemed the drugs safe to stay on their shelves. "We will continue to monitor this situation closely," Rexall said in a statement. "If a patient has any concerns or questions about any medications they are taking, we would encourage them to speak with their Rexall pharmacist."
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In all the packages the Star purchased in January and early February, the drugs were labelled under the store's own brand, with the name of the tablets' Canadian manufacturer - Pharmascience - in small print. No store had any disclaimer stating products from the company are now under quarantine. Pharmascience, which voluntarily agreed to the government's quarantine, said it retests all of the ingredients it imports and is confident the allergy tablets are safe.
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"Safety is our priority. The desloratadine products that have been released on the Canadian market have passed strict quality control tests and have also been deemed safe by Health Canada," company spokeswoman Maria Angelini said. The company said it has secured a new supplier of the chemical ingredients used to make the allergy medication. The problems at the India facility, Dr. Reddy's Laboratories in Srikakulam District, were troubling and numerous, according to an inspection report obtained by the Star.
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During a November inspection, agents from the U.S. Food and Drug Administration (FDA) found Dr. Reddy staff repeatedly retested raw materials found to have unacceptable levels of impurities and did not document or report the undesirable results. These problems date back to January 2012. The name of the specific products that failed purity tests are redacted by the FDA from the inspection report, making it impossible to tell which specific drugs are affected.
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The inspectors' review of one company hard drive "uncovered evidence that analytical raw data had been collected throughout the month of November 2014 and had been deleted," according to FDA inspectors. "The identity of the product(s) analyzed could not be determined." The first day of the inspection, agents found more data and test results sitting in the trash room, tucked in bags listed as waste material.
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The U.S. agents also raised concerns about the water used to manufacture the drug ingredients. A probe of the microbiology lab found "significant growth of both bacteria and mould, and appeared to be TNTC (too numerous to count)." The company's data used for detecting worrisome trends did not mention the problem, inspectors found. Meanwhile, the facility failed "to have adequate toilet and clean washing facilities supplied with hot water, soap or detergent," inspectors found.
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A spokesman for Dr. Reddy's said the company agreed to a quarantine and no drug ingredients are currently being exported to Canada. Nick Cappuccino said the firm has conducted its own internal review and has "no reason to question the safety of the products involved. "We are now working collaboratively with (Health Canada) to address their concerns with the goal of lifting the voluntary quarantine as quickly as possible," Cappuccino said.
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The University of Ottawa's Attaran, however, said the inspectors' findings should be treated more seriously. "The cheapest greasy spoon in Toronto would be shut down if it had these conditions, but the pharmaceutical company sending stuff to Canada is allowed?" he said. He questions why the government is allowing products originating from the facility to remain on pharmacy shelves, considering Canada's Food and Drugs Act prohibits the sale of any drug manufactured under unsanitary conditions. "The law is very clear on this," he said. "We have evidence here that the product was manufactured under unsanitary conditions, and they're selling it. What more does Health Canada want?"
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The government said its decisions about regulatory actions are made on a case-by-case basis and can be "deployed in a graduated and proportional fashion, and tailored to the specifics of individual circumstances." Since a Star investigation in September revealed drug products banned from the U.S. market have been allowed by Health Canada into Canadian pharmacies, the government has banned or quarantined imports from at least nine Indian drug manufacturing facilities. The facilities make more than 100 drugs and drug ingredients imported into Canada. © 2015 Torstar Corporation
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It's beyond time for a clear policy on paying donors for plasma - The Globe and Mail - 1 views

www.theglobeandmail.com/...article29944680

plasma private

shared by Cheryl Stadnichuk on 10 May 16 - No Cached

Canadian Plasma Resources, having failed miserably with its plan to pay plasma donors in Toronto, has now set up shop in Saskatoon.Why Saskatchewan – or any other province, for that matter – would align itself with a company that has a controversial history and business plan is odd, especially given Canada’s painful history with tainted blood. And it is doubly puzzling because the provinces own Canadian Blood Services (CBS), the not-for-profit agency that collects blood and plasma (from volunteer, non-remunerated donors) in Canada, and whose efforts are undermined by the private company’s tactics. It’s as if the right hand doesn’t know what the left hand is doing.
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Regardless, the festering presence of Canadian Plasma Resources has forced us to come to grips with the pros and cons of paid plasma. The Krever Inquiry – an exhaustive examination of the debacle that left more than 30,000 Canadians infected with HIV-AIDS and hepatitis C from tainted blood and blood products – said that donors should not be paid, “except in rare circumstances.”The World Health Organization also says countries should aspire to 100-per-cent voluntary blood and plasma donations by 2020. But the stark reality is that blood (and plasma in particular) is a big and profitable business with an expanding market.
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Ethically, the notion of paying for bodily fluids and body parts makes us uncomfortable. In Canada, we have banned the sale of sperm, eggs and organs, in large part due to fears the poor and vulnerable could be exploited. But only two provinces, Quebec and Ontario, have banned the sale of blood and plasma.There is also a safety issue. While there is evidence that paying for blood attracts higher-risk donors, it doesn’t necessarily mean the end product is less safe – even if companies such as Canadian Plasma Resources set-up shop next door to homeless shelters.
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Regardless of source, it’s important to ensure the safety and security of supply for patients who need blood and blood products. Currently, CBS collects about 200,000 litres of plasma annually. That is enough to produce only about 22 per cent of blood products such as intravenous immunoglobulin, which is used to treat a growing number of immune disorders. That product is purchased from the United States and Switzerland.
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Currently, there are no manufacturers of blood products in Canada. However, both Green Cross Biotherapeutics and Therapure Biopharma are getting into the business. Within five years, CBS hopes to increase collection markedly to about 500,000 litres a year, with the use of dedicated plasma collection centres. But CBS has no plans to pay donors, other than the traditional cookies and juice. Nor does it plan to buy plasma from other providers, such as Canadian Plasma Resources.In fact, what Canadian Plasma Resources plans to do with the plasma it has collected is unclear as it does not have license from the U.S. Food and Drug Administration, which means it essentially can’t sell its plasma in the United States. What is clear, however, is that there is a lot of action in the blood business; as opportunities arise, we must be careful to not repeat the errors at the root of the tainted-blood debacle. What policy makers need to do now is come up with a clear, coherent position on issues such as paying for plasma and domestic production of blood products rather than grasping at every shiny bauble that comes along.
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Let Blood Services lead the way - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|ntnp|20150414|218428860

from heather pharmacare cbs drugs

shared by Govind Rao on 14 Apr 15 - No Cached

National Post Tue Apr 14 2015
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I magine having to choose between putting food on the table or buying necessary medication. Research suggests this is the case for one in 10 Canadians who can't afford to fill their prescriptions. Canada is the only country with universal health care that does not also have universal drug coverage. Even for those who do have private or public drug coverage, there are discrepancies in what and who is covered from province to province. Canadians also pay more for drugs than citizens in almost any other Western nation. These are just a few of the arguments that have reignited calls for a national pharmacare program. It is not a new concept, but one that is gaining traction as leaders are turning over every stone to "bend the cost curve" in health care downward. In a recently published study in the Canadian Medical Association Journal (CMAJ), health economists and researchers concluded a universal drug program could actually save Canadians billions of dollars. Great savings are achieved by pooling provincial and territorial needs and resources to increase buying power, eliminate duplication and establish a platform for collaboration and cost-sharing. If health-care leaders are looking for proof that provinces and territories can do more together than they can on their own when it comes to the provision of life-saving and enhancing drug therapies, they need look no further than the blood system they created close to 20 years ago.
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Many are aware that since its creation in 1998, Canadian Blood Services has been in the business of collecting, processing and distributing blood components in all provinces and territories outside Quebec. But few realize we have also been running a national formulary of biological drugs, providing universal and equitable access to plasma-derived medicine at no cost to patients for nearly two decades. Our organization has sole responsibility for managing a national portfolio of plasma-derived products and their synthetic alternatives worth about $500 million a year. These life-saving pharmaceuticals are used to treat people with hemophilia and other bleeding disorders, patients with inherited and acquired immune disorders, burn and trauma victims, and many others. A national, scalable, cost-shared infrastructure and logistics network ensures the right product gets to the right patient, at the right time.
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Our approach to managing this drug portfolio is based on best practices in public tendering. This means we provide a competitive, transparent mechanism to achieve best pricing. In fact, governments are benefiting from Canadian Blood Services' success in negotiating an estimated $600 million in savings over five years through 2018 - a testament to the value of pan-Canadian buying power and proof of concept of one of the arguments in the CMAJ study. Some detractors of tendering suggest it can put supply at risk by placing all the purchaser's eggs in that one proverbial basket. However, in our process, we avoid single-sourcing whenever possible, not only to encourage competitive pricing, but to ensure security of supply. Carrying multiple brands of a product, purchasing them in smaller, diverse lots, and negotiating a dedicated and guaranteed "safety stock" are all measures we take to mitigate risks to supply disruption.
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We have also focused on product choice by incorporating stakeholder (physician and patient) input where appropriate in our tendering processes. Through our medical directors, we provide expert advice when a physician has a patient-based issue that could benefit from an additional specialist perspective - added value for patients and health systems. We also independently qualify new suppliers and audit them periodically, adding another layer of vigilance and product safety for patients. We are often aware early on of supplier issues in bringing products to market or maintaining adequate Canadian supplies, which helps to mitigate the risk of shortages. Because of our governance structure, once a plasma-derived drug is accepted in our portfolio, it becomes available in all jurisdictions. This practice effectively reduces geographic or financial barriers to care, and is consistent with the principles of universal access informing the Canada Health Act and medicare. Equitable access also encourages consistency of practice, and fosters pan-Canadian dialogue on best practices for optimal product utilization. Canadian Blood Services collaborates with health-system leaders, including governments, transfusion medicine physicians and others, to help ensure appropriate utilization and to further control costs.
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By offering our experience, we are not proposing Canadian Blood Services should bulk-purchase other drugs or that our model is a "cookie cutter" solution to apply to national pharmacare, in part or in whole. Rather, we are suggesting there are important lessons from our 17 years' experience that can be leveraged, and that a national drug program is not only possible - it is already being done, with significant benefits to patients and health system funders. A system that ensures no Canadian patient is left unable to afford life-saving medication, while at the same time driving down system costs, is not only good politics, it's good policy. National Post Dr. Graham Sher is CEO of Canadian Blood Services.
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Judge slams Ambrose for Apotex drug ban; Federal court quashes action, says health mini... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20151016|231507864

from heather generics drugs international court

shared by Govind Rao on 16 Oct 15 - No Cached

Toronto Star Fri Oct 16 2015
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Health Minister Rona Ambrose acted for an "improper purpose" when, during a political and media firestorm, she banned drug products from Canadian pharmaceutical giant Apotex's two Indian facilities, a federal court judge has ruled. The decision, handed down by Justice Michael Manson this week, said Ambrose ignored the company's right to respond to the government's concerns before the sweeping regulatory action was taken a year ago. The judge also quashed the ban and told the minister to take back her public statements related to the ban. "The import ban was motivated by the minister's desire to ease pressure triggered from the media and in the House of Commons," the ruling said, adding that it was "an action taken without legal authority."
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"As Minister of Health, I remain committed to protecting the health and safety of Canadians." A Health Canada spokesman said the department is reviewing the decision. After the Apotex suit was filed in court last year, Ambrose told the Star that she stood by her decision to ban Apotex products. "Canadians expect Health Canada to take the action needed to help protect them from drug safety risks," she said at the time. "We stand by our decision to take precautionary action to protect the health and safety of Canadians." During cross-examination of Health Canada witnesses during the case, officials stated there was no evidence that products "produced a risk or threat to the health of consumers," the judge noted in his ruling.
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Apotex says it feels vindicated by the decision. "Apotex always has been and remains a most trusted partner in the global healthcare community. Apotex is fully dedicated to producing highest quality, safe, and efficacious medicines for all of our global consumers," said Apotex CEO and president Dr. Jeremy Desai in a company press release. Ambrose issued a short statement, but did not address the judge's comments.
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In the court challenge, Apotex alleged Ambrose acted with "malice" toward the company and buckled under political pressure after a Star investigation that detailed U.S. regulatory findings of widespread problems in the company's Bangalore facilities. Agents from the U.S. Food and Drug Administration, in reports obtained by the Star, stated they found staff at the Indian plants discarding unfavourable lab results and retesting suspect samples until they yielded the desirable outcome. (The federal court ruling does not make any findings regarding the conditions of the Indian plants.) Pressure on Parliament Hill on the minister mounted after the articles last year, while critics lambasted Ambrose's department as "feeble, inadequate and incompetent."
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Apotex, which has decried the costly ban as illegal, has always said its Indian-made products are safe and effective. The federal court ruling by Manson quashed the import ban, though Health Canada had already lifted it about a month ago, allowing the pharmaceutical giant to import its products under strict conditions. The regulator said in September that recent inspections of the two Indian facilities found "satisfactory progress" had been made to address its concerns about the company's data integrity. The ban had lasted 11 months. The court ruling does not say if the strict conditions are still in place. The judge ordered the government to pay at least part of Apotex's court costs, though the decision does not provide specifics. The decision also says that the order for Ambrose and Health Canada officials to retract their public statements related to the import ban shall be done "on terms to be agreed to by the parties."
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In announcing the ban last year, Ambrose declared the trust between Apotex and the regulator was "broken." However, the judge ruled the minister's statements, intended to show the public she was taking strong action, were improperly fuelled by political expediency. "If the import ban was motivated by the purpose of protecting health and safety, it is curious that the minister and Health Canada would publicly assure that the banned drug products were safe and at no point issued any recall," Manson said in his decision. The judge found there was no evidence that there were serious health risks requiring the government to invoke an immediate ban without consulting the company.
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The regulator had known about the problems at the plants for months and had been communicating with Apotex behind the scenes about what the company was doing to get its facilities up to acceptable standards, the decision said. Meanwhile, just days before the ban, a Health Canada official told Apotex that the regulator's own inspection had given one of the two facilities a passing grade.
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CHSRF. February 2011. (paper on inflation in health sector) - 0 views

www.chsrf.ca/...esisCostDriversENG_1.sflb.ashx

funding fromdelicious

shared by Irene Jansen on 23 Jan 12 - No Cached

Irene Jansen on 23 Jan 12

Andrew Sharpe, who runs the centre fit the study of living standards, wrote a paper a few years ago about productivity in the health care sector and about how statscan's approach ignore much of the productivity gains. Like many productivity measures for

<div class="cArrow"> </div><div class="cContentInner">Andrew Sharpe, who runs the centre fit the study of living standards, wrote a paper a few years ago about productivity in the health care sector and about how statscan's approach ignore much of the productivity gains. Like many productivity measures for </div>

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North America home healthcare market: $130 billion industry by 2017 - 1 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|233679|nxbg|20130812|175322873

from heather ltc US privatization

shared by Govind Rao on 13 Aug 13 - No Cached

Govind Rao on 13 Aug 13

CompaniesandMarkets.com Mon Aug 12 2013, 2:11pm ET The North America home healthcare market was valued at $90.9 billion in 2012; it is poised to grow at a CAGR of 7.5% to reach $130.4 billion by 2017. Home healthcare market includes products, services, and telehealth. The home care product category comprises homecare testing, screening & monitoring devices, home healthcare therapeutic equipment, mobility assist & other devices, fitness, and nutrition products. Services include unskilled care, rehabilitation therapy, infusion therapy, and respiratory therapy, while telehealth includes home telehealth monitoring devices and telehealth services.

<div class="cArrow"> </div><div class="cContentInner">CompaniesandMarkets.com Mon Aug 12 2013, 2:11pm ET The North America home healthcare market was valued at $90.9 billion in 2012; it is poised to grow at a CAGR of 7.5% to reach $130.4 billion by 2017. Home healthcare market includes products, services, and telehealth. The home care product category comprises homecare testing, screening & monitoring devices, home healthcare therapeutic equipment, mobility assist & other devices, fitness, and nutrition products. Services include unskilled care, rehabilitation therapy, infusion therapy, and respiratory therapy, while telehealth includes home telehealth monitoring devices and telehealth services.</div>

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Disposable linens will be used by hospitals NB - 0 views

www.fpinfomart.ca/...175128446

from heather NB hospital laundry

shared by Govind Rao on 09 Aug 13 - No Cached

Govind Rao on 09 Aug 13

The Daily Gleaner (Fredericton) Fri Aug 9 2013 Page: A1 Section: A Byline: ADAM BOWIE bowie.adam@dailygleaner.com The Horizon Health Network will move to disposable surgical linens and customized surgical kits by the winter of 2014. For more than a year, union officials who represent health-care providers and allied health professionals from across the province have expressed concerns about a proposed plan to switch from reusable operating room linens to disposable one-off products in provincial hospitals, citing environmental impacts and potential job losses as negative factors. In that time, The Daily Gleaner submitted multiple requests for information to the Horizon Health Network about the proposal. Several times the newspaper was told that it was under consideration and that nobody from the province's largest regional health authority would be commenting on the nature of the planned changes. Now Horizon officials say the changes will happen late next year and they've outlined the reasons behind the push to transition to a new product. Margaret Melanson, the Horizon Health Network's executive director of the Saint John zone and chairwoman of the regional health authority's surgical committee, said hospitals in the Fredericton, Saint John and Miramichi zones will soon be making the change, noting facilities in the Moncton zone are already using disposable surgical linens. "These products would be used predominantly within the surgical areas, the operating rooms; however, also within labour and delivery suites, within clinics and ambulatory areas, where small, minor surgical procedures are performed, and other areas, such as interventional radiology," she said. for more email hfarrow@cupe.ca

<div class="cArrow"> </div><div class="cContentInner">The Daily Gleaner (Fredericton) Fri Aug 9 2013 Page: A1 Section: A Byline: ADAM BOWIE bowie.adam@dailygleaner.com The Horizon Health Network will move to disposable surgical linens and customized surgical kits by the winter of 2014. For more than a year, union officials who represent health-care providers and allied health professionals from across the province have expressed concerns about a proposed plan to switch from reusable operating room linens to disposable one-off products in provincial hospitals, citing environmental impacts and potential job losses as negative factors. In that time, The Daily Gleaner submitted multiple requests for information to the Horizon Health Network about the proposal. Several times the newspaper was told that it was under consideration and that nobody from the province's largest regional health authority would be commenting on the nature of the planned changes. Now Horizon officials say the changes will happen late next year and they've outlined the reasons behind the push to transition to a new product. Margaret Melanson, the Horizon Health Network's executive director of the Saint John zone and chairwoman of the regional health authority's surgical committee, said hospitals in the Fredericton, Saint John and Miramichi zones will soon be making the change, noting facilities in the Moncton zone are already using disposable surgical linens. "These products would be used predominantly within the surgical areas, the operating rooms; however, also within labour and delivery suites, within clinics and ambulatory areas, where small, minor surgical procedures are performed, and other areas, such as interventional radiology," she said. for more email hfarrow@cupe.ca</div>

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CHPI: New Research Suggests That the Solution to Healthcare Sustainability in Canada is... - 0 views

www.sys-con.com/3045816

from heather sustainability research

shared by Govind Rao on 09 Apr 14 - No Cached

April 7, 2014
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A research paper published by the Canadian Health Policy Institute (CHPI)
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suggests that the solution to the sustainability challenge in healthcare is productivity gains - not rationing access to medical goods and services.The research compared productivity growth in healthcare relative to other economic sectors in Canada. It observed that between 1987 and 2006, productivity for total industry grew at an annual rate of approximately 1.1%, with a slight acceleration in the latter decade. By contrast, over the same period, healthcare showed average annual productivity declines of 0.4%, with the declining trend accelerating in the latter decade. The paper also examined health outcomes over the same period of time. It found that paradoxically, lagging economic productivity in health care has coincided with continually improving health outcomes for Canadians. The analysis was based on data from the Centre for the Study of Living Standards, the Canadian Institute for Health Information and Statistics Canada.
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Paying for plasma - Canada's double standard? - Healthy Debate - 0 views

healthydebate.ca/...paying-plasma

shared by Govind Rao on 17 Apr 14 - No Cached

by Meera Dalal, Christopher Doig & Andreas Laupacis
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April 17, 2014
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Canadian Blood Services sends some of the plasma collected to pharmaceutical companies to be manufactured into plasma protein products. However to meet Canadians’ needs, about 885,000 litres of plasma protein products are bought annually from US or European companies. Canadian Plasma Resources plans to open three clinics, two in Toronto and one in Hamilton, for the sole purpose of collecting plasma for plasma protein products manufacturing.
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According to Canadian Blood Services, to be able to manufacture our own plasma protein products we would need to collect 700,000 litres of plasma.
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In comparison, private US clinics collect over 20 million liters a year from over 40 million donors.
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Health Canada conducted a roundtable discussion on the views of Canadians about paying donors for plasma in March 2013. At this discussion, a joint presentation between Health Canada and Canadian Blood Services stated that “no country in the world [including Canada] has been able to meet their need for plasma with a solely volunteer model.” However, in June 2013, Health Canada went on to say that “provinces and territories have the authority to allow or disallow the payment of plasma donors.”
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Many Canadians find the idea of paying for body fluids, which is often mixed in with ideas like payment for organ donation, distasteful.
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Ultimately, safety concerns need to be balanced with the heavy use of plasma protein products by Canadian patients, taking into account the best current estimates of the risks of paid donation, and recognizing that donors from other countries are paid. Is it time for a revision to current policies around paying Canadians for plasma, or should they remain the same?
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What is driving health care costs? - 0 views

www.healthydebate.ca/...health-care-spending

funding wages hospitals drugs sustainability

shared by Irene Jansen on 23 Jan 12 - No Cached

Although many Canadians believe that the aging population is driving health care costs in Canada, the CIHI report suggests that this is not the case, which is consistent with other research.
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The salaries of doctors, nurses and other skilled health care professionals have risen more quickly than the average Canadian salaries in the last decade.  As well, the report notes that compensation for doctors grew faster than the wages of other health and social service workers in the past decade.
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Over one in four health care dollars in Canada is spent on hospitals. With about 60% of hospital budgets consumed by staff wages, this is a major component of health care spending .
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 Hospital costs decreased significantly from 1991 to 2001, both in absolute terms and as a proportion of the health care budget. The hospital share of total public health care spending was 47% in 1991, and was reduced to 37% in 2001. However, in the past ten years the proportion of health care spending on hospitals has remained steady at 37%.
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Fewer new drugs on the market, a number of drugs coming off patent, and more price negotiation by governments have contributed to a decline in the growth of drug costs. On the other hand, greater use of drugs by Canadians (such as drugs to decrease cholesterol) and an increase in the population has contributed to a small overall increase in drug costs. In 2001, drugs accounted for 8% of public health care spending; this increased to 9% in 2011.
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Darius Tahir: Innovating The Health Care Work Force | The New Republic - 0 views

www.tnr.com/...care-labor-force-nurses-reform

productivity utilization nursing us

shared by Irene Jansen on 23 Jan 12 - No Cached

As a recent paper in the New England Journal of Medicine by Bob Kocher and Nikhil Sahni showed, labor productivity growth in the health care sector actually fell by .6 percent between 1990 and 2010, a result which corroborates the findings of a 2010 paper by heath economist David Cutler.
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the most promising answer seems to lie in allowing basic medicine to be practiced in more places and by an increasingly diverse set of practitioners
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Kocher and Sahni write that a “different quantity and mix of workers engaging in a higher value set of activities” is necessary to increase productivity, with one of their suggestions being to relax licensure and scope of practice requirements for nurse practitioners and other non-doctor health care workers
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As Ashish Jha, an associate professor at Harvard Public School of Medicine and a practicing physician, told me, “What you see in other industries is when there’s been an uptick of technology, it has allowed everybody to move up in terms of the kinds of work they do. [In health care] it [should] allow nurses do stuff only doctors could do before.”
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a morass of state laws blocks nurses and other non-MDs from performing many tasks
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Each change is approved piecemeal, often over the objections of physicians’ groups.
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Recently there’s been an uptick in what’s known as “retail clinics”—that is, small health clinics being located in retail stores, often in strip malls. CVS is one big brand that’s made an investment, and it has been rumored that Wal-Mart is interested in entering the market as well.
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Austin Frakt, a health economist and one of Carroll’s co-bloggers, notes that such clinics tend to poach younger and more affluent patients
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contribute to the fragmentation of care problem in the health system by creating another place generating records and care and prescriptions that’s unconnected to everything else
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When academic papers attempt to gauge productivity, the measure is derived from things it can count: visits to the doctor, number of scans, etc. But it’s possible, Frakt says, “to imagine a situation where greater quality means fewer visits to the doctor.”
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We have new technology, people with bright ideas … but the dominant players in the market have a very specific idea of how they’re being paid.”
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Experimental Measures of Output and Productivity in the Canadian Hospital Sec... - 0 views

www.statcan.gc.ca/...aftertoc-aprestdm2-eng.htm

funding hospitals

shared by Doug Allan on 23 Apr 14 - No Cached

Recent discussions about health care spending have focused on two issues: 1) the extent to which the increase in heath care spending is due to an increase in the quantity as opposed to the price of health care services, and 2) the efficiency and productivity of health care providers (e.g., hospital sectors, office of physicians, and long-term care).
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The key to addressing both issues is a direct output measure of health care services—a measure that does not currently exist.
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The main objective of this paper is to develop an experimental direct output measure for the Canadian hospital sector
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Measurement of direct output starts with a definition of the unit of output and weights used for aggregation. Ideally, the unit of output should capture the complete treatment, encompassing the path a patient takes through heterogeneous health care institutions to receive full and final treatment. This is known as disease-based approach.
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But implementation of this ideal definition requires tracking individual patients across health care institutions; existing data rarely allow such linkages.
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The Atkinson Report (Atkinson, 2005) and Dawson et al. (2005) recommend that the marginal value of a treatment be used to derive a value-weighted activity index as the ideal output measure, where the marginal value is based on the effect of the treatment on the patient’s health outcome.
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A cost-weighted activity index, when inappropriately constructed, might introduce a substitution bias. Substitution bias arises when a shift in the composition of treatments (from inpatient to outpatient treatment) occurs, and inpatient treatment and outpatient treatment are assigned to different case types and are aggregated with their respective unit costs even though they both have the same effect on outcome. If outpatient treatment is less expensive, a cost-weighted activity index will indicate a decline in the hospital sector’s volume of output. This is counterintuitive, since the volume of hospital service under the above assumption does not change when outpatient and inpatient treatments have the same effect on health outcomes and are valued equally by patients.
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A value-weighted activity index captures such quality changes and does not suffer from substitution bias. For a value-added activity index, weights for aggregating treatments are based on the effect of treatments on health outcomes. To the extent that shifts from inpatient treatment to less expensive outpatient treatment have no effect on health outcomes, a value-weighted index will show a decline in the price of the hospital output but no change in the volume of hospital output.
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National Ambulatory Care Reporting System (NACRS)
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Outpatient data for Ontario are from the NACRS.
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The preferred estimate is the cost-weighted activity index based on the detailed case type aggregation and corrected for substitution bias. This “quality” adjusted estimate of hospital sector output over the 2002-to-2010 period rose 4.3% per year.
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The price index of hospital sector output derived from the quality-adjusted volume index measure increased 2.7% per year. Growth in the price of the hospital sector is slightly higher than growth in the price of gross domestic product over that period (2.5% per year). Labour productivity calculated as the ratio of output to hours worked in the Canadian hospital sector is estimated to have increased 2.6% per year over the 2002-to-2010 period. This represents annual growth of 4.3% for output and 1.7% for hours worked.
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The analysis reveals a large substitution bias in the cost-weighted volume index of output of the hospital sector when inpatient and outpatient cases are aggregated using their respective unit costs as weights. The bias is estimated to be about 2.6% to 3.3% annual growth in the volume index of the output of hospital sector for the period 2002 to 2010.
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Nova Scotia Health Authority eyes privatizing food production in Halifax hospitals - No... - 0 views

www.cbc.ca/...in-halifax-hospitals-1.3142081

from heather NS hospital food privatization

shared by Govind Rao on 08 Jul 15 - No Cached

Food production accounts for two-thirds of N.S. Health Authority deficit
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Jul 07, 2015
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The Nova Scotia Health Authority says they're looking at privatizing food production in some Halifax hospitals, and has given government employees three months to come up with alternatives to save money. Hospital staff who serve the public at various Tim Hortons and cafeterias within a dozen hospitals in the Halifax area are currently making more money per hour than equivalent positions elsewhere.  The Nova Scotia Health Authority says the hospitals, located in the former Capital Health district, have lost a total of $8 million in the past six years. 
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Drug prices expected to jump as result of trade deal - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20151207|235293114

from heather drug costs trade pharmacare

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The Globe and Mail Mon Dec 7 2015
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The intellectual-property provisions in the Trans-Pacific Partnership agreement will drive up global drug prices and make it harder to treat diseases in developing countries, Medecins sans Frontieres (Doctors Without Borders) says. A month after the final text of the TPP was released, the medical humanitarian organization has completed its analysis of the portions of the massive trade pact that will affect drug costs.
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Despite changes from earlier leaked versions of the text, there are still serious problems, Judit Rius, MSF's U.S. legal policy adviser, said. "This is catastrophic. This is very negative. The impact is going to be at multiple levels," Ms. Rius said in an interview. "First of all, it is going to delay access to generic competition [for brand-name drugs], which is a proven intervention to reduce the price of medicines."
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Ms. Rius said there were six problem areas - from MSF's perspective - in the early leaked versions of the TPP. Three have been eliminated in the final text, although she said some of those were "absurd" in the first place. Among them was a provision that would have made it illegal to oppose a patent before it was granted and another that would have forced governments to allow surgical techniques to be patented. There are three key remaining problem provisions, according to the MSF analysis. One would allow pharmaceutical companies to "evergreen" their product patents, essentially making small changes to a drug's use to extend its protection from competition. Another would extend patent protection if there are delays in regulatory approval of a new product.
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More broadly, allowing greater monopoly protection for brand-name drug makers will diminish innovation at other firms, Ms. Rius said. "If you are trying to develop a pediatric formulation of a product, if you are trying to combine different pills into one pill, ... if you are trying to improve a medicine and create a second generation, all of that technology and knowledge is going to be protected by secondary patents." The final text of the sweeping trade pact, which has been in the works for eight years, was released in early November. Canada is one of 12 countries that have negotiated the pact, although it was the former Conservative government that signed on. Prime Minister Justin Trudeau said his government will wait for parliamentary hearings on the TPP before deciding on ratification. Each country has to ratify the agreement before it comes into effect.
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For generic drug makers, she said, the TPP will create additional legal barriers that will get in the way of making new products, and that will stunt the industry. The TPP will actually raise drug prices, especially in developing countries, she said, and this "will affect our capacity, and the capacity of the ministries of health with whom we work, to scale up treatment programs and reach as many people as needed."
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A third would allow developers of certain advanced drugs - called biologics - to keep their clinical data private for up to eight years. That would make it much tougher for competitors to create similar drugs, or at least delay that from happening. This "data exclusivity" rule would be new for some of the countries that are part of the TPP group, although Canada already has a similar provision in place. Indeed, many of the provisions of the TPP are already part of the Canadian scene, at least in some form, said trade lawyer Larry Herman, of Herman & Associates in Toronto. The former Conservative government had said the TPP was "in line" with Canada's existing patent laws, and this appears to be true from his read of that part of the text, Mr. Herman said.
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Still, he said, from a global perspective "there is no doubt that the agreement increases patent protection and enhances the monopoly rights of the patent owner." From the perspective of Canada's generic drug industry, the TPP has to be looked at in conjunction with the Comprehensive Economic and Trade Agreement (CETA) between Canada and the European Union, said Jim Keon, president of the Canadian Generic Pharmaceutical Association.
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CETA, which has not yet taken effect, would extend patent protection for drugs and cut into the business of Canadian generic drug makers - thus boosting drug costs - Mr. Keon said. But it also contains some specific protection for the generic industry to mitigate that impact. It is not clear yet whether the TPP will allow those mitigating measures to be implemented in Canada, he said. And because of the immense complexity of the TPP, "you've got all sorts of potential for misinterpretation here," Mr. Keon added.
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Walkom: Canada's never-ending medicare fight - thestar.com - 0 views

www.thestar.com/...-s-never-ending-medicare-fight

manning insurance medicare user fees comparisons social programs sustainability

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The most depressing element of Canada’s on-again, off-again medicare debate is its repetitiveness. The country is forced to fight the same battle again and again. It’s as if our political elites learn nothing. I was reminded of that this weekend when Reform Party founder Preston Manning showed up on CTV’s Question Period to — again — make his pitch for two-tier health care.
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Manning has been pushing two-tier medicine since 2005. That’s when he and former Ontario premier Mike Harris wrote that Canada’s medicare system should be replaced by a narrowly defined scheme focused on catastrophic illness and financed, in part, by user fees. All other health care would be paid for privately.
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Any number of studies have demonstrated that so-called single payer public insurance systems like Canadian medicare are more efficient than two-tier schemes
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And user fees? Even a Senate committee that had been warm to the idea of charging patients each time they saw a doctor changed its mind when faced with the evidence.
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But the real problem with two-tier medicine, as former Saskatchewan premier Roy Romanow noted on the same CTV show, is that it simply shifts costs.
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Manning made much of the fact that Quebec’s government devotes proportionally less of it provincial budget to health —30 per cent of program spending as opposed to about 40 per cent in Ontario. He appeared to attribute this to the fact that Quebec, unlike Ontario, allows physicians to opt out of medicare and bill patients privately. But the real reason why the Quebec government spends less in proportional terms on health care is that it spends more in absolute terms on everything else. Provincial government program spending per capita in Quebec is $11,457. In Ontario, the figure is $9,223.
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total health spending in Ontario represents 11.9 per cent of the province’s gross domestic product. In Quebec, the comparable figure is 12.4 per cent
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The Germans, Dutch and French, all of whom are praised by two-tier fans, spend more of their gross domestic product on health care than we do.
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Surely it’s more productive to build on what we have — a successful, publicly funded, universal health insurance system that covers doctors and hospitals. It could be improved or even expanded. But it works. That’s why Canadians keep fighting for it. Over and over and over again.
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Lean not all rosy - 0 views

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

lean sk

shared by Irene Jansen on 23 Jan 12 - No Cached

In the auto industry, this system is more commonly known as "management by stress," as it drastically increases work intensity, imposes tight time discipline on tasks, and removes barriers and buffers from the production process. It is essentially a system under such extreme stress that it creates a sense of urgency and anxiety in the workforce in order to induce continued improvements in productivity, lest the system break down.
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Indeed, the Japanese had to invent a word, karoshi, or "death from overwork," in response to the implementation of Lean production methods at Toyota.
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Simon Enoch Director, Sask. Office Canadian Centre for Policy Alternatives
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'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

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The Globe and Mail Sat May 23 2015
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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?
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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?" ..
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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.
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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.
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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.
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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
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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.
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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
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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.
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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.
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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."
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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
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"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."
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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.
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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?"
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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.
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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.
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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.
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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
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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."
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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.
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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."
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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.
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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?
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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.
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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.
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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."
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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.
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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.
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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."
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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
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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."
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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.
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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
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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?
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$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
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Is it time to nationalize the drug industry? | Physicians for a National Health Program - 0 views

www.pnhp.org/...-nationalize-the-drug-industry

from heather pharmacare US drugs drug

shared by Govind Rao on 06 Jul 15 - No Cached

By Ben HirschlerReuters, June 30, 2015
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Novartis plans to test a novel pricing model with some customers when it launches its keenly awaited new heart failure drug Entresto, the Swiss company's head of pharmaceuticals said on Tuesday.
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In this paper, we estimate a copula-based bivariate dynamic hurdle model of prescription drug and nondrug expenditures to test the cost-offset hypothesis, which posits that increased expenditures on prescription drugs are offset by reductions in other nondrug expenditures.
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Comment: By Don McCanne With the marketing success of outrageously priced drugs, the pharmaceutical industry is now devising schemes to be sure that their new products that are protected by patents will continue to be introduced with similar outrageous prices. This concept of adding “cost offsets” to the pricing is not new, but it now has a label that supposedly legitimizes its inclusion in pricing decisions.
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Perhaps more despicable is this entry from a draft of the infamous Trans-Pacific Partnership Agreement, which contains the following in its statement of principles: “(d) the need to recognize the value of pharmaceutical products and medical devices through the operation of competitive markets or by adopting or maintaining procedures that appropriately value the objectively demonstrated therapeutic significance of a pharmaceutical product or medical device.”
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There could not be an industry that cries out more for government intervention to protect consumers than the pharmaceutical industry (oh wait, the private insurance industry, of course, but that's another topic). Many suggest that it is time to demand negotiation of drug prices, or even to dictate fair prices. But should that be our opening position? How about calling for nationalization of the industry, at least their U.S. subsidiaries. That should get their attention. They have to know that we're serious about wanting relief from their greed.
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Drilling Down - Understanding Oil Prices and Their Economic Impact - Bank of Canada - 0 views

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from heather economics budget federal provinces

shared by Govind Rao on 13 Jan 15 - No Cached

13 January 2015
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Good afternoon. I want to thank the Madison International Trade Association for inviting me to this annual outlook event. I’m happy to be back in America’s Midwest, a region that has many important ties to Canada. Your economy has a lot in common with ours, and it is affected by many of the same global forces. The dramatic drop in oil prices over the past few months is certainly a major new force in the world economy today (Chart 1). Oil prices affect almost everyone, for better or for worse. Petroleum products are a big slice of families’ budgets and a significant cost of production for a myriad of industries. Oil is especially important to both of our countries. In Canada, oil extraction now accounts for about 3 per cent of our GDP and crude oil about 14 per cent of our exports. The United States is still the world’s largest consumer of oil and, with the emergence of shale-oil production, has become the biggest producer too.
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Hospital pest woes blamed on renovations; Official says rodents do not pose imminent he... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|cahr|20150119|212716167

from heather bc privatization food health and safety safety hospital

shared by Govind Rao on 19 Jan 15 - No Cached

Calgary Herald Mon Jan 19 2015
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Rats scurrying down hospital hallways, chewing through wires and nibbling on food scraps near the cafeteria. These are a few of the recent rodent sightings reported by public health inspectors, nurses and staff members at B.C. Women's and Children's Hospital in Vancouver.
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Inspectors issued verbal and written directives after the Dec. 22 visit, according to the environmental health inspection report, which notes: "Minimal pest proofing has been completed to date which is contributing to the difficulty in controlling and abating the rodent activity with the food services." The report also mentions: "A number of food products have been chewed through resulting in products being discarded," and "wiring of equipment chewed on in the retail side which also raises a safety concern." The most recent inspection report lists a "Target Completion Date" for rodent control recommendations as Jan. 27. Taki said the hospital has an action plan in place with the help of the pest control company. "We've asked them to almost quadruple-up on the service until everything gets under control," said Taki.
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A surging rat population in the hospital's cafeteria and food preparation area has prompted management to step up rodent control efforts in recent weeks. Inspectors believe that despite the increase, the rodents do not pose an imminent health risk to the hospital's patients, visitors or staff, said Richard Taki, regional director of health protection for Vancouver Coastal Health. But the results of last month's inspection highlight the hospital's ongoing challenges dealing with vermin, a situation hospital management and health inspectors say has been exacerbated by demolition and construction work in recent months. Inspection reports from 2013 show Vancouver Coastal Health had previously identified issues with rats and mice in the hospital cafeteria and more recently, last month's inspection found signs the problem had worsened.
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"I don't think it's any different from any restaurant that has a rodent problem. They have rodents, they're under control, they've got a company looking after it. They're working toward resolving a problem, but you know, we live in a city that has rats everywhere." Nurses have seen the pest problem worsen, along with general cleanliness, said Claudette Jut, regional chair of the B.C. Nurses Union council. The Hospital Employees Union has identified the issue of short staffed cleaning and food service in the hospital and raised it "on several occasions" with the private contractor who employs the workers, said HEU spokesman Mike Old. "It's hard for us to tell what exactly has contributed to the rat infestation," said Old. "But it's a problem, I think, that the delivery of services is so badly fragmented because of privatization."
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Frank Levenheck, director of facilities management for B.C. Women's and Children's Hospital, said demolition and construction on the hospital campus has contributed to the cafeteria's rodent issue. Over the past three weeks, hospital management has increased its efforts, Levenheck said, which includes working to seal holes in the building that act as entry points for vermin, more frequent cleaning and more frequent visits from the pest control company. Demolition for the hospital redevelopment began last May. Excavation began in August and is scheduled to be complete in February. Eight months before demolition began, hospital management had been directed to improve rodent control, records show. A VCH inspection on Sept. 3, 2013 found issues with "Inadequate Insect/Rodent Control," noting: "Areas have not been cleaned and Manager not aware if Pest Control has been in to specifically address these new sightings. Communication between services found to be poor and lacking in followup."
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A week later, a followup reinspection report dated Sept. 10, 2013, noted: "Rat droppings still to be THOROUGHLY cleaned from underneath the heater vents in the production area. Noted mouse droppings in warehouse areas have not been cleaned up." The next Inspection Report, from July 2014, does not specify whether the rodent situation had improved or worsened since the problems noted in the report from the September before. The July 2014 report was the most recent posted to the Vancouver Coastal Health website until Postmedia News contacted the health authority this month to ask about inspections. Taki acknowledged the Dec. 22 inspection and provided Postmedia with a copy of the report, which was subsequently uploaded to the health authority's website.
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Kristy Anderson, a spokeswoman from the provincial Ministry of Health, said if an inspector finds a food service establishment is not responsive to food safety notices or orders, the establishment "could be fined or ultimately be required to shut down until the situation is remedied. To our knowledge this has never occurred in a hospital or health authority-run facility."
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Eight months before demolition, management at B.C. Women's and Children's Hospital had been directed to improve rodent control, records show.
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