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Irene Jansen

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

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

privatization quality costs excellent

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

Public solicitation for organ donors: a time for direction in Canada - 0 views

www.cmaj.ca/487

cma organs

shared by Heather Farrow on 18 Apr 16 - No Cached
  • CMAJ April 19, 2016 vol. 188 no. 7 First published February 29, 2016, doi: 10.1503/cmaj.150964
  • The disparity between supply and demand for transplantable solid organs has resulted in strategies to drive increased organ donation, including public solicitations for living donors. Public organ solicitation occurs when a recipient or their representative solicits an organ for transplantation by public broadcast (e.g., social media or a public notice). The intended donor and recipient may not have a prior relationship. Lack of regulation of public solicitations for organ donation in Canada is a cause for concern. We call for careful screening of altruistic donors within a well-organized system that links willing donors with a maximum number of beneficiaries.
  • Public solicitation for organs offers an opportunity to find a living donor for potential recipients who do not have one within their social or familial network. Thus, solicitations are a way to redress a somewhat natural injustice, whereby some people have more friends or family members who are willing to donate than others. Accepting these donations does not discriminate1 nor does it disadvantage those on the waiting list.2 Solicitation leads to access to an organ that would not otherwise have been available for donation.3 In addition to being a benefit to the direct recipient, every transplant reduces the demand on the waiting list.2 Solicitation can also increase the awareness of organ shortages and may elicit more donors for other recipients.3
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  • However, there are concerns. Organ solicitations have been criticized as unfair, because they enable donation to identified recipients rather than to a recipient on a waiting list. Celebrity status and access to resources clearly provide increased opportunities to find a donor. A person with a high profile or more appealing story may be perceived as getting ahead in the transplant system, which could influence the public against organ donation.4 Recipients who are computer literate, social media savvy or English-speaking have enhanced access to potential donors beyond their local community and are more likely to find a donor than those without these characteristics.2 Publicity surrounding personal stories involving organ solicitation can be misleading and encourage offers to the solicitor, without considering donations to those with greatest need.5 However, all living donation is inequitable in that the donor chooses to whom to donate — generally someone they know — without any requirement to donate to the wait-list recipient with the greatest need.
  • One concern with public solicitations for organs is the potential for exposure of the recipient to harms from a donor who is unknown to them, which may in turn damage the reputation of transplant programs.3 Canadian law requires a minimum donor age for living donors, voluntary consent and no exchange of goods for an organ.6 Public solicitation may increase the potential for exchange of valuable considerations for an organ, because the donor is unknown to the recipient.
  • Two recent, well-publicized Canadian cases focused attention on these issues. The owner of the Ottawa Senators hockey team, who needed a new liver, used his public profile to solicit an anonymous donor.7 In the other case, the family of a young girl who needed a liver transplant made a public appeal through a Facebook page.8 The solicitation was fuelled by media attention surrounding this touching story, whereby the child’s twin had received liver tissue donated by their father, who could only donate once. The solicitation received more than 500 responses from people willing to donate.8 These two public solicitations for organs received markedly different public responses: one faced criticism9 and the other garnered sympathy. The difference in public perceptions was likely due to the different recipient profiles. In both cases, anonymous donors came forward, were screened and donated a part of their livers.
  • There are no guidelines for public solicitation of organs in Canada. Canadian transplant programs have had to address this issue on a case-by-case basis, often without consensus. Within Canada, different responses to organ solicitation by potential donors may be producing inequity of access to organs. Transplant programs and their patients could benefit from guidance on how to address the challenges raised by public solicitations. Many transplant doctors would be comfortable with public solicitation only if the donor became a nondirected altruistic donor, by which the organ is allocated to the next suitable recipient on the waiting list rather than to the actual solicitor (unpublished survey data, July 2015). Transplant doctors consider the next best thing to be to ensure that a relationship existed between the recipient and the solicited donor before donation occurs.
  • Donors who respond to public solicitations should be considered for transplantation. However, transplant programs must ensure that the motivation for donation is based on altruism rather than secondary intention, and that donors meet medical and psychosocial criteria for living donors, provide informed consent and agree to meet the requirements of the program regarding contact with the recipient. Although they should not be dissuaded from donating to the intended recipient, solicited donors should be made aware of alternatives such as donating to the recipient with the greatest need. A model is Canada’s National Kidney Paired Donation program. This program is the best option for candidates who have living kidney donors who are willing to donate and medically able, but who are incompatible with their intended
  • recipient. The program coordinates a chain of multiple transplants so that a willing donor’s organ can find its way to a compatible recipient while the intended recipient also receives an organ.10 This system allows the most people in need of an organ to get one. Even if the solicited donor and recipient are compatible, they can still choose to enter the National Kidney Paired Donation program as a pair, to benefit the greater transplant community, because a critical number of pairs are required for the overall success of the program.10 Whether donors from a public solicitation should remain anonymous to their recipients is a decision best left to the transplant program.
  • Donations of living organs are valued. Solicited organ donation helps to identify willing donors. It is an important facet of living donation and should be promoted. However, solicited organ donors should be encouraged to consider anonymous nondirected organ donation within systems, such as the National Kidney Paired Donation program, to maximize the number of patients in need who receive a transplant from a willing altruistic donor.
Govind Rao

Privatization: what it is, why it matters - Infomart - 0 views

www.fpinfomart.ca/...223358003

from heather NL privatization union

shared by Govind Rao on 23 Jun 15 - No Cached
  • The Telegram (St. John's) Tue Jun 23 2015
  • With oil prices down, an aging population and high unemployment, the conservative government of Newfoundland and Labrador is looking for a silver bullet to cut costs for public services and infrastructure. Their sights are settling on privatization to be that silver bullet. What is privatization? In its most narrow sense, privatization is the whole or partial sale of public services and/or infrastructure. It can include the sale of assets, functions or the entire institution.
  • With privatization, the service or infrastructure becomes funded and/or run by a private corporation. Privatization usually includes not only a change in ownership but also a change in the priorities, responsibilities and role of the state. Advocates of privatization offer free-market competition as the path to economic and social success, with promises of cost savings, lower risk, greater efficiency and more individual choice. Privatization takes several forms in Canada, including:
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  • ? full privatization: where a government enterprise is sold in full to private investors. ? publicly funded with services and management delivered privately, sometimes unknown to the consumer. ? public funding of private services: government provides vouchers to consumers for the purchase of goods and services from private providers.
  • ? public/private partnerships (P3s): full outside contracting, management and service delivery of traditionally delivered public services such as hospitals, roads, schools and prisons. This can include private finance, design, building, operation and possibly temporary ownership of an asset. Can privatization deliver? After decades of experimentation with privatization in different forms across Canada, the data is clear on the failure to deliver on its promises and the high cost society pays - multiple costs, not only in economic terms but also quality and access to services, quality and quantity of jobs, as well as transparency and accountability.
  • Public/private partnerships (P3s) are the fastest-growing model of privatization in Canada. The P3 models vary but all include the reliance on private sector borrowing to finance the development of public infrastructure projects in a long-term lease arrangement; it is effectively leasing rather than owning and sometimes that lease includes maintenance as well. P3s cost more. Governments have always been able to borrow money more cheaply than private corporations. According to a University of Toronto study of 28 P3 projects in Ontario, P3s cost, on average, 16 per cent more than a traditional public contract. A recent auditor general of Ontario report found that P3 projects cost the province $8 billion more than if they were done under the traditional model.
  • If they cost more, why do politicians promote them? Political expediency - in P3 lease agreements the debt stays off the books or is postponed for decades. P3s hide debt - which is a dream for politicians looking for easy wins in hard economic times. It is also ideological and it is about private sector lobbying and influence. Public services are a boon to private sector deliverers with guaranteed public payments and profit margins over the long term. Supporters of privatization claim that it leads to better pricing for the public as consumers. A comparison of privately owned Manitoba Telecom Services, privatized in 1997, to SaskTel, Saskatchewan's publicly owned telecommunications crown corporation shows this to not be true. Twenty years after privatization of MTS, the cost of a basic phone with SaskTel is $8 less per month than from MTS.
  • Private corporations demand a shroud of confidentiality in order to protect their competitive position. This means that privatization reduces both transparency and accountability. An example of this is the Ontario privatization of municipal water testing which has been linked to the May 2000 bacterial contamination of municipal water in Walkerton, Ont., led to the deaths of at least seven people and the serious illness of 2,300 more from water contaminated with E. coli. The absence of criteria governing quality of testing, and the lack of provisions made for notification of results to authorities contributed to the worst public health disaster involving municipal water in Canadian history.
  • Health care is a sector where there is huge pressure on government to control cost, particularly in Newfoundland and Labrador with the aging demographic. Private interests see great profit opportunities. But in health care, for-profit does not deliver. In Manitoba, living in a for-profit long-term care facility increased the odds of dying in hospital or being hospitalized.
  • In a metadata analysis of hospitals in the U.S., Dr. Philip Devereaux, a cardiologist at McMaster University, concluded that the death rate in for-profit hospitals was two per cent higher than in not-for-profit facilities. In Alberta, the Health Quality Council of Alberta's Long Term Care Family Experience Survey in 2012 found that, on average, private and volunteer operated facilities offered poorer quality in terms of staffing levels, care of residents' belongings, and assistance with daily living activities such as toileting, drinking and eating, than publicly operated ones.
  • The scathing Ontario auditor general report indicates that there needs to be extensive and comprehensive reviews of provincial privatization projects. Until proper cost-benefit analyses and public reviews and reform of private funding and procurement models occur, governments and public bodies should place moratoria on further public-private infrastructure contracts. The citizens pay either way, but they pay more in a privatized model - either as tax payers or out of pocket.
  • The government has alternatives. The Newfoundland and Labrador Federation of Labour has published a number of reports and fact sheets on the progressive revenue options open to the provincial government. There are a variety of progressive revenue options open to municipalities as well. There are no silver bullets. It is time to stop stigmatizing government and public services and recognize them for what they are: the way we pool our resources to buy services cheaper, control costs, and maintain accountability for quality.
  • his should be a debate based on evidence, not ideology. Mary Shortall, president, Unifor Local 597
Govind Rao

Private-public partnerships a misplaced fascination - Infomart - 0 views

www.fpinfomart.ca/...210311455

from heather p3 ontario fraud

shared by Govind Rao on 12 Dec 14 - No Cached
  • Waterloo Region Record Fri Dec 12 2014
  • Ontario's Liberal government has an almost pathological desire to involve the private sector in public business. When awarding contracts for new power plants, it has favoured private electricity firms over publicly owned Ontario Power Generation. It insists that large-scale public construction projects, such as hospitals, be handled by private firms paid from the public purse. It is anxious to contract out the delivery of public medicare services to private clinics. For a while, it even privatized regulation, giving industry groups the authority to charge consumers fees for handling electronic and other kinds of waste. In one notorious case, the Liberal government established an arm's-length public agency called Ornge to run the province's air ambulance service. Then, inexplicably, it allowed this agency to set up a web of privately owned, profit-making subsidiaries. Finally, someone has blown the whistle.
  • On Tuesday, provincial auditor general Bonnie Lysyk zeroed in on just one element of the pathology - the government's overweening urge to have private-sector firms design, fund, construct and manage public projects. The government refers to these as alternative financing and procurement schemes. It says they save taxpayers money. Do they? Lysyk looked at 74 public-private projects started since 2005 to answer that question. She found that, in total, they cost $8 billion more than if they had been built and managed by the government alone. In one telling example, she looked at the construction of two near-identical buildings for an unnamed Mississauga college. The first, handled by the public sector, was completed on time and on budget. Over the objection of both the college and then mayor Hazel McCallion, the government decreed that the second building be funded and handled by a private project manager. When the figures are adjusted for inflation and other variables, that second building is expected to cost taxpayers 10 per cent more per square foot. The reason is straightforward. Big projects are always built with borrowed money. And governments can borrow far more cheaply than private firms.
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  • Private project managers also tend to charge higher legal and management fees. As well, they must return profits to their owners. Aficionados of public-private partnerships insist that while all of this may be true, privately managed projects are far more likely to come in on time and under budget. That is the argument used by Infrastructure Ontario, the body charged with handling public-private deals. It says that if the 74 projects had been handled by the public sector, delays and overruns would have cost taxpayers - in net terms - about $6 billion more. It also says that publicly managed projects are five times more likely to come in over budget than privately managed ones. Is any of this true? Lysyk is not convinced. She points out that Infrastructure Ontario has no empirical evidence to back up its claims and instead bases them on the judgment of outside advisers who, her report says, make their case "anecdotally" and tend to cast publicly managed projects "in a negative light." She also notes that Infrastructure Ontario's initial cost estimates for public-private partnerships are systematically inflated. One result (which she is too polite to mention) is that private-public schemes usually appear to come in under budget. That makes everyone look good.
  • The Liberals may be the grand priests of private-public partnerships. But they are not the only ones to embrace this particular theology. In the 1990s, Bob Rae's New Democratic Party government famously arranged for a private consortium to finance, build and operate Highway 407, largely to avoid saddling the province with $1 billion more in debt. Yet in the end, the Rae government had to borrow the $1 billion itself - and then pass it on to the consortium. The private-sector partners just couldn't raise the cash as cheaply. Little has changed since then. On the face of it, public-private partnerships seem a good way to save money. In reality, as Lysyk has confirmed, they usually cost taxpayers more. Thomas Walkom is a news services columnist.
Govind Rao

How progressives can take back Canada - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20150510|220189979

from heather communications

shared by Govind Rao on 11 May 15 - No Cached
  • Toronto Star Sun May 10 2015
  • There is a basic cognitive science result I call "pre-conscious assimilation." Within a tenth of a second, incoming information - whether in language, vision, or touch - is unconsciously changed, often radically, to information that better fits what is already in your brain. In short, what you become conscious of often depends on what you already assume, not on external facts presented. Those brain structures are called "frames." If the facts don't fit your frames, the frames stay; the facts are ignored, belittled or attacked. The facts alone won't set you free. All words are defined relative to largely unconscious cognitive frames. Hearing a word activates and strengthens the frame.
  • If I say "Don't think of an elephant!" you will think of an elephant. Arguing against, or negating, frames just helps the other side. This is a key insight for politicians. All politics is about morality, about doing what you assume is right. Different policies follow from different notions of morality. When you speak your moral language, you strengthen your political frames. When you speak in the language of your opponents, regardless of what you say, you only strengthen theirs.
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  • Conservatives understand this. They are trained not to use progressive language, but to use conservative language and conservative frames. Conservative training institutes have, for decades, been educating tens of thousands of conservatives on how to think and talk conservative. That is how a conservative minority has come to rule Canada, overwhelming the progressive majority spread across three parties.
  • A prerequisite for bringing the parties together is unifying progressive thought and language, and training ordinary Canadians, who are overwhelmingly progressive, to understand the values that unite them across parties and issues, and to learn to express those values no matter which party you are in. Being a progressive is natural to Canadians. It means caring about others as well as taking care of yourself, and it means working through the government to provide public resources for all. Private business and private life depend on public resources - roads, bridges, sewers, an electric grid, satellite communication, public schools and research universities, public health and national health care, public safety, and on and on. The private depends on the public, both in business and private life.
  • This truth is the basis of what has traditionally been the best in Canadian life: kindness, warmth, hospitality, co-operation, community and what goes with all that, including public education, health care for all, a love of nature and care for the environment, a welcoming of immigrants, a respect for native peoples, an aversion to war. As an American, those were the values that I and other Americans associated with Canada. The centre has been empathy - caring and acting on that care.
  • Until Stephen Harper - and the American framing and communication industry that made him possible. Conservatives have a different understanding of morality and with it, democracy. Conservative morality means individual responsibility, not social responsibility. Every man his own authority, not depending on or accepting any responsibility for others. But conservatism means denying a central truth: that private life and business depend on public resources. Indeed, it means destroying public resources and maximizing private control and private gain.
  • It means putting public health in private hands, making everyone pay through the nose for maintaining their bodies. It means destroying unions. Unions are about freedom, freedom from corporate servitude and wage slavery, freedom from unsafe working conditions, and the freedom in later life that comes from fair pensions, which are delayed payments for work done earlier in life. It means destroying nature for private gain, not public benefit.
  • This is what we'll get as long as progressives focus their political efforts on fighting within conservative frames. For progressives to win, they must become aware of and state their deepest values, and they must bring back to life, through language, the values that made Canada Canada. That starts with saying the unsaid, what progressives know but don't utter: Working people are profit creators and as such, deserve a fair share of the profits - a living wage and safe, reasonable working conditions.
  • It means saying that corporations control our lives in thousands of ways - for their benefit, not ours, and with no accountability to an electorate. We need to point out that ensuring our food is safe and that our cosmetics don't cause cancer requires that we are able to constrain the power of private interests. After all, we might point out, the private depends on public resources so it really ought to better serve the public good. George Lakoff is a professor of cognitive science at the University of California and author of The All New Don't Think of an Elephant.
Irene Jansen

Medecins Québécois pour un Regime Public. Two-Tier Radiology: Quebec's Creep... - 2 views

www.mqrp.qc.ca

doctors quebec coalition ally private clinics

shared by Irene Jansen on 19 Nov 12 - No Cached
  • Irene Jansen on 19 Nov 12
     
    Our 2012 annual report is now available in English The report shows: "While it has more material and human resources, Quebec is less effective than Canada as a whole in providing accessible medical imaging services. The exclusion from public coverage of CAT scan, MRI and ultrasound tests performed outside a hospital leads to joint public-private practice that has the effect of draining resources from the public to the private sector. This damaging distortion leads to problems of access to medical imaging for most patients…"  The report documents the inequitable, inefficient, costly and potentially unsafe utilization of medical imaging technology in Quebec's unique and highly privatized system.  One aspect, the relatively effective use of technology in hospitals compared to private clinics (which would be better yet if the system were entirely public), is clearly not limited to Quebec: "According to a 2008 study by Bercovici and Bell of public hospitals and private clinics offering MRIs in several provinces, including Quebec, the rate of use of machines is about 50% higher in hospitals than in private clinics: an average of 14.7 hours of operation per day during the week and 11.8 hours per day on weekends for hospital machines, compared to 9.7 hours per day during the week and 8.2 hours per day on weekends for machines in clinics." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645224/ The recommendations are also valuable information. 
Irene Jansen

Healthcare Policy Vol. 7 No. 1 2011 Do Private Clinics or Expedited Fees Redu... - 0 views

www.longwoods.com/...22528

waits privatization private clinics wcb

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Discussion: An overall difference of approximately three work weeks in disability duration may have meaningful clinical and quality-of-life implications for injured workers. However, minimal differences in expedited surgical wait times by private clinics versus public hospitals, and small differences in return-to-work outcomes favouring the public hospital group, suggest that a future economic evaluation of workers' compensation policies related to surgical setting is warranted.
  • In 2004, for example, WorkSafeBC (the workers' compensation system in British Columbia) paid almost 375% more ($3,222) for an expedited knee surgery performed in a private clinic than for a non-expedited knee procedure in a public hospital ($859) (both fees represent the aggregation of facility, surgical and anaesthetists' fees)
    • Irene Jansen
      Irene Jansen on 23 Jan 12
       
      ownership and quality (for-profit = worse quality)
  • ...6 more annotations...
  • As a policy under the workers' compensation insurance system, expedited fees were effective in reducing wait time to surgery. While a difference of only two weeks may not improve longer-term clinical outcomes post-surgery, it represents a reduction in the total disability duration (i.e., pain, suffering, quality of life) for the injured worker and increases the worker's likelihood of successfully returning to work; the reduced disability duration also represents a cost saving to the workers' compensation system for time-loss benefits and to employers who pay compensation premiums based on the frequency and duration of their claims experience.
    • Irene Jansen
      Irene Jansen on 23 Jan 12
       
      See two paragraphs down, which suggests that expedited patients did not in fact return to work faster.
  • the provision of surgeries "after hours" or within private clinics may result in a redistribution of finite resources (e.g., surgeons, surgeon time, surgical staff) from one insurance provider to another, favouring those associated with higher fees, thus creating inequities. An evaluation of the effect of workers' compensation policies on inequity in the provincial healthcare system was not part of this study and warrants future investigation.
  • Despite surgery wait time differences, injured workers in the public hospital group tended to do slightly better in terms of time to return to work after surgery compared to workers in the private clinic group
  • . In this case, the improved outcomes were a shorter disability duration and earlier return to work for injured workers. Some might argue that the approximate one-week difference was not statistically significant and, as such, the provision of surgeries with private clinics "does no harm" within the context of the workers' compensation environment. Yet, as with expedited fees, it remains unclear whether the reliance on for-profit clinics increases capacity for surgeries with costs borne appropriately by employers and industries for work-related injuries, or whether they redistribute finite resources away from the provision of surgeries within the public healthcare system. Further, minimal differences in disability duration for patients treated by private clinics relative to those treated in public hospitals, given the added cost associated with surgeries performed in for-profit clinics, suggest that a future economic evaluation of this workers' compensation policy is warranted.
  • the time leading up to surgery may be confounded by co-morbidities and that individuals with complications may be directed to the public system
  • A difference of approximately two weeks in surgery wait time associated with the expedited fee policy may have meaningful clinical and quality-of-life implications for injured workers, in addition to being cost-effective policy for workers' compensation insurance systems, but did not affect the return-to-work time post-surgery as part of total disability duration. Minimal (and not statistically significant) differences in disability duration were observed for surgeries performed in private clinics versus public hospitals.
  • Irene Jansen on 23 Jan 12
     
    An overall difference of approximately three work weeks in disability duration may have meaningful clinical and quality-of-life implications for injured workers. However, minimal differences in expedited surgical wait times by private clinics versus public hospitals, and small differences in return-to-work outcomes favouring the public hospital group, suggest that a future economic evaluation of workers' compensation policies related to surgical setting is warranted.
Govind Rao

Private-public partnerships a misplaced fascination - Infomart - 0 views

www.fpinfomart.ca/...210197890

from heather p3 ontario

shared by Govind Rao on 11 Dec 14 - No Cached
  • Toronto Star Thu Dec 11 2014
  • Ontario's Liberal government has an almost pathological desire to involve the private sector in public business. When awarding contracts for new power plants, it has favoured private electricity firms over publicly-owned Ontario Power Generation. It insists that large-scale public construction projects, such as hospitals, be handled by private firms paid from the public purse. It is anxious to contract out the delivery of public medicare services to private clinics. For a while, it even privatized regulation, giving industry groups the authority to charge consumers fees for handling electronic and other kinds of waste.
  • In one notorious case, the Liberal government established an arm's-length public agency called ORNGE to run the province's air ambulance service. Then, inexplicably, it allowed this agency to set up a web of privately owned, profit-making subsidiaries. Finally, someone has blown the whistle. On Tuesday, provincial auditor general Bonnie Lysyk zeroed in on just one element of the pathology - the government's overweening urge to have private-sector firms design, fund, construct and manage public projects. The government refers to these as alternative financing and procurement schemes. It says they save taxpayers money.
  • ...3 more annotations...
  • Do they? Lysyk looked at 74 public-private projects started since 2005 to answer that question. She found that, in total, they cost $8 billion more than if they had been built and managed by the government alone. In one telling example, she looked at the construction of two near-identical buildings for an unnamed Mississauga college. The first, handled by the public sector, was completed on time and on-budget. Over the objection of the both the college and then mayor Hazel McCallion, the government decreed that the second building be funded and handled by a private project manager. When the figures are adjusted for inflation and other variables, that second building is expected to cost taxpayers 10 per cent more per square foot. The reason is straightforward. Big projects are always built with borrowed money. And governments can borrow far more cheaply than private firms.
  • Private project managers also tend to charge higher legal and management fees. As well, they must return profits to their owners. Aficionados of public-private partnerships insist that while all of this may be true, privately managed projects are far more likely to come in on time and under budget. That is the argument used by Infrastructure Ontario, the body charged with handling public-private deals. It says that if the 74 projects had been handled by the public sector, delays and overruns would have cost taxpayers - in net terms - about $6 billion more. It also says that publicly managed projects are five times more likely to come in over budget than privately managed ones.
  • Thomas Walkom's column appears Wednesday, Thursday and Saturday.
Govind Rao

Shift continuing care to public sector; For-profit facilities do an inferior job, write... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|edjn|20151209|235447866

from heather continuing care ltc Alberta privatization quality

shared by Govind Rao on 09 Dec 15 - No Cached
  • Edmonton Journal Wed Dec 9 2015
  • Alberta's continuing care facilities have a patchwork of ownership models. While these facilities are all funded by public money, they are owned and operated either publicly, through Alberta Health Services and its subsidiaries (CapitalCare in Edmonton and Carewest in Calgary), or privately, by both non-profit organizations and for-profit corporations. There are issues that exist regardless of who the provider is: staffing levels are not meeting the needs of patients and continuing care is chronically underfunded in Alberta. However, fixing only those issues ignores the bigger picture.
  • Evidence provided by the 2013 Parkland Institute report From Bad to Worse shows that Alberta's publicly owned long-term care facilities are "significantly better than for-profit facilities" for hours of care they provide to each facility resident. This should not come as a surprise, since the primary responsibility of a for-profit corporation is to ensure adequate shareholder return on investment. These facilities are funded by government dollars, and information made public last year shows corporations expecting to make an average profit level of 27 per cent, or $5,500 per bed, per year. That money would be better spent on care for Albertans instead of being pocketed by shareholders.
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  • A large portion of those profits are possible because of unregulated "hospitality" fees, and an operational funding model that does not require government funds for front-line staffto actually go toward staffpay. No regulation exists for staff-to-patient ratios or to ensure patient and family councils are welcomed at each facility. Contracts between these providers and the government are confidential, meaning Albertans do not have the right to know how much public money is being doled out or what the terms of the contract are, and whether or not care is the No. 1 priority in these arrangements. This "wild west" model of continuing care providers was set up by the previous PC government, but it remains in place under the NDP government. However, there is hope positive change is coming. While the PC government significantly expanded the role of for-profit corporations in continuing care, the new government has taken a different position. Responding to promises from the previous government to open new care beds in Alberta, on Nov. 19, 2014, then-opposition leader Rachel Notley said in the legislature, "We don't argue with the need for more spaces for seniors; we do think that they should be publicly funded, publicly delivered."
  • In the same spirit, the NDP's election platform promised to open 2,000 public long-term care beds and "end the PCs' costly experiments in privatization, and redirect the funds to publicly delivered services." The previous government not only stopped building new public beds, but also unnecessarily closed hundreds of functional public long-term care beds and often funded the construction of replacement beds owned by for-profit corporations. Some of the closed facilities are currently empty and could still be reopened for public use.
  • In light of the problems the previous government created by funding private, for-profit care, the new government should begin by standardizing and limiting fees charged to residents, disclosing the amounts these corporations are being given and spending on direct care and how much of the public money is going to their shareholders, and setting standards for staff-topatient ratios. The most meaningful sign the new government can send would be to make good on their promise to open 2,000 public long-term care spaces, where profit is not a factor and care is the No. 1 priority. Fulfilling that promise should be the government's first step to phasing out private, for-profit continuing care. Our public health care dollars should not be given to corporate shareholders; it should be spent on care for Albertans. Private, for-profit care facilities are no more acceptable than Ralph Klein's short-lived private, for-profit hospitals. Noel Somerville is the chair of Public Interest Alberta's Seniors Task Force. Sandra Azocar is the executive director of Friends of Medicare.
Govind Rao

Economic inequality is bad for our health - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20150426|219226356

from heather determinants poverty

shared by Govind Rao on 28 Apr 15 - No Cached
  • Toronto Star Sun Apr 26 2015
  • The powerful relationship between poverty and health has been documented for nearly two centuries. We have long known that a person's economic position is the strongest predictor of their health status. Being poor means dying sooner and dying sicker. A Toronto Public Health report released earlier this week concludes that poverty is literally imprinting itself on the lives of Torontonians. The findings presented in the report are grim. Over the past decade, health inequalities between the rich and the poor have persisted. In some cases, they have grown wider. Opportunities to be healthy in Toronto remain as unequally distributed as ever. The report rightfully attributes these inequalities to the social determinants of health - a diverse range of factors including income, education, employment and housing.
  • We live in a divided city and the deepening of economic cleavages has become a defining feature of our civic landscape. Income inequality is on the rise. Housing is becoming less affordable. Neighbourhoods are becoming more polarized. And the cost of living has far outpaced individual earnings. In Toronto, as elsewhere, the social determinants of health have suffered significant decline. As the report makes clear, the poorest among our city's residents have borne the greatest part of this burden. These trends have affected the health of the poor in countless ways. They have constrained access to quality health care. They have increased susceptibility to harmful behaviours, such as smoking. They have compromised the adequacy and stability of housing conditions. They have restricted access to nutritious foods. They have heightened exposures to daily stress and adversity that get under our skin and harm not only our minds but our bodies as well. In fact, research has shown that economic conditions underlie almost every pathway leading to almost every health outcome.
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  • oronto has made little progress in the fight against poverty over the last decade and thus it's to be expected that health inequality remains stark. We find little fault in the actions of Toronto Public Health. Rather, as the science makes clear, the true guardians of our health are the policy-makers that determine whether all Torontonians - and all Canadians, more generally - are able to keep up with the costs of everyday life. What can we do? We can create widespread recognition that when our governments fail to redress inequalities, they undermine the health of our society. We can engage in civic and political action to help pass public policies that reduce the economic distance between the rich and the poor. We can also support organizations that advocate on behalf of these policies, including Toronto Public Health and the labour unions that protect the conditions of low-wage workers.
  • So it shouldn't come as a surprise that, despite a decade of public programs intended to promote health equity, the health status of the poorest Torontonians hasn't improved. In fact, this was entirely predictable. At the heart of the issue are two important insights provided by our best available science. First, public health programs that are designed to encourage people to alter their lifestyles and behaviours simply do not address the myriad other associations between economic position and health status. Attempts to address any one problem do little to fundamentally interrupt the overall correlation. Second, because public health programs do not address the "causes of the causes," they are incapable of stemming the tide of new individuals that develop poor health-related behaviours. No sooner has one cohort been exposed to a health-promotion program than another is ready and waiting.
  • Health inequalities are one of the most formidable public health problems of our time. The science strongly supports Toronto Public Health's insights that public health programs are wholly insufficient to alleviate their burden. The solution lies in tackling the unequal distribution of resources that has become a defining feature of our city and our society at large. Arjumand Siddiqi is assistant professor and Faraz Vahid Shahidi is a doctoral student at the Dalla Lana School of Public Health, University of Toronto. Correspondence should be sent to Ms. Siddiqi at: aa.siddiqi@utoronto.ca
Govind Rao

Province enlists private surgery clinics; $10M plan for up to 1,000 procedures takes ai... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|vasn|20150602|221789192

from heather bc private clinics privatization

shared by Govind Rao on 02 Jun 15 - No Cached
  • Vancouver Sun Tue Jun 2 2015
  • "The use of private surgical clinics within the publiclypaid and publicly-administered health care system has always been an important part of the system," he said. Of the 541,885 publicly-funded surgeries in 2013, 14, 5,503 were done in private facilities using public money. The Vancouver Island Health Authority is seeking private clinics to conduct 55,000 day surgeries over five years to ease the pressure on hospital operating rooms.
  • Vancouver Coastal Health said it expects to fund 350 additional surgeries, including day surgeries conducted in leased private operating rooms. Fraser Health said it would provide 500 extra procedures over the summer. "About one per cent of the surgeries done in British Columbia are actually done in private clinics but paid for publicly," said Lake, who described an "unprecedented demand" and unacceptable waiting times facing the public system. "We want to see if we can optimize that. I think patients want to have their surgeries done. If the quality is there, and it reduces wait lists and is paid for and administered by the public system, I think British Columbians would agree with that approach."
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  • The announcement comes as the provincial government prepares to defend itself in a lawsuit filed by Brian Day, an orthopedic surgeon, co-owner of the Cambie Surgery Centre and 2016 presidential candidate for Doctors of B.C. Day contends in his suit that patients should have the constitutional right to pay for care in private clinics if waits in the public system are too long.
  • "I think this is a good initiative. I think it's, in a way, brave of the government to do this when it's involved in a lawsuit," said Day. He said the province's announcement did not put it in an awkward position going into the court case, given that "contracting out has been going on for years," but it showed that the public sector is stressed to the point that it cannot handle the workload. "Obviously I support what the government's doing here, but I think there's a touch of hypocrisy going on when they're involved in a lawsuit where they claim that wait lists are not the fault of the hospitals or themselves but the fault of the doctors," Day said. "There are two wait lists.
  • There are the patients waiting for surgery. Then there are the surgeons waiting to be able to do the surgery. ... The surgeons are waiting because they can't get operating time." Day's lawsuit is expected to last seven months and is tentatively scheduled in the B.C. Supreme Court at the end of the year. Under current laws, private clinics are not supposed to collect money from patients if the treatment is an insured service in the public system. Lake said B.C. remains fully against a two-tier health system, but the government has used private clinics in the past and considers many of its physicians to be private health care contractors.
  • B.C. is turning to private clinics to help ease a massive backlog of surgeries, even as it prepares to fight a court battle against private medicine. Health Minister Terry Lake announced $10 million on Monday to push through common surgical procedures - orthopedics, hernias, cataracts, gall bladder, plastic surgery, and ear, nose and throat procedures - for those waiting more than 40 weeks. The extra money will be used to conduct up to 1,000 new surgeries, some of which will be done in private clinics when there are no available operating rooms in public hospitals.
  • A Health Ministry official said the "cost of doing procedures in a private surgical facility is generally comparable to what it would have cost to do them in a public health care facility" but could not offer a specific comparison. There were almost 72,000 adults waiting for surgery in B.C. at the end of April. Approximately 90 per cent of patients receive surgeries within 33 weeks, according to a government website.
  • The reality is we're still struggling with wait times despite a huge increase in the number of surgeries that we are performing each and every year," said Lake. NDP critic Judy Darcy chastised the government for turning to private clinics when underfunding has left some hospital surgical rooms empty. The government estimates 82 per cent of its 295 operating rooms are fully operational, with the rest unused due to financial or staffing shortages.
  • "It's a very small Band-Aid on a very big problem," said Darcy. "It's yet another short-term fix that shifts services to private clinics rather than addressing the serious problems in the public system." If the province properly funded the public operating rooms it could help retain staff and have a better long-term impact on waiting times than short-term contracts with the private sector, she said.
  • Darcy also accused government of "talking out of both sides of its mouth" by relying on public surgical suites to knock down waiting times while at the same time fighting against them in court. Lake said the $10 million will also be used to "optimize the booking system" for surgeries, which could mean sending a patient to a hospital outside their home city if it has extra capacity in an operating room.
  • He also suggested B.C. could move to a "first available surgeon model" where patients are referred to whoever can conduct the surgery quickest rather than to a preferred surgeon. The government will announce further ways it intends to increase surgical capacity later this year. rshaw@vancouversun.com mrobinson@vancouversun.com
Govind Rao

Time to speak up on health services - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|brrt|20150520|220833984

from heather Ontario coalition campaign cuts

shared by Govind Rao on 20 May 15 - No Cached
  • Brockville Recorder and Times Wed May 20 2015
  • Since fears for the future of Brockville General Hospital's maternity ward became public in February, there has been a consistent chorus of voices calling on the public to "speak up" for local health care. Now, with three consecutive meetings dedicated to the future of local or regional health services, local residents cannot argue they did not have a chance to be heard. There has been plenty of speaking up already, in the form of social media advocacy and a rally in front of BGH by the Canadian Union of Public Employees (CUPE) in April.
  • If it's more advocacy-driven events one seeks, there is always the Ontario Health Coalition's "Public Meeting to Save Our Hospital Services," scheduled for Thursday, May 28, at 7 p.m. at the Brockville Convention Centre. However, it would be wrong to underestimate the importance of the public meetings organized by local health care institutions. On Tuesday, the South East Local Health Integration Network (LHIN) held a public open house seeking input on the future of regional health services. The event drew many people already involved with BGH and its operations, in particular hospital board members, as well as members of the broader general public. Not counting those already in the sector, organizers say, the four-hour event drew 38 people. Their input will contribute toward the development of a health care plan for the broader region of Southeastern Ontario.
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  • It would have been more productive, however, had more members of the general public attended. People who did not attend can still answer a survey online, through May 29, at www.surveymonkey.com/s/healthcaretomorrow. BGH officials at the event were eager to remind people that another open house, this one specific to the future of the local hospital, is scheduled for Tuesday, June 2, from 5 p.m. to 8 p.m. at the 1000 Islands Mall. The June 2 meeting will give the public a chance to hear directly from BGH officials about the challenges the hospital faces as it tries to address a $1.9-million shortfall. BGH officials have pledged to listen to the public on how it will deal with that shortfall. They have also promised that, while service delivery may be changed as efficiencies are sought, the services themselves will not be reduced. This is an important opportunity -one of many, we hope -to show them the public is watching. This is not a meeting to skip. @RipNTearRon on Twitter
Govind Rao

Closing hospital cafeterias won't accomplish much - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|frdg|20151127|234591166

from heather NB hospital food cuts

shared by Govind Rao on 27 Nov 15 - No Cached
  • The Daily Gleaner (Fredericton) Fri Nov 27 2015
  • Last week, the Horizon Health Network announced that it was closing some hospital cafeterias and substantially reducing the hours of others. This change is meant to save the health network some of the money that it currently spends on the cafeterias, but it will only save the health network a tiny amount of money, while imposing a real cost on vulnerable New Brunswickers, most notably those who are ill in hospital and their families, as well as the staff that makes hospitals run efficiently and provides the public services that are delivered in hospitals. In the greater scheme of things, this decision will have no real impact on New Brunswick's fiscal health but it will hurt those New Brunswickers who need the service in a very tangible way.
  • If Horizon Health is going to treat food service as a commercial operation and not treat it as a public service, then it should go all the way and privatize food service operations in New Brunswick's hospitals. In doing so, though, the health network needs to realize that food service in hospitals has to be accessible for a wide range of hours; it should be a requirement of any contracts signed with private food service providers that the privatized cafeterias remain open and serve food, at a minimum, from 8 a.m. to 8 p.m., or maybe even require them to remain open 24 hours a day. As well, privatizing the food service operations in our hospitals risks having our workforce lose good, unionized jobs, at a time when good jobs are hard to find in New Brunswick; doing so should thus only happen after a serious public debate
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  • The reality is that, when a loved one is in hospital, you cannot schedule your meals at normal hours. You need access to nutritious food, not to mention to the relief from the stress of sitting by the bedside of a loved one who is ill, whenever it is convenient, for example when your ill loved one is being looked after by the medical staff or when they drift off to sleep. It is therefore an important public service to provide the members of the public who have to make use of the hospital with access to good, nutritious food beyond the normal hours when the rest of us have breakfast, lunch, and dinner. These cafeterias are not really "commercial operations" but part of the public service of a hospital; as CUPE local President Norma Robinson pointed out, nutritious food is a necessary part of a patient's recovery. It is also a necessary part of a patient's family members' continuing health.
  • Alternatively, maybe the smart thing for Horizon Health to do is to accept that food service is part of the public service that our hospitals provide and therefore get on with providing food services to those who use our hospitals as a public service, not as "commercial operations." This means that the health network needs to accept that providing adequate food services, including by investing in new equipment and putting the cafeterias in better locations to increase visitorship, will cost the health network money. The harsh truth is that trying to balance Horizon Health's and the provincial government's books by reducing the hours of cafeterias that, in total, are losing $350,000 a year is the public finance equivalent of trying to get rich by looking for loose change behind your couch cushions.
  • If the government of New Brunswick wants to have the health care system contribute to reduced government expenditures and a balanced provincial budget, reducing the hours of hospital cafeterias is simply a side-show; it will have no meaningful effect on the provincial budget. If the provincial government wants to reduce expenditures on the health care system in a meaningful way, it and the health networks should engage in real health care reform.
  • As part of these reforms, they should either close or downgrade a number of hospitals to basic health care and triage centres and build the health-care system around a few full-service, high-quality regional hospitals. If the evidence of other provinces that had a plethora of small rural hospitals but rationalized their health care service delivery as part of a health care reform agenda is anything to go by, these reforms will also have valuable side-effect of providing New Brunswickers with better health care and making them healthier. As well as not saving any significant amount of public money, closing cafeterias in hospitals or substantially reducing their hours, on the other hand, will not do anything to make people healthier, either. If it cannot make a serious contribution to either public sector cost containment or health reform and will harm people in the process, why do it?
  • an Peach has worked in senior positions in federal, provincial, and territorial governments and at universities across Canada; he also served as vice-president, Policy for the New Brunswick NDP between 2012-15. His expertise is in constitutional law, federalism and intergovernmental relations, Aboriginal law and policy, and the policy-making process.
Govind Rao

Contracting out of surgical preparation and delivery - 2 views

www.ochu.on.ca/contracting_out.php

from heather cupe ontario hospital private clinics privatization

shared by Govind Rao on 24 Nov 14 - No Cached
  • Contracting Out Hospital Work to Private Clinics – Backgrounder For years CUPE has been concerned the Ontario government would transfer public hospital surgeries and diagnostic tests to private clinics. CUPE began campaigning in earnest against this possibility some years ago with a tour of the province by British Health Secretary Frank Dobson who talked about the disastrous British experience with private surgical clinics.Unfortunately, the provincial Liberal government has now moved in this direction. The door opened a few years ago with the introduction of fee for service hospital funding (sometimes called Activities Based Funding). Then in the fall of 2013 the government announced regulatory changes to facilitate this privatization, with the government finally announcing Request for Proposals for the summer of 2014.
  • Hospitals are the main focus of the government’s health care cuts. They do not see community hospitals as providing a broad range of services to the local ... [Read More]population, but instead wish to remove an untold range of services from local hospitals and transfer them to specialized private clinics. The proposal would remove the most lucrative, high volume and easiest procedures from community hospitals. The remaining community hospitals would be left with the most difficult services. If they chose to compete with the private clinics, they would have to specialize in a narrow range of services. The government’s plan is the opposite of one-stop, integrated public health care. This proposed privatization of surgeries and diagnostic tests is in addition to the aggressive attempts to remove non-acute care services from hospitals (e.g. outpatient clinics, complex continuing care, rehabilitation, long-term care, primary care, etc.). As acute care currently accounts for only about 1/3 of current hospital funding, these attacks are a grave threat to the viability of community hospitals, and in fact we are now seeing a wave of hospital shut-downs that is somewhat reminiscent of the Mike Harris era. Despite the government’s rhetoric about keeping care non-profit, services that are being cut from local hospitals now are being privatized to for-profit owned corporations. Even if the private clinics did start out as non-profit (which has not been the case so far) the whole system of private clinics could be privatized with a stroke of a pen.
  • Ontario Health Care Privatization: The push for health care privatization in Ontario picked up in 2001 when Ontario Health Minister Tony Clement announced two privatized P3 hospital projects, the Royal Ottawa and the Brampton Civic (part of William Osler Health Centre). Spirited community-based campaigns, including P3 plebiscites in many towns, forced the Liberal government to greatly narrow the scope of the privatization of support jobs (i.e. CUPE jobs) in subsequent P3 hospitals. Nevertheless privatization of the hospital financing continues, despite revelations by the provincial Auditor General that confirmed claims by CUPE and others that the Osler project cost hundreds of millions more due to the P3.
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  • MRI and CT Clinics: The PC government also tried to set up private MRI and CT clinics outside of hospitals. Community/labour campaigns however were able to stop this. A key factor was that, to increase their revenue, the private clinics were allowed to bill private patients for a certain number of hours each week (with the rest of the week dedicated to patients paid for by the public system). As the public insurance system must pay for all ‘medically necessary’ hospital services, the government was left to try to explain why any reputable clinic would allow patients to subject themselves to such tests for medically unnecessary reasons. Since this episode, private clinics have been in the news – but mostly for the wrong reasons. Private surgical and diagnostic clinics: Initially, the government let the emerging industry slip entirely free of public reporting and oversight. However, after the September 2007 death of Krista Stryland, a young mother who underwent liposuction at a Toronto cosmetic clinic, the government required the industry to face some modest oversight in 2010. Unfortunately this was not by a public authority, but through self-regulation by the doctors (even though the doctors themselves had lobbied to expand this private industry).
  • Then in the fall of 2011, following disclosure that 6,800 patients would have to be notified that faulty infection control procedures at a private clinic could have exposed them to HIV or hepatitis, the then Health Minister, Deb Matthews, declined to introduce oversight by a public authority, despite public pressure. Instead she comments, “Government can’t do everything. A professional (regulating body) like the College of Physicians and Surgeons, they take responsibility for their members....At this point I am delighted the College is taking that responsibility seriously and has found a problem that we need to fix.” Eventually the College of Physicians and Surgeons released a report on the private clinics that mentions that some 29% of the private clinics fall short in some way – but the College would not indicate which ones – or how they fell short. This caused public uproar, with the Toronto Star playing a leading role (as it would continue to do). Again, the government promised improvements. In the last two months however, the Star has followed up and revealed (after our urging) that the public reports from the College of Physicians and Surgeons fall far short. They also ran a series of often front page stories on serious quality problems at private clinics.
Govind Rao

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

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

from heather privatization medicare poverty ally

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

National pharmacare plan not the answer; Quebec model is the one to follow writes, Yani... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|otct|20150819|227385877

from heather pharmacare

shared by Govind Rao on 19 Aug 15 - No Cached
  • Ottawa Citizen Wed Aug 19 2015
  • Many of those calling for a pan-Canadian pharmacare monopoly undoubtedly have the best of intentions. They want all Canadians to have access to the drugs they need, regardless of ability to pay, and they want to control costs. But good intentions do not guarantee good results - and in this particular case, international experience has much to teach us about the dangers of monopolistic drug insurance plans. Under Canada's current mixed public-private system, administered by the provinces, 42 per cent of prescription drug spending in the country is paid for by public insurance plans. The rest is funded privately, either out-of-pocket by patients themselves (22 per cent), or through private insurance plans (36 per cent). In every province, low-income seniors and children, welfare recipients, and people suffering from certain serious illnesses enjoy complete or nearly complete coverage. In all, about 98 per cent of the Canadian population has private or public drug insurance coverage.
  • It's true that some people report having to forgo requesting a prescription or skip a dose for reasons of cost. In a recent Commonwealth Fund study, 8 per cent of Canadians with belowaverage incomes said they had not taken a drug because of cost. But this phenomenon is hardly unique to Canada. Indeed, the same study found that this percentage was 11 per cent in France, 14 per cent in Australia, and 18 per cent in New Zealand. What explains these findings is the fact that the public insurance plans in place in other OECD countries, even those that are universal, don't cover pharmaceutical expenses in their entirety. A sensible portion of costs are paid by the insured - and generally a larger portion than in Canada.
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  • Rather than moving toward a countrywide public monopoly, Canada's provinces should follow the lead of Quebec, which in 1997 implemented a reform that made drug insurance coverage in the province universal, but that relies on a range of insurers, public and private. The costs of the Quebec system have risen since its implementation, but this is largely because Quebec has resisted the temptation to ration access to innovative drugs. Indeed, among Canadian provinces, Quebec provides the most generous coverage by far. Whereas on average 23 per cent of all drugs approved by Health Canada between 2004 and 2012 were reimbursable by Canada's provincial public plans as of December 2013, the proportion in Quebec was 38 per cent.
  • A national plan, it is argued, would provide the public insurer with greater negotiating power, allowing it to obtain price concessions from pharmaceutical companies. But the savings would largely come from increased rationing rather than from greater efficiency. In the United Kingdom, there has been one policy after another since the 1990s aimed at controlling spending. Patients continue to suffer the consequences of a lack of access to many proven drugs. Likely as a result of such restrictions, despite screening rates that are among the highest in the world, English patients have lower survival rates for various cancers than most other industrialized countries. In New Zealand, another country frequently held up as a model, patients' access to innovative drugs is just as restricted, if not more so. Of all the drugs approved in the country from 2009 to 2014, barely 13 per cent were reimbursable by the public insurance plan, the worst result among 20 countries evaluated.
  • It is also important to note that while Quebec spends more on drugs, this goes hand in hand with lower overall costs in the public health care system compared to other provinces, as more accessible pharmaceutical therapies have likely replaced other kinds of more expensive medical care, like hospital surgeries. Quebec's mixed universal plan is not perfect, but it does provide coverage to all residents. And only 4.4 per cent of Quebecers say they had to forgo taking their medicines or skip a dose for financial reasons - less than the residents of all other Canadian provinces, and less than the residents of many other countries, too. If one is concerned with universal access to the latest drugs, that's a far better model to follow. Yanick Labrie is an economist at the Montreal Economic Institute (www.iedm.org)
Govind Rao

Funds should be better invested in Canada's public health care system - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|bcvi|20150915|229391583

from heather bc privatization private clinics

shared by Govind Rao on 16 Sep 15 - No Cached
  • Campbell River Mirror Tue Sep 15 2015
  • Our provincial government is seeking to change the BC Health Act to permit patient stays of up to three nights in private, for profit, surgery clinics so their plan into the future is to embrace private, for profit, surgery clinics. In the provincial government's own report it states the reason why our public hospital operating rooms sit idle quite often is due to lack of funding. The government and Island Health think it is okay to contract out these surgeries because the surgeries are still being publicly funded but our taxpayer dollars will be spending more for the profit margin.
  • It is extremely concerning that our provincial government is contracting up to 55,000 surgeries to a private, for profit, surgery clinic which is yet to be built. If this company is locating in Victoria they must have received assurance for long term commitments to enable them to locate there permanently. Surgical Centres Ltd. is "based" in Calgary, they have two private, for profit, surgery clinics in Calgary, two in B.C., two in Saskatchewan. Are the owners American?
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  • Dr. Brendon Carr (president and CEO of Island Health) when asked at the Island Health Board meeting here in June stated that there will be a premium in cost for the surgeries at the private clinic. We know private, for profit, health care is more expensive. He said they have the information and would provide it, but when I wrote and asked what the difference in cost for the taxpayers between surgeries in public or private, for profit, operating rooms, Mr. Peters declined to answer the question.
  • It is extremely concerning that our provincial government is contracting up to 55,000 surgeries to a private surgery clinic Re: Deal with private contractor could reduce surgery wait times - J.R. Rardon. The above noted article was in the Aug. 26, Campbell River Mirror. Reading the headline I have to ask "but at what cost?"
  • I pointed out to Dr. Carr that we have a shortage of doctors in Canada and he agreed. He said it would be the same doctors doing the surgeries in the private, for profit, surgery clinics. I asked how they can usurp our doctors into the private system without straining our public system more. He just said they will be watching it. That doesn't bode well for our public operating rooms. I fear that our provincial government is seriously undermining our position in defending the Dr. Brian Day court case on behalf of all British Columbians. At the very least it looks like a huge conflict of interest when they are seeking to contract an enormous number of surgeries to private clinics.
  • Our provincial and federal governments seem determined to starve the public health care system in favour of private, for profit, health care. They have let the surgery wait lists increase substantially. Our federal government refused to renegotiate the Canada Health Accord and brought in a new funding formula. They are telling us they are "increasing"  funding of the transfer payments to the provinces by three per cent, tied to the cost of living. Currently they are paying six per cent annually so this actually is a massive cut to the provinces for public health care in the amount of $36 billion over the next 10 years. With the federal government's cuts to health care funding, the share of federal CHT cash payments in provincial-territorial health spending will decrease substantially from 20.4 per cent in 2010-11 to less than 12 per cent over the next 25 years. This, according to the Parliamentary Budget Office, will bring the level of federal cash support for health care to historical lows. National Medicare was implemented across Canada by provinces and territories on the understanding that the federal government would contribute roughly 50 percent of the spending on Medicare.
  • Canadians are vehemently opposed to private health care whether it is using our public tax dollars or not. Canadians should not have to suffer and wait a long time for surgery. Funds would be far better invested in the public health care system which is being starved by our governments. It is very difficult for Canadians to see our medicare in serious jeopardy. The Canadian Medical Assoc., Canadian Doctors for Medicare, Canadian Health Coalition, Council of Canadians, B.C. Health Coalition, HEU, CUPE, Citizens for Quality Health Care and many others are united to protect, strengthen and expand our public health care. Please check out their websites and get more information. Please vote in the next two elections and vote for health care for the benefit of all Canadians. Lois Jarvis Citizens for Quality Health Care Campbell River
Govind Rao

Civil servants need fair wages - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246200|ntnp|20150219|214799993

from heather cupe wages

shared by Govind Rao on 20 Feb 15 - No Cached
  • National Post Thu Feb 19 2015
  • Re: "Fat public sector paycheques," Charles Lammam and Niels Veldhuis, Feb. 18 Funded by right-wing corporate interests, the Fraser Institute's latest in a series of distorted studies on public sector compensation only aims to spur animosity between Canadian workers. This is a troubling distraction from the real issues of income inequality.
  • CUPE's own study, B attle of the Wages, shows a small overall premium for public sector workers - less than two percent - when comparing workers in similar occupations. But this is entirely due to a smaller pay gap for women in the public sector than in the private sector. The Canadian Centre for Policy Alternative's own analysis, Narrowing the Gap, shows that higher public sector wages are attributed to higher wages for workers most discriminated against in the private sector. This analysis shows women, radicalized and Aboriginal workers are the ones seeing higher, and much fairer, wages in the public sector.
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  • Driving down the compensation of public sector workers won't address the growing income inequality gap between working people and the richest Canadians. We need real action that will help all Canadian workers - public and private sector alike. Affordable and accessible child care, strengthened public health care, an expanded Canada Pension Plan that will give millions of Canadians a secure retirement income, and building an economy that is based on good jobs with fair wages for all.
  • Paul Moist, National President, Canadian Union of Public Employees
Govind Rao

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

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

from heather mental health privatization

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

Liberals' silence on health funding shows they can't be trusted with our cherished publ... - 0 views

cupe.ca/shed-public-health-care-system

from heather cupe federal election accord

shared by Govind Rao on 06 Oct 15 - No Cached
  • The release of the Liberal platform last weekend makes it clear that they have no plan for one of Canadians’ top issues: public health care. The words ‘health care’ do not appear in the plan. There is no mention of a national prescription drug program. There is nothing on the expansion of federal funding for public home care and long-term care.
  • But two the two most disturbing elements of the plan for Canadians should be its total silence on restoring the $36 billion in cuts Harper has made to federal health care transfers over 10 years; and the Liberals’ stated intention to find $6.5 billion of ‘efficiencies’ in years three and four of their first mandate to bring their deficit-spending plan back to balance.
  • This is particularly worrisome when we think back to the Liberals’ actions the last time they set their sights on balancing the budget, during the 1990s. Paul Martin’s cuts to health care federal transfers by nearly 50 per cent in the five years starting in 1993-94 were devastating. This meant federal health care transfers relative to provincial-territorial spending fell below 10 per cent.
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  • The health care system was in crisis. It took nearly 15 years of incremental increases to bring the federal portion of health funding back to the level is was at before Paul Martin took his axe to it. Going through an exercise like that again would be devastating for the health services that Canadians depend on each and every day.
  • Adding fuel to the speculation that the Liberals are planning massive cuts to health funding is Trudeau’s September 2nd letter to the Council of the Federation that makes no firm commitments to health care or federal transfers. The only firm commitment was to improve the federal-provincial relationship. That’s pretty thin gruel considering the state of that relationship after 10 years of Stephen Harper!
  • All Canadians who are concerned with the future of health care in this country need to scratch below Trudeau’s soothing words and take a look at his hard numbers. When you break down their plan, 77 per cent of the value of their “new investments” are tax shifts and benefits (including others not listed under that category), 12 per cent is the catch-all of ‘infrastructure’ spending (though most Canadians don’t think of early learning and cultural facilities as ‘infrastructure’), and five per cent is EI (paid for through EI premiums).
  • That leaves only six per cent, or a little over two billion a year for everything else. How much of that available funding will go to public home care and long-term care? How much will go to the provinces for new hospital beds after years of cuts? On reading the Liberal plan, we have to conclude: not a penny.
  • Their plan also targets $6.5 billion in spending reductions from an expenditure review. Will health care be on the table for cuts, if they can’t meet that ambitious target? John McCallum said on Saturday that in the effort to balance their books before the next election, ‘everything was on the table.’ Contrast this with Tom Mulcair’s plan for health care under a federal NDP government, and the stark choice is brought in to focus. 
  • Mulcair has committed to reversing Harper’s $36 billion in health care transfer cuts to the provinces.  He has committed to investing $5.4 billion into new public health care programs, including a prescription drugs, a plan for 41,000 home care and 5,000 long-term care spots. Over five million more Canadians will have access to primary health care through his plan to build 200 Community Health Clinics. And there are practical policy initiatives on mental health for youth, Alzheimer’s and dementia care.
  • Canadians cherish their universal Medicare system as one of the things that makes Canada great. They want a federal government that will commit the necessary funding and leadership to build the public health care system of our collective futures, to meet the challenges of an aging population and increasing drug costs. The next party to lead the federal government should be judged by the real dollars and focused policy it has committed to meet Canadians’ health care needs.
  • On that measure, the Liberal plan is dead on arrival. Paul Moist is national president of the Canadian Union of Public Employees. Representing over 633,000 members, including over 153,000 working in the health care sector, it is Canada’s largest union.
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