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Govind Rao

Barrette sparks unrest; Health minister's reform plans panned by many - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|mtgz|20150107|211920693

from heather Quebec cuts reforms legislation

shared by Govind Rao on 07 Jan 15 - No Cached
  • Montreal Gazette Wed Jan 7 2015
  • But Dr. Gaétan Barrette, Quebec's health minister since April, seems to thrive offthe criticism as he pushes ahead with major reforms to the province's health-care system.
  • The big question, though, is whether the minister has the support of the public and the medical community to accomplish those reforms - already dubbed "la révolution Barrette" - when the National Assembly reconvenes on Feb. 10.
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  • "I'm here to listen to the province's eight million people, not the 8,000" general practitioners, Barrette told reporters on Nov. 28, the day he made public one of his more controversial proposals - threatening doctors with penalties of up to 30 per cent of their income if they don't see more patients.
  • Most people who observe the health-care system would say something had to give, something needed to be done," said Antonia Maioni, a professor in McGill University's Institute for Health and Social Policy.
  • During a heated exchange in the National Assembly with Diane Lamarre, the PQ's health critic, Barrette insinuated that she might be suffering from a "form of epilepsy" after she kept repeating the same questions about Bill 10. That remark drew a rebuke from House Speaker Jacques Chagnon.
  • But it's not Barrette's zingers that have made him so polarizing as health minister: it's his plans to overhaul the public system and the way he's gone about it.
  • Barrette, by comparison, announced his reforms only four months after being appointed health minister. None of his proposals - from abolishing regional health agencies to penalizing doctors financially - were alluded to in the Liberal election platform.
  • The reforms were unveiled in quick succession as Bills 10 and 20, with no public consultation beforehand.
  • Barrette has had a hard time garnering widespread support for Bill 10, his effort at restructuring Quebec's health system. The bill has two goals: to downsize Quebec's costly, Byzantine health bureaucracy, and to streamline the governance of its institutions.
  • Critics have assailed Bill 10 not so much for its goal of cutting administrative costs by more than $200 million a year as its objective to eliminate the boards of directors of many health institutions - from rehab centres to hospitals. Quebec's anglophone community is particularly concerned that many bilingual institutions would vanish in "one fell swoop," as former Liberal MNA Clifford Lincoln has warned. The bill would also confer on the health minister - in this case, Barrette - the power to hand-pick members of so-called mega boards.
  • 140 amendments in December
  • continue to make services available in English - a measure that critics contend is still no guarantee for the anglo community. The relatively high number of amendments - even for a complex piece of legislation like Bill 10 - would suggest that Barrette underestimated both the opposition to his reforms and the possible unintended consequences.
  • In November, Barrette tabled Bill 20, which the minister himself described as "first the carrot, now the stick."
  • Like his first piece of legislation, Bill 20 has two goals: to compel both medical specialists and family doctors to follow more patients or risk being docked their pay; and to no longer cover in vitro fertilization under medicare.
  • Many couples and fertility specialists are also incensed by his plan to de-list IVF from medicare, denouncing his proposals as draconian and hastily formulated. There's no doubting that Barrette's proposed reforms are part of the Liberal government's austerity agenda. But beyond that, it's not so clear what his overall vision might be for Quebec's beleaguered health system, critics argue. And that lack of vision might mean the difference between whether those reforms succeed or fail.
Govind Rao

What's holding up home-care reform? - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246471|tost|20151206|235237118

from heather home care Ontario reforms

shared by Govind Rao on 07 Dec 15 - No Cached
  • Toronto Star Sun Dec 6 2015
  • After months of planning and false starts, Ontario Health Minister Eric Hoskins finally has all the proof he needs to push ahead at full speed with sweeping changes to the province's troubled home-care system. So what's holding him up? For weeks, Hoskins has been signalling he will release a "discussion document" outlining radical reforms, including scrapping the beleaguered 14 Community Care Access Centres (CCACs) that co-ordinate home-care delivery across the province.
  • He received even more evidence this past week that it's time to transform the system with the release of auditor general Bonnie Lysyk's annual report. Lysyk listed a wide range of mismanagement, poor oversight and horror cases in which patients failed to get services such as nursing, physiotherapy and personal support on time or in enough quantity to make a lasting difference in their health. In many instances patients had to wait almost a year just for an initial assessment. In recent days, Hoskins has been telling key health-sector players he will release his discussion paper "before the holidays."
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  • The document is expected to propose shifting much of the CCACs' home-care planning and oversight roles to the 14 Local Health Integration Networks (LHINs) that now are responsible for overall regional planning, funding and health-care integration. The job of co-ordinating face-to-face services, which now falls to CCAC staffers, may be moved to primary care agencies, such as hospitals or community health clinics led by doctors or nurse practitioners. The goal is to save more than $200 million by eliminating the bureaucracy-heavy CCACs, with their high-paid executives, and directing the savings to front-line services.
  • More than 700,000 Ontario residents receive care annually at home or in community settings. The province spends $2.5 billion a year on home and community care, about 4 per cent of its total health budget. Despite overwhelming evidence that the system is in dire need of reform, Hoskins seems reluctant to move ahead with any speed. Two months ago his office cancelled a private lock-up for home-care stakeholders at which they were to discuss a "white paper" on reforms. Hoskins also scrapped plans for a special home-care task force on the grounds it would be viewed as just another stalling tactic. Still, Hoskins is indeed moving, albeit slowly.
  • On Nov. 20, he spoke privately with the board chairs and chief executive officers of the 14 CCACs about the coming changes. On Nov. 30, Bob Bell, the deputy health minister, met with the same CCAC bosses and while he didn't share any "concrete plans," he did suggest health ministry officials will consult with CCACs and other agencies about the proposed changes "in the new year." And on Dec. 1, Hoskins wrote to the CCAC bosses to explain that his ministry has every intention of "working together with CCACs to build a health care system that truly responds to the needs of patients and their families." Again, no specifics were mentioned. Clearly, Hoskins is dealing with a health-care establishment that is reluctant to change. That includes the CCACs, LHINs, doctors and his own bureaucrats.
  • LHIN officials, for example, don't want to be in charge of direct delivery of care. They have few staffers who actually know how to run a big health system on a day-to-day basis. At the same time, the LHINs have their own troubles, as Lysyk noted in her report. She said their "marching orders are not clear enough" and performance gaps are widening, especially on wait times. In the weeks ahead, Hoskins must address whether the LHINs are ready to assume greater duties, whether they should be in the health-care delivery sector at all and how to achieve better integration of hospitals, public health, primary care and home-care agencies. Also, he should look at whether all - not just some - home-care delivery should be left to private and non-profit service providers. Hoskins and his bureaucrats may be delaying the reform push until they develop "the perfect plan."
  • But Hoskins, who has shown true vision in this initiative, should view the document as the starting point - not the end point - for wholesale reforms that cut out an entire layer of costly bureaucracy and that improve the delivery of services that patients need and deserve. Everyone in the health-care sector is primed and ready to act, although not eagerly in all cases. Just as important is the fact that more delays and more wasted tax dollars won't fix the broken system. So it's time for Hoskins to end the needless holdups and move swiftly and boldly on behalf of the people who really matter - Ontario patients. Bob Hepburn's column appears Sunday. bhepburn@thestar.ca
  • Ontario Health Minister Eric Hoskins may be delaying action until his team develops "the perfect plan" for home-care delivery, Bob Hepburn writes. • Chris Young/THE CANADIAN PRESS file photo
Heather Farrow

Battle lines drawn amid health-care overhaul - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|tost|20160827|254784460

accord privatization

shared by Heather Farrow on 29 Aug 16 - No Cached
  • Toronto Star Sat Aug 27 2016
  • Preparations are underway for a milestone summit this fall that could be a defining moment for Canadian quality of life in the 21st century. Ottawa appears determined to overhaul Canada's $219-billion health-care industry. It is keen to use the once-in-a-decade expiry of the Health Accord as the opportunity for reform. The Health Accord is the means by which Ottawa injects funds into Medicare with health-care transfers to the provinces and territories, and renegotiation of a new accord has consumed several months.
  • At this historic moment, the feds are prepared to be the prime architect of change, if balky provinces and territories put up their usual stubborn resistance to it. Provinces and territories have consistently demanded more money from Ottawa with no strings attached. They denounce specific uses of the funds as a federal intrusion on their bailiwicks. But as Jane Philpott, the federal health minister, said earlier this week, "There has never been a major development in the history of health care in Canada where the federal government was not there." Indeed.
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  • For instance, there would be no Medicare - the national achievement of which Canadians are proudest - had Ottawa not unilaterally imposed it across the country in the 1960s. Ontario was among the holdouts, until its then premier discovered that Ontarians wanted what the feds were offering. Today, the feds have that same advantage of popular support for reform.
  • A Canadian Medical Association (CMA) poll that mirrors the results of other polls shows Canadians are strongly supportive of major health care reforms in mental-health services (83 per cent), more affordable prescription drugs (80 per cent), palliative care (80 per cent) and home care (79 per cent), among other health services. Philpott is an ardent champion of "targeted funding," to ensure that federal money gets spent on the Grits' priorities of improved home care, palliative care and mental health treatment. By contrast, the sub-governments share the view of Quebec Premier Philippe Couillard, that "We are totally opposed to targeted funding." Give us the money, let us decide how to spend it.
  • Philpott's valid grievance is that the $41 billion Ottawa transferred to sub-governments during the previous 2004-2014 Health Accord, which expired two years ago, did not bring health-care reform. "We didn't buy change," as the minister puts it. This time, Ottawa wants to see results for its money. In a remarkable speech to the CMA this week, Philpott indicted the sub-governments for their routine violations of the Canada Health Act, which has undercut "a fair and just society." She condemned the system as plodding and unco-ordinated, an assessment few Canadians would disagree with.
  • And acceding to the subgovernment's rote demands - an increase in federal funds with no strings attached - holds exactly zero chance of forcing reform. After all, the health minister noted, there are many countries that spend less than Canada on health care, yet boast better health outcomes. Examples: Britain, Italy, Spain, Norway, Israel and Ireland, among others. The sub-governments should have seen this confrontation coming. A Harper government also frustrated with lack of health-care reform slashed the increase in federal health transfers from 6 per cent to 3 per cent in a bid to force better spending decisions on provinces and territories.
  • It will be a struggle for the sub-governments to marshal a convincing argument against Philpott's insistence that Ottawa must have a role in moving Canadian health care "from the middle of the pack to out in front." Here's what the traditional hands-off, no-strings-attached status quo has gotten us: The World Health Organization (WHO), an arm of the UN, ranks Canada a dismal 30th in quality of health care, trailing Colombia, Cyprus and Morocco. (France and Italy rank 1st and 2nd, respectively.) Total Canadian health-care spending has more than doubled, to $219 billion, over the past 15 years, with no comparable across-the-board improvement in quality of health of Canadians. And as a percentage of GDP, Canadian health care spending has jumped from 8.3 to 10.3 in that period.
Govind Rao

Ontario plans health-care overhaul; Changes to include deep reforms for home care, incl... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20151124|234361282

from heather Ontario home care

shared by Govind Rao on 24 Nov 15 - No Cached
  • The Globe and Mail Tue Nov 24 2015
  • The Ontario government is preparing to overhaul health care in the province, including scrapping its troubled system for delivering home care and reforming primary care with the aim of improving patient access. The proposed changes, mapped out in a paper to be made public in the coming weeks, will be the focus of consultations in the new year and are expected to touch on all aspects of the health system.
  • A centrepiece of the proposals will be the expansion of the role played by the province's Local Health Integration Networks. At the same time, the province would eliminate Ontario's 14 Community Care Access Centres (CCACs), the public agencies responsible for overseeing the delivery of services such as nursing, physiotherapy and help with personal care for the sick and the elderly in their homes. The agencies have long been a lightning rod for criticism, and were the focus of a Globe and Mail investigation this year that found inconsistent standards of care and a lack of transparency that left patients and their families struggling to access services.
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  • As well, a report this fall from Ontario Auditor-General Bonnie Lysyk found that as little as 61 cents out of every dollar spent by the agencies goes to face-to-face client services, and discovered gaps in the level of care offered across the province. A second report on home care will be included in the Auditor-General's annual report in early December.
  • Suggested changes to the way primary care is delivered by family doctors and other health-care providers are also expected to gain wide attention, especially from doctors, who are in a battle with government over fees. Ontario Health Minister Eric Hoskins has been hinting for some time that change was in the works, but the existence of a policy paper and its contents have been kept under wraps.
  • Individuals familiar with different aspects of the document, who spoke to The Globe on the condition that they not be identified, describe it as "transformational" - a term that has become a favourite of the Health Minister. Earlier this month, Dr. Hoskins delivered a speech at a hospital conference in Toronto in which he repeatedly spoke of "system transformation" and the need for stronger "local governance."
  • The minister responded to questions from The Globe in a statement Monday night, saying that the ministry is "putting together a document which we hope will serve as a starting point for discussions and consultation about how we can better integrate various parts of the system and improve the patient experience." "We plan to share that discussion document in the coming weeks and will be engaging with our partners, including care providers and the public, to solicit feedback on those ideas to achieve deeper integration," the statement said.
  • The plans for change come at a critical time for Ontario's Liberal government as it looks to cut costs and tame the provincial deficit. To do that, keeping health-care spending in check is imperative, but the minister has also pledged to make improvements such as ensuring more people have access to primary care, and are not reliant on walk-in clinics and emergency rooms for after-hours nonurgent care. Any efforts to change how primary care is paid for or organized are likely to meet resistance from doctors, who are already at odds with the province after it imposed a contract and two rounds of fee cuts this year.
  • An expert panel report on primary-care reform - released quietly this fall and widely criticized by doctors - recommends dividing the province into "patient care groups," similar to school boards, with each group responsible for ensuring every resident in the area has access to primary care. As a prelude to the coming reform, at least one merger plan among two hospitals and a CCAC was paused this fall after the ministry advised the boards involved of the coming changes.
  • John Davies, chair of the board of William Osler Health System in Brampton, Ont., said merger talks with the Central West CCAC and Headwaters Health Care Centre in Orangeville, Ont., were suspended after deputy Health Minister Bob Bell wrote to them a few weeks ago advising them to suspend talks because of the coming reforms. Those familiar with the proposed reforms say the beefed-up local health networks will be given responsibility for overseeing home care, with front-line workers and case managers retaining their jobs.
  • "For the client, there will be no change," one source said. Some aspects of home care involving patients who have been hospitalized will continue to move over to a new model called "bundled care," which has been piloted by St. Joseph's Health System in Hamilton and was recently expanded to six other sites, one source said. The province will also look at tailoring care delivery to the needs of local communities, with different models possible for urban and rural settings, another source said.
Irene Jansen

Will Falk (Mowate Centre). October 31 2011. How to reform health care - thestar.com - 0 views

www.thestar.com/...107--how-to-reform-health-care

accord shared services specialty clinics abf

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Modernize the organization of hospitals
  • specialty clinics providing routine procedures efficiently and accessibly
  • with public funding and in partnership with traditional hospitals
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  • Policy-makers should strengthen regional bodies, specialty care networks, and support mergers and acquisitions that build scale.
  • Reform the way health services are purchased. The health-care pricing system is fundamentally broken. Global budgeting for hospitals and inflation in fee-for-service payments for doctors need to be urgently reformed in most provinces.
  • These reforms do not rely on new revenues or any form of privatization to create a fiscally sustainable system. They could all take place within the Canada Health Act and are consistent with its principles.
  • Will Falk is executive fellow in residence at the Mowat Centre at the University of Toronto. He is lead author of a new report, Fiscal Sustainability and the Transformation of Canada's Healthcare System.
Irene Jansen

C.D. Howe Institute - Healthcare Reform - 0 views

www.cdhowe.org/...healthcare-reform

think tank

shared by Irene Jansen on 23 Jan 12 - No Cached
  • The C.D. Howe Institute has launched a new healthcare reform initiative
  • The engagement of a health policy scholar, professor Åke Blomqvist, who will work with the Institute’s in-house researchers to guide health policy research and dissemination
  • Increased emphasis on health policy publications in our research program
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  • A major conference on Healthcare Reform
  • An expanded series of healthcare reform policy roundtables and conferences across Canada
Irene Jansen

BMA moves to full opposition on healthcare reforms | BMJ - 0 views

www.bmj.com/...bmj.d7930

privatization reforms nhs

shared by Irene Jansen on 23 Jan 12 - No Cached
  • The BMA has changed its official policy to one of full opposition to the Health and Social Care Bill and its proposed reforms of the NHS.
  • In its paper it said that, despite several successful amendments to the bill, major areas of concerns had still not been dealt with sufficiently, such as a continuing over-reliance on market forces to shape care and concerns about the future delivery of public health and medical education.
  • Professor Pollock believed that the bill could be stopped, saying, “What the BMA are saying to the House of Lords is that they now have complete opposition to the bill, so the Lords must take this seriously if the majority of doctors are now opposing it.”
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  • Jacky Davis, a founding member of the campaigning group Keep Our NHS Public and a BMA council member, told the BMJ: “For about 18 months we have tried to do the reasonable thing and persuade politicians that this [bill] is wrong, and a lot of people believe there is no amendment now that could make this palatable, let alone workable.”
  • There is only about six weeks left to influence the Lords before it goes back to the Commons
  • several factors coming to a head—such as the recent government document outlining how clinical commissioning groups would have to use the commercial sector for commissioning support; the recent NHS operating framework, which made it clear that around £3.8bn (€4.4bn; $5.9bn) was being spent just on the structural changes of the reforms; and the fact that the NHS’s drive for quality improvements seemed to be on hold while much time and attention were focused on structural change in the health service—meant that the BMA was more comfortable opposing the reforms
Irene Jansen

Clemens and Esmail: Let's remove barriers to health-care reform - 0 views

www.canada.com/...story.html

cha privatization neoliberalism

shared by Irene Jansen on 21 Jun 12 - No Cached
  • the Canada Health Act is incompatible with a number of policy options that have been successfully implemented in other countries
  • If the provinces are to proceed with meaningful reform, the act will have to be revised
  • cost-sharing, allowing private parallel health care, employing privately owned and operated surgical facilities and hospitals to deliver universally accessible care, and using independent insurers to operate the universal insurance scheme
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  • the principles of universality, inter-provincial portability and comprehensiveness should all be retained in their current form
  • Some sections of the Canada Health Act do, however, need to be revised
  • Section 8, which contains the requirement for public administration, requires a single, non-profit insurer, thus preventing competition and alternate forms of ownership and operation of the insurer
  • Section 12 covers accessibility and is one of the more problematic sections
  • It is also intimately related to sections 18 through 21. These sections disallow the use of extra billing and user charges. We recommend repealing these prohibitions
  • We also recommend that Section 12 focus on accessibility for those experiencing low income by encouraging the provinces to shelter such people from the burden of user fees, co-pays, or other financial contributions.
  • The federal government has taken some productive first steps in reforming the transfer payments and accordant conditions attached to them. However, the federal government must now revise the Canada Health Act
  • Jason Clemens and Nadeem Esmail are co-authors of First, Do No Harm: How the Canada Health Act Obstructs Reform and Innovation, which was recently released by the Macdonald-Laurier Institute.
Govind Rao

New book addresses the complexities within the reform process for healthcare in Canada - 1 views

www.cfhi-fcass.ca/...ocess-for-healthcare-in-Canada

from heather privatization

shared by Govind Rao on 04 Feb 14 - No Cached
  • 29/01/2014
  • Paradigm Freeze: Why it is So Hard to Reform Health-Care Policy in Canada Edited by Harvey Lazar, Pierre-Gerlier Forest, John N. Lavis and John Church
  • This book addresses the complexities within the reform process for healthcare in Canada. It relies on experts to answer these complex yet fundamental questions: 1) Why has healthcare reform proved a stumbling block for provincial governments across Canada? 2) What efforts have been made to improve a struggling system, and how have they succeeded or failed?
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.
Cheryl Stadnichuk

Health Reform In Ontario Must Include Oral Health Care | Jacquie Maund - 0 views

www.huffingtonpost.ca/...reform-ontario_b_10071550.html

dental Medicare Ontario

shared by Cheryl Stadnichuk on 25 May 16 - No Cached
  • 05/23/2016 1
  • The Ontario government's proposed reform of the provincial health-care system is going forward with a glaring omission: primary mouth care. To make this reform truly "Patients First," Dr. Eric Hoskins, Minister of Health and Long Term Care, must include primary care for the mouth.
  • Dentists are not part of the primary health-care system and physicians are not trained to deal with mouth diseases, such as those that affect teeth and gums. Primary mouth care is not covered under OHIP, and hospitals are not equipped to deliver dental care. Ontario only has public dental programs for low income children under 18, and a patchwork of basic services for people receiving social assistance.
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  • In 2014, there were almost 61,000 hospital emergency room visits for dental problems. The most common complaints were abscesses and dental pain. It is estimated that every nine minutes a person shows up in a hospital emergency room with a dental problem. The minimum cost of each hospital visit is $513. As a result, taxpayers spend approximately $31 million annually to have physicians acknowledge that patients have dental disease which they cannot treat.
  • The College of Dental Hygienists of Ontario estimates that two to three million Ontarians have not seen a dentist in the past year. The main reason is the cost.
Irene Jansen

Saskatchewan premier to push health-care reform at national conference - Winnipeg Free ... - 2 views

www.winnipegfreepress.com/...onal-conference-147784065.html

sk lean private clinics wall

shared by Irene Jansen on 18 Apr 12 - No Cached
  • Saskatchewan's premier is pushing for reforms to health care that he says include bold targets and new ways of delivering services.
  • isn't sustainable," Wall said
  • He'll speak to the group and take part in a panel discussion with economist Don Drummond and Globe and Mail journalist Andr� Picard.
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  • Wall wants to talk about reforms being made to improve care in Saskatchewan, including the delivery of publicly funded services by private surgical clinics.
  • lean management techniques
Irene Jansen

The Mowat Centre for Policy Innovation. A TRANSFORMATIVE BLUEPRINT FOR REDUCED COSTS, I... - 0 views

www.mowatcentre.ca/press-releases.php

abf private clinics competitive bidding it

shared by Irene Jansen on 23 Jan 12 - No Cached
  • the Mowat Centre at the University of Toronto has released a blueprint for transformative changes to the healthcare system
  • The report recommends five significant changes: • Modernize the organization of hospitals, with academic centres focused on diagnostic work-ups, specialty clinics providing routine procedures efficiently and accessibly, and networks of care that monitor patient well-being • Embrace the ‘‘virtualization’ of many existing services that are currently only delivered in person • Widely deploy digitization by reforming agencies so that they can respond to technological change more quickly and by providing more IT funding directly to providers • Encourage organic governance evolution without undertaking wholesale restructuring, and • Reform the way health services are purchased.
  • The report is part of the Shifting Gears Series on the transformation of public services and was supported financially by KPMG.
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  • To read the full report, please click here
  • Irene Jansen on 23 Jan 12
     
    National Post coverage: Innovations seen as lowering health costs. National Post. Nov 1 2011 Tom Blackwell  Provinces must find ways to profit from efficiencies - like the steadily falling cost of cataract surgery. While favouring marketstyle competition, the academics draw the line at allowing a private tier of medicine or even expanding the role of privatehealth operators in the public system. Set up more stand-alone clinics, like those that do cataract surgeries. Move away from block funding of hospitals (an institution is paid a lump sum every year to cover most services) toward payments tied to treatment of individual patients. Cap increases in physicians' fees, link fees more closely to changes in technology and hold auctions in the public system, to get the best deal for providing some procedures. Experience suggests doctors may not welcome some of their proposals. In 2002, a $4-million study funded by the Ontario government - and initially supported by the Ontario Medical Association - recommended an overhaul of the fee schedule to better reflect the up-to-date value of each doctor service. It would have meant income drops for some specialists - such as the opthalmologists who do cataracts - while others would earn more. See also: Health Care reform? Despite frightful predictions of ever-rising costs, governments can reap savings by managing change Toronto Star Nov 1 2011  Opinion  Will Falk
Irene Jansen

MPs are urged to end inaction on social care reform | BMJ - 0 views

www.bmj.com/...bmj.e12

home care england

shared by Irene Jansen on 23 Jan 12 - No Cached
  • A coalition of experts has called on politicians of all parties to agree urgent reforms of adult social care in England
  • have written to the Daily Telegraph urging “fundamental and lasting reform” of a system that they say harms society, the economy, and the dignity of elderly and disabled people (http://tgr.ph/tIkRRk).
  • The signatories warn that an estimated 800 000 elderly people are being left without basic care and as a result are “lonely, isolated and at risk.” Others face losing their homes and savings because of soaring care bills, while disabled people are deprived of the support they need to live independently.
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  • Signatories to the letter include Hamish Meldrum, chairman of the British Medical Association, Brendan Barber, general secretary of the Trades Union Congress, and representatives of the British Red Cross and leading health insurers.
  • The current coalition government is expected to produce a white paper on social care by April in response to recommendations from the independent Dilnot commission into the funding of care and support, published in July 2011 (BMJ 2011;343:d4261, doi:10.1136/bmj.d4261).
  • Andrew Dilnot, an economist, recommended a new partnership model under which people would pay up to a maximum £35 000 (€42 000; $55 000) towards the cost of their care and be eligible for full state support beyond that.
  • He has since said that the country’s economic woes should not be an excuse for inaction and argued that it was “nonsense” for anyone to suggest that reform would be too expensive to implement (BMJ 2011;343:d7689, 28 Nov, doi:10.1136/bmj.d7689).
Govind Rao

CMAJ: A closer look at European health care reforms - 0 views

www.cmaj.ca/...pean-health-care-reforms.xhtml

from heather privatization Europe international comparisons

shared by Govind Rao on 29 Nov 13 - No Cached
  • November 29, 2013 A closer look at European health care reforms
  • The openness to try innovative solutions is the "most striking difference" between the health care systems of European countries and Canada, according to the Macdonald-Laurier Institute, a public policy think tank in Ottawa, Ontario.
  • Canada should look to Sweden and Switzerland for examples of potentially beneficial health reforms, including activity-based funding, more private provision of care and allowing doctors to practise under both private and public systems, the institute's reports in A European Flavour For Medicine.
Govind Rao

Discussion of health care reform is too often confined to our bubble - Healthy Debate - 0 views

healthydebate.ca/...e-reform-often-confined-bubble

from heather reforms privatization quality cuts

shared by Govind Rao on 26 Sep 14 - No Cached
  • by Maaike deVries & Jonathan Gravel (Show all posts by Maaike deVries & Jonathan Gravel) September 15, 2014
  • When it comes to reforming health care, most insiders can speak passionately and at length to the inadequacies of our system. We’ll quote the experts, reference reports and all nod in agreement. Most Canadians do not participate in these discussions. The reasons for their lack of involvement and, more symptomatically, their inattention to health care during Canadian elections has been described elsewhere. Chief among those reasons is the belief that our system is the best in the world, particularly when in juxtaposition to US health care.
  • On their current track, provinces will spend more than 50% of total available revenues on health care by 2028, so how could we not have a system that performs exceptionally well? Unfortunately, it is well known among insiders that high price does not necessarily translate into high quality care, as clearly demonstrated by the recent Commonwealth Fund report showing Canada ranked in the bottom third of all five evaluated dimensions of health system performance (quality, access, efficiency, equity and healthy lives) compared to 10 industrialized countries. We, the writers and readers of Healthy Debate, should strive to bring these conversations to the people outside the bubble.
Govind Rao

Family doctors weighing their options; Changes to Bill 20 are welcome, but the buzz amo... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|mtgz|20150530|221592846

from heather Quebec doctors cuts privatization

shared by Govind Rao on 01 Jun 15 - No Cached
  • Montreal Gazette Sat May 30 2015
  • Doctors are willing to do their part to improve access, O'Dell said, but the Health Department must make participation in the Groupes de médecine de famille (GMF) more attractive by funding electronic records and support staff, and boosting mental health services and long-term beds in nursing homes. Dr. Catherine Duong, president of a collective of 550 general practitioners known by the French acronym ROME, said that the biggest threat of exodus is among doctors who live near the Ontario border. Physicians in that neighbouring province earn, on average, 15 per cent more than those in Quebec, and pay lower income taxes.
  • She went home thinking of her game plan as the provincial government prepares to pass Bill 20, the controversial carrot-and-stick health reform that Health Minister Gaétan Barrette would soften after alienating many of Quebec's doctors with the threat of clawing back 30 per cent of their salary if they failed meet a patient quota. Barrette announced this week that Bill 20's sanctions would not apply to family physicians for two years - taking the immediate sting out of the bill while keeping the onus on doctors to improve patient access. Which is small comfort to busy family doctors like Saoud.
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  • "I go help mothers with their sick children while I leave mine at home," Saoud said. "I can't see how I can do more." Saoud has three young children. She devotes 60 per cent of her workweek to a Montreal hospital's emergency department - irregular hours that include evening and weekend shifts - while the rest of her schedule is split between a walk-in clinic and what's known as "dépannage," replacing doctors in Quebec's more remote regions at least once a month. What she wants is more time for her job as a mother - helping with their homework and sharing meals - and not have to meet "an impossible" quota of following 1,500 patients, as the original Bill 20 would have required of each family doctor.
  • I am already at my maximum," said Saoud. And so, she has applied for a licence to practise outside Quebec. Nearly 24 per cent of Quebecers are on a waiting list or desperately searching for a family doctor. The crisis is rooted in a 1990s provincial government plan to save money by encouraging doctors to retire early. Staffing shortages ensued, and family doctors were obliged to fill the gaps by working outside their clinics in hospitals and far-flung regions. Quebec has attempted, with little success, to improve primary care over the last two decades by expanding community health clinics (CLSCs) and creating pools of doctors known as Groupes de médecine de famille (GMF) but both limped along under budget constraints and heavy bureaucracy. Barrette contends that the province has more than enough physicians to meet its needs, but that a profound structural change is needed.
  • He presented Bill 20 last fall as his road map to ensure that every Quebecer has a regular doctor. But the bill's punitive measures sparked widespread discontent among doctors against what they called a one-size-fits all, state-controlled, conveyor-belt approach to medicine. Doctors were further incensed at Barrette's assertion that doctors are not productive enough - which they saw as being accused of laziness - and frustrated at being blamed for a broken health system.
  • Like Saoud, many doctors prepared exit plans - from retiring to leaving the province. Some med students, many of whom were actively recruited to shore up Quebec's supply of family doctors, began reconsidering family medicine - or simply leaving to do their residency out-of-province, according to the Fédération des médecins résidents du Québec. Saoud was heading home to her sick daughter on Monday when Barrette announced he had cut a deal with the provincial federation of family physicians to exempt them from Bill 20 - temporarily. There would be no quotas and no penalties, Barrette said, as long as family physicians were able to collectively ensure that 85 per cent of Quebecers had a family doctor by the end of 2017. But Saoud says the change will not keep her here. And she's not alone.
  • The buzz among disillusioned physicians is that "everyone has a Plan B." And while the bill's delay has eased tensions a notch, some doctors are saying the two-year delay simply means they now have until 2017 to prepare a better exit. Bill 20 remains a guillotine above the heads of doctors. "Most definitely, there are physicians investing in Ontario licences and poised to leave if Bill 20 passes. I myself may have to leave," family physician Maggie O'Dell, who works at the Wakefield Family Medical Centre near the Ontario border, said before the bill was modified. And after Barrette backtracked, she had this to say: "It's nice to have reprieve, so it's a relief - for now ... a reason for many to hold back on pulling up stakes in the short term."
  • Montreal family physician Fahimy Saoud hated leaving her sick 5-year-old in someone else's care this week, but it was her turn to staffa walk-in clinic and she didn't want to let those patients down. But as the day wore on, Saoud kept hearing her daughter's plea when she left the house: "Who will take care of me?" So on Monday, after seeing everyone in the waiting room, Saoud left the clinic early; her daughter needed her as much as her patients did.
  • The group's recent survey - 204 of its members responded - indicated that Bill 20's sanctions would backfire. While the survey was taken three days before Barrette modified Bill 20, Duong said the results reveal that doctors, in particular those whose mother tongue is English, are at risk of leaving the province. Among the 134 francophone doctors polled about their intentions if Bill 20 were applied, 32 per cent said they would resign from hospitals, 12 per cent said they would leave Quebec and another nine per cent would go into private care.
  • Among the 70 anglophone respondents, seven said they already sent letters of resignations to their hospitals (it's not clear whether they are keeping their office family practice) and among the remaining 63 doctors, 34 - more than half - said they planned to leave Quebec. Another seven said they would retire early, seven would move to the private system and three would stop working as family doctors. It's a small sample, Duong conceded, but the study is nonetheless alarming.
  • We are worried that doctors will leave," Duong said, noting that every year, more doctors are opting out of the provincial insurance board (RAMQ), meaning they are no longer on the public payroll, though it's not clear whether they went to private practice or left Quebec. RAMQ representative Marc Lortie confirmed this week that 246 family physicians dropped out of RAMQ between May 2014 and May 2015, up from 204 the previous year and 187 in 2012-2013.
  • In the wake of Monday's announcement to put offBill 20's sanctions, many doctors remain skeptical of Barrette's 85-per-cent target, Duong says, "because it's far too ambitious a goal." Whatever doctors' efforts, Duong says, the reform will fail if the government doesn't help them do their jobs - for example, by abolishing mandatory hospital work. Others suggest the crisis between the province's doctors and Quebec's health minister is over. Bill 20 was heavy-handed, they argue, but if it leads to doctors taking on more patients it will have been a successful negotiating tool. Dr. Yoanna Skrobik, a critical care researcher and adjunct professor at McGill University's department of medicine, is among those who wholeheartedly support the Barrette reform.
  • It's the most dramatic change in the history of Quebec's health system, and the best thing that's ever happened to patients," said Skrobik, who worked side by side with Barrette at Maisonneuve-Rosemont Hospital in the early 2000s, when Barrette was chief of radiology and she was an intensivecare physician. She said that if 85 per cent of Quebecers have a family doctor, the quality of health care in the province will be much improved. Doctors may be offended by Barrette's manner, and by what they see as an attack on their autonomy, Skrobik said, "but it's also true that he puts patient care in the forefront."
  • But Saoud also has priorities. She earned her first medical degree in Haiti, then had to obtain it again after emigrating to Montreal. There's a saying among those who work in the ER, she said: "We know when we go in, but we don't know when we will leave." Saoud, who won the Nadine St-Pierre Award for her research as a resident in family medicine in 2009, still loves being a doctor. "It can be frustrating, but it's really gratifying work. Helping someone is really the cherry on the sundae. But my priority is not that." She would rather not force the children to uproot, but she's skeptical doctors can meet the demands of the health reform. And possible sanctions in two years could force her to to make a tough choice.
  • "My male colleagues don't have that issue. The bill is discriminatory. I'm just asking for the right to be a mother and not simply a doctor." With her permit application process in motion, Saoud says she will go wherever her licence takes her. cfidelman@montrealgazette.com twitter.com/HealthIssues
  • Medical students from four major Quebec universities demonstrate against Bill 20 in March near the legislature in Quebec City. • VINCENZO D'ALTO, MONTREAL GAZETTE / Dr. Fanny Hersson-Edery, left, at a diabetes clinic she runs with nurse Jen Reoch. Hersson has a full schedule, from research to teaching and seeing patients.
Govind Rao

CIHR reforms contradict consultant reports - 0 views

www.cmaj.ca/...E67

from heather research

shared by Govind Rao on 02 Feb 15 - No Cached
  • CMAJ February 3, 2015 vol. 187 no. 2 First published December 15, 2014, doi: 10.1503/cmaj.109-4963
  • Paul Webster
  • Reforms to the longstanding scientific advisory system at the Canadian Institutes of Health Research (CIHR) are under attack from a high-profile group of the institute’s leading scientific advisors. CIHR is kneecapping its scientific outreach capabilities, these advisors say. And in doing so, they add, CIHR has ignored warnings and advice from the two expert panels it convened to lead scientific consultations on its reforms.
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  • The reforms will reduce the number of institute advisory boards (IABs) serving CIHR’s 13 health research institutes from 13 to 4; each of these 4 boards will be assigned to 3 or 4 institutes. This will result in a dramatic narrowing of CIHR’s access to specialist, scientific guidance, according to the chairs of five of the current IABs.
Govind Rao

CJAD 800 - News. Talk. Radio. :: College of Physicians speaks out against health reform... - 0 views

www.cjad.com/...eaks-out-against-health-reform

from heather Quebec cuts legislation

shared by Govind Rao on 03 Feb 15 - No Cached
  • Posted on 2/3/2015 1:30:00 PM by Tina Tenneriello
  • Just a few days before Quebec's health minister Gaetan Barrette is expected to rush in Bill 10 Friday, the College of Physicians says it has concerns with the new health care reform. At a press conferenceTuesday morning it presented 5 key issues.  The first, transparency. "We want to know the big picture of the reform, that's the main thing we are asking for, transparency," Dr. Yves Robert, the secretary of the College of Physicians said. Dr. Robert said they're not as concerned about Bill 10.
  • "It's more about saving money by taking off a slice of bureaucratic administration, that's less our business, once it's set up, we don't want the quality of services to be affected, that we'll check, that's my job, but for Bill 20 and 28 it concerns us because it's about the quality of practice," Dr. Charles Bertrand, the head of the College said. He says Bill 20 will impose quotas on family doctors, which Quebec has tried before and it didn't fix the problem.  "It is another coercive measure, we've faced many in the past also with incentives and it didn't solve the problem.  We want every stakeholder to find solutions," Dr. Robert said.
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  • Bill 20 would also mean paid in vitro fertilization. As for Bill 28, Dr. Robert says it would give the government power to choose what medical services would be insured or not. He says it would also allow the minister to make secret arrangements with pharmaceuticals, to get draw backs, but citizens would pay the same price for their drugs. Minister Barrette said his critics have their own agendas.
Irene Jansen

NHS reforms: From today the Coalition has put the NHS up for grabs - Telegraph - 0 views

www.telegraph.co.uk/...-put-the-NHS-up-for-grabs.html

shared by Irene Jansen on 02 Apr 13 - No Cached
  • Today the Health And Social Care Act – in other words, the Coalition’s highly controversial NHS reforms – comes into effect.
  • For the first time in NHS history, the majority of treatments will be put out to tender: private organisations will be competing to win contracts to provide NHS healthcare.
  • It wasn’t until a few weeks before the law came into effect that those missing pieces became available, when the Health Secretary, Jeremy Hunt, quietly announced the new regulations and attempts were made to push them through parliament. What was now clear was that the regulations effectively forced CCGs to put all services out to tender to the private sector and forbade them to favour the NHS as the provider.
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  • After a public outcry and criticism from the House of Lords at the way the Government had slipped in the Section 75 regulations at the eleventh hour, Hunt had them hastily rewritten. But most experts agree that there was no meaningful change. GPs are allowed to keep some services within the NHS, but only in particular circumstances, such as when no private sector provider comes forward to bid. Everything else is up for grabs.
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