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Experimental Measures of Output and Productivity in the Canadian Hospital Sec... - 0 views

www.statcan.gc.ca/...aftertoc-aprestdm2-eng.htm funding hospitals
shared by Doug Allan on 23 Apr 14 - No Cached
  • Recent discussions about health care spending have focused on two issues: 1) the extent to which the increase in heath care spending is due to an increase in the quantity as opposed to the price of health care services, and 2) the efficiency and productivity of health care providers (e.g., hospital sectors, office of physicians, and long-term care).
  • The key to addressing both issues is a direct output measure of health care services—a measure that does not currently exist.
  • The main objective of this paper is to develop an experimental direct output measure for the Canadian hospital sector
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  • Measurement of direct output starts with a definition of the unit of output and weights used for aggregation. Ideally, the unit of output should capture the complete treatment, encompassing the path a patient takes through heterogeneous health care institutions to receive full and final treatment. This is known as disease-based approach.
  • But implementation of this ideal definition requires tracking individual patients across health care institutions; existing data rarely allow such linkages.
  • The Atkinson Report (Atkinson, 2005) and Dawson et al. (2005) recommend that the marginal value of a treatment be used to derive a value-weighted activity index as the ideal output measure, where the marginal value is based on the effect of the treatment on the patient’s health outcome.
  • A cost-weighted activity index, when inappropriately constructed, might introduce a substitution bias. Substitution bias arises when a shift in the composition of treatments (from inpatient to outpatient treatment) occurs, and inpatient treatment and outpatient treatment are assigned to different case types and are aggregated with their respective unit costs even though they both have the same effect on outcome. If outpatient treatment is less expensive, a cost-weighted activity index will indicate a decline in the hospital sector’s volume of output. This is counterintuitive, since the volume of hospital service under the above assumption does not change when outpatient and inpatient treatments have the same effect on health outcomes and are valued equally by patients.
  • A value-weighted activity index captures such quality changes and does not suffer from substitution bias. For a value-added activity index, weights for aggregating treatments are based on the effect of treatments on health outcomes. To the extent that shifts from inpatient treatment to less expensive outpatient treatment have no effect on health outcomes, a value-weighted index will show a decline in the price of the hospital output but no change in the volume of hospital output.
  • National Ambulatory Care Reporting System (NACRS)
  • Outpatient data for Ontario are from the NACRS.
  • The preferred estimate is the cost-weighted activity index based on the detailed case type aggregation and corrected for substitution bias. This “quality” adjusted estimate of hospital sector output over the 2002-to-2010 period rose 4.3% per year.
  • The price index of hospital sector output derived from the quality-adjusted volume index measure increased 2.7% per year. Growth in the price of the hospital sector is slightly higher than growth in the price of gross domestic product over that period (2.5% per year). Labour productivity calculated as the ratio of output to hours worked in the Canadian hospital sector is estimated to have increased 2.6% per year over the 2002-to-2010 period. This represents annual growth of 4.3% for output and 1.7% for hours worked.
  • The analysis reveals a large substitution bias in the cost-weighted volume index of output of the hospital sector when inpatient and outpatient cases are aggregated using their respective unit costs as weights. The bias is estimated to be about 2.6% to 3.3% annual growth in the volume index of the output of hospital sector for the period 2002 to 2010.
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Health Council Canada. Seniors in need, caregivers in distress: What are the home care ... - 1 views

www.healthcouncilcanada.ca/rpt_det_gen.php home care
shared by Irene Jansen on 09 May 12 - No Cached
    • Irene Jansen
      Irene Jansen on 09 May 12
       
      Good:     * documents high level of care needs of home care clients, unmet needs, user fees, and variation between provincial programs      * calls on governments to spend more on home care of all types (but not necessarily new money, see below)    * re. substitution for hospital care, says that intensive home care supports need to be in place or family caregivers will burn out (p. 18, 19, 53)    * recommends competitive wages and benefits, maximized scopes of practice, and opportunities for career development and continuing education for home care workers (p. 49-50, 56)
    • Irene Jansen
      Irene Jansen on 09 May 12
       
      Bad:    * No mention of privatization and the impacts.    * Argues for substitution of home care for hospital beds without mentioning (1) hospital overcrowding and associated problems, or (2) that a significant part of the savings comes from poor pay/benefits/conditions for home care workers    * Does not call on governments to spend more on home care as additional money - rather "determine how best to allocate funds" and find "appropriate balance" (p. 55)    * Recommends investment in home care before any new LTC beds, referring to Denmark without highlighting that Denmark spends more than Canada on residential LTC (1.02 vs 0.96% GDP) as well as spending far more on home care (1.02 vs 0.21% GDP) see p. 53- and that Denmark provided job security and wage parity in the shift from residential to home-based care.    * Mentions self-managed care (individualized spending) in positive light (p. 54) and John Abbott promoted it at CFNU March 8 continuing care event.
    • Irene Jansen
      Irene Jansen on 09 May 12
       
      Questions:    * Claims 51% increase in home care recipients in the last decade (p. 6 citing a 2008 report), but McGrail 2008 report claims 1% (vs 6% growth in overall spending, i.e. more spent per user) between 1994-2004.    * Claims that 93% of seniors want to stay at home as long as possible (p. 6), which in some media coverage was interpreted as "93% prefer home care to residential LTC". On the latter, I've seen far lower estimates, e.g. 75% - and confidence in provider, sense of security more important than location.    * Are the claims re. home superior to hospital care well substantiated, i.e. how strong are those studies? (e.g. claim that Home First is "better for patients", p. 19 - citation is a LHIN report, but LHINs push this policy on families), also p. 39    * Ontario Home First different than NS Home Again program; NS provides up to 56 hr/wk for 60 days, higher than Ontario? (p. 19)
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  • Seniors in need, caregivers in distress: What are the home care priorities for seniors in Canada? explores the growing issue of home care in Canada. The report takes a deeper look at the seniors who are receiving home care, the family caregivers that are lending support, as well as the challenges of home care in Canada.
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CBC On the Money December 19, 2011 - Armine Yalnizyan on Flaherty's announcement of CHT... - 0 views

www.cbc.ca/video accord federal diktat cht
shared by Irene Jansen on 23 Jan 12 - No Cached
  • Irene Jansen on 23 Jan 12
     
    At 5 min, Armine says that we overuse hospitals and "we can integrate more fully into the communities". Does she mean substitution of community care for acute care? Armine also says in this interview that the six percent increases in CHT every year translates to 0.9% - 1.4% of provincial revenue.
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Physician assisted dying is not a substitute for providing mental health support - Poli... - 0 views

policyoptions.irpp.org/...roviding-mental-health-support from heather mental health suicide
shared by Govind Rao on 04 Apr 16 - No Cached
  • Attention to mental health care and social supports must begin well before the point where a person's life is on the line.
  • Jennifer ChandlerSimon Hatcher March 11, 2016 
  • Why the concern?  Physician assisted dying is not a real ‘choice’ for those with mental illness if we don’t first offer them adequate care and support.  And the unfortunate reality is that, in Canada, mental health is vastly under-serviced.
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Home First program deprives some elderly patients of right to apply for long-term care,... - 0 views

www.ottawacitizen.com/...story.html ontario home care substitution
shared by Irene Jansen on 14 Nov 12 - No Cached
  • Some seniors are being pushed out of hospital too soon under the province’s Home First policy, says a lawyer who advocates for older people.
  • Jane Meadus, a lawyer with the Toronto-based Advocacy Centre for the Elderly (ACE)
  • “While many patients will do well at home with extra home-care services, there are many who are too sick to be cared for at home.”
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  • ACE has received about 250 complaints from across Ontario in the past year, including from Ottawa, about hospital discharges. “Discharge from hospital is the No. 1 issue in our office,” said Meadus.
  • In other cases, people are being pressured to enter private retirement homes, which can cost $5,000 a month and might not be able to provide the care needed
  • some elderly patients are being “forced” to go home to recuperate without being given the option to apply for long-term care and waiting for a bed while in hospital. And that might violate their legal rights.
  • this policy runs contrary to the provincial Long Term Care Homes Act
  • Without being provided with the correct information, they cannot make an informed choice as is required by the law. Hospitals cannot require physicians to discharge before the person can be safely cared for in the appropriate destination.”
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CMAJ: Imprisoning the mentally ill - 0 views

www.cmaj.ca/...isoning_the_mentally_ill.xhtml substitution mental health
shared by Irene Jansen on 17 Jan 13 - No Cached
  • "Federal penitentiaries are fast becoming our nation's largest psychiatric facilities and repositories for the mentally ill," wrote Howard Sapers, the Correctional Investigator of Canada
  • 30.1% of female offenders and 14.5% of male offenders had been previously hospitalized for psychiatric reasons
  • So prevalent is the incidence of mental health problems in prisons that experts have identified the burden as being three times that of the general Canadian population (Behav Sci Law 2009;27:811-31).
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  • "deinstitutionalization," resulted in the virtual emptying, and subsequent closure, of many psychiatric facilities across the country (Can J Psychiatry 2012;57[2]:Insert 1-6).
  • The comprehensive community support systems that were meant to sustain deinstitutionalization never fully materialized.
  • In 1959, the nation had 65 000 beds in mental health facilities (Can J Psychiatry 2012;57[2]:Insert 1-6). Today, there are just 10 653 beds (www.who.int/mental_health/evidence/atlas/profiles/can_mh_profile.pdf).
  • But transinstitutionalization isn’t the sole factor at play in the disproportionate incarceration of the mentally ill, several experts say. They point to Prime Minister Stephen Harper’s "get tough on crime agenda" as also having had a substantial impact on the numbers of incarcerated.
  • As a corollary, the conditions of confinement essentially increase the rate of mental illness
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Doug Allan. A tiny response to growing elder needs - 0 views

ochuleftwords.blogspot.ca/...se-to-growing-elder-needs.html ontario ltc substitution cupe
shared by Irene Jansen on 17 Jan 13 - No Cached
  • The Ontario government’s 26 page Action Plan for Seniors came out yesterday. 
  • Perhaps the biggest proposal here is their plan to designate 250 beds in long-term care as ‘assess and restore’ beds.   Essentially this means opening hospital beds in long term care facilities.  Instead of using long-term care to provide long-term residential care, they want to use long-term care to provide short-term care (providing curative treatment, as in the hospitals).   
  • The government promises only to “designate” 250 beds – they do not promise to create 250 beds. 
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  • Bottom line – what they have promised here is a rounding error in the overall health care budget.
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Not all home and community care receiving increases this year | OPSEU Diablogue - 0 views

diablogue.org/...-receiving-increases-this-year Ontario hospital substitution
shared by Irene Jansen on 19 Mar 13 - No Cached
  • It’s always been an odd concept to us to separate out hospitals from other community-based providers. If hospitals are not operating in their communities, where the heck are they operating?
  • hospitals are health care citadels within their communities and attract far more community involvement than some of the so-called private for-profit “community-based” health care providers
  • Walk into the lobby of any hospital and you’ll likely see an information desk with volunteers from the community sitting behind it. If you’ve had heart surgery recently, you’ll have probably received a visit by a hospital volunteer who is there to answer your questions. Community volunteers are key to making fundraising foundations work for hospitals.
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  • hospital boards are mostly made up of people who live in the community
  • public hospitals not only serve their communities, but they also operate beyond their walls in what most would consider as home care work
  • CEO of the Royal Ottawa Health Care Group, told us he was receiving no increase in funding for the ACT (Assertive Community Treatment) teams that visit client homes to provide mental health support. These workers rarely even see the inside of a hospital. Yet because of their connection to the hospital, they suffer under the same freeze to base budgets.
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Top A&E doctors warn: 'We cannot guarantee safe care for patients anymore' - UK Politic... - 0 views

www.independent.co.uk/...-patients-anymore-8624513.html UK safety ER
shared by CPAS RECHERCHE on 21 May 13 - No Cached
  • // div.slideshow img { display: none; } 1 / 2Top A&E doctors have warned 'We cannot guarantee safe care for patients anymore'Rex //
  • A combination of “toxic overcrowding” and “institutional exhaustion” is putting lives at risk, according to the letter to senior NHS managers from the leaders of 18 emergency departments.
  • Last week, figures showed that the number of patients attending casualty units in England has increased by a million in the 12 months leading up to January 2013.
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  • Speaking before his appearance at the Health Select Committee, he conceded that urgent care services were “getting closer to the cliff edge,” with A&E admission increasing by 51 per cent over the past 10 years
  • The letter from the 20 A&E leaders talks of the “institutional exhaustion” of the nursing, medical and even clerical staff who being pushed ever harder by the growing volume of work with little outside support
  • . It also describes how doctors and nurses are being forced to work in what are verging on dangerous environments
  • They further warn that overcrowding is likely to lead to more deaths in hospitals and reveal that standards of care are deteriorating as serious clinical incidents and delays are rising.
  • The letter states: “The aforementioned issues have led to us routinely substituting quality care with merely safe care; while this is not acceptable to us, what is entirely unacceptable is the delivery of unsafe care; but this is now the prospect we find ourselves facing on too frequent a basis
  • Recent developments such as the introduction of 111 and financial penalties for holding ambulance crews in ED are touted as solutions to the crisis: however we as ED physicians recognise that these measures will actually make the problem worse instead of better, and evidence is already emerging to support our opinions.
  • Furthermore, we firmly believe and strongly recommend that ED leads should be intimately involved with and consulted on the commissioning of Emergency services in the region, as well as other related emergency care changes-such as 111.
  • There is toxic ED overcrowding, the likes of which we have never seen before.
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Density and the city: How will Toronto health care cope with population growth? - Healt... - 0 views

www.healthzone.ca/...re-cope-with-population-growth emerg substitution Ontario chc
shared by Irene Jansen on 28 Jan 13 - No Cached
  • Orleans Urgent Care
  • a walk-in clinic on steroids
  • “Urgent care, if done properly and not affiliated with a public facility — because costs go up — in the right spots, where there are crowded emergency departments and difficulty accessing care, they could fill the gap.”
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  • The cost of seeing a single patient, who is typically treated and out the door within a few hours, is minimal next to the single-patient cost at a hospital. Sardana said the average is about $12 per patient, compared with roughly $180 at a hospital.
  • Urgent care centres aren’t nearly as common in Canada as they are in the United States. Since the late 1990s, the number of such clinics south of the border has grown to nearly 9,000, according to a 2011 report from the Urgent Care Association of America.
  • While the Orleans clinic carries a full staff, Sardana said it isn’t easy to find physicians and nurses experienced in emergency-room care
  • While the pay is still good, it isn’t comparable to hospital salaries.
  • More than 70 community health centres now exist across the province, offering access to primary health care through doctors, nurse practitioners, dietitians and other services — again, limiting the need to rely on hospitals.
  • A study released in March by the Association of Ontario Health Centres found that patients who took advantage of community health centres used a hospital 21 per cent less than patients who received their care elsewhere.
  • “We need to do a much better job with models of care and places of accessing care within the system that already have demonstrated some of the burdens that we’re potentially looking at urgent care clinics to take care of.”
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There are hidden costs of moving care out of hospitals. Jeremy Petch and Danielle Marti... - 4 views

healthydebate.ca/...f-moving-care-out-of-hospitals Ontario home care substitution
shared by Irene Jansen on 21 Feb 13 - No Cached
  • Providing care in the home also raises hopes of substantial cost savings for the government
  • If done well, moving care out of hospitals could improve patient care, while reducing health care spending. However, there are hidden costs, both financial and human, of moving care into the home that have received little public attention, including lower wages, riskier work environments and greater burdens on family caregivers.
  • A major source of expected savings from a shift to home care is lower wages
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  • Personal support workers in the home care sector can be paid as little as $12.50/hour compared to hourly rates of $18 to $23 for their hospital-based colleagues.
  • Similar disparities have also been observed for other care workers, including registered nurses.
  • In addition, home care workers often do not get steady hours
  • According to Stella Yeadon, a representative for the Canadian Union of Public Employees, this is largely because union organizing is very challenging in the home care sector. Unlike the hospital environment where workers are in a single building, home care workers rarely meet one another.
  • support for family caregivers was notably absent from both Ontario’s Action Plan for Healthcare and the year-one update released last month. Support for caregivers is part of Ontario’s new Seniors Strategy, but it remains to be seen how much of this strategy will translate into action.
  • turnover as workers leave home care for higher paying jobs at hospitals is bad for patients
  • Low wages and limited benefits across an entire sector raise concerns about the possibility of recruiting skilled care workers. “
  • low wages could pose real barriers to recruiting and retaining staff.
  • Health care workers face substantial health risks as part of their work, due to their exposure to infectious diseases, violence from patients/residents with dementia, allergic reactions from chemical agents, and injuries resulting from lifting patients.
  • There is currently limited data on the occupational health risks of delivering care in the home. However, some care may be riskier in the home, where workers are more likely to be without either backup from other staff or mechanical assistance (such as patient lifts), as compared to workers in a hospital or a long-term care facility.
  • According to a report from the Ontario Health Coalition, another contributor to lower wages is the Ontario government’s procurement policy for Community Care Access Centres (CCAC), which requires CCACs to contract out home care services. While competitive bidding for contracts has been somewhat successful in keeping costs down for CCACs, it has done so largely by “driving down wages,”
  • patients who need home care do not have families to care for them
  • there’s no one to care for them but me and they need more help.”
  • lower wages and riskier environments raise the possibility that the quality of care may be negatively affected as services are moved from hospital to community settings.
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Quebec's plan to empower pharmacists - and undermine medicare - The Globe and Mail - 2 views

www.theglobeandmail.com/...article21978873 from heather Quebec privatization pharmacare pharmacists
shared by Govind Rao on 08 Dec 14 - No Cached
  • The Globe and Mail Published Sunday, Dec. 07 2014
  • Innovation is usually a good thing, particularly when it comes to improving Canada’s unwieldy public health system. Some experiments, however, risk doing more harm than good.Legislators in Quebec are preparing a strategic shift to ease the mounting pressure on front-line care, with Bill 41 aiming to give pharmacists more power to provide therapeutic services. Under the proposed law, pharmacists would be permitted to renew and adjust prescriptions, substitute medications, write prescriptions for minor, previously-diagnosed conditions, order lab tests, and administer drugs. Rather than clogging up the waiting areas of clinics and hospitals, waiting to see a doctor, people suffering from minor ailments will be able to pop over to the nearest drug store for a consultation with a health professional. It’s about time pharmacists were recognized as more than mere pill counters, something that happened long ago in countries like France.
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Firestorm over Wildrose's health-care policy pits myths against reality - The Globe and... - 0 views

www.theglobeandmail.com/...article2404555 alberta waits private clinics home care substitution
shared by Irene Jansen on 17 Apr 12 - No Cached
  • Danielle Smith, leader of the Alberta Wildrose Party (and, if the polls are to be believed, the premier-to-be), said that if her party forms the next government on April 23, it will allow a mix of public and private health-care delivery.Ho-hum.
  • A mix of private and public health-care delivery – with public administration – is the norm in Canada.
  • Yet, predictably, Ms. Smith’s comments sparked an outcry.
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  • Patients care not a whit who delivers their care; they care about quality, accessibility and affordability. So too should governments.
  • We need to stop vilifying everyone – and politicians in particular – who states the obvious: that private care has a place in our health system. At the same time, we need to dispense with the tiresome stereotypes, good and bad, about private delivery of care.
  • There is nothing wrong with contracting out work.
  • Part of the Wildrose platform is the Alberta Patient Wait Time Guarantee, an initiative to reduce waits for 10 common surgical procedures. Ms. Smith said if guaranteed waiting times could not be met within the province, patients could seek the procedures from private clinics in Alberta or in other jurisdictions (Canadian or U.S.) and the province would pay.
  • we need to get beyond the knee-jerk “all private care is evil” rhetoric
  • What should be of much greater concern to citizens, in Alberta and other provinces, is what Wildrose (or the Progressive Conservatives, if they are re-elected) would do with the public administration side of the system.
  • we need to fix our fundamental approach to delivering care – to put the emphasis on managing chronic disease and caring for people in the community and take it away from the outmoded approach of providing all acute care in institutions.
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TheSpec - Home care's 'race to the bottom' - 1 views

www.thespec.com/...home-care-s-race-to-the-bottom home care on two tier wages union competitive bidding substitution integration
shared by Irene Jansen on 30 Apr 12 - No Cached
  • St. Joseph's Home Care is ready to compete for a flood of opportunity believed to be coming this fall when the province is expected to overhaul how contracts are awarded.
  • The home care agency — run by the same organization as St. Joseph's Hospital and Villa — cut wages by up to 15 per cent in all new contracts it wins.
  • The $13.96 starting hourly rate is now below Hamilton's living wage of $14.95. It takes five years to reach the top rate of $15.31.
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  • That's also below the starting wage of $16.07 for personal support workers, dietary aides, health aides and home cleaners.
  • Kim Ciavarella, president of St. Joseph's Home Care. “We introduced this new tier so we'd be able to bid on those contracts. It positions us very nicely.”
  • The 190 workers came close to striking over the two-tier system that sees lower wages go to staff working on any new contracts
  • “We feel it's a race to the bottom,” said Bill Hulme, community care lead for the Service Employees International Union Local 1 Canada, which represents 10,000 home care workers including those at St. Joseph's.
  • The low wages, combined with a lack of job security, have made home care the most unstable sector of the health care system and the hardest in which to retain staff, says Jane Aronson, a home care researcher and director of McMaster's school of social work.
  • “I find it unfathomable that at the same time the provincial and federal governments keep saying home care is very important, it's organized so those who are its front line staff won't have security and in this instance won't even have a living wage,” she said. “It's not a field people can afford to work in very long so we lose people with skills.
  • home care workers make far less than the hourly wage because they're often not paid for their transportation time between clients
  • The province halted competitive bidding in January 2008 to try to resolve some of these issues. It's expected something new will be in place this fall.
  • St. Joseph's Health System is testing what it calls “bundled care,” which involves the province giving a set amount of money to provide diagnostic, hospital, long term care and home care to patients with a co-ordinator overseeing it all and acting as a point of contact.
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Growth in drug spending slows in Canada: study - The Globe and Mail - 1 views

www.theglobeandmail.com/...article2421660 drugs spending
shared by Irene Jansen on 08 May 12 - No Cached
  • Total drug costs rose just 4 per cent between 2010 and 2011, the Canadian Institute for Health Information reports.Michael Hunt, director of pharmaceuticals at CIHI, said this is a “far cry” from the double-digit increases that were commonplace through the 1990s and 2000s. In fact, it’s the smallest annual increase since 1985, when national record-keeping began.
  • “Spending is slowing down,” Mr. Hunt said. He cited a number of inter-related factors:* Patent expiration for some blockbuster drugs, such as Lipitor, have resulted in cheaper generic versions being available.* Tough new generic pricing policies; Ontario for example sets the price of generics at 25 per cent of the brand name price, down from 50 per cent.* Policies like generic substitution, where insurance plans cover only the price of the generic, not the brand name drug.* Changing usage patterns – for example, re-thinking how cholesterol-lowering drugs like statins are prescribed.* The number of new drugs brought to market has been falling steadily for the past decade.
  • While spending may be waning, Canadians remain among the most enthusiastic consumers of drugs in the world.
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  • In fact, only Americans, at $1,147 per capita, spend more on drugs than Canadians, at $890.
  • unlike citizens of most other developed countries, Canadians pay for the majority of their prescription drugs with private insurance or out-of-pocket.
  • About 39 per cent of prescription drug costs are financed by the public sector in Canada, compared to 85 per cent in Britain.
  • Public spending on prescription drugs was $12.1-billion last year, up just 2.2 per cent; private spending was $15.1-billion, up 6.8 per cent.
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The faulty premise for the Drummond Commission (article based on Salima Valiani's paper... - 0 views

rabble.ca/...ty-premise-drummond-commission union ontario economics rn drummond ltc
shared by Irene Jansen on 13 Feb 12 - No Cached
  • By not taxing the lenders and the wealthy, government lacks the base from which to uphold the common good. Government puts the common good in the pocket of the lenders, by both borrowing and cutting. Take for example, Ontario hospitals unable to meet the cost of fulfilling peoples' needs due to insufficient funding from the Ontario government which then cut registered nurse positions.
  • In 1999 the Ontario Ministry of Health and Long-Term Care created the Capital Renewal Program and began subsidizing private profits by granting money to companies to create desperately needed long-term care beds.
  • "Fixing the Fiscal House: Alternative macroeconomic solutions for Ontario," is a research paper recently released by the Ontario Nurses' Association
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  • The Ontario government should bolster employment, and hence domestic demand in the economy, by increasing investment in public services and social programs
  • Drawing on post-2008 public investment measures adopted in China, Brazil, Australia and Kenya, the paper demonstrates how the Ontario government can be a leader in bringing the Ontario economy out of economic crisis for the common good, including eventually eliminating the deficit and debt.
  • the Ontario government should commit financial resources to create an additional 9,000 permanent full-time equivalent RN positions by the end of fiscal year 2014-2015 in order to begin addressing the particularly low RN-to-patient ratios in Ontario relative to other Canadian provinces.
  • mass construction of low-income housing in Ontario
  • In the long-term care sector, a minimum staffing standard should be funded and regulated at an average of 3.5 worked hours of nursing and personal care per resident, per day, including 0.68 RN hours per patient per day.
  • not substituting or replacing RNs with registered practical nurses
  • increase state revenue through taxation of corporations and the wealthy, beginning with cancelling the reduction of the corporate tax rate to 10 per cent.
  • work with the federal government to establish job creation targets in various areas. This should include job-intensive green job creation and fully subsidized skills training programs
  • For the full research paper see:http://www.ona.org/publications_forms/research_series.html
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A simple solution to high drug costs | Troy Media - 0 views

www.troymedia.com/...le-solution-to-high-drug-costs drugs generics
shared by Irene Jansen on 13 Mar 12 - No Cached
  • In Canada the drug industry spends roughly $3 billion per year marketing its products, two-thirds of which goes towards the salaries of the sales reps who visit our physicians regularly, and the drug samples they use to enhance their one-on-one learning sessions.
  • even if the generic pills are a different colour or shape it’s still the same active ingredient.
  • In the U.S., when a big name drug goes generic the generic sales take off. In this case, more than 70 per cent of U.S. patients were switched to the generic atrovastatin. Why? U.S. drug plans enforce generic prescribing, so many of them will make the switch to the lower-cost generic drugs.
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  • Canada’s doctors, on the other hand, aren’t significantly influenced by drug plans. In Canada, more than half the former Lipitor patients have been switched to the newest still-patented anti-cholesterol drug, Crestor, which is not proven to be any more effective than generic atorvastatin. And it’s certainly more expensive than the lower priced generic.
  • Even as provincial governments have rules for enforcing generic substitution, many people are covered by their employer-sponsored private insurance plans, which have no such rules.
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Canada News: Taxpayers could save big if hospitals and provinces harmonized drug plans:... - 1 views

www.thestar.com/...es-harmonized-drug-plans-study drugs purchasing hospitals government spending
shared by Irene Jansen on 27 Jun 12 - No Cached
  • Taxpayers could save millions of dollars if hospitals and provincial governments harmonized their prescription drug plans, according to new research.
  • Hospitals and provincial drug benefit programs are not working together to get the best deals from drug manufacturers and they pay a big price for not doing so
  • Hospitals band together to get better bulk deals from drug manufacturers but they work independent of provincial drug plans. Bell said it’s not unheard of for manufacturers to give hospitals better deals on costly newer generation drugs than they give to provincial drug benefit programs.
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  • study published in the journal PLoS One
  • health care expenditures in Canada are on a steep upward climb
  • hospitals and governments should look at ways to break down the silos around prescription drug purchasing and dispensing
  • Substituting the least expensive version of each drug could have saved $1.6 million, or 47 per cent, for PPIs
  • Medications represent an increasing share of those costs, currently around 16 per cent.
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Robert Evans on doctor shortage Healthcare Policy Vol. 7 No. 2 :: Longwoods.com - 3 views

www.longwoods.com/22659 doctors hhr ally excellent
shared by Irene Jansen on 06 Sep 12 - No Cached
  • And second, a lid must be placed on APP program payments. Funding for benefit and incentive programs should be folded into the negotiation of fee schedules, recognizing that they are, like fees, simply part of the average prices physicians receive for their services.
    • Irene Jansen
      Irene Jansen on 06 Sep 12
       
      Alternative payments program (app) is the term used to describe the funding of physician services through means other than the fee-for-service method.
  • the coming increases in numbers have, once again, foreclosed for decades the possibilities for exploiting the full competence of complementary and substitute health personnel, expanding interprofessional team practice and in general, shifting the mix
  • Including rapid growth in net immigration, the annual "crop" has nearly doubled.
  • ...16 more annotations...
  • Canadian medical schools have expanded their annual enrolment by 80% over the last 13 years
  • major increase in physician supply per capita, from 1970 to 1990, did not result in underemployed physicians. Utilization of physicians' services adapted to the increased supply. Whether the additional physicians were "needed," and what impact their activities might have had on the health of Canadians, are good and debatable questions
  • In the last decade, medical expenditure per physician has also risen, by nearly 35% above general inflation.
  • Each of these waves of expansion responded to widespread perceptions of a looming "physician shortage." How accurate were those perceptions? In the case of the first wave, they rested on assumptions that were simply wrong, and by a wide margin. Medical schools were built to serve people who never arrived.
  • it is politically extremely difficult, almost impossible, to cut back on medical school places once they have been opened.2
  • Does all this increased diagnostic activity among the very elderly actually generate health benefits?
  • (Population has grown by about 14%.)
  • Table 1. Canadian health spending, percentage increase per capita, inflation-adjusted   1999–2004 2004–2009 1999–2009 Hospitals 19.1 11.7 33.0 Physicians 16.4 24.4 44.8 Rx drugs 46.1 19.0 73.7 Total health 22.2 16.5 42.3 Provincial governments 21.2 17.7 42.6  
  • Over the nine-year period, there were very large increases in the per capita volume of diagnostic services – imaging and laboratory tests. Adjusting for fee changes, per capita expenditures on these rose by 28.4% and 42.1%, respectively.
  • much greater among the older age groups – 59.4% and 64.4%, respectively, for those over 75
  • money has been poured into reimbursing diagnostic services for the elderly and very elderly, but access to primary care for the non-elderly appears to have been constrained
  • insofar as more recently trained physicians tend to be more reliant on the ever-expanding arsenal of diagnostic technology, overall expenditures per physician will continue to rise as their numbers grow
  • As in the case of the previous major expansion, the impact on the total supply of physicians will unfold slowly, but relentlessly, over decades.
  • a lot of money is going out the door and no one has a clear picture of what it is buying
  • The question of Canadian physician supply is now moot. The new doctors are on their way, and whether or not we will need them all is no longer relevant. It may be that as cost containment efforts begin to bite we will again see renewed limits on the inflow of foreign-trained physicians, but we will not be able to turn down the domestic taps as supply increases.
  • Growth in diagnostic testing has to be brought under control, both in how ordering decisions are made and in how tests are paid for.
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December 2010. Eugene Forsey vs. Maxime Bernier | Canadian Centre for Policy Alternatives - 0 views

www.policyalternatives.ca/...ugene-forsey-vs-maxime-bernier accord fed-prov
shared by Irene Jansen on 23 Jan 12 - No Cached
  •      The dispute about the federal “spending power” is not new.
  • For them, spending by the federal government in fields like health and education – fields mainly under provincial jurisdiction – is an outrage. They want to see the Government of Canada abandon those domains entirely, ending the current system of transfer payments to the provinces and replacing them with "tax points" so that provincial governments could raise the necessary money themselves.
  • As Ontario Finance Minister Dwight Duncan has astutely suggested, Bernier should take a look at the actual consequences, province by province, of substituting tax points for the federal spending power. The results would likely be less than desirable, even for Quebec.
  • ...15 more annotations...
  • To download all those tasks to the provinces would risk turning many Canadians into second-class citizens.
  • "The big, rich provinces can do it, [but] with what consequences? The small, poor ones cannot; at any rate without massive help from that central government which [further decentralization] would enfeeble."
  • Section 36 of our repatriated Constitution Act, 1982, which explicitly states a shared commitment to:
  •      Federal jurisdiction has been chipped away since then
  • despite those rulings, the federal government retains its powers in many fields, and shares jurisdiction with the provinces in a number of others
  •   To further limit or eliminate the federal spending power would severely disrupt the practical balancing mechanisms that characterize Canadian federalism. It would also go against the principles of fairness and welfare (or well-being), which are inherent in the Canadian tradition.
  • As my father regularly pointed out, the BNA Act (now the Constitution Act, 1867), gave the Dominion government broad powers "to make laws for the Peace, Order and Good Government of Canada," embracing all matters – foreseeable or otherwise – that were not "assigned exclusively to the legislatures of the provinces."
  • "(a) promoting equal opportunities for the well-being of Canadians; (b) furthering economic development to reduce disparity in opportunities; and (c) providing essential public services of reasonable quality to all Canadians.”
  • radically decentralist goal
  • "instead of sending money to the provinces, Ottawa would cut its taxes and let them use the fiscal room that has been vacated.”
  • this is the position of “two of the greatest conservative statesmen of our generation, Preston Manning and Mike Harris,” as well as of the Fraser Institute
  •      Bernier's portrayal of Macdonald, Cartier, and the rest as avid provincialists is thoroughly debunked in Dad's popular and authoritative handbook How Canadians Govern Themselves
  • cite the historical record to show that our country was intended from the start to be "a real federation, a real 'union,' "une grande et puissante nation," not a league of states or of sovereign or semi-independent provinces."
  • "Only a real country," he said, "with a powerful national Government and Parliament, can have any hope of controlling inflation and restoring full employment. Only a real country can maintain the unemployment insurance, the family allowances and child tax credits, the Medicare, which we now enjoy. Only a real country can give the people of the poorer provinces anything like modern educational and social services."
  • deteriorating patchwork of policies and programs that weaken the system and aggravate disparities between provinces
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