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Outsourced medical transcription is usually performed by home-based subcontractors who must put in about double the hours to earn the same wage, and work with few benefits.

outsourced medical transcriptionists do not have access to secure electronic medical records or other health care team members within the hospital system

Our in-house medical transcriptionists already spend a lot of their time editing and correcting outsourced work.

British Columbians should be concerned about the privacy of their records

Medical transcriptionists are responsible for transcribing physicians’ dictation of surgical procedures, consultations, patient histories, test results, and various other reports.

"The goal is to introduce new technologies and inventive management practices, while achieving significant savings throughout the health-care system by standardizing the processes around managing these services, coordinating their planning and improving operational efficiency," Boudreau said. "Close to 1,800 people work to deliver food and cleaning services in New Brunswick hospitals. These employees are a vital part of our delivery of health care and the vast majority of them will continue to be government employees and CUPE members." But union officials said they don't believe it. They see the food service privatization as the tip of a much bigger iceberg that will lead to more cuts to jobs and, eventually, a lower level of service for New Brunswick taxpayers. Norma Robinson, president of CUPE Local 1252, said the union represents over 1,200 hospital support staff, paramedics, licensed practical nurses, patient care attendants and others. She said the Gallant government is trying to pick up on a plan that was started by the Alward Conservatives.

Robinson says union officials were called into a meeting last Thursday and told about the privatization plan. "This is not just about the jobs, it's about the service," Robinson said after her speech to the city hall rally. "We're talking about taking a publicly owned service and putting it in the hands of a private-for-profit corporation. It's not going to cost less, it's going to cost more because they are going to want to make a profit. That's our point, we don't want private companies coming in and taking over any public service in this province," Robinson said. "This is the tip of the iceberg. There are several areas they could look at to privatize. They are not being transparent with their information. They are doing a review of all services in the province, not just in hospitals. It's looking at all levels of government." Robinson called on taxpayers and voters to voice their anger at potential reductions in service as a result of cost-cutting and privatization. "We want answers. We want this stopped. We don't want privatization to come into this province, so we are going to try to stop this before this disease spreads and completely engulfs New Brunswick," Robinson said.

Patrick Colford, president of the New Brunswick Federation of Labour, was another speaker at the rally who said it was time for workers in the province to rise up against the government and fight cost-cutting that results in service reductions. "It's a taxpayer issue and where do taxpayers want their money spent?" he said after his speech. "Whether you are unionized or not, you are still a taxpayer. Is this about protecting jobs? Yes it might be but that's not the whole picture by any means. It's about protecting services that we depend on every day. "Talk to anybody who's ever been on EI and how frustrating it gets trying to talk to a human being to get answers, or somebody who goes to Service New Brunswick and has to take a number and sit there and wait. Or when you go to the emergency room and sit there and wait. All these cuts do is divide the population. Nobody wants to cut services and when the government comes in and says they are going to cut these public services and save X amount of dollars, people don't see the whole picture. The people who do are being vocal about it."

the job cuts obviously won't be targeted solely - or perhaps at all - at the nursing workforce

Tarjan admitted she thinks health care in the province needs to be "right-sized" but she wouldn't comment on specifics of what she would like to see, except to say that she thinks there is a surplus of acute service

The member of the scheduling team responsible for that work unit would receive the request along with a list of employees that have the skill-sets and availability to work in that vacationing staffer's place. "They assign that work according to the various union collective agreements," he said. However, if the matter is unfolding in a shorter period of time, such as if someone was calling in sick for a shift scheduled to start later today, there's a different protocol. "Obviously that needs more immediate attention. There's an actual telephone call from a manager or a supervisor at (the unit) to a dedicated line in the scheduling centre," he said. Together, the employee's manager would work with the scheduling team to sort out the appropriate person to be offered the shift. Why is Horizon making this change? The goal is to lighten the administrative load on health-care managers across the province so they can focus on the day-to-day delivery of care.

"We're taking that sort of task or transaction work out of the nursing units. Typically, it's done by ward clerks or, in many cases, the managers themselves. It consumes a lot of their time. But that's only part of their job. They have responsibilities for other operational requirements in their various units," he said. Doull said the health authority also sees value in managing schedules in a consistent way across the province. "What we want to do for all of the areas is standardize the processes and the application of the collective agreement rules. So instead of having (more than) 200 people in Horizon who have as some small part of their job (tried) to get by in doing scheduling work as best they can with no formal software support or training, we're going to bring that into a purpose-built department," he said. "And there are efficiency payoffs for that, both financial and operational, for us as an organization." He did acknowledge that there will still be room for personal interventions by managers, particularly if a quick conversation at the office door can resolve a pressing matter easily and effectively.

If a matter is of an urgent nature, the employee can contact their manager or appointed supervisor directly and have a conversation about the request for time off and the manager can figure out a specific way to handle the situation. "All the manager is going to do is simply call the centre in Saint John, or email the staffing team that they work with, and say, 'An employee has talked to me. This is what we're going to do and here's how I want you to deal with the shift on Saturday,'" he said. "The manager always has that direct-line option to deal with things that are of a more timely nature." Although, too much of that can be a problem, said Doull, explaining that in some units across the province managers can fall into routines where the easiest employee to reach, or the most willing employee to work, receives most of the overtime or sick-time shift offers. "Later on, one of the four or five people (ahead of the preferred employee) may very well come back and say, 'I have a grievance because I should have been offered that shift. What are you going to do for me?' And we may be in a situation of having to, in effect, pay twice for time that needs to be worked," he said.

"I wouldn't characterize it that it happens often, but it certainly happens often enough that we know about it and it's one of the problems that we're specifically trying to solve." Members of the scheduling team are working to determine which site will be the next to adopt this new staffing system. Ultimately, when the scheduling team is fully operational and slotting shifts for units across Horizon, a team of 21 staff members will be working at the Saint John centre between the hours of 5 a.m. and 11 p.m. "That's roughly 70 full-time equivalent (positions for our team)," he said.

Doull said he knows many employees are likely worried about this change, but the move is expected to create significant savings for Horizon. "What we're looking to do is return time to managers and clinical staff," he said. "We know patients have a better experience if they know who the manager is in their area and they're able to interact with them regularly ... We know staff are more satisfied at work if they're able to have access to their manager." There are also savings expected through reductions in payroll errors.

"If someone puts in the wrong code for a specific number of hours and an employee gets paid the wrong thing, we know how often we're going back and correcting these. What this system will do is take a lot of the manual data entry of our pay processes away," he said. "It'll be automated and driven by what the employee is scheduled to work." It should also help to highlight problems in specific units, he said. "If we have an area, for example, that is using a lot of overtime, we'll know who is not there, why they're not there, which positions are not actually filled because there's nobody to work them, and we'll be better able as an organization to identify where our recruiting issues are," he said.

Ralph McBride, CUPE Local 1252's provincial co-ordinator, said he's concerned about the economic impacts the move could have on communities across the province. "We're not overly impressed with centralizing services. We see this as taking away important jobs in rural New Brunswick and moving them to urban centres," he said. "We think there are economic hard times happening currently in the Miramichi. This won't help." There are no plans to integrate this system with scheduling protocols used by the Vitalité Health Network. The Daily Gleaner requested information from the Vitalité Health Network on how the province's other regional health authority schedules its staff and the paper is still waiting for a response.

These services, which are delivered by private companies or non-profit organizations but funded primarily by government requisitions on a per client basis, have been targeted by pay equity programs over the past three years because wage rates are barely above minimum wage.

The coalition is made up of 650 individuals and 83 organizations that educates and advocates for the adoption and the implementation of adequate legislation in order to achieve pay equity - equal pay for work of equal value - for all workers in both the public and private sectors.

meeting of the Council of Atlantic Premiers

Alward cited the 2002 Royal Commission on the Future of Health Care in Canada and the subsequent report penned by Roy Romanow that stated Ottawa should not pay less than 25 per cent of health-care costs.

He said that since the 2004 agreement, the health transfer peaked at roughly 23 per cent."And actually we have seen it decline in recent years," Alward said.

the agreement should include additional funding that respects and reflects jurisdictional health priorities

It should also be based on the current allocations and utilize a per-cent province annual escalator, instead of a national total six per cent escalator.

the federal government has a declining part in health-care funding and yet they are coming to us and they are saying they want accountability for the money we are spending

But if union workers are still on the job, it seems highly likely to us that all union rights previously achieved by way of collective bargaining with the actual employer - you taxpayers by way of government - are still in play. CUPE representative Norma Robinson has already voiced concerns. She says the department has already told the union that it is taking bids from three big private-sector providers - Sodexo, Aramark and Compass Group - toward signing a 10-year contract in three or four months. She is certainly within her rights to ask what impact that contract will have on the contract public sector workers have with government.

Perhaps the minister prefers to wait until the contract is signed before saying more, but it seems to us that whatever efficiencies the successful bidder intends to achieve will depend a lot on how it and the union co-operate within the strictures of collective agreements. It is one thing to centralize a kitchen service, for example, and another to respect any pertinent contractual language, such as 'manning' and seniority. Ms. Robinson already sees this move as the first step toward privatization of health care. While Ms. Robinson has said nothing further in that regard, some might interpret that statement as a harbinger of labour unrest for the health department over the course of that private 'management contract.'

Having said that, we are optimistic that some efficiencies will be achieved immediately if all management functions are removed from the collective agreements; it is logical to expect as much given the bidding process should get taxpayers to the lowest price possible for those specific functions. And while we sympathize with union concerns, we endorse privatization of health care; the more the better.

Not long ago union voices were predicting dire consequences when laundry services were centralized for the sake of efficiency. They didn't happen. Should anyone voice similar concerns about a private-sector management contract about, for example, the quality of hospital food, many a patient might chuckle. This government is trying to reduce massive debt and stop deficit spending. Thus it is welcome news to also hear Horizon Health Network CEO John McGarry suggest private health-care firms could move such professions as physiotherapy, audiology and dietetics out of the province's hospitals, which he also notes are too numerous.

Mr. Georgiou, 51, is a long-time senior public servant. Between 2006 and 2012, he held various executive positions at Infrastructure Ontario, the procurement agency that was set up to administer the McGuinty government's ambitious plans to restore the province's outdated infrastructure through public-private partnerships. He was a project manager on the construction of several major projects, including some of the facilities for this summer's Pan Am and Parapan Games, eventually rising to the role of chief administrative officer. How he ended up admitting he issued false invoices - and why that information was not passed on by at least one of his former colleagues at Infrastructure Ontario - dates back to 2009, after a whistleblower complained to management at York about questionable invoices.

Court records show the scheme required Mr. Georgiou to invoice the university, through two family-owned companies, for work that those companies never performed. After cashing York's cheques, he passed on about $40,000 of the total $65,000 paid by York to an intermediary who was connected to a facilities official at the university. Mr. Georgiou said he kept $25,000 to declare for income tax purposes. "Once these events came to light, I fully co-operated with the authorities and counsel for York University, and I assisted them with their investigation. In addition, I ensured that the party who requested the invoices, repaid the entire amount to York University," he said in the statement. He did not address questions about what he told St. Michael's, if anything, about his role in the scheme.

St. Michael's and Infrastructure Ontario have ordered forensic audits. "These swift and prudent actions have been taken by the Board of Directors and Management to preserve and protect the public trust invested in St. Michael's Hospital," a statement from St. Michael's said. In its own statement, Infrastructure Ontario said it was "very troubled" by some of the facts The Globe presented to four of its officials in an interview. "The activity in question goes against everything [Infrastructure Ontario] stands for," said Bert Clark, the agency's chief executive, and Linda Robinson, vice-chair of Infrastructure Ontario's board. Mr. Georgiou, who has been placed on a leave of absence from the hospital, said in an e-mail that The Globe had not provided him enough time to give proper answers to about 40 questions it e-mailed to him last Wednesday. In a statement, he said he never profited from the "exercise" at York and stressed that he was never charged criminally for his role in the false invoice scheme.

York investigated and concluded it had been the victim of a $1.2-million kickback scheme involving false invoices for nonexistent construction and maintenance work. A forensic audit determined that between 2007 and 2010, the university cut cheques to eight different companies for services that were never rendered. The York investigation found that two of those companies, Arsenal Facilities Consultants Inc. and Toronto Engineering Company, were connected to Mr. Georgiou. (He was the listed officer and director of AFC, and the other company was owned by his wife and her parents.) Mr. Georgiou and his lawyer, Gary Clewley, agreed to meet with auditors in February of 2011, and Mr. Georgiou admitted writing three false invoices totalling $64,800 between the two companies. The Globe has obtained a transcript of this meeting, which was marked "confidential" but included in court filings. Mr. Georgiou created paperwork showing that AFC did $22,000 worth of door lock repairs in November, 2007. In February, and then again in April, 2008, he drew up documents claiming that TECO completed a total of $42,800 worth of watermain work.

He wrote these invoices, he told investigators, at the request of a friend who had nothing to do with the university, a parking industry executive named Luigi Lato. According to Mr. Georgiou, Mr. Lato told him maintenance work had been performed and he was hoping Mr. Georgiou could create invoices for that work. But for reasons Mr. Lato never explained, Mr. Georgiou said, whoever did the work did not issue their own invoices. Mr. Georgiou said he believed Mr. Lato was doing a "favour" for a friend at York who needed to pay for the work. A lawyer and an auditor for York pressed Mr. Georgiou on why the companies that actually did this work would not, or could not, issue invoices, and Mr. Georgiou said he did not know.

"There were no details provided to me," he explained at one point. Pressed further, he said, "I didn't ask any questions." York paid AFC and TECO, but Mr. Georgiou told investigators he did not keep the money. He withheld about $25,000 to declare as income tax for both companies, which he said he paid. As for the rest of the money, he made two trips to see Mr. Lato in which he paid him a total of about $40,000 in cash. Mr. Lato could not be reached for comment.

William McDowell, a lawyer acting for York, asked Mr. Georgiou how the teller at his bank reacted when he withdrew $14,500 in cash for Mr. Lato's first instalment: "Doesn't your banker kind of squint when you go in and ask for $14,500 in cash?" Mr. Georgiou replied: "I didn't go into the bank and ask for $14,500 in cash, you know, like in one shot. I had, you know, some cash at home, went to the bank for some cash..." About a year later, on Jan. 26, 2012, York filed a statement of claim against all of the people and companies it believed had defrauded the university, including Mr. Georgiou. The same day, the university's general counsel, Harriet Lewis, met with a senior executive at Infrastructure Ontario, Bill Ralph, who at the time was the procurement agency's chief risk officer, both York and IO said in separate statements. Ms. Lewis informed Mr. Ralph that York had launched a lawsuit against Mr. Georgiou and others because of what the internal investigation uncovered.

Mr. Ralph did not respond to requests for comment. Two weeks after the meeting, Mr. Georgiou suddenly resigned. A few days later, the CEO of Infrastructure Ontario, David Livingston, announced in a company-wide e-mail that Mr. Georgiou was "leaving." The departure e-mail made reference to "various personal and family matters" Mr. Georgiou needed to address. "I know it was a tough decision for him, but I admire him for making it." Mr. Livingston did not respond to repeated requests for comment e-mailed to him and to his lawyer. After leaving IO, Mr. Livingston was appointed chief of staff in May, 2012, to Dalton McGuinty, then premier of Ontario. Mr. Livingston has been accused by Ontario Provincial Police of orchestrating a plan to purge government records after the controversial cancellation of two power plants. He has denied through his lawyer that he did anything wrong.

Employment lawyer Natalie MacDonald said a chief risk officer should give the board of directors any information that could damage the organization's reputation. A risk officer has a "duty to inform the board so it can make an informed decision," Ms. MacDonald said, speaking generally. But according to Infrastructure Ontario's organization chart, the chief risk officer reports directly to the CEO rather than to the board. In an interview last Wednesday, Ms. Robinson, the board vicechair, said the news that Mr. Georgiou had, at one time, been named a defendant in the lawsuit and admitted writing false invoices never made its way to the agency's board.

In April of 2012, Mr. Georgiou and Mr. Lato signed a settlement agreement with York that required them to pay restitution - the amount has not been disclosed in public documents - which Mr. Georgiou said in his statement to The Globe was covered by the "party" who requested the invoices. One of the conditions of the settlement is that York "shall not make any statements to the media" about the agreement or about allegations levelled in York's claim, except to say that Mr. Georgiou co-operated.

Seven months later, St. Michael's board meeting minutes show that it had identified a preferred candidate to replace its chief administrative officer, and in the New Year, Mr. Georgiou officially started his new job. In its statement, St. Michael's said an external search firm was enlisted to identify Mr. Georgiou, and a separate firm conducted reference interviews. The issues at York were "never disclosed by Mr. Georgiou," St. Michael's statement said.

In his statement to The Globe, Mr. Georgiou said he has led the hospital in securing government funding, as well as capital redevelopment funding. "During my tenure at St. Michael's we have achieved tremendous results for the hospital both in the excellence of our hospital's performance as well in the success of our redevelopment project."

Prescription drug spending in Canada's private sector has increased nearly fivefold in 20 years, from $3.6 billion in 1993 to $15.9 billion in 2013 [3x[3]Express Script Canada. 2013 Drug trend report. ESI, Mississauga; 2014 (http://www.express-scripts.ca/sites/default/files/uploads/FINAL_executive%20summary_FINAL.pdf [accessed 01.06.14])See all References][3].

Private drug plans in Canada are often considered wasteful because they accept paying for higher priced drugs that do not improve health outcomes for users and use costly sub-optimal dispensing intervals for maintenance medications. As a consequence, it is estimated that private drug plans in Canada wasted $5.1 billion in 2012, which is money spent without receiving therapeutic benefits in return [4x[4]Express Scripts Canada. Poor patient decisions waste up to $5.1 billion annually, according to express script Canada. (June)Press release, ; 2013 (http://www.express-scripts.ca/about/canadian-press/poor-patient-decisions-waste-51-billion-annually-according-express-scripts [accessed 01.06.14])See all References][4]. This amount represented 52% of the total expenditures of $9.8 billion by private insurers on prescription drugs for that year [5x[5]Canadian Institute for Health Information. Drug Expenditure in Canada 1985 to 2012. CIHI, Ottawa; 2013See all References][5].

Respondents from all categories mentioned that, in contrast to employers, the over-riding objective of unions is to maximize their benefits with minimal co-payments for their employees.

The study focused on large unionized workplaces that had Administrative Services Only (ASO) plans, where the employer is responsible for the costs of benefit plans and bears the risks associated with it, while insurers are just hired to manage claims.

This study focused on ASO arrangements because they are the most common insurance option chosen by large private-sector firms [16x[16]Sanofi. Sanofi Canada healthcare survey. Rogers Publishing, Laval; 2012See all References][16]. Those organizations whose activities resided solely in the province of Québec, where the regulation of private drug plans differs [17x[17]Commissaire de la santé et du bien être du, Québec., Les médicaments d’ordonnance: État de la situation au Québec. Gouvernement du Québec, Québec; 2014See all References][17], were excluded.

Respondents from all categories indicated that consistency of benefits with other market players is of significance to employers.

Sean O’BradyxSean O’BradySearch for articles by this authorAffiliationsÉcole de relations industrielles, Université de Montréal, Montreal, Quebec, CanadaInteruniversity Research Centre on Globalization and Work (CRIMT), Montreal, Quebec, Canada, Marc-André GagnonxMarc-André GagnonSearch for articles by this authorAffiliationsSchool of Public Policy and Administration, Carleton University, Ottawa, Ontario, CanadaCorrespondenceCorresponding author at: School of Public Policy and Administration, Carleton University (RB 5224), 1125 Colonel By Drive, Ottawa, Ontario, Canada K1S 5B6. Tel.: +1 613 520 2600.xMarc-André GagnonSearch for articles by this authorAffiliationsSchool of Public Policy and Administration, Carleton University, Ottawa, Ontario, CanadaCorrespondenceCorresponding author at: School of Public Policy and Administration, Carleton University (RB 5224), 1125 Colonel By Drive, Ottawa, Ontario, Canada K1S 5B6. Tel.: +1 613 520 2600., Alan Cassels

Finally, employers were most concerned with the government's role in distributing the costs associated with drug coverage among public and private players in the system. In fact, each employer expressed concern over this. Three of the four employers expressed concern over the government's role as a plan sponsor and how governments shift costs to the private sector. As described by one employer, “the government is a very big consumer of drugs” and if the drug companies “start losing money on the government side, they pass it on to private insurance”. Thus, government regulations that help employers contain costs are desired.

the employer always has the advantage in this stuff because they have all of the information with respect to the reports and the costs from the insurer or the advisor”

According to one consultant, “no one knows the cost of drug benefit plans.” This respondent was arguing that few involved in benefit design, either in private firms, unions, or insurers, are sufficiently competent to undertake proper analyses of claims data so they do not really know how proposed plan changes could affect them. This lack of expertise has ramifications for the education of stakeholders on the outcomes of benefit design.

However, when speaking of for-profit insurers, participants from all groups argued that insurers have no financial incentives to cut costs for employers, as indicated by one employer saying: “from my experience on the committees, I don’t get the impression that the insurers are there to save costs for the employers. I haven’t seen it. It's always been the other direction.” This claim was also corroborated by a benefits consultant, who argued that “there has been a fair bit of inertia, you know, amongst the providers out there in actually doing something too radical, too leading edge” because “there's no direct financial incentive for insurance companies or pharmacy benefit managers to actually help employers save money”.

Expanding on this, another consultant argued that an insurer's commission structure, which is based on volumes of claims expressed in a dollar value, may in fact discourage insurance companies from proposing plan designs that reduce the volumes of claims, as doing so would adversely affect company profits. Furthermore, another benefits consultant indicated that insurers are experts who calculate risk and thereby have no aptitude for the creation of formularies. According to this respondent, the impact is that insurance companies excel at managing risk, yet fare poorly in designing cost-effective plans that rely on the design and implementation of formularies.

An interesting finding from the interview data was that respondents from all interviewed groups declared being in favor of introducing some sort of arrangement for a national drug plan. Some favored having a universal pharmacare program which would apply to all drugs, while others favored programs tailored for catastrophic drug coverage. Two of the insurers that responded to this question explicitly favored some form of universal catastrophic drug coverage while the other favored universal pharmacare.

Each of the union representatives and one employer interviewed for this study expressed their support for universal pharmacare. Three out of five consultants argued in favor of a national pharmacare plan while the other two favored some other form of national risk pooling or formulary management to address costs.

While a majority of interviewees favored some form of universal coverage, a few respondents from the insurer and employer sides expressed concerns that universal pharmacare is not feasible.

The employers indicated that their over-riding strategy is to maintain cost-neutrality in providing drug benefits – in the context of overall compensation – to employees: any increases in the costs of a particular benefits area must be off-set by cost-savings elsewhere. Controlling knowledge was also frequently reported by the union-side respondents (and by one consultant that services employers) as a strategy to achieve greater control over negotiations and plan design by firms. According to one union representative, “

Marc-Andre Gagnon has received research funding by the Canadian Federation of Nurses’ Unions for a different research project related to drug coverage in Canada. Alan Cassels is co-director of DECA (Drug Evaluation Consulting and Analysis). The authors would like to acknowledge the financial contribution of the Canadian Health Coalition in order to pay for the transcription of interviews.

"Once again the New Brunswick government is exaggerating the province's fiscal problems to impose austerity and spending cuts going along with those who alleged that New Brunswick will be over the cliff if it didn't start to cut spending. It's absurd but it's just the type of scaremongering they use to force through cuts to public services and sales of public assets - because they know the public wouldn't stand for it unless they were spooked," L�g�re said.

CUPE economist Toby Sanger told the meeting that the new government is committing the same mistakes former governments made, but expecting radically better results.

To repeat the same mistakes of their predecessors and continue with these policies is, at best, ignorant or stupid," Sanger said.

Austerity has failed here in the past, as it has around the world, Sangster said, according to a prepared copy of his and L�g�re's remarks. CUPE believes the province's structural program review asks the wrong questions when it asks what the province should stop doing; instead it should ask what other things it can do to increase revenues and grow the economy. The union suggests rolling back earlier cuts to corporate tax rates, imposing higher taxes on high-income earners and closing tax loopholes to generate $400 million more per year. Boosting revenue by 1.5 per cent would put the province in a surplus position, CUPE claims.

The provincial government's strategic revue is looking at ways to cut costs and increase revenues for the expected spring budget and the 2016 budget. Minister of Health Victor Boudreau, who is in charge of the review, had no comment.