Ms. Banerji said Inuit may also have a genetic predisposition to these types of infections. But until those environmental conditions are addressed, a medicine called palivizumab is effective against such infections. In 2010, the Canadian Pediatric Society recommended that "consideration should be given" to administering a preventative drug to all fullterm Inuit infants younger than six months of age in areas with high rates of hospital admissions for respiratory infections. The territory currently gives palivizumab only to children born prematurely or who have chronic heart or lung conditions. The region of Nunavik has recently changed its policy and will administer the drug to all newborns. Palivizumab costs about $6,500 an infant. Ms. Banerji said the cost of treatment, including flying sick kids south, is so high that it would be cheaper to give it to all babies born in the worst areas. She says that policy would save $36,000 for each hospital admission avoided. It would also save wear and tear on families. "A mother has to either come with her two-month-old baby to the hospital in Ottawa and leave all the rest of the kids behind, or the baby's there all alone. It has a huge societal impact." The government of Nunavut has received a copy of the paper. The territory's chief medical officer of health was travelling Tuesday and not immediately available to react to its findings. © 2016 The Globe and Mail Inc. All Rights Reserved.

Those changes included cutting wait times, improving home care, electronic records and telehealth, better access to care in the North, a national pharmaceuticals strategy, improvements in prevention in public health and accountability and better reporting to Canadians. Philpott's assessment Tuesday was the provinces had intended to live up to their commitments but that it hadn't happened. "The transformation to the system didn't follow," she said. Philpott said Canadians want to be able to measure where new money is going, such as the number of hours of therapy delivered in a mental health program or the number of additional home care visits added. Manitoba Health Minister Kelvin Goertzen said in a later conference call he agrees there needs to be more reform and innovation, particularly when it comes to accountability and meeting specific performance targets. "I would take exception that there hasn't been any innovation," he said. "Could there have been more? Sure."

Goertzen said Manitoba will be announcing more health-care targets shortly, with plans to better account for the dollars spent. He said additional funding for home care or mental health would be welcome but Ottawa needs to be a better partner on the day-to-day business of health-care delivery, and the three per cent increase isn't enough. The provinces have long complained Ottawa was to contribute half the cost of medicare but its contribution is now around one-fifth. They want the accord to move Ottawa to contributing 25 per cent. "We didn't get that commitment today," said Goertzen. The provinces want to discuss the health accord with Prime Minister Justin Trudeau when they all meet in Ottawa in December. Trudeau called that meeting to discuss climate change and the new carbon price he is requiring all provinces to impose. Health care is not currently on the agenda. mia.rabson@freepress.mb.ca

Federal Health Minister Jane Philpott, who co-chaired Tuesday's talks, tried to steer the conversation away from money and toward system improvement, innovation and accountability. She repeatedly pointed out that Canada spends more on health care than many other developed countries that have superior health systems. She expressed disappointment that planned system improvements that Ottawa funded in the 2004 health accord did not materialize. Philpott indicated that she wants new funds to be targeted to such areas as mental health and system innovation. She also reiterated an earlier commitment to provide $3 billion for home care, including palliative care.

I have made it clear to them that we would love, for instance, to invest in innovation," she said. "I want to know how they want to use those investments in innovation. I have told them that I am very interested in mental-health care." Hoskins said his provincial and federal counterparts are on board with that, but that they need a boost in the annual increase in health funding as well just to maintain the status quo. "You can transform and we have to transform, but you have to do that in a way which respects and understands that you need to sustain the existing system," he said. Hoskins cited a Conference Board of Canada report that found that a spending increase of 4.4 per cent is needed "just to keep the lights on, just to keep the existing services working" because of pressures from a growing and aging population. Quebec Health Minister Gaétan Barrette said Ottawa's current plans for health spending will amount to $60 billion less over the next decade for the provinces and territories.

"It says to Canadians, 'We will not provide up to the level of $60 billion.' That's what's at stake," he said. The 2004 health accord - which includes annual funding hikes of 6 per cent - expires next spring. The former Conservative government decided unilaterally that annual health spending will increase at a lower rate of 3 per cent after that. The provincial and territorial ministers are hoping Prime Minister Justin Trudeau will reconsider that when the first ministers meet later this year. Hoskins said a 50-per-cent cut in the annual funding increase will translate to $1 billion less for the provinces and territories next year. Ontario alone stands to lose $400 million. Philpott apologized about confusion over comments she made earlier on accountability for funds. Some provincial and territorial ministers expressed anger over an insinuation that health transfers were not being spent on health. Philpott said that was not what she meant.

I apologize if people misunderstood," she said. "There is certainly no intention to make accusations." Philpott said the Canada Health Transfer, which stands at $36 billion, will increase by about $19 billion over the next five years. "It's really important for Canadians to know that we are going to continue to contribute to the Canada Heath Transfer," the federal minister said. Philpott said that over the last five years, $9 of every new $10 spent on health in Canada came from the Canada Health Transfer. "We are contributing he largest part to spending." In addition to the Canada Health Transfer, extra funds will be provided for targeted priorities with strings attached to ensure transformation goals are met, she said.

This is Canadians' money ... We want to find a way that we can work together so that as we agree to make new investments, that we have already got a sense of plan," Philpott said. In elaborating on why Ottawa should fund new, more efficient ways of providing health care while at the same time provide sufficient funding for the current health system, Hoskins offered the example of dialysis for kidney failure. The ministers discussed how it would make more sense to monitor blood pressure to prevent kidney failure and thereby lessen the need for dialysis, he noted. "That's great and we are all working toward that end, but you still have to provide dialysis today because that individual who needs it will be dead in three weeks without it," Hoskins said.

The intervenor coalition includes Canadian Doctors for Medicare, Friends of BC Medicare, Glyn Townson, who has AIDS, Thomas McGregor, who has muscular dystrophy, and family physicians Dr. Duncan Etches and Dr. Robert Woollard, both professors at the University of British Columbia. A second intervenor group representing four patients also warned that the Charter challenge would lead to an inequitable health system across Canada. “This case is indeed about the future of the public health care system, in its ideal and actual forms,” said the group’s lawyer Marjorie Brown, according to a report in The Globe and Mail. Cambie and its co-plaintiffs, who made their opening argument last week, say the BC law barring extra billing, so-called dual or blended practices and the use of private insurance for publicly covered services violates Sections 7 and 15 of the Canadian Charter of Rights and Freedoms.

A successful Charter challenge in BC would mean an inequitable health system, where those who can pay get priority service, states an intervenor coalition.

Moreover, they claim the prohibitions exacerbate the under-funded public system’s problems, especially waiting lists for various treatments and surgeries. Allowing a “hybrid” system would relieve the strain. The coalition brief, echoing the BC government’s lengthy opening argument, said there’s no evidence that creating a two-tier system would reduce wait times. But there is a risk of hollowing out the public system as resources migrate to the more lucrative private alternative. Those who couldn’t afford private insurance could still find themselves waiting for treatment, thus undermining the principles of universality and equity spelled out in the Canada Health Act, Latimer said in her submission. Latimer also questioned whether the legislation falls within the scope of the Charter, more often invoked to overturn criminal laws, not those with socio-economic objectives.

“This legislation is intended to protect the right to life and security of the person of all British Columbians, including the vulnerable and silent rights-holders whose equal access to quality health care depends upon the challenged protections,” Latimer stated. There’s also a risk of sapping the public system of not only doctors but nurses, lab technicians, administrators and others drawn to the more lucrative private market, the brief said. Dual practices could also foster “cream-skimming,” where private clinics handle simpler but profitable procedures, leaving complex cases to the public system. The British Columbia Anesthesiologists’ Society, intervening to support the challenge, will be making arguments later in the trial, which is due to last at least until February 2017. The federal government is expected to begin making arguments in several months.

Penner’s argument addressed core questions in the closely watched case: Does the law infringe doctors’ freedom to provide and patients’ right to receive timely medical care and, if it does, are those restrictions reasonable under the Canadian Charter of Rights and Freedoms?

The strains on the public system, such as waiting lists to see specialists and for surgeries, are “indisputable facts,” Penner told Justice John Steeves. But the remedy proposed by the plaintiffs — a hybrid system where doctors can deliver private and medicare services and patients can buy insurance for services already covered by medicare — will not solve the problem. In fact, said Penner, it could make things worse by disrupting the public system and diverting resources from it.

Penner warned that if the Cambie plaintiffs win their challenge, the implications will extend outside British Columbia. Other provinces have similar restrictions on physician practice and private insurance that, like BC, are tied to federal transfer payments under the Canada Health Act. The trial opened Sept. 6 when Peter Gall, acting for Cambie, an affiliated clinic and several patients, argued BC’s Medicare Protection Act handcuffed both doctors and those seeking timely care.

The law prevents physicians from operating both inside and outside of the provincial Medical Services Plan. The restriction on so-called dual or blended practices violates Section 7 of the Charter of Rights and Freedoms guaranteeing “right to life, liberty and security of the person,” Gall said.

Orthopedic surgeon Dr. Brian Day of Cambie Surgery Centre says provincial laws limiting private care have resulted in rationing and long waiting lists.

The law also keeps residents from using private insurance to pay for treatment for things covered by the public system, despite the fact that some groups, such as those covered under WorkSafe BC injury claims, get expedited private care. That violates the Charter’s equality provisions under Section 15, argued Gall. The arguments echoed long-held positions of orthopedic surgeon Dr. Brian Day, Cambie’s co-founder and the visible face of the case. He contends provincial laws limiting private care have resulted in rationing and long waiting lists.

The alleged Charter violations are far from clear cut, said Penner, as he reviewed previous Charter decisions. A key test, for instance, is whether legislation violates the principles of fundamental justice under Section 7. Past rulings have specifically warned against applying it to social policies, he pointed out. Gall noted that the Supreme Court of Canada’s 2005 decision in the Dr. Jacques Chaoulli challenge affirmed Quebecers’ right to use private medical insurance to pay for publicly insured services when the public system was inadequate.

But Penner said the wording of the Canadian and Quebec charters differ on fundamental freedoms and only three of nine Supreme Court justices found the Quebec law violated the Canadian Charter in Chaoulli. The evidence in the Cambie case is not the same, he added. “It will tell a very different story.” Even if evidence points to Charter violations, he said, such violations are legal under Section 1 of the Charter, which allows “reasonable limits prescribed by law as can be demonstrably justified in a free and democratic society.”

The justification here is government’s ability to ensure universal access based on need, not ability to pay, said Penner, adding courts have deferred to legislatures on social policies such as those covering housing. Granting the plaintiffs’ application would reverse that by putting patients with money or insurance ahead of those without, said Penner.

Penner was expected to take two days to present the government’s defence, with intervenors on both sides of the case presenting separate arguments later in the week. The trial is scheduled to last six months and hear from dozens of witnesses, including experts, historians and patients. Steeves’ decision is expected to end up being reviewed by the Supreme Court.

Dr. Brian Day's court challenge is underway in Vancouver. The main issue is whether Canadians should be permitted to pay privately for "medically necessary services" already covered by their provincial health plan. Is there a need for increased private health care in Canada? If so, can it be implemented without jeopardizing the public system?

Philpott admits "innovation" is required. Yet governments are constrained by blindly adhering to certain parts of the CHA, while ignoring others. As Ben Eisen of the Fraser Institute has emphasized, provinces have been forbidden to experiment with user-fees, copayments, etc. that would encourage individuals to use health services more responsibly. A "two-tier" system has always existed. Federal prisoners, Workplace Safety and Insurance Board patients, members of the military and RCMP, politicians and professional athletes usually obtain more timely care - often at private facilities. For those not near an inter-provincial border and not a member of a "special group," the main option for timely care may be to go to the United States. This provides employment to American doctors and nurses and profits to U.S. hospitals. Wouldn't it make more sense to allow all Canadians to spend their after-tax discretionary income on health in their own province? Frozen hospital budgets have caused excessive wait times for knee and hip replacements as operating rooms often don't function at full capacity. According to a 2013 survey, 15 per cent of Canadian surgeons considered themselves underemployed and 64 per cent cited poor access to ORs. About 25 per cent of nurses in Newfoundland and Labrador work only part of the year.

If orthopedic surgeons had access to additional "private" OR time, wait times could be shortened for all Canadians and new employment would be created for health-care professionals. If hospitals were permitted to operate electively on Americans and other foreign patients, this would bring in extra revenue and relieve the strain on provincial health ministries. So that MDs did not abandon the public system, they could be required to work 25 to 30 hours per week in the public system in order to receive government reimbursement for malpractice insurance. Most MDs would confine their practice to the public system. They deserve fair treatment. Philpott should amend the Canada Health Act to mandate binding arbitration when provincial negotiations fail, as they have in Ontario. Since 1984, the population has grown and aged, new diseases have been recognized, and new drugs and technologies have developed. Some 32 years ago, it was understood that Ottawa would pay half of health costs. Now it covers less than a quarter. We need to amend and modernize the Canada Health Act. Where wait times are excessive, certain diagnostic services and surgical procedures should allow for private access for all Canadians - not just a select few. This would maximally utilize expensive equipment and provide new employment for nurses, technicians and surgeons. It would provide extra revenue that would help to keep universal public health care sustainable and accessible for all Canadians. Ottawa should then enforce all sections of the Canada Health Act on all provinces and territories. Dr. Charles Shaver Ottawa

Meanwhile, Philpott has promised to spend $3 billion extra on home care and palliative care over the next four years, helping provinces with those costs as the population ages. Hoskins said the provinces and territories, on average, now cover 80 per cent of costs in the health-care system.

$3-billion over four years in home care and palliative care.

Dr. Philpott pointed to an oft-quoted report from the New York-based Commonwealth Fund which ranked Canada 10th out of 11 developed countries on health-care performance – only the U.S. placed lower. The report gave Canada especially poor marks for its efficiency and timeliness of care.

By ANGELO PERSICHILLI

Monday, Oct. 17, 2016

TORONTO—A few weeks ago, Canadian consumers rejoiced because the cost of prescription drugs in Canada were lower than in the United States. But do they know that the cost of drugs in Canada is much higher than in most of the European countries?Laureano Leone, born in Italy, with a degree in pharmacy from the U.S., an Order of Canada, and experience as a former Ontario Liberal MPP, says that “it is unbelievable how our governments waste billions of dollars paying high prices for pharmaceuticals at the time when they close hospitals.”

Leone says that his findings have been validated by a renowned professor of York University, Joel Lexchin, and they “show that we are losing millions of dollars every day. Still there is refusal in recognition by the political establishment.”

Dozens of laundry workers in Sudbury have been handed layoff notices. All 36 employees are with Sudbury Hospital Services, a local business that does laundry for Health Sciences North. The slated layoffs come as the hospital is opting instead to do business with a company called Mohawk Shared Services in Hamilton. According to Joe Pilon, the hospital's chief operating officer, Health Sciences North expects to save $500,000 per year.

At Chartwell, a chain of 27 homes, chief operating officer Karen Sullivan said the pharmacy that services the chain, MediSystem, pays for "many additional valued-added services" such as employee education, nurse leadership sessions and conferences for leaders of homes. MediSystem also pays for Wi-Fi systems and therapeutic care equipment at the homes, Sullivan said in an email. The Star asked pharmacies what they are told the money is used for. Among the responses from pharmacies were "staff education," "resident programs" and payments toward Wi-Fi systems. Classic Care, a pharmacy, said the money it pays covers monthly rent of an area in the nursing home, staff education, technology and "donations and sponsorships" for conferences and other training. Other pharmacies, such as Rexall, say their fees have paid for diabetes education, for example. The largest pharmacies serving long-term-care homes in Ontario include Medical Pharmacies Group, MediSystem (owned by Loblaw), Classic Care (Centric Health) and Rexall. The fees are not new. Pharmacies have willingly offered money or agreed to demands for years. But there's a growing outrage among some who say homes are more interested in "inducements" than "clinical excellence" that pharmacies can provide seniors. Last year, after the Ontario government cut each dispensing fee by $1.26 (it is now $5.57 per prescription in nursing homes), sources said some pharmacies wanted to stop paying the fees. The problem was, the sources said, that the homes refused to give up the extra cash flow and other drug companies were willing to pay, so nothing changed.

It's usually the larger companies that can afford to pay. One insider said smaller pharmacies now ask the homes, "Do you want the money or do you want good service? Because we can't afford to give both." Sources said the Ontario Ministry of Health and Long-Term Care knows the money changes hands but does nothing to stop it. Instead, pharmacies are "held hostage" by the homes, the source said. One home that no longer charges the fees is John Noble Home in Brantford, a municipally operated 156-bed facility. The Star obtained a 2010 request for proposals (RFP) that noted "only proposals with a minimum rebate of $20,000 annually will be considered for the project." A spokesperson for the city said the RFP "references a previously approved practice employed by several long-term care homes." A recent RFP did not ask for a rebate, though some offered to pay. The city spokesperson, Maria Visocchi, said it chose a pharmacy that "demonstrated qualifications and experience, project understanding, approach and methodology, medication system processes and quality control." This pharmacy did not offer a rebate. Not all pharmacists pay. Teresa Pitre runs Hogan Pharmacy Partners in Cambridge and serves long-term-care homes that don't ask for money. Instead, she signed contracts with several homes in the People Care chain to provide a "highly personalized approach." Pitre sends a registered pharmaceutical technician into each home daily to relieve nurses of much of their work regarding medication, confusion over communications and extensive paperwork. Her company also puts a bookshelf-sized dispensing machine in each home, which holds medication (pain relievers, antibiotics or insulin) that residents need on short notice but, in the traditional system, often can't get for hours. "I really wanted our pharmacy to be a partner with homes instead of servicing them and just meeting the requirements," she said. Meadus says the added cost of bed fees means pharmacies have no reason to reduce their rates, either by lowering dispensing fees or not charging the $2 co-payment.

A recent Star story revealed that pharmacies serving nursing homes typically charge dispensing fees for drugs once a week, rather than once a month as they typically do in a community pharmacy. Long-term-care pharmacies told the Star they charge the weekly fee because the medication for frail residents can change weekly. That was a claim hotly disputed by some family members the Star spoke to, including Margaret Calver, who has spent years documenting the costs of dispensing fees at Markhaven Nursing Home, where her husband is a resident. "This needs oversight and that's the problem," she said. "Nobody is doing the checks and balances." Moira Welsh can be reached at mwelsh@thestar.ca.

In the letter to Timmings, lawyer Michael Polvere of Siskinds wrote, "While we encourage all honest and fair debate on the issues, defamatory and untrue statements made of and concerning our client, the LHSC, will not be tolerated and will be met with swift action. The LHSC intends to hold both RNAO and yourself personally responsible for the conduct of this meeting." At the 6:30 p.m. meeting at Wolf Performance Hall in the Central Library, Timmings will lead discussion on a nurses' association report that claims cash-strapped hospitals are cutting registered nurses and replacing them with less qualified and lower-paid staff to the detriment of patients. "These (changes) are detrimental to Ontarians, to nurses, and to the future of health and health care in Ontario," conclude authors of the report Mind the Safety Gap in Health System Transformation: Reclaiming the Role of the RN. No one should be muzzled from discussing key health issues and LHSC's efforts should be addressed by Ontario Health Minister Eric Hoskins, Grinspun said. Hoskins couldn't be reached for comment Thursday. Nor could officials at LHSC. Earlier this year, Glendining refused to comment publicly on Burkoski's firing but defended the hospital in internal memos that insisted that the nurses' association had told a one-sided story and that safety was always a priority.

In his concluding remarks, Canadian Medical Association (CMA) president Dr. Granger Avery posed this question recently at the Canada 2020 Summit: "Is it fair to place the full burden of health care costs on governments?" Does the CMA not realize that we pay for our health care through our taxation system? What we need is a coordinated health system based on the principles of the Canada Health Act with doctor, hospital and drug care available to all Canadians no matter where they live and how much money they have. While Dr. Day may in fact be successful, I for one do not wish him success. My wish is that the people we elect will see the need for leadership in improving a system we can indeed be proud of. Dr. Tom Gaskell

Bras d'Or (Past president of the Canadian Association of Retired Teachers)