"We struck that kind of a partnership back in 2004, made some specific commitments together in return for funding, and by and large, we were quite successful in achieving those stated objectives."

Mayor Michael Bloomberg is fighting this change

A similar law enacted in 2003 in Los Angeles requires companies receiving city subsidies to pay workers $10.42 an hour or $11.67 without benefits. Despite warnings that the city would lose projects, Donald Spivack, a development official in Los Angeles, said at a Council hearing last month that those predictions were wrong and that he was unaware of any project that was canceled because of the wage requirement. The Center for American Progress found that 15 cities with living wage laws, including Los Angeles, Philadelphia, Cleveland and San Francisco, “had the same levels of employment growth” as other similar cities without the requirements.

Mayor Bloomberg’s arguments against this modest wage increase contrast with his endorsement of a 2002 city law that now sets a minimum of $10 an hour for about 60,000 workers employed by service contractors hired by the city, many of them home health care workers. Home care workers got a similar increase as part of Gov. Andrew Cuomo’s Medicaid redesign this year.

Last year, amid rising health care expenses nationally, C.P.I. helped cut Seattle Children’s costs per patient by 3.7 percent, for a total savings of $23 million

the hospital avoided spending $180 million on capital projects by using its facilities more efficiently

It served 38,000 patients last year, up from 27,000 in 2004, without expansion or adding beds.

Similar methods are now in place at other hospitals and health systems, including Beth Israel Deaconess Medical Center in Boston, Park Nicollet Health Services in Minneapolis and Virginia Mason Medical Center, also in Seattle.

To increase the number of surgeries the hospital could perform, Dr. Chand’s team spent about $20,000 overhauling the process to sterilize instruments, avoiding a $3.5 million expenditure to expand that department. More efficient scheduling in the M.R.I. department reduced the average waiting time for non-emergency M.R.I.’s from 25 days to 1 to 2.

Eugene Litvak, president and chief executive of the Institute for Healthcare Optimization and an adjunct professor of operations management at the Harvard School of Public Health.

“The health care industry could be on the verge of an efficiency revolution, because it is currently so far behind in applying operations management methodologies,” says Professor Litvak.

not everyone believes that factory-floor methods belong in a hospital ward.

Nellie Munn, a registered nurse at the Minneapolis campus of Children’s Hospitals and Clinics of Minnesota, thinks that many of the changes instituted by her hospital are inappropriate. She says that in an effort to reduce waste, consultants observed her and her colleagues and tried to determine the amount of time each of their tasks should take. But procedure times can’t always be standardized, she says. For example, some children need to be calmed before IV’s are inserted into their arms, or parents may need more information. “The essence of nursing,” she says, “is much more than a sum of the parts you can observe and write down on a wall full of sticky notes.”

That’s supported by a recent cost comparison of private and semi-private hospital rooms conducted by Dr. Anthony Boardman, professor of business administration at the Sauder School of Business at the University of British Columbia in Vancouver (Journal of Benefit-Cost Analysis 2011; 2[1]:article 3). It found that private rooms were vastly superior on financial counts, as improved infection control, along with heightened privacy, improved sleep and fewer preventable medical errors contributed to reduced lengths of hospital stay. Taking everything into consideration, Boardman calculated the “net social benefit” (benefits minus costs) of a bed in private room compared to a semi-private room was about $70 000.

As compelling is research showing that single-occupancy rooms actually lead to higher hospital occupancy rates (Bobrow M, Thomas J. 2000: Building Type Basics for Healthcare Facilities. p. 145–57). Because of the need to isolate patients with nosocomial infections, hospitals with multi-bedded rooms can only reach a maximum occupancy of 80%–85%.

Nanaimo Seniors Village laid off union staff in order to hire contract workers in 2007

In 2010, Ladysmith's Lodge on 4th laid off about 140 unionized workers and contracted out their positions.

all three of the facilities in the region that have used Bill 29 to hire cheaper staff have some kind of contract with the Vancouver Island Health Authority to provide beds

Health human resources: credentialing and immigration.

Aboriginal health system improvement.

New technology approver and regulator.

Health promotion and disease prevention.

Epidemic preparation.

Will Falk, executive fellow in residence at the Mowat Centre for Policy Innovation

If the Saskatchewan Party had wanted to meaningfully test the relative merits of private and public delivery for expanded health care services, it could easily have done so - guiding one of the province's major health regions toward increasing capacity through a private service delivery model, and the other toward expanded public service delivery. And it could then have compared the two to see which produced better returns on our public funding.However, that would have involved actually supporting some enhanced public service delivery - which is apparently utterly unacceptable to the Saskatchewan Party. And more importantly, it would have created a risk that the public system might perform better on the evidence.

Wall has tip-toed around the reality that in some cases the public/private mix has led to fewer services being performed than in the public system we started with.

there's been no evidencebased policy at work in our healthcare system under the Saskatchewan Party. Instead, the Wall government has been manufacturing policybased "evidence" to support its spin in favour of private service delivery

The problem, say experts, has its roots in the Quebec government’s so-called “virage ambulatoire” of 1995-98, a transformation of mental-health services in the province from hospital-based to community-based service that was driven by provincial budget-cutting. The province closed hospitals, slashed personnel and put thousands of patients on the street, but with a pledge to transfer money to community services for those former patients. However, experts say less than one-quarter of the money cut from hospital services was ever reinvested in community services.

the federal government ramped up its share of the nation’s total health care spending while private businesses reduced their share

Out-of-pocket spending by consumers rose in 2010 compared with 2009, as many workers paid higher premiums, deductibles and co-payments or lost their insurance coverage. But out-of-pocket spending still grew more slowly than the annual average between 2000 and 2008

It identifies trends in opinion, focusing in particular on public attitudes about quality, sustainability and public versus private provision of services.

It also suggests that media content and public opinion are intimately linked.

Attitudes about the state of the Canadian healthcare system in general have shown slight improvement over the past five years.

Levels of approval for the current state of the healthcare system are somewhat lower in Quebec than elsewhere in Canada.

system is in jeopardy

unsustainable

there is a downward shift in the proportion of respondents who feel that governments are likely to be able to improve the current system in the near future

steady (consideration) of alternative options

majority support for private sector delivery

more recent coverage focuses somewhat more on disease outbreaks (e.g., H1N1 flu) and also fitness and nutrition.

Wealthier individuals are more supportive of privatized healthcare.

Atlantic residents show greater levels of support for the system and spending, while residents of Western Canada show the opposite pattern. Both Quebecers and Westerners tolerate privatization to a greater extent.

Exposure to the mass media affects healthcare opinions. People who watch television and read newspapers more frequently have a slightly greater tendency to name health as an important issue and to support an increase in government healthcare budgets.

Canadians are influenced by the actual volume of media discussion about healthcare, across elections. In years when health is more prevalent in the media, issue salience is more widespread, there is more support for healthcare spending, private hospitals are less accepted and paying to jump the queue is less endorsed.

Assessments of healthcare vary as a function of different types of experience with the healthcare system. Hospitalization is linked to increases in positive ratings.

Waiting for access to emergency room services or appointments with a doctor is associated with increasingly negative attitudes. 

Promote innovation

Examine alternate models of care to avoid unnecessary hospitalization

There is a need to identify financing options that do not impose burdens on government budgets.

The social insurance (SI) model, common in Europe and used in Canada to finance public pensions and employment insurance, has been suggested as a way to raise revenue to improve access to non-CHA services.

This paper examines the implications of using the SI model to expand coverage to services such as pharmaceuticals and long-term care.