The veteran medical officer of health said the proposal suggests municipalities would pay the same share of the new health units'operation as they do now - 25 per cent - but he argued they could receive "quite a bit less representation."

He said it would also require "a huge commitment from government, which we have not yet seen" and on an "exceedingly tight" deadline.

"At least three major pieces of legislation would have to be changed to accommodate this," said Gemmill.

"I've seen a lot of them ... they don't really save money.

"I don't foresee amalgamations happening," Gemmill said, recalling the mergers of municipalities and school boards.

"I would not see the public health work force jeopardized in any way," he added. "There are very well-trained people who are doing a great job and that needs to be maintained."

Before his 2016 retirement, Schabas said health units could possibly save money by sharing a single medical officer of health and sharing some services. Schabas worked two days per week and was otherwise on call. He was paid $244,317 in 2016.

At the time of Schabas'remarks, Paul Huras, the chief executive officer of the South East Local Health Integration Network, said it was worth considering but sharing services may not work because of health units'distinct mandates. Huras said health units could benefit from better links with other health care providers and, if they could save money, may have more to spend on front-line staff.

Gemmill said health unit staff and Huras will meet Monday.

Board member Egerton Boyce, a Belleville councillor, said he attended a recent AMO panel on the subject. He said he left with the impression the concept is "likely not going to happen for a long time."

Health board members referred the matter to their governance committee and are expected to provide the resulting feedback to the health ministry. "There's merit to looking at the system," Gemmill told reporters. "It's been 50 years since the last time it was restructured in a major way." But he said the changes would be "a mammoth chore" and remain "very unlikely" before the election

"That included Mount Sinai Hospital, the Hospital For Sick Children, Sunnybrook Hospital and McMaster University Centre," said MacDonald.

"All of which were either closed or restricted."

According to the Mount Sinai Hospital website 1,100 babies are admitted to that hospital's Newton Glassman NICU each year.

He pointed out that so far no babies have needed to be sent outside of the province.

Ontario Ministry of Health and Long Term Care officials confirmed that some NICUs are facing an unusual "surge," in critically ill babies, but emphasized the situation is temporary and that they are working with the Local Health Integration Networks and affected hospitals to take immediate action.

"This is a fluctuating situation and hospitals are working closely and in coordination to manage these pressures," said Mark Nesbitt, ministry spokesperson.

"The NICU situation continues to show improvement since last week, this is consistent with the fluctuating nature of patient flow."

Nesbitt says there is no single cause for the sudden increase in babies requiring highly specialized care.

"On Tuesday night of last week (Aug. 22) the possibilities were that the child would have to go to Ottawa or possibly out of province."

"The situation is stabilizing," said Nesbitt on Sept. 1.

"While we know there is always more work to do, investing in health care is a top priority of our government. That's why as part of the 2017 Budget, we are investing an additional $518 million in all public hospitals, a 3.1 per cent overall increase to the hospital sector, to improve patient access to care, reduce wait times, and improve the patient experience for all Ontarians at their local hospital."

He said the ministry is monitoring the situation and will increase NICU capacities as necessary.

While MacDonald said he is optimistic the right people are now listening he pointed out that on Aug. 28 there were still issues at McMaster University Centre because their transport team, which picks up the sick babies from other hospitals did not have enough nurses.

He argues that ultimately this is a government funding issue, which needs to be resolved to expand the capacity of the NICUs at these children's hospitals.

"They have pared down things so much and have gotten away with it in the past and have been able to send babies to other units within the metro area, but for this cycle this wasn't a possibility," said MacDonald.

"There is a need for government funding, not just for beds, but for nurses. Nurses are critical to the running of a NICU. They look after the patients. We of course have to make decisions about how to manage the patients, but the nurses are the ones that deal with the kids from minute to minute. They are with them all the time and if they don't have enough nurses to staff the units then the units will close or the transfer team will close down, like what happened on Monday."

MacDonald also pointed out that while the province is attributing this problem to a "surge" in critically ill babies, the NICU bed shortage has really been happening on a smaller scale for years.

"It is only getting worse with the government cutbacks."

He attributes this reaction to the reality that NICU bed shortages is not a local issue, but a national one with similar problems recently reported in the Maritimes, Alberta, Manitoba and British Columbia.

In the coming months, a pilot project will be conducted involving three private clinics in the Montreal area (Clinique de chirurgie Dix30, Rockland MD and Groupe Opmedic).

At a press conference, Barrette said the new hospital funding system will be implemented gradually.

Despite the use of private clinics, he insisted the pilot project had nothing to do with privatizing health care.

After the reorganization of the health-care network and reviewing doctor remuneration, the transformation of hospital financing methods is the third part of Barrette's health reform initiative.

The CHT associated equalization payment is expected to be $1.05 billion in 2008–2009.

Figure 1 – Total Canada Health Transfer Entitlement, 2004–2005 to 2008–2009

The federal government’s formula for calculating the value of the cash transfer, the tax point transfer and the associated equalization payment under the CHT ensures that the total entitlement provides an equal per capita amount across all provinces. Figure 2 presents the total CHT entitlement amount per capita and per province for 2008–2009. As can be seen, the total CHT entitlement per capita amounted to $1,100 for all provinces.

The gene can render bacteria resistant to colistin, an antibiotic that had been shelved because of its toxic side-effects until bacteria became resistant to other more commonly used antibiotics. Without colistin as an antibiotic of last resort, some patients would have no treatment for infection.

The discovery was all the more alarming because the gene is so easily shared. It is contained on a free-floating part of the DNA called a plasmid, which means it can easily move to other bacteria. Public health officials around the globe fear it could mark the beginning of the post-antibiotic era, in which infections once treatable could prove fatal.

"This is almost a perfect storm," said Dr. Vanessa Allen, chief of medical microbiology at Public Health Ontario.

Allen, who is also a physician at Toronto's Sunnybrook Hospital, said she has seen patients over the last few years who "would not have made it" if not for colistin. Without the ability to use it or other antibiotics, patients could die from illnesses long considered treatable. "It means there may be infections we can't treat."

Discovery of the gene MCR-1 was first reported in The Lancet in November. Chinese scientists reported they found it on 260 samples of E. coli from patients, meat and livestock. The report said the gene was "currently confined to China," but could spread easily around the globe.

Canada, like other countries, has launched a national initiative to prevent microbial resistance, said Allen, led by the Public Health Agency of Canada.

Members of the public, she said, also have to help by not asking for antibiotics for viral infections, and using antibiotics properly when they are needed.

Toye said hospitals and labs must also do everything they can, including identifying cases of antibioticresistant bacteria and maintaining good infection control in hospitals. epayne@postmedia.com

The national trend masks some regional differences. For example, the number of doctors in Alberta and Saskatchewan has increased by 20% in the last 5 years, the highest among the provinces. During the same period, British Columbia, Quebec and Prince Edward Island had the lowest increases of between 10% and 11%.

More doctors are graduating in Canada than ever before.

The number of female physicians is growing rapidly.

After more than a decade of significant growth, the proportion of total payments made to physicians through alternative payment plans (APPs) instead of fee for service (FFS) appears to have stabilized.

In 2013–2014, 28% of payments to physicians were received through APPs and 71% through FFS, which remained virtually unchanged since 2009.

"We need to do better as a nation to prepare for the growing needs of our seniors in long-term care," said Candace Chartier, Chair of CALTC. "Too often the answer we hear from governments across Canada is that 'we'll invest in home care or prevention strategies.' The reality is that our seniors who live in long-term care homes require care 24 hours a day. They can no longer live at home."

91% are concerned or somewhat concerned that there won't be enough long term care beds to the meet the future needs.

"All of the long-term care leaders meeting today are frustrated that none of the political parties in the middle of this election campaign are talking about the challenges facing our seniors in long-term care," said Chartier. "We're calling on them to start talking about what's important to Canadians."

93% are concerned or somewhat concerned that patients are waiting too long for placement in a long-term care home.

91% are concerned or somewhat concerned that homes are not being properly staffed to meet the needs of seniors;

When asked to choose between delaying additional investments until government's budget woes improve or to invest now, almost 80% believe that due to the aging population that we need to invest immediately.

Only 2 in 10 believe there will enough staff to provide care to seniors when they need it.

Less than 2 in 10 are confident that hospitals and long-term care homes will be to handle the needs of Canada's aging population.

1.5 in 10 are confident that long-term care homes will be prepared for the rising number of Canadians living with dementia.

93% believe for the federal government to work with the provinces to ensure that Canadians have access to the same level and quality of long term care regardless of where they live in Canada.

92% believe the federal government should ensure that long-term care homes are prepared for the rising number of seniors with dementia.

89% believe the federal government should lead a national long term care strategy with benchmarks to address inequities in access and funding for long term care.

85% believe the federal government should lead the development of a comprehensive, national dementia strategy.

British Columbia Health Minister Terry Lake told The Globe and Mail on Tuesday that the current system, in which the federal money is allotted on a per-capita basis, ignores the fact that some provinces have much older populations than others.

That is about the point when the PBO says the provinces and territories will be in the best financial position, after which increasing health-care expenditures will force a long, steep slide toward deficits and, by 2034, their budgets will be chronically in the red.

"Provinces are responsible for health-care delivery," Melissa Lantsman, a spokeswoman for Finance Minister Joe Oliver, said in an e-mail. "Nevertheless, our government is increasing health funding at a higher rate than provinces are spending it.

"When an older province has higher health-care costs because we have older residents, that should be reflected in the Canada Health Transfer as a population-needs based approach," Mr. Lake said.

The universal child-care benefit, which was increased in this year's budget and resulted in the delivery of $3-billion in cheques to Canadians this week, will have only a minor impact on fiscal room because the cash transfers are not indexed to inflation, the report said.

The report also says the federal government is on track to eliminate its own net debt over the next 35 years.

Melissa Newitt, the national co-ordinator of the Canadian Health Coalition, an advocacy group for public health care, said the PBO report is more evidence that a new national health accord is needed. That accord, she said, should provide stable funding, set national standards and include a national drug plan and a national seniors plan.

Many of the country's hospitals were built in the 1960s or earlier through a federal funding program. With these hospitals now reaching their "best before" date, it's time for the federal government to invest again, Tholl said.

The design of new hospitals is not only aesthetic. These facilities have natural lighting, better noise control and more private rooms that are comfortable for patients and prevent disease spread, said Dr. Michael Gardam, director of infection prevention and control at the University Health Network in Toronto.

Investing in hospital maintenance was one solution on the agenda at Tuesday's health care conference. But current maintenance costs need between $2.8-billion and $3.21-billion every year, according to the HealthCareCan study - and the funding wouldn't address the years of work that was put off.

Apart from structural problems such as leaky roofs, older hospitals are also at higher risk of outbreaks because of the facilities' poor ventilation, shortage of private rooms and overall design.

"We're not advocating for renovating this old house, we're saying we need new facilities for the future."

"Any new hospital built in Ontario over the last five years is a dramatic improvement over the old ones," Dr. Gardam said.

The new McGill University Health Centre replaced four facilities, yet has fewer beds with the intention to be more efficient than the aging buildings it supplanted, Tholl said. Not only is the design better, but the building includes more medical services (such as equipment and testing) so that patients can access what they need faster. The Montreal example is one that could be replicated in other communities, he said.

"If we build a new hospital and 20 per cent of patients should be cared for elsewhere, you're not going to get the benefit from that hospital," Dr. Gardam said.

The complete findings of the HealthCareCan study on hospital's deferred maintenance costs will be released this fall.

Paré noted that hospitals that have common patient rooms and shared bathrooms - as is the case at the Lakeshore - are vulnerable to outbreaks.

The number of Lakeshore patients testing positive for VRE soared to 244 in 2014-2015 from 111 the year before, with most of that increase occurring in the first three months of this year.

The Lakeshore carries out handwashing audits of stafftwice a year to determine the percentage of health professionals who inadvertently spread germs to patients. Hospital officials were unable to provide statistics on the percentage of staffwho wash their hands regularly, referring questions about its hand-washing compliance rate to the Public Health Department. However, the department referred such questions back to the Lakeshore.

VRE is normally found in the stool, and that's why hand-washing is so important. Patients with weakened immune systems are susceptible to VRE infections in the urinary tract, bloodstream, heart valves and the brain. Open wounds can also be infected by VRE.

VRE infections have become a major problem in hospitals across North America and Europe in the past decade, as new strains of the bacteria have emerged. Many studies have blamed shoddy infection control in hospitals for the spread of the superbug.

To make aging at home a reality for all Canadians, we must redesign the delivery of home care to make it more accessible, accountable and affordable.

As government funding continues to decline, unpaid caregivers — typically a spouse or child — are having to fill the gap or pay out of pocket to hire care privately. In 2007, approximately 3.1 million Canadians, largely women between the ages of 45–64 years old (44%) (StatsCan 2012), were estimated to act as an informal caregiver to their loved ones, providing over 1.5 billion hours of care annually.

These caregivers provide 10 times the number of care hours by formal services, which is not only taxing on their personal well-being and their relationship with their recipient, but also on Canada’s economy — the cost to businesses from absenteeism and turnover related to unpaid care was estimated to be $1.28 billion in 2007.

The Caring Economy is made up of for-profit marketplaces that serve the needs of others. Like the Sharing Economy, it is a marketplace that empowers neighbours to care for neighbours— removing the need for corporations to intervene. Through the latest mobile technology, businesses in the caring economy connect the supply of care to the demand for care.

In the Caring Economy, there are two key end users: the demand side that needs to hire care and are willing to pay and the supply side that has time and is looking to help. Demand side users can build their own personalized team of care providers, communicate directly within the platform, and pay on demand via mobile payments — a seamless, convenient and transparent process. This is made possible through a peer-to-peer marketplace that uses mobile technology to efficiently manage the relationships between paid care-workers to primary caregivers and their loved ones — on demand. Simply put, it is Uber for home care.

At its core, this model redesigns how care is delivered to make ‘aging in place’ a reality. The model’s objective is threefold — to help seniors age with dignity, to unburden their family caregivers, and to turn compassionate people and Personal Support Workers (PSWs) into ‘micro-entrepreneurs’ — providing them with an opportunity to earn a 20–30% higher wage- a win, win, win.

The Uplift® smartphone platform delivers on-demand home care services — at the touch of a button. As a company, we are laser focused on harnessing the latest mobile technology and analytical problem solving to deliver a superior user experience that fulfills the aging population’s demand for higher quality care. We are setting the new standard.Our app is an affordable solution to expensive agency fees. We offer 30–50% lower fees than private agencies. We are also an innovative substitute to long-term care.As an organization, we are devoted to making a positive impact in the world. Moreover, we are a pioneer of the ‘caring economy’ — where neighbours can care for neighbours and caregivers are empowered.

“one thing is clear — the coalition they are discussing is between the Liberals and the NDP, to supplant a Conservative minority.’’

Liberal Leader Justin Trudeau has been stick handling around the idea of a coalition with the NDP if the Conservatives win a minority in October.

Trudeau has said he’d “maybe, but maybe not’’ be open to a coalition with the NDP if Tom Mulcair wasn’t leader of the party.

Meanwhile, Mulcair has said he’s open to a coalition if it’s necessary to defeat Prime Minister Stephen Harper’s Conservatives.

PE is available to minimize the potential harm from exposure to pathogens such as the Ebola virus. When PPE is worn, removed, and discarded properly, it is effective in protecting the person wearing it and the patients and health care workers with whom that person comes into contact.

"Contracting out, contract flipping and sales of business will become more and more frequent as B.C.'s privatization of seniors' care and hospital support services enters its second decade," says Pearson.

"And these workers – many of them among the lowest paid in our public health care system – deserve stronger employment security and protection of their hard-earned wages and benefits," adds Pearson. "As it stands, they don't even know if they'll be hired by a new contractor."

Most health care workers have no access to even the weak successorship provisions in the Labour Code. The B.C. Liberals excluded both public employers and publicly-subsidized private employers from these provisions in 2002 and 2003.

Two other briefings published by the Campaign today, called ‘Keep hospitals cooking’ [2] and ‘Making more of the money we spend on hospital food’ [2], reveal that: Patients prefer meals which have been cooked by NHS staff in the hospital’s own kitchen [6], and that preparing and cooking food in this way could cost hospitals less than buying delivered ready meals which are reheated before being served on the ward [7]. Only £4 of every £10 pounds (40%) spent by taxpayers’ every year on hospital food is likely to meet the Department of Health’s ‘compulsory nutritional and quality’ standards [8]. And with concerns about the accuracy of the results of hospital food inspections, campaigners believe that the number of NHS Trusts meeting the standards may even be less than this [3].

Alex Jackson, Co-ordinator of the Campaign for Better Hospital Food, said: “The results of the Daily Mail’s hospital food investigation help to support the findings of our own research, which informs our three briefings published today.

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

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, “

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.

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.

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.

Our findings show that everyone keeps each other in the dark about the drug plans they negotiate. Employers who understand the technical details of their drug plans withhold data on drug spending from employees, thus awarding them an advantage in the negotiating process. Union experts may understand that their drug plans are inefficient but they often lack sufficient detail of drug spending in order to convince employees about the need to introduce cost-containment measures.

But why are private plans so inefficient in Canada? We can learn a lot about why companies squander tons of money on prescription drugs by looking at how they negotiate drug plans with their employees and other players in the insurance universe. Our new study in Health Policy analyzes how drug plans are negotiated in the private sector.

Insurers could raise awareness to change this irrational norm of covering everything, since covered drugs often do not provide additional therapeutic value for money. One solution would be to proactively implement managed drug formularies. However, insurers’ financial incentives are not aligned with those of their clients because inefficient drug plans are unfortunately very profitable for insurers.

The problem is that insurers are paid as a percentage of the drug bill. So the bigger the bill, the more they make – a principle that runs counter to the drive to root out and eliminate waste in the compensation package. Sometimes drug companies explicitly target private drug plans for their products because such plans do not implement restrictions to get value for money.

Most of the interviewees agreed that a universal pharmacare program in Canada makes sense and we need to move in that direction.