For all the shortfalls in Ontario’s health system, the reality is that despite having among the lowest per capita levels of funding, the province is matching if not excelling the Canadian average in many categories measured by the Canadian Institute for Health Information (CIHI).
Whether this reflects well on Ontario or badly on the rest of the Canada is an open debate.
CIHI is widely respected as being an unbiased source of information for health planners although they remain at the mercy of local health providers who provide the inputs.
Mortality rates, for example, have been known to fluctuate widely once a hospital has learned to game the system. Only unexpected deaths count, so most deaths become expected.
CIHI has established a site where you can compare provinces on 37 indicators. Just enter your province and determine whether you want the summary or the detailed report. (Click here to access the site)
Dexter Whitfield, Director of the European Services Strategy Unit and Adjunct Associate Professor, Australian Workplace Innovation and Social Research Centre, University of Adelaide. Whitfield spoke at an Ottawa conference this week noting the acceleration of privatization during periods of austerity.
Canada has the dubious distinction of being a global leader when it comes to outsourcing and privatization of public services and infrastructure.
The rush to outsource comes with very little debate in our legislatures and rarely rises above the noise during general elections. Yet it represents a fundamental shift in how we access government services.
We’re in Ottawa this week for a national conference organized by the National Union and the Public Services Foundation of Canada on new forms of privatization. The message is clear – no public sector worker is safe from a tsunami that threatens to cut jobs, reduce wages, degrades public services, costs more, reduces accountable and ultimately attacks democracy.
Privatization and outsourcing take various forms, including public-private partnerships, social impact bonds, direct service contracting and even the transfer of funds to individual users who are forced to become their own employer.
Dexter Whitfield, a professor at Australia’s University of Adelaide, notes that private-public comparisons are often misleading, pitting new proposals against the status quo rather than a comparable public option. Not only are in-house proposals discouraged, but are actively blocked.
Kat Lanteigne and Dmitr Chepovetsk in a scene from Tainted.
Tainted has been on the road for three days now, encountering enthusiastic, emotional and well-informed audiences in Hamilton, London and Windsor. Next week there will be six more performances in Toronto, Kingston, Ottawa and Thunder Bay. Two special performances will take place in a committee room at Queen’s Park and in the Center block of the Canadian Parliament.
Tainted tells the story of the fictional Steele family, which playwright Kat Lanteigne imagines to be living in a modest working-class house near Hamilton. The three sons in the story are hemophiliacs; the play opening with 12-year old Leo at summer camp getting instructed how to self-infuse his Factor 8 from his older brother while rehearsing a speech that will profess his love for the camp’s 22-year old lifeguard.
For Leo, he didn’t see his love coming, and neither did the family see the tsunami that was about the overtake them as that life-sustaining Factor 8 turns out to be contaminated with Hepatitis C and HIV.
The roller coaster of a play charms us in the early going as we get to know the Steeles – then ramps up as the inevitable tragedy unfolds.
The Champlain CCAC continues to lurch from crisis to crisis. Is it time for the province to intervene — again?
“It’s a question of how we can do work more efficiently and maybe less people.” – Patrice Connolly, vice-president of people and stakeholder engagement, Champlain CCAC.
The Ottawa Sun is reporting the Champlain CCAC has cut services to a patient who has multiple sclerosis and cannot bathe, dress, or cook. Without his visits he cannot also do the exercises needed to keep him from stiffening up.
Over the summer Champlain realized that it was headed for a $6.8 million operating deficit and reset the threshold for personal support services to an assessment score (RAI) of 15.5 – this on a scale that goes to 28.
Further, staff have been told to instruct patients in need of care how to access other services, “many of which have a co-pay fee.”
States the Champlain CCAC in their June minutes: “staff recognize this is a hardship for clients and families, however the Champlain CCAC must also work within the budget it is provided.”
Sean Meagher (ED of Canadian Doctors for Medicare) and lawyer Steven Shrybman discuss the potential threat to Canadian Medicare by the Charter challenge in the BC Supreme Court.
They had to dodge a marathon to get there, but it was worth it.
Participants at this weekend’s Ontario Health Coalition Action Assembly were in a buoyant mood despite the many challenges facing the health system.
Rather than finding defeat, activists took heart that Canadians still feel strongly about public Medicare despite a much more well-funded opposition from business elites.
The delegates crammed into a modest community centre gym where getting to a speaker’s microphone was at times a logistical challenge. It wasn’t lost on anyone that this low-budget grassroots organization was having a significant impact in defending our public health system as Director Natalie Mehra listed off successes the coalition has achieved over the past year.
“If the public was not with us Medicare would have been gone a long time ago,” said Doris Grinspun, CEO of the Registered Nurses Association of Ontario, who participated in a panel looking at how we push back.
Grinspun warned that “medical tourism” threatened to bring an end to the single tier system. If Ontario hospitals were selling a ticket to the front of the line to international patients with money, it was only a matter of time before rich Ontarians demanded the same right. That principle is what is keeping the RNAO fighting so hard on this issue.
The Peterborough County-City Health Unit claimed it couldn’t afford to make overdue pay adjustments in September for its smallest bargaining unit. The question is, does it have the resources it needs to respond to the next big virus?
In September Peterborough residents narrowly avoided the first strike in their health unit’s history. Despite acknowledging significant inequities in how they compensate staff, the Peterborough County-City Health Unit argued they couldn’t afford to play catch-up with the smallest of the unit’s three staff bargaining units. Professional staff at PCCHU were earning as much as $3,000 a year less than internal counterparts with identical job descriptions.
That should be worrying for more reasons than just internal equity.
They key to health reform is to ensure there are sufficient resources upstream so that expensive problems don’t fester downstream.
The PCCHU admits that for some programs there have been no increases in funding for about a decade.
Public Health Units played an important role in limiting the spread of SARS in 2003-04. According its website, Public Health Ontario has been recently working with the Ontario Ministry of Health and Long-Term Care, the Public Health Agency of Canada and other partners to monitor and provide timely guidance regarding the respiratory illness EV-D68. Should Ebola be confirmed in Canada, public health units will also be called upon to track and stem the spread of the deadly virus.
July 8 the Ontario Health Coalition brought more than 80,000 signed cards to the Ontario legislature opposing the transfer of clinical services from hospitals to private clinics. (Photo courtesy the Ontario Health Coalition)
The media is applauding Health Minister Dr. Eric Hoskins this week for promising greater transparency around private clinic inspections that had previously been kept secret by Toronto Public Health and The College of Physicians and Surgeons of Ontario (TCPSO).
Tom Closson, the former President and CEO of the Ontario Hospital Association, suggested in the Toronto Star last week that “bringing out-of-hospital clinics up to the same standard as hospitals regarding transparency would increase public confidence in the care they are seeking.”
Ontario’s Action Plan for health care includes systematically taking clinical services out of public hospitals and transferring them to a sector that has a history of two-tier medicine, questionable user fees, unnecessary up-selling, significant quality control issues and too little transparency. The latest revelations, particularly around infection control at several private clinics in Toronto, may have persuaded the government not to carry out spring and summer competitions for selected hospital clinical services – at least for now.
They may have learned from the Ottawa Hospital’s ill-timed decision early in 2013 to divest 5,000 endoscopies to the private sector at the same time the TCPSO was making public the list of clinics that failed inspection public – including one Ottawa endoscopy clinic that may have exposed patients to HIV, hepatitis B and hepatitis C from equipment that may not have been properly sterilized.
This spring the Ontario Health Coalition collected more than 80,000 postcards expressing opposition to the transfer of services from public hospitals to private clinics. Without any clear indication from government whether the competitions are on hold, the coalition is now working towards a November 21st mass rally in Toronto to push further on the issue.