Category Archives: Health System

With professor emeritus Colin Leys & Ontario Health Coalition director Natalie Mehra
When: Saturday, June 19, 2010 / 12:30 – 3:30 pm
Where: OISE (Ontario Institute for Studies in Education) 252 Bloor St. West,
7th Floor, Peace Room
Presentation~Discussion~Strategy Session

Long term care wait times topped concerns by the Ontario Health Quality Council in its annual report released yesterday.

The OHQC says average wait time for a long term care bed is now 105 days. If you are waiting while at home, its 173 days (or about six months). Wait times for long term care placement has tripled since the spring of 2005. The council does suggest that one in four people presently in a long term care have light care needs and could be cared for in an alternate setting if one were available.

Despite Ontario spending $60 million last year on its ER wait times strategy, one in four patients still spend more time in the emergency department than the recommended target. About 6 per cent of patients leave the emergency department before being seen.

Ontarians are making no progress on finding family doctors. About 730,000 Ontarians are still without a doctor, about half are actively looking. Only 53 per cent of Ontarians can see their doctor on the same day or next day when sick – nine out of 10 surveyed say they think waits are too long for an appointment. There has been no change in the percentage of Ontarians without a family doctor over the last three years.

Doctors are also picking up the pace of converting their patient records into electronic files. In 2007 only 26 per cent of doctors maintained electronic records. In 2009 it was 43 per cent – still not quite half.

The report is also critical of the government’s ability to alter the social determinants of health. “Progress has been stalled for the past three years addressing unhealthy behaviours that could lead to chronic diseases. (Coincidentally, the NDP’s France Gelinas introduced a private members bill yesterday calling for fast food restaurants to post the calorie count of items on their menu boards.)

Other key wait time initiatives have had mixed results. Wait times have decreased for cataract surgery as well as hip and knee replacements. About 95 per cent of elective cardiovascular procedures are done on time. The Council does say that wait times are still too high for CT, MRI and urgent surgeries. They offer the example of urgent cancer cases, of which only 53 per cent are completed within the two week target.

While some progress is being made on diabetes, the report says there is huge room for improvement as many people are not getting the right monitoring.

Despite four years of the Local Health Integration Networks, whose mandate it is to integrate the health system, the report found Ontario does a poor job of sharing information across the system. Physicians are reporting delays in getting information from hospitals and specialists, while only one quarter of patients who leave hospital feel they have all the information they need.

Health economist Robert G. Evans has an alternate take on the question of health care sustainability. As bankers continue to claim health care costs will gobble up government budgets, Evans replied this week in the Toronto Star that health care is as sustainable as we want it to be.  Evans says public Medicare expenditures have been relatively stable. However, private insurance, primarily for drugs and dentistry, now accounts for 12.7 per cent of Canadian health care spending – 14^th highest in the world. Evans says health care has taken an increasing share of provincial spending as a “simple consequence of large cuts in non-health programs, not out-of-control medicare spending.” The economist points out that between 1997 and 2004 tax cuts removed about $170.8 billion from public sector revenues. Total provincial revenues are now about $35 billion per year less as a result, or about half the current provincial spending on Medicare. … After telling OPSEU their plans were firm to cut all seven full-time RPNs at St. Francis Memorial Hospital, the Barry’s Bay health care facility changed its mind after the story found its way into the local media. Four of the seven full-time jobs have now been saved. The remaining three have already taken voluntary exit package. … Police have laid fraud charges against the administrator of an Ottawa-area long term care facility. Joanne Talbot-Brisson appeared in court May 28 on 25 charges, including criminal breach of trust, fraud over $5,000, theft over $5,000, possession of the proceeds of crime, misappropriation of money held under direction, falsifying employment records and uttering a forged document. Two other women were also charged. It is unclear whether the newly passed Retirement Home Act would have made any difference. Jane Meadus, a lawyer with the Advocacy Centre for the Elderly (ACE), told the Ottawa Citizen that privately run care homes are “a bit of the wild west. They’re called different things in different places. There really doesn’t seem to be oversight.” . … Despite an occupancy rate of 98.8 per cent, the North Simcoe Muskoka LHIN says there are no plans to open up any more long term care beds in that region. Like other hospitals, Soldier’s Memorial Hospital in Orillia is shedding beds. The hospital plans to cut 25 beds over the next two years. Community members are concerned that with nursing home beds full, alternate level of care patients will have nowhere to go. Ontario has 56 per cent fewer hospital beds per capita than it did in 1990.

Beware of bankers who profess to be health care experts. Don Drummond and Derek Burleton of TD Economics released a report yesterday blaming health care for the present fiscal deficit and recommending a variety of ways of bringing down costs, including taking “rich” seniors off the Ontario Drug Benefit Plan.

Have they no shame? Do they just assume our collective memories are so short that we have forgotten the role of the international financial services sector in bringing down the world economy in 2008? Now they are rewriting history to suggest it was health care that sent our deficits soaring.

Returning to record bank profits – which will be taxed less thanks to Dwight Duncan’s recent budget – the TD Economics executives feel it is their place to tell us to tighten our belts and do without. In Duncan’s budget new tax cuts cost Ontario $4 billion for 2010/11. The increase in costs for public health care was $2.2 billion. That’s right — increased tax cuts cost more than increased health care spending.

Next year the government plans to reduce increases in health care spending to an arbitrary 3 per cent, but the corporate gravy train will continue with more tax cuts.

Under this scenario, you could freeze health care spending and it would eat up a larger percentage of the provincial budget by virtue of a shrinking capacity by government to raise the money it needs. So, where are the editorials talking about tax cuts being unsustainable?

The Chicken Littles of health care spending Armageddon really don’t like to look at health care spending as a percentage of the overall economy. This is how most international economists analyse health care spending. Health care spending cost 10 per cent of Canada’s gross domestic product (GDP) during the last recession in 1992. Last year health care spending amounted to 11.9 per cent. This is not because of any major growth in health care spending in 2009, but because the economy actually shrunk. The year before health care had cost 10.8 per cent of GDP – that’s less than a one per cent change over close to 20 years. These figures are for all health care, both public and private. About seven cents of every dollar spent on health care is public. In Ontario it’s a little bit less.

Hospitals always appear to be the target of bankers and policy makers. Hospitals have actually been shrinking as a percentage of the public health care pie. There was a time when hospitals accounted for more than 50 per cent of public health care spending. Now it’s below 28 per cent.

The fastest rising costs in health care are for drugs – something the government has just begun to tackle amid the firestorm from Shoppers Drug Mart and other commercial retailers. In Canada we now spend more on drugs than we do physicians.

The bankers acknowledge that much of our present-day expenses are related to the fact that Premier Harris and his counterparts across Canada slashed health care funding throughout the 1990s. And we know that when you do that, you don’t save money, you defer expenses until another day, often at greater cost.

Presumably when you play catch up a funny thing happens – you actually catch up. Nobody is saying health care will cost 8 per cent this year. Hospitals are getting 1.5 per cent in global funding. The OHA said at one point they needed 3 per cent. Yet the bankers say costs will rise at an annual pace of at least 6.5 per cent over the next 20 years. According to whom? Where are their figures coming from?

Dwight Duncan often repeats the mantra that health care will swallow up 70 cents of every program dollar within 12 years. Yet the most recent budget says health care is only 40 cents of the program dollar, but when adjusted for some accounting changes unrelated to health care, that figure jumps to 46 cents. In 2007 it was 47 cents on the program dollar. If you were making a little chart of this, the line would be trending slightly downward, not upward, even accepting the effects of accounting changes.

If we are trending slightly downward over the last three years, how do we suddenly get to 70 cents of every program dollar in a little more than a decade? To do so would mean an increase of 2 cents on the program dollar every year. Even in the most lavish years of spending we never saw that rate of increase. Not once.

The government has never explained how it arrived at that figure, but it was been echoed in bankers reports and in the mainstream media since March. Apparently if they keep on saying it, we’ll all believe that there’s a problem with health care spending and be more likely to accept the unacceptable.

Our single-payer system remains the most efficient model for delivering health care. Regardless of what the cost is, all alternatives are worse. Just look at the U.S.

There is much we can do to improve how we spend our health care dollars. It may be counterintuitive, but if a public plan can buy drugs for less, why would we want to move people out of that plan, as the bankers suggest? Shouldn’t we instead expand the plan? Wouldn’t it make sense for all of us to pay a bit more in taxes to save us substantial out-of -pocket expenses? In a January Vector Poll, 57 per cent of Canadians said they would actually pay more for better health care.

If the bankers recognize fee for service does not work well for doctors, why would they want to move hospitals towards that model?

Nobody calculates the cost of the constant upheaval in the system. It’s been more than a decade since the Health Restructuring Commission issued its report. The constant restructuring continues at great expense. The system never gels because it never gets the opportunity to do so. Now the bankers want more of the same.

Keeping track of the various entities the McGuinty government has set up to manage health care is a challenge. The Local Health Integration Networks have been a colossal flop. We already have an Ontario Health Quality Council – but the bankers want a Commission on Quality and Value for Health Care. The appetite for this level of bureaucracy is endless, especially after gutting the actual Ministry of Health. Recently the Central East LHIN complained they were getting no new staff but were receiving increased responsibilities from the province for capital projects. The same LHIN has no problem approving plans that continually remove front line care providers from their jobs while expecting hospitals to do more.

The system can be improved, but let’s make it about quality first. When we have quality, every health care expert agrees the costs will no longer be an issue. Instead of being stampeded by the banks into doing something rash, we need to take the time to figure this out and get it right.

For years the Ministry of Health has beat the drum on the benefits of shifting hospital-based services to community agencies. Now that the Local Health Integration Networks (LHINs) are signing accountability agreements with these agencies and monitoring their activities, the Minister of Health may wish to have second thoughts about this direction.

At its May 18 meeting, the Central East LHIN board were given their first look at the difficulties of working with this sector, which includes community support services, community mental health and addictions, community health centres and the Central East Community Care Access Centre (CE CCAC).

Staff cautioned that the agencies had data quality issues, meaning any evaluation of their performance had to be taken with a large grain of salt.

While the LHIN claims it has to do a lot of initial handholding, including actually filling out reports for some of the smaller agencies. The LHIN claims that some agencies have been submitting blank forms, while others are not even familiar with how to use an Excel spreadsheet. Some have reported balanced budgets, only to have deficits revealed through an audit. The LHIN reported that staff turnover is very high at these community agencies. As soon as the LHIN trains someone in how to carry out the reporting requirements, the individual ends up leaving to work somewhere else.

“We are bending over backwards to work with these groups,” said CE LHIN Chair Foster Loucks, “but some day there is going to be a reckoning.”

The LHIN has said that some of the small agencies may be forced to integrate with other health care providers if they cannot carry out the administrative reporting required of them. The LHIN has also threatened providers who cannot meet deadlines with fines.

Paul Barker, a Senior Director with the CE LHIN, said there were a number of organizations in the community sector where program quality and financial management is an issue.

Many of the agencies the LHIN is left to work with have chronic deficit situations, a situation the Ministry of Health overlooked, showing more interest in recouping surpluses than giving consideration to growing deficits.

Unlike the hospital sector, there are no industry benchmarks by which to measure the performance of these community-based organizations.

One LHIN board member looked at the charts and wondered if it was a case of “garbage in, garbage out,” since the information was unreliable.

The LHIN also said it was having difficulties even establishing what the benchmarks should be, especially in mental health.

Board members had a difficult time understanding the context of the projected deficits for these agencies without having their full budgets. The biggest deficit is being faced by the CE CCAC which is looking at a $9.6 million deficit to finish the fiscal year.

Given the Minister of Health’s other mantra – of evidence-based decision-making – one has to wonder where any of the evidence existed to suggest taking quality services out of accountable public hospitals and giving them to a select group including a number of poorly run community-based agencies was ever going to benefit Ontarians.

About 350 OPSEU members picketed the Liberal policy conference at Blue Mountain Resort in Collingwood May 14th.  Upset about a spring budget that placed corporate tax cuts ahead of public needs such as health care, education and social services, OPSEU members stopped cars, handed out leaflets, and spoke to members of the public. A short video of the four-hour picket is below.

While she still expects to lift the moratorium on competitive bidding in home care, Health Minister Deb Matthews told the London Free Press that a review of competitive bidding is currently underway. OPSEU has asked for details. … The Ontario Hospital Association is proposing a new bylaw that would prohibit all board-appointed professional staff from engaging in any conduct that would adversely affect a hospital’s “reputation or standing in the community.” The bylaw suggests these professionals must raise concerns through proper channels. The doctors could lose their privileges at the hospital should they speak out. While the government has been dragging its heels on bringing hospitals under Freedom of Information legislation – something Health Minister Deb Matthews had promised at last year’s OHA conference – it appears the hospital association is preparing to gag those who are most likely to serve as whistleblowers. …. The Milton Canadian Champion addresses the new “Excellent Care for All Act” in its May 13 editorial. The Milton newspaper questions whether the bill is needed. “We find it incredibly frustrating that we need yet another piece of legislation telling people they should be doing their jobs properly,” they write. “Our health-care system has been on life support for years. It will take more than the Excellent Care for All Act to right this mess.” The newspaper suggests what the system really needs is more funding to expand hospitals and hire more staff.

Waits are increasing in Ontario for speech-language pathologists, and according to the Toronto Star, some patients are being told to pay out of pocket to hire therapists at rates of up to $150 per hour. The newspaper reports that Community Care Access Centres (CCACs) have cut the amount of referrals to speech-language pathologists, instead focusing their funding on “higher priority cases.” A spokesperson for Health Minister Deb Matthews acknowledged the wait lists, but said “those who need service the most are getting it.” … As Ontario grapples with moving alternate level of care patients from hospitals to retirement homes, patients may wonder if their shift out of the hospital may eventually come with a bill attached should the province follow British Columbia’s lead. BC is quietly phasing in fees for convalescent care of $29.40 per day, or $894.40 per month. Similar fees had already been in place for palliative and respite care.  Patients can apply for a reduction in the rate through a hardship provision. … The Ottawa Hospital wants to reopen the deal it just signed in March with CUPE. Claiming it was getting less money than expected, the Ottawa Hospital says it cannot afford the deal. CUPE is looking at pushing the dispute into arbitration. Meanwhile, the Ottawa Hospital has calculated that asking staff not to be sick will reduce the number of sick days.  CEO Dr. Jack Kitts sent a memo out to all staff stating the hospital’s absenteeism rate is “significantly worse than most of our peers across the province.” On average, workers at the hospital call in sick 12 to 13 times a year.  The Ottawa Hospital CEO would do well to look at Professor Linda Duxbury’s study on role overload to gain a better understanding why his staff is burning out. (See  https://opseudiablogue.wordpress.com/2010/02/02/health-care-workers-face-anxiety-fatigue-burnout-as-a-result-of-“role-overload”-study/) The average sick days lost at Ontario’s hospitals is 10.3 days (2009), although other hospitals are struggling with similar absenteeism rates to the Ottawa Hospital, including Orillia Soldiers Memorial Hospital and the Peterborough Regional Health Centre. … A Quebec patient who wasn’t told she tested positive for cervical cancer three years ago is suing the hospital that conducted the test for $760,000. The Charles-Lemoyne Hospital in Longueil never called about her test results. The cancer is now inoperable, and the woman has been given months to live.

At a recent conference on health care innovation, speakers were less obsessed with how to make hospital CEOs do the jobs they are paid for and instead focused on what they call “upstream” expenditures as the key to reigning in expenditures.

The reality is most of our spending is on treatment, not prevention. The argument goes, if you spend on prevention, you save the downstream costs of treatment. However in every key opportunity, money spent on prevention is a tiny drop compared to the flow of funding into treatment.

Glenn Berill, Chief of Pediatrics at the North York General Hospital, told an April 26 Insight Conference that today’s younger generation will likely be the first to live shorter lives than their parents. Why? Canada is ranked fifth in the world for childhood obesity, a risk factor for heart disease, strokes, cancer, kidney failure, asthma, arthritis, blindness, mental health problems and falls.

Berill says the cost of obesity in Canada has been estimated to be $4.3 billion (2005 dollars), $1.8 billion in direct health care costs and $2.5 billion in indirect costs.

Instead of establishing a healthy lifestyle, by the time half of Canada’s children reach age 11, they will have had at least one dieting experience.

Berill made the case that we need to tackle the issue of obesity beyond the strict confines of the Ministry of Health. He points out that other jurisdictions have limited children’s food marketing, that school boards need to open up schoolyards past 4 pm and that city planners need to include sidewalks in new residential neighbourhoods to keep children physically active.

The North York doctor facetiously suggested that “turning off all electricity between 4 pm and 6 pm” would benefit North American children the most.

Part of the problem of dealing with the epidemic is that about a third of parents do not recognize obesity in their own children.

 While Ontario has taken some steps to addressing the question, it is not nearly enough.

The problem continues to be super sized and is not just limited to children. At ages 40 to 69 years, the percentage of males and females whose waist circumference placed them at a high risk more than doubled between 1981 and 2007-09. At ages 20 to 39 years it quadrupled.

 A few days after Berrill’s presentation, Active Health Kids Canada released a new report echoing his comments.

 According to the report, less than half the children between the ages 1 and 5 are getting the necessary two hours of exercise they need each day for healthy growth and development. While Ontario licensed care providers must provide two hours of physical activity per day, babysitters and unlicensed children’s home care providers are not subject to those requirements.

 The study also notes that in 1971 the average kid started watching TV at age four. Today it is five months.