Category Archives: Health System

Want to solve the ALC problem? Stop designating patients as ALC.

In Dr. David Walker’s summer ALC (alternate level of care) report he gives the example of the Toronto Central LHIN’s efforts to reduce their ALC roster.

Alternate level of care patients are said to be indivdiuals who have completed their acute care but are unable to go home or secure a long term care bed. There used to be an ugly word for them — bed blockers — which appeared to put the blame on the patient for a failure of the system to provide a continuum of care.

The Toronto Central LHIN identified 148 long-stay ALC patients for review. While the LHIN was able to transition 28 of these ALC patients to alternate destinations, 22 were deemed medically unstable and not ALC at all. That’s nearly 15 per cent.

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Foundation calls for more powerful LHINs – but how accountable will they be?

Board members of the Local Health Integration Networks (LHINs) serve at the pleasure of the government of the day. They are appointed by Order in Council, and have a reporting relationship directly to the Minister of Health.

There isn’t much direct criticism from the LHINs of government health care policies, including organization of the LHINs.

Last week the Change Foundation issued a new report on integrated health care — Winning Conditions to improve patient experiences: integrated health care in Ontario. What’s significant is the Change Foundation report was reviewed by key players within the system, including Bill MacLeod, CEO of the Mississauga Halton LHIN.

While the Change Foundation suggests the final report wasn’t necessarily endorsed by the reviewers, this is an organization that has some high level participation from key stakeholders, including former deputy minister Ron Sapsford, who sits on the Foundation board alongside departing Ontario Hospital Association CEO Tom Closson.

The Change Foundation suggests that the LHINs function differently in reality than on paper, calling their “authority” a debatable point, the conditions on which they’ve had to operate “have been hardly winning.”

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Public or private, there is only one health care funder — us

On Wednesday former Saskatchewan Premier Roy Romanow expressed some regret over the cuts he made to health care while his province faced a tough economy. Speaking at a Canadian Health Coalition forum in Ottawa, Romanow admitted that pushing health care costs on to individuals was a false economy. The cuts have also created a lasting legacy for his political party, which has struggled to maintain seats in rural Saskatchewan after closure of many small town hospitals. This may be a direct lesson for Dalton McGuinty, whose government has itself toyed with the idea of reducing the scope of services at rural hospitals and delisted some OHIP coverage, particularly around physiotherapy, eye examinations, and chiropractic care.

Whether we pay through our tax dollars, or pay out-of-pocket, as Canadians we still pay. Evidence would suggest the difference between the two is a single-payer (tax-funded) health system is far more efficient and equitable.

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Docs more likely to make unnecessary referrals when they have ownership of the diagnostic service — study

There is a considerable body of evidence to suggest more investor-owned private delivery of public health care will increase costs and leave the government paying for unnecessary services.

The latest evidence comes from a Duke University study presented at the Radiological Society of North America this week.

The Duke University study reveals that doctors who have a stake in MRI (Magnet Resonance Imaging) scanners are far more likely to refer patients for scans.

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All the fuss about parking-centered care

Patient-centered care is the latest catch phrase being used by health care administrators, politicians and policy wonks.

It has become so frequent in its use it has actually supplanted the mandatory use of “evidence-based decision making” as this year’s mantra.

Despite the mantra, most of us would be hard pressed to point to a specific initiative that trumps the patients’ interest over that of the interests of institutional health care providers.

It is therefore interesting to see the response to the Canadian Medical Association Journal’s (CMAJ) recent editorial that calls upon hospitals to abandon 1 per cent of their revenue to make parking free.

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Retirement homes in conflict of interest over abuse line — ACE

Have a complaint about abuse at a retirement home? The telephone line you are required to call is operated by the trade association run by the retirement homes – a conflict of interest according to the Advocacy Centre for the Elderly (ACE).

This spring the Ontario government introduced a new Retirement Homes Act, promising to immediately enact provisions to protect seniors living in these homes from abuse.

While the Retirement Homes Regulatory Authority (RHRA) is being set up as part of that Act, the public is being advised to call the Complaints Response and Information Service line (CRIS).

The CRIS line is operated by the Ontario Retirement Community Association (ORCA), the private sector trade association for retirement home operators. That means if you have a complaint about a retirement home, you have to take it back to the advocates for that home. 

ACE is concerned that CRIS will continue to operate the line after this initial set up period, triaging complaints and deciding what gets forwarded on to the independent authority responsible for licensing and inspecting retirement homes.

“ACE has raised this concern with the Office of the Minister Responsible for Seniors given that what is considered abuse and neglect may be different from the perspective of the operators of the CRIS line, the tenants (residents) of the homes, the home operators, and the Authority,” writes Judith Wahl, executive director of ACE in the centre latest newsletter.

ACE is also asking questions about whether complaints to the CRIS line operators will be required to be kept confidential from ORCA – the operator’s employer.

ACE is calling for an independent call line to be maintained directly by the regulator authority, and not by the trade association.

Retirement homes have become more populated with seniors with higher levels of acuity in the absence of available spaces in Ontario’s regulated nursing home sector.

Retirement homes are also being used by hospitals to off-load “alternate level of care” patients who are unable to go home on a short-term basis. The government says they are protecting these patients by applying the Long Term Care Act to these specific beds.

HCDC pocket calendars on their way

Are you a OPSEU health care member? Our popular pocket calendars are being sent out today to OPSEU health care locals.

This year’s Health Care Divisional Council calendar has a fresh new design that’s both attractive and easier to use.

The calendar puts together as many health-related dates as possible, from Weedless Wednesday to National Physiotherapy Month. If your professional date is missing, please let us know and we’ll endeavor to get it into next year’s calendar.

The calendar also includes a selection of health care related quotes and introductions from President Warren (Smokey) Thomas, Vice-President/Treasurer Eddy Almeida, and HCDC Chair Sara Labelle. This year’s theme is the growing income gap, which has a direct impact on population health.

If you are a OPSEU health care member, and would like a free copy, please contact your local later this week.

Drummond tips hat on health care – calls for more private delivery of public health care

While we are still waiting for the Drummond Commission report on the Reform of Public Services in Ontario, Don Drummond himself is giving broad hints at what may be ahead for health care.

The latest is a November 17 paper published by the C.D. Howe Institute: Therapy or Surgery? A Prescription for Canada’s Health System.

In it Drummond continues to scaremonger with his ‘sky is falling’ predictions even while health care costs are dropping as a percentage of the size of the overall economy and as a percentage of provincial program spending.

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Roy Romanow to speak at CHC event Nov 30 in Ottawa

Roy Romanow, the former Chair fo the Commission of the Future of Health in Canada, will be the keynote speaker November 30 at a free Canadian Health Coalition event in Ottawa.

The two-hour event at the Fairmount Chateau Laurier includes two panel discussions, one looking at threats to Medicare, the other looking at what the way forward should be.

Globe and Mail health reporter Andre Picard will moderate the panel discussions.

Panelists include Diana Gibson (Parkland Institute, Alberta); Dr. Marie- Claude Goulet (Médecins Québécois pour le Régime Public); Allan Maslove and  Marc-André Gagnon (Carleton University School of Public Policy and Administration); Natalie Mehra (Ontario Health Coalition); John Abbott (Health Council of Canada); and Dr. Michael Rachlis (Independent policy analyst) and Sharon Scholzberg-Gray (Past-President Canadian Healthcare Association).

This event takes place in the Adam Room of the Chateau Laurier in Ottawa. Not in Ottawa? You can watch it streamed live at http://healthcoalition.ca . To register to attend this free event, e-mail brad@healthcoalition.ca or call 819-770-1626.

Less debt helped governments reinvest in health care — CIHI

There is no question that the last decade was a period of reinvestment in health care.

The recent report on health care cost drivers by the Canadian Institute for Health Information (CIHI) suggests governments made a conscious decision to invest in health care when revenues became available from eliminating deficits and paying down debt.

By reducing the amount spent on servicing that debt, governments across Canada were able to increase spending on key areas at a rate that exceeded overall revenue growth.

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