Category Archives: Uncategorized

The day after: health care issues still smoldering

There’s got to be a morning after.

Tim Hudak has announced he is stepping down and the Kathleen Wynne Liberals now have a majority parliament.

So what happens now?

There are several outstanding issues in health care.

The first is the fate of the Local Health Integration Networks. The standing committee charged with conducting the legislated review travelled the province holding hearings over the winter. Despite Tim Hudak’s promise to replace them with “health hubs,” there was little interest in the issue on the campaign trail. The likely result will be some minor tinkering and they will soldier on. After eight years the LHINs appear to have found their legs although clearly there are still some community members who feel left out of the process. Last year’s five per cent cut to their budgets likely didn’t help the LHINs connect with those communities.

We’ve noticed that despite a province-wide Ontario Health Coalition campaign opposing the siphoning off of hospital services to private clinics, the province is moving forward with competitions to auction cataract surgeries, endoscopies and other diagnostic services. The Windsor Regional Hospital is already in one of these competitions with the private MyHealth Vision Care. MyHealth manages 16 Independent Health Facilities in Ontario and say they are developing 18 more. The hospital is the midst of capital planning for a new outpatient facility. Being caught in these kind of arbitrary competitions makes it difficult to plan. CEO David Musyj told the Windsor Star that the cataract decision will have an effect on the entire health system. “We don’t want to do something prematurely that negatively impacts what we’re trying to create into the future for the community.” The Wynne government could find themselves in a considerable battle over this issue. The Ontario Health Coalition have collected nearly 100,000 postcards from Ontarians who don’t want to see private clinics take over this work. They plan to present the postcards to Queen’s Park soon.

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Tories can’t add — Hudak way off on LHIN savings

Photo of 32 staff at the Central East Local Health Integration Network. The Tories suggest the Local Health Integration Networks have an average of 142 staff, which is not true.

The entire staff of the Central East LHIN. Does this look like 142 people to you?

Somebody please go to the buck store and get PC leader Tim Hudak a calculator.

We previously reported that the Tories long-standing pledge to eliminate the Local Health Integration Networks (LHINs) was missing from their platform.

Tim Hudak did eventually get around to the issue, renewing this promise.

Unfortunately, the promise also revealed more bad math. Far from being a “straight shooter,” Hudak’s campaign appears to be untroubled about facts.

Inside Queen’s Park reported yesterday that Hudak said he will cut 2,000 positions at the LHINs and save about $250 million.

Really?

Given there are 14 LHINs that would represent an average staff of 142.8 and an operating budget of nearly $18 million each.

We’ve sat through enough LHIN board meetings to realize this is way off. That prompted us to trek through the 14 annual reports presented on-line by the LHINs to check out their audited statements. We also went looking for their staff directories to add ‘em up.

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Who’s values will prevail on Thursday?

Whoever shows up to the polls tomorrow may determine Ontario’s next Premier and whether she or he enjoys a majority or minority government.

The question is, will that be decided by a majority of Ontarians, or will it reflect a different set of values decided upon by a much more motivated minority?

We do know that turnout to the advance polls was six per cent lower than last time, when the current minority government was decided by less than half of the eligible voters.

Worst still, according to ThreeHundredEight.com, only about one in four eligible voters admit that they have been following the election closely.

All you have to do is look around your community to observe so many fewer election signs.

That’s frightening given what is at stake.

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The end of efficiency – will appropriate care become the new system of rationing hospital services?

Former OHA President Tom Closson speaking at Longwood's Breakfast With The Chiefs June 10.

Former OHA President Tom Closson speaking at Longwood’s Breakfast With The Chiefs June 10.

The relentless pursuit of efficiency may be coming to an end for Ontario hospitals.

Thank goodness.

As former OHA chief Tom Closson said today at Longwood’s Breakfast With The Chiefs forum, year after year it gets more difficult for hospital CEOs to balance their budgets — “you can’t cut the same thing as you cut last year.”

This hardly means that hospitals are about to enter a new era of sustainable funding, especially in Ontario where public health care spending is already the lowest per capita of any Canadian province. Closson says Ontario hospitals also have the lowest worked hours per weighted case, the shortest length of stay in acute care, and the fewest beds per capita.

Have we found bottom yet?

Closson says we still have to reduce costs “because we have to.” Instead of seeking more efficiency, a new approach is needed.

Closson was joined by the Hay Group’s Mark Hundert and Chris Helyar to preach the new orthodoxy of appropriateness and to suggest that the HBAM (Hospital Based Allocation Model) of funding needs fixing.

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Greens leave out health care from their streamlined platform

The Greens had an in-depth party platform on health care in 2011. In this election they can barely bring themselves the say the word “health.”

The only mention it gets in the Greens streamlined platform is around poverty reduction and their commitment to double the exemption for small business to pay the employer health tax. That, incidentally, means less health care revenue.

Last time out they were raising warning bells about health care sustainability while promising billions more for seniors care and the interdisciplinary primary care sector. Despite the endless scandals around long-term care, they wanted to cut the number of regulations that protect frail residents in Ontario’s nursing homes. They also wanted to make the LHINs more responsive to their communities.

This time the Greens plan to tackle poverty reduction by setting a longer term goal of establishing a guaranteed annual income for all citizens, not just seniors. In the meantime they would double the Ontario Child Benefit for children of families who live close to the poverty line. There is also a vague commitment around youth unemployment, although it goes no further than urging young people “to tell us what they have to offer … we want to hear about their great ideas.”

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Parties respond to Alliance questionnaire on mental health

We’ve previously noted that all parties had little to say in their official platforms when it comes to mental health care.

The Ontario Mental Health and Addictions Alliance recently surveyed the four main parties asking a series of specific questions about mental health care. The Greens, Liberals and NDP answered the questions, the PCs instead sent a form letter about Tim Hudak’s widely discredited Million Jobs Plan, reiterated the PC health hubs plan and made some non-specific comments about integration. The official PC platform only says that mental health will be a priority. “We will take the fragmented services now offered and replace them with a comprehensive approach to help some of our most vulnerable citizens,” they say.
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Two-thirds of Ontarians would vote for a strong health care platform — Nanos

It was a curious decision by the media conglomerate putting on the Tuesday’s leaders debate. Limiting viewer questions to six, you’d have thought one of them would have dealt with Ontario’s struggling health care system.

As it was, health care was raised only by NDP leader Andrea Horwath, when she noted the NDP’s wait time pledge in her final summary.

The Ontario Medical Association and Nanos suggest Ontarians were dealt a disservice by the way the conglomerate produced the program. According to a poll taken between May 22-26, more than two-thirds of Ontarians (67.6%) said a strong health care platform would have an impact on their vote.

Further 87.9 per cent said that health care is an important issue to them personally.

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Beach Reads: Intersection between commerce and health care leads to murder

The intersection of health and commerce perpetually raises the question whether the impetus for change is motivated by good health practice or private greed?

Our pollster regularly reminds us that profit is not a dirty word, but when it comes to health care, you want to be sure that the prescribed treatment is safe and based on good evidence, not necessarily on the best rate of return for the prescriber.

U.S. publisher Astor + Blue have recently sent us two works of fiction – a thriller and a mystery – that both pivot on this intersection of commerce and health.

The first, Deadly Errors by Allen Wyler, is actually a reprint of 2005 thriller written by the Seattle-based neurosurgeon turned fiction-writer.

The novel deals with a Dr. Tyler Matthews who discovers a series of unexplainable medical errors that he suspects may be linked to a new Med-InDx electronic health record that is being piloted at the Seattle-based hospital where he works.
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Kingston hospital project to cost $164.9 million more under privatized deal

Ontarians are paying a premium of $164.9 million to replace Kingston’s mental health and rehab hospitals with a public private partnership. That’s nearly 38 per cent more than the public alternative.

The figures come from Infrastructure Ontario’s own Value for Money (VFM) document recently posted on-line.

The VFM notes the basic costs of the new hospital would have been $435.9 million had the province pursued the more traditional public procurement processes. Instead contracts were signed to build the same hospital for $600.8 million under a scheme that bundles 30-year financing and maintenance with the project’s design-and-build contract. When inflation and ongoing maintenance costs are applied to the contract, that amount rises to $901 million over the life of the agreement.

Infrastructure Ontario justifies the higher price tag by arguing the P3 actually saves $152.5 million by transferring the risk of cost overruns to the private sector. They calculate that risk at a staggering 88 per cent of the cost of the publicly-procured model – or $383.6 million on the $435.9 million price tag.
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Shocking police statistics show health restructuring targets for what they are – hopelessly outdated

If ever there were evidence to suggest its time the government abandon the mental health bed targets set out in the 1990s Health Restructuring Commission, it is the skyrocketing encounters between police and Ontarians with mental illness.

According to the Toronto Star this weekend, Mental Health Act apprehensions have skyrocketed in the Ontario capital from 520 in 1997 to 8,441 in 2013.

Police can apprehend someone with mental illness if they pose a threat to themselves or others or are unable to care for themselves.

The Star notes that mental health funding has declined since the 1970s when it represented 11.3 per cent of total public health care spending. Today Ontario sits at 7 per cent – slightly below the national average of 7.2 per cent and a great distance from the goal of the Mental Health Commission of Canada to increase the share to 9 per cent. Even that recommendation is presently below what many developed countries are spending.

It’s clear from the numbers that we didn’t substitute community care for institutional care – we mostly just eliminated mental health care.

Now the results are there for everyone to see.

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