Squeaky Wheels: Are more Ontario hospital CEOs likely to publicly air their grievances?

Posted on May 1, 2013 | 1 comment

It makes us wonder why so few hospital CEOs are willing to publicly go to bat for their institutions. It’s true that in the past public advocacy was not always met with great appreciation at Queen’s Park, which has the power to take over a hospital and deal with sticky problems in their own way. Joe De Mora’s time at the Kingston General Hospital certainly comes to mind.

With hospitals having experienced their first year of a base funding freeze, and with perhaps a second lurking in tomorrow’s provincial budget, CEOs are going to be under a lot of pressure by communities reluctant to give up health services – especially in tough economic times. With costs rising and increased demand on their doorstep, a freeze represents a significant real cut to hospitals. High profile job losses at Ontario hospitals are already part of the landscape. The question is, what will year two of this look like and who will stick their head out to say something?

While some CEOs are parroting the Queen’s Park line about restructuring, others are starting to get some traction on their issues.

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Bangladesh tragedy — factory manager’s words come back to haunt us

Posted on April 30, 2013 | 3 comments
Factory workers make Levis Dockers at one of the better employers in the free trade zone.

Factory workers make Levis Dockers at one of the better employers in the free trade zone.

In hindsight the words sound eerie.

In February we were in Nicaragua on a rare tour of a Maquila factory that manufactures Levis Dockers pants for the U.S. and Argentina. These factories are usually reluctant to let foreigners in, but this one had a better record than most. It had a good relationship with both its union and an activist women’s group operating within the plant.

Wages at this factory are very low by international standards, but higher than others in Managua’s Maquila zones. The manager of the factory told us that some in the U.S. thought he was doing a good thing by raising his more than 3,000 workers out of poverty. He said they were wrong – his plant wasn’t taking workers out of poverty, only from “misery to poverty.” He said at $45 a week, nobody was getting out of poverty.

Unlike many foreign-owned plants in Nicaragua, this plant had invested in training for its workers and owned its equipment. Many companies simply lease their equipment and building, leaving at a moment’s notice without paying their bills, including worker wages.

The problem with a global economy is there are no real rules for the treatment of workers, only international agreements that give corporations extraordinary rights over sovereign governments.

The Nicaraguan plant manager told us that the wages he paid meant they were losing contracts elsewhere. He specifically said he lost one major contract to Bangladesh were the workers are making a third of the poverty wages he pays his Nicaraguan labourers.

Yes, Bangladesh.

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Will $260 million help restore home care clinical services? Maybe

Posted on April 30, 2013 | 1 comment

For home care this is significant.

With their feet held to the fire by the NDP, the Wynne government announced last week they were going to invest $260 million in additional funding for home and community care services this year.

It was a significant enough announcement that the press release came from the Premier’s office, not from the Minister of Health.

Depending on how it’s allocated, this could be the single largest increase in home care funding since the Liberals came to power in October 2003.

Given the loose definition of “community,” we wonder how much of that will actually be delivered via the Community Care Access Centres and their contract agencies, and how much will end up at the Community Health Centres, Family Health Teams and other community-based provider organizations.

Unfortunately, they aren’t saying where this money will come from, only that it will be reallocated from elsewhere in the health budget. That could mean this “new” funding will also come with a sharp increase in demand from wherever the cuts are being made.

Part of that money will likely include the $33 million announced for physiotherapy delivered by the CCACs. That reverses a multi-year trend where funding for all home care therapies were being reduced at the same time as hospitals were being encouraged to reduce or axe outpatient rehab services. The end result for too many Ontarians was to pay out-of-pocket or go without.

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Gagnon: Rising drug costs unsustainable — not Medicare

Posted on April 29, 2013 | 2 comments
Dr. Marc Andre Gagnon speaking at the Students for Medicare conference in Toronto April 27.

Dr. Marc Andre Gagnon speaking at the Students for Medicare conference in Toronto April 27.

Dr. Marc Andre Gagnon says that while Medicare is sustainable, rising drug costs are not.

A leading expert on pharmaceutical policy in Canada, Carleton University’s Gagnon spoke Saturday at the Students for Medicare conference in Toronto.

Gagnon says drug costs have been rising by an average of 10 per cent annually since 1988. Even with the so-called “patent cliff” where major blockbuster drugs have dropped in price due to the recent availability of generics, overall drug costs are still rising by 4.7 per cent per year.

The patent cliff benefit won’t last according to Gagnon. Within two or three years costs will be rising again unless the system is reformed.

For Gagnon, it’s not so much a question of if we have reform, but what kind of reform we want. Drug costs in Canada and Japan are rising faster than any other industrialized nation and provinces are under pressure to act.

In Canada 44 per cent of spending on drugs is public, 38 per cent paid for by private insurance, and 18 per cent paid out-of-pocket.

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Debate should be about better public care, not defending status quo

Posted on April 29, 2013 | 2 comments
Dr. Danielle Martin speaking at the Students for Medicare conference April 27.

Dr. Danielle Martin speaking at the Students for Medicare conference April 27.

Dr. Danielle Martin calls it a “trap.”

Opponents of Medicare argue that privatization or two-tier health care is the answer to the problems that face Canada’s health system.

The trap is to get caught defending the status quo in that debate.

Chair of Canadian Doctors for Medicare, Martin argued at Saturday’s Students for Medicare conference that we should be advocating for a better public system, not defending one that shows mediocre results for what Canadians are spending.

“Who thinks long waits are acceptable?” she asks the room.

Martin argues that what is driving cost is not aging or population growth, but increased utilization of the health care system by all ages.

“More docs, diagnostics and drugs – are we any healthier as a result?” she says.

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Denise Wagler-Allan winner of this year’s HCDC pop quiz

Posted on April 26, 2013 | Leave a comment

Congratulations to Denise Wagler-Allan — winner of this year’s Health Care Divisional Council annual pop quiz. A $100 gift certificate goes to the delegate/alternate whose entry was first to be drawn and has the answers to the quiz correct.

At this year’s OPSEU Convention our annual health care quiz was more challenging than ever. Many delegates found the quiz fun and informative. Thankfully our marking allowed for a number of correct answers.

For those wishing to know the answers to our quiz, click on the link below:

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Would the PCs slash health spending even further?

Posted on April 24, 2013 | Leave a comment

The Ontario PCs have released a new video with finance critic Peter Shurman suggesting the Liberals cannot balance their budget on schedule by restraining health care to 2 per cent and education to 1 per cent.

The timing appears a bit off. The video was released just a day after it was revealed the deficit will be $5 billion lower than expected, coming in a $9.8 billion rather than $14.8 billion for 2012-13.

It’s almost laughable the Tories are still using Don Drummond’s ridiculous projections that we are on our way to a $30 billion deficit when the numbers are clearly heading in the opposite direction.

Unfortunately Shurman doesn’t really provide the detailed answer to his mythical problem, although ominously he suggests a plan of action and the “courage to implement it” is what’s needed. That courage, so we are led to believe, includes more tax cuts.

He complains that the government’s spending plans are only known for three years. That means there are no budget details beyond 2015-16. To Shurman, this is his big “aha!” moment.

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$30 million back on hospital books as part of new purchasing model

Posted on April 23, 2013 | Leave a comment

At yesterday’s Central East LHIN The Scarborough Hospital (TSH) was asked to treat $2 million it thought it had coming back from Plexxus as “bad debt.”

Plexxus is a not-for-profit owned by 11 GTA hospitals, including TSH. A group-purchasing company, it uses the size of the 11 hospitals to negotiate better pricing on goods and services used by these hospitals. Many of the people who do purchasing for Plexxus are still employed by the 11 hospitals, some of them members of OPSEU.

As one of the 11, the question is, how could TSH write off bad debt essentially owed to itself, especially when the decisions on how this money got stranded was made by the group of hospitals?

David Yundt, President and CEO of Plexxus says he prefers not to call it bad debt, which suggests Plexxus is not paying back what it owes to its member hospitals.

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Red dots

Posted on April 22, 2013 | Leave a comment

In the age of accountability, being careful about your spending gets interesting when you don’t know much you will have to spend.

Each provincial budget usually gives some indication of what to expect in the coming years, so while this year’s offering is not expected until May 2nd, it is likely that hospital administrators are already planning (and worrying) none-the-less.

Prognostication is not always an exact science. When the Drummond Commission recommended restraining health care to 2.5 per cent, few expected the government to exceed that in last year’s budget. Instead Finance Minister Dwight Duncan delivered a 2012-13 budget that gave health care 2.45 per cent with promises of an average of 2.1 per cent over three years. If hospital administrators started doing back of the envelope calculations with those disappointing numbers, they may have been rudely surprised to find hospital base budgets were singled out for no increase from that money – not even a modest crumb to cover inflation, aging or population growth.

April 1st marks the beginning of a new fiscal year. Usually hospitals have a good idea what they are to receive by this point, even if much of the community sector ends up waiting months more to get their dollars confirmed.

There likely isn’t a hospital administrator who is counting on more than zero, so how much the LHINs have available for separately funded surgical volumes really starts to matter.

The Ministry of Health has yet to determine how much it is going to spend on quality-based procedures (QBP), another of Deb Matthews’ Orwellian terms for what is effectively fee-for-service for select procedures.

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$2 million in bad debt adds to woes of The Scarborough Hospital

Posted on April 22, 2013 | 3 comments

Last week The Scarborough Hospital announced it was eliminating 98 positions as part of its efforts reduce a $17 million annual deficit. On top of that, the hospital has found itself saddled with $2 million in bad debt related to its participation in Plexxus, a joint-purchasing company it shares with 10 other GTA hospitals. The hospital is presently seeking to amortize that bad debt over a longer period of time.

Eliminating the deficit at a time of base funding freezes has been particularly painful. Last year The Scarborough Hospital was spurned as a potential suitor in a proposed merger with the Toronto East General Hospital. More recently the LHIN stepped in amid community uproar over a plan to move all maternal and newborn programs to the Birchmount campus of The Scarborough Hospital. The initial plan also called for Birchmount to become a centre for day surgery, leaving more complex procedures to the main campus.

While The Scarborough Hospital is still implementing 111 of 139 proposals to reduce costs – resulting in $8 million in annual savings – changes in service delivery require further community consultation and discussion between health service providers. To that end, the Central East LHIN told The Scarborough Hospital to work with the Rouge Valley Health System to look more broadly at service delivery in the eastern edge of the City of Toronto.

What these service changes will look like is anybody’s guess at this point.

The two hospitals are appointing representatives to a joint leadership committee that will look at how services are delivered in the Scarborough region. That committee will also include professional and community representation.

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