Tag Archives: Health care reform

Picard blames health professionals for slow pace of “reform”

How can we improve Canada’s health system? Blaming the professionals who deliver care defies logic.

You may be very surprised to learn that one prominent journalist says the biggest obstacles to health care reform are the people who deliver it – or more specifically, their unions and associations.

Globe and Mail public health reporter Andre Picard comes back to so-called “vested interests” over and over again in a monograph (The Path To Health Care Reform: Policy and Politics) published last fall by the business-sponsored Conference Board of Canada.

Picard says of health care reform: “those who stand to lose the most are principally health professionals – specifically, the organizations that represent them, from unions to professional organizations.”

As such, so his theory goes, “they have a lot of power right now, and they’re not going to give up without a fight.”

Why would health professionals lose from health reform? Picard never says, although makes vague references to the poaching of professionals that is supposedly driving labour costs up. Really?

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Poking the beast – “P” word missing from reform talk

The problem with discussing health care sustainability is there is no definition of what that means. Data would suggest that our health care spending is not out of control – the so-called cost curve has already been bent. Past increases appear to have occurred in sync with economic growth, the exception being the economic crash of 2008. Clearly those who are worried about sustainability are not equating it with affordability.

Across Canada the average increase in provincial health care spending this year is 2 per cent – hardly a matter of excess especially when one considers aging and population growth.

While Canada has done better than just about every other country in the OECD in controlling health costs, it has often come at a difference kind of price given quality issues that persist.

This week the Conference Board of Canada is hosting a two-day conference in Toronto on health care sustainability. Next week the discussions will be sure to spill over into the Ontario Hospital Association’s annual get-together at HealthAchieve. We’ll be at both.

Earlier this year health policy analyst Steven Lewis and former Cancer Care Ontario CEO Dr. Terrence Sullivan issued a paper on how to keep the cost curve bent.

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Hospitals: I am a dinosaur. Hear me roar.

This is what we’re all expected to believe: if you cut the funding from hospitals and give it to community-based care, our health system will become more effective and sustainable.

The people who say hospitals should be nothing but acute care centers appear to be winning the debate on health care reform despite a lack of evidence to support their views. Those of us who suggest otherwise are quickly labelled dinosaurs.

Even the warm and friendly Canadian Centre of Policy Alternatives appears to be getting in on the act, suggesting in their federal alternative budget that as long as the community services remain not-for-profit, all will be well. They recommend an increasing share of federal transfers should be used to enhance primary and community-based care, not to support hospitals.

When we think about expensive hospitals, we think about beds.

And yet, the CCPA acknowledges that Canada already has the highest rate of day surgery in the world – an average of 87 per cent of all surgeries.

They point out that hospitals have only increased slightly as a percentage of spending relative to the size of the economy, from 3 per cent in the 1970s to 3.4 per cent in 2009. That’s more than 30 years.

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OHC Lobby: MPPs reluctant to halt hospital bed cuts

Yesterday 120 Ontario Health Coalition members entered Queen’s Park to meet with 70 MPPs a day after one of the most controversial provincial budgets in recent history. There are a total of 107 MPPs in the legislature.

With health care funding falling below that recommended by the Drummond Commission on Public Service Reform, one opposition MPP told his visitors, “there is a significant bump in the road coming.”

The lobbyists arrived at the MPPs offices to talk about jammed hospitals; thousands on wait lists for nursing home beds, and severely rationed home care. They also expressed their concerns about the prospects for increased privatization.

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How to lose a public health care system – Leys speaks to activists in Toronto

UK professor Colin Leys spoke to health care activists May 16th in Toronto. The event was organized by the Ontario Health Coalition.

It’s not a simple matter for a western democracy to lose a public health system. Citizens strongly support tax-funded public systems. In Canada, we believe it to be one of our defining features.

Yet in England the National Health Service (NHS) is being gradually eroded and taken over by giant U.S. health maintenance organizations (HMOs) and run increasingly on market principles.

What is more frightening, is the gradual approach in England has strong parallels to Canada.

UK professor Colin Leys has documented this transition from a public health care system to a market-based one in his new book, “The Plot Against the NHS.”

Meeting with a group of health care activists May 16 in Toronto, Leys pointed out the irony of the U.S. having the most inefficient health system in the world and exporting it now to other countries.

Leys said that current initiatives of UK Prime Minister David Cameron’s government were made possible by a decade of gradual market initiatives under the Labour government of Tony Blair and Gordon Brown. While Scotland and Wales have turned back towards a more public system, England continues the march towards a more Americanized system.

Cameron’s new health care bill would leave it up to consortia of doctors to determine how public health care funding is spent. Many of these consortia are in fact owned by private for-profit companies such as the U.S. health care giant UnitedHealth and Virgin, better known for operating record stores. Given doctors have little or no experience in buying or “commissioning” health care services, private firms are moving in to take up this role.

The ability of these general practitioner commissioning bodies includes discretion over what services they will buy and which should be publicly available.

That includes buying public health services from “any willing provider” approved and registered by the system monitor.

“The bill also removes the duty of the Secretary of State for Health to provide a National Health Service,” says Leys.

What has angered many in England is the fact that Prime Minister Cameron has done this without any discussion of the bill in the UK’s last election.

In fact, “Cameron promised no more top-down reorganizations of the NHS,” says Leys.

Leys says the new bill will mean the loss of comprehensiveness through delisting – something the professor says is already taking place.

It is also likely the bill will pave the way for more user co-payments as cash-strapped health foundations respond to cost pressures.

Leys says that while Cameron “pretends” to exempt the NHS from cuts, the reality is more of the system funding is being siphoned off into “social care,” creating a net real cut.

The new bill also takes a cap off of the number of private patients English hospitals are allowed to take on, shifting the hospital model to focus on raising money through more private patient income.

Many doctors assumed that because their trusts are no longer answerable to the Department of Health that there would be more freedom from bureaucratic control, says Leys. Instead they are now even less free under the new private model.

While many of these shifts to market-based health care were taking place under the labour government, the UK government dramatically increased public funding to more closely resemble their peers in the rest of Europe. The results were improvements in wait times that were mistakenly attributed to increased privatization.

Leys says there are many holes in the new act, including no provision for failing hospitals.

Nor is there any approval process when a private company sells their assets to another.

The debate rages on in Britain. The Royal College of Nurses has passed a no-confidence motion in the plan, which has in turn stiffened the resistance of many of the country’s doctors, says Leys.

Given the complicity of the Labour Party in setting up these reforms, the official opposition has been noticeably muted in its criticism.

Cameron has recently told the media he would not allow private companies to cherry pick the NHS, that there would be no privatization, and that patients would experience no up front costs.

Within days of promising this, news reported that the Labour Party leader would have to pay for surgery on his nose because it was considered to be a low priority for his local health care trust.

The Ontario government has closely followed the path of health care changes in the English NHS. At present Jim Easton is touring the province speaking to groups such as the Ontario Hospital Association and the Ontario Association of Community Care Access Centres.

Easton is the NHS National Director for Improvement and Efficiency. It has been his job to cut billions of pounds out of the NHS.

The timing of Easton’s tour suggests the McGuinty government is seriously considering rolling back health care costs on this side of the Atlantic too.

Given years of Ontario’s own changes to a market-oriented health system, we may be paving the way for similar reforms should Tim Hudak’s Tories come to power.