Looking for Solutions in Health Care for 2006 and Beyond

Our health care system needs to change to accommodate new demographics, new technologies and new pharmacologic advancement.

The roots of compassion and caring in health care should not change however, and it is with this in mind that the dialogue of change should be had surrounding health care.

How can we adapt to different needs that emerge as our population ages?

How can we  find sustainability in the midst of so many new advancements?

How can individuals become more empowered in serving their own health care needs?

What role does the individual have in enabling the  health care of others  beyond paying taxes?

Many questions like these need to be answered and if we are willing to look with open minds at the problems within our health care system, and beyond political posturing, then we can find new  solutions to take us further into this century. 





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More Honesty in Canadian Healthcare

The New Year has begun with a few bumps in Canada:

1. Ontario physicians settled with the Ministry of Health and Long Term Care just in time to have Ontario teachers take to the streets, offended by their treatment at the hands of government. Will this become a shell game for tax payers' dollars? Savings from one area simply redistributed to another?

2. Canada's First Nations groups are armed with drums, signs and anger about many things including living conditions on reserves and resource sharing. Will anybody recognize and acknowledge that the issues surrounding Aboriginal poverty are not as a result of lack of government money but due to lack of accountable self-governance and complex social problems?

3. Ontario's economy is still in a slump mired in deep debt and deficit. Will Premier McGuinty stop insisting that he has done a wonderful job as he walks out the door after proroguing legislature at the tail end of a spending spree legacy?

4. Alberta's economy is shuddering as energy prices hover and do not bring in the anticipated revenue for government to cover rising health care needs. Will this era drag Alberta down too? So much for relying on Alberta to keep Canada's economy on "full tilt ahead".

5. The Canadian trade deficit jumps as weak markets hit exports and the Feds struggle to reduce deficits. Will the vocal groups insisting that the Federal government bail out provinces for spending beyond their means in health care see the reality?

6. Alberta's inquiry into "queue-jumping" points to the reality that even people who can afford to pay for their MRIs or other types of care are forced to be dependent on a lagging public system. Will Abertans see the inquiry for what it is...a waste of time and energy?

7. Quebec stumbles with charges of corruption on building its major health facility while it can't even manage to keep its own paramedic supply sufficient to meet demand. Will the Quebec government open up more private health care options?

8.  Saskatchewan is sitting pretty with oil and potash and a premier that supports entrepreneurial spirit but despite its best efforts hospitals are overcapacity. Will Brad Wall continue his use of private clinics to provide public services and will there be increased use of private options to improve access?

9. Maritime provinces face high unemployment and low levels of skilled labour and an aging population ahead of the rest of Canada. How will it maintain its health human resources and public health care infrastructure as times become more tough? Will oil be enough?

10. BC continues to lean on prevention as a way of reducing health care costs. Will it work? Will the benefits of more hospitable climate of the major cities mean longer lives and more social entitlement costs?

11. Manitoba lays no charges after patient dies in an ER in 2008 with a bladder infection. Does it have to be this hard to get access to care? and what does it say about our universal, accessible health care?

Lots of events point to the fragility of our current state, health care included.

It is important we have leaders at the helm who can see the problems, address them with honesty and avoid decision-making influenced by cheerleaders in their ranks.

Jeffrey Simpson writes in The Globe and Mail on January 11, 2013 about the "Inconvenient truth: We don't have the best health-care system".

He gives credit to Alberta's Fred Horne and Ontario's Deb Matthews for their honesty. He states that  instead of telling the electorate that Canada's health care system is the best, they have  started with "the truth".

Simpson may be right but Canadians still do not have the "whole" truth. Politicians shy away from telling the whole truth in part because it is not politically helpful to them but also because some of them still believe Canada's system is better than it is in reality.

According to Simpson, the Environics Institute has some significant findings on Canadian perspectives about its health care system. Simpson writes:

"What about private payment? The Institute asked whether Canadians should have the right to buy private health care - here comes the condition -"if they do not receive timely access to services in the public system"- and here comes another condition - "even if this might weaken the principle of universal access to health care for all Canadians because some people might have quicker access to services."

55% per cent said YES

43 percent said NO

Even more telling are the comments in response to the article. It seems that Canadians are becoming more aware that an alternative is needed to an overburdened public health care system that is not managing to provide necessary and timely access now let alone in the future.

We need as many solutions to finding increased access as possible. It is no longer feasible for Canadians to deny realities or for interest groups to insist Canadians keep their blinders on.

I hope that in 2013 more honesty about the need for a hybrid health care system can be supported and that more Canadians will understand the benefit of creating options for care beyond the core public health care programs that exist.

Cheers to 2013 and to all of you who have made and continue to make such valuable contributions here! Thank you.


I will post a link to Jeffrey Simpson's article in the comment section.



Reader Comments (383)

Hard not to become angered when a family member becomes a "client processed" by the health care system and $4.6 million goes for salaries, stipends and reimburzza (typo?) to one person over 2 years at ORNGE.
February 9, 2013 | Unregistered CommenterEklimek

It's not the waste (although that's disturbing), it's that the former premier, the new premier, and the Minister claim they didn't know and couldn't control it, that is discouraging. The same backroom deals that established these things, could have generated the call to say "fix" it. It didn't occur because cover-ups are easier.

Now with all the MPPs leaving, and the new premier struggling to assure she smiles her way into the various groups needed to gain votes, nothing changes. Just stay away from the growing margins, pay your taxes, and convert what you can to cash transactions.
February 9, 2013 | Unregistered CommentermovingforwardOntario
" We don't have a clue what's going on but ee'll look into it"....should be the script written under this NP NOT signage.

In the UK the Home Secretary is disgusted that noone has been charged for the deaths in the unnecessary NHS...he remarked that compassion had been crushed out of the doctors and nurses working in the NHS...certainly the various colleges should be involved, but the main focus of the police should be on those who did the crushing.

In Ontario compassion has not yet been crushed out of the medical profession, doctors and nurses alike...but it is being squeezed.

It is time to rein in the "squeezers" in our system...right from the cabinet to the Minister of Health to the bureacracy of the MOHLTC and hospitals to the LHINs to the hierarchies of the professional colleges and representative organizations....and the pointy headed know it all self styled health experts advising them all should be tarred , feathered and thrown into a cesspit.
February 9, 2013 | Unregistered CommenterAndris
Wish I could correct my flubs..." We'll look into it"..." Unnecessary. Deaths"...perhaps " unnecessary NHS" was a Freudian slip.
February 9, 2013 | Unregistered CommenterAndris
Both healthacare systems in Canada and the UK are run by managers.

Neither are run by doctors.

Both are dysfunctional and in increasing decay.

It is the managers and their ilk who should be scrutenized, investigated and raked over the coals...yet it is the doctors who are getting shafted and tha managers who are wearing teflon as they get shuffled about and promoted.
February 9, 2013 | Unregistered CommenterAndris
As the muddle of ORNGE continues on,since the responsible Board members were government apointees, and they authourized the cheques, the government has every ability to legal right to pursue them for settlement.

Will the new Premier take up her responsiblities?
February 10, 2013 | Unregistered CommentermoingforwardOntario
If she had gonads she would...and earn respect and votes accordingly.

She does have her finger prints on most of the Liberal governments' debacles so she probably won't.
February 10, 2013 | Unregistered CommenterAndris
I'm not sure how Ms Wynne will manage. When I watched her jumping up and down on her winning evening I couldn't help but think that she is not the kind of leader we need..

But apparently, of all the provinces, Ontario has fewer citizens that know about economic and global events....
February 10, 2013 | Unregistered CommenterMerrilee Fullerton (realist)
If you don't have a clue about what is going on elsewhere and don't have a grasp of economic factors that could affect your life, I guess you just vote for the status quo. Scary stuff.

February 10, 2013 | Unregistered CommenterMerrilee Fullerton (realist)
<<Both healthacare systems in Canada and the UK are run by managers...Neither are run by doctors.>>
- Andris


ORNGE was (and is) run by a doctor. eHealth was chaired by a doctor.

Just sayin'.
February 10, 2013 | Unregistered CommenterExecutive Lead Blogger


I don't believe any group has a monopoly on Character.
The issue in both ORNGE and eHealth is that attempts to accomplish were driven too fast.

In the case of eHealth, the end somehow justified the means and we know how well that usually works out...

In the case of ORNGE, I suspect that accolades were given in some instances and the back patting and groupthink prevented anyone from speaking out lest they have their heads cut off...

Both ORNGE and eHealth were victims of their culture.
February 10, 2013 | Unregistered CommenterMerrilee Fullerton (realist)
ELB is quite right. As the demands and authority increase character assumes more importance.

Nearly all men can stand adversity, but if you want to test a man's character, give him power. - Abraham Lincoln
February 10, 2013 | Unregistered CommenterEklimek
An article in the Daily Telegraph is headlined " To fix the NHS, politicians must say the unsayable"...the same is true in Ontario/ Canada.
February 10, 2013 | Unregistered CommenterAndris
ELB ...you are right...our profession spits up Mazzas and Porters who seem to be more interested in things other than medicine.

Nevertheless we work in a medical world, an environment designed and managed by politicians, so called health care experts , bureaucrats and managers , some of which are only medical doctors in name....methinks that they entered medicine for the wrong reason and never saw it as a vocation.

A previous colleague of mine always wanted to be an artist, but was driven into medicine by his parents.

When his parents died, he retired to paint...working as a locum only long enough to earn the money to cover paint, canvas and supplies.
February 10, 2013 | Unregistered CommenterAndris
To be fair, and by means of an apology, my point was not to embarrass the medical profession at the expense of the management (or any other) profession.

I liked Dr. K's Lincoln quote. It is so true.

I have worked for and with some exceptional physician and non-physician leaders...people for whom I would 'go up the hill'.

I just hope that if I am ever in a similar leadership position,I can display the same qualities.
February 10, 2013 | Unregistered CommenterExecutive Lead Blogger
I came across the following leadership referring to General Schwartzkopf (RIP) and thought it was appropriate to our conversation here. I'm just trying to think of the leaders, both political and non-political, that we've had in health care over the past 20 years and how the principles of leadership outlined here apply (applied) to them):

February 10, 2013 | Unregistered CommenterMerrilee Fullerton (realist)
"If politicians like me do not persuade the public of the need for these changes, then the vulnerable in our society will be put at risk. In return for this candour, the British people must accept this new reality. It is an untenable position for the public to demand politicians to tell the truth, only then to vote them out because what they’ve said is unpopular. If you really want a better NHS, then you will have to find the courage to vote for it. "

That pretty much hits it on the head....
February 10, 2013 | Unregistered CommenterMerrilee Fullerton (realist)
"Continuing to pay lip service to failed systems is just not acceptable. Neither is a short-termist and timid five-year plan. It is high time that politicians told the truth about the NHS. The system we have is not the envy of the Western world and outcomes are not as good as they should be. It cannot be right that criticism of the status quo is a political taboo. Professional politicians should cease ducking the issue just because it fails to deliver short-term electoral gain."
February 10, 2013 | Unregistered CommenterMerrilee Fullerton (realist)

It's over. Central has won, free health care with no accountability. Change the leadership, start the rah rah speech about change, and someone else fault, and the party will continue.
February 10, 2013 | Unregistered CommentermovingforwardOntario
'Won' what, specifically? mfO, please don't tell me that there are a bunch of politicians and senior bureaucrats with a renewed bounce in their step that are high-fiving each other when they pass in Hepburn block corridors.

Ontario Health Care Lite and dirty is not a Super Bowl Beer commercial, is it?

Central only thinks that it has 'won'. Same old problems, same old tired solutions and a lack of horse power to deliver.

Seen this? Great new commercial from Heart & Stroke. Says it all. No one in government is bold enough to have this conversation with the electorate.

Congratulations to Heart & Stroke for launching it, but this should have been initiated by our elected leaders.
February 10, 2013 | Unregistered CommenterExecutive Lead Blogger
" Leadership is the combination of courage and judgement, neither of which being of much use without the other". (Can't remember who made the quote, but I love it).
February 10, 2013 | Unregistered CommenterAndris
The ad is problematic in that it offers no solutions and suggests that there might be one. There is one, it is not the one we want. That may be the bigger problem, we cling to the fantasy - Living longer, without getting old.
February 10, 2013 | Unregistered CommenterEklimek
I'm onside with eklimek on this one. I appreciate what is behind the ad...and it is well-intentioned...and it is about growing old in a healthy way and "bending the curve" at the end of life.

Ironically, it is a sudden heart attack that will cause death quickly for elderly patients who are susceptible and it is dementia that will create the not so pleasant scenario in the last 10 years of life.

If you live past the heart/disease/heart attack, past the cancer and dodge diabetes, you will then have a 50% chance of having dementia once you hit 85+ and for which, at this time, there is no known cure or effective treatment.

So "bending the health care curve" at the end of life is still a fantasy and likely to remain so. It is fine to try to bend the cost curve but presently not possible.
February 10, 2013 | Unregistered CommenterMerrilee Fullerton (realist)
hi fiving is alive and well at central. The old guard is departed. The new Wynne smiles are in. All can be dumped on the former premier. Happiness is in place. Neither the NDP or Cons can gather the votes, thus no election. We bumble on. All the old players remain entrenched as CEOS. The plan is good.
February 10, 2013 | Unregistered CommentermovingforwardOntario
So we cannot expect " honesty in Ontario health care" as the Wynne era begins?

Reality imposes itself no matter who sits on the throne in Queen's Park...plan or no plan.
February 10, 2013 | Unregistered CommenterAndris
Growing old

“After having repeatedly examined my conscience before God, I have come to the certainty that my strengths due to an advanced age are no longer suited to an adequate exercise of the Petrine ministry,” he told the cardinals. “I am well aware that this ministry, due to its essential spiritual nature, must be carried out not only by words and deeds but no less with prayer and suffering."

“His age is weighing on him,” the 89-year-old said of his 85-year-old brother. “At this age my brother wants more rest.”
February 11, 2013 | Unregistered CommenterEklimek
In the UK his NHS doctor would tick the box " most likely to die in one year" so that further money would not be wasted...and if admitted to hospital the liverpool pathway would kick in....happily he remains in Italy with its superior health care system.
February 11, 2013 | Unregistered CommenterAndris
I've not heard much about the Italian health care system. Can someone educate us?

I have heard many stories about little old ladies living independently or very close to their kin, well into their nineties, scattered in villages across the countryside.

Does anyone think that there is a "Milano cura percoso"?
February 11, 2013 | Unregistered CommenterExecutive Lead Blogger
Based on this


There seems a trend that Canada is not maintaining
February 11, 2013 | Unregistered CommenterEklimek
The last WHO rating of the world's health care systems rated the French system at #1, Italy at #2, the UK at #18, Canada at # 30 and the USA at #37.

The Pope has access to #2.
February 11, 2013 | Unregistered CommenterAndris
Just a note:

Since October, no open representation in a parliamentary fashion. Now a new Premier not subjected to exposure to public review through the polls. Unlikely that Queen's Park will reopen until budget time, at which time, it is likely that neither opposition party will trigger an election.

When one questions how we got where we are, one thinks it is obvious. It is a third world political process.
February 12, 2013 | Unregistered CommentermovingforwardOntario
But it feels good .... .?

London North Centre MPP Deb Matthews, who remains health minister but will also serve as deputy premier, said she was moved by the significance of the swearing-in. “Today I have to say is a pretty emotional day. I think all of us sitting there watching Kathleen being sworn in as the first woman in that position, having the Aboriginal drumming — a lot of firsts today and it feels pretty wonderful to be part of that,” Matthews said.
February 12, 2013 | Unregistered CommenterEklimek
Of course pomp and circumstance makes all things good, but in reality, we have an uniquely ontario issue, we have no functioning open process to debate and move things ahead. It is the family compact all over again. We are ruled, not governed.
February 12, 2013 | Unregistered CommentermovingforwardOntario
Not uniquely Ontario. Other countries have no fully functioning democracy. No one cares.

At least not here.

February 12, 2013 | Unregistered Commentereklimek
After the shuffling:

Taxes and fees will be up, and teachers will be paid more.

No election this year.
February 13, 2013 | Unregistered CommentermovingforwardOntario
Teachers will get more...the reward for standing up to the government and ignoring public oppinion.

Doctors will get less...the punishment for rolling over in the face of the government bullying and their desire not to offend the public.

Teacher morale goes up, medical doctor's morale goes down.
February 13, 2013 | Unregistered CommenterAndris
Watching the Westminster dog show last night...the Portuguese water dog got first in class , our Sophie was very pleased.

The OMA should have been entered, it is very obedient and rolls over on command.
February 13, 2013 | Unregistered CommenterAndris
Unintended consequences of PHIPA. Some may have seen this article


A response from the OMA addressed regarding reminder messages for pending appointments is extracted (below). The implications are substantial in terms of volume of missed appointments and follow up care.

“… voicemail messages - express consent is required in these situations. There are scenarios in which individuals share voicemails and do not wish for others to hear about their upcoming physician appointments. As such, if you wish to leave messages for patients, you must obtain express consent from each patient.”

So from here on no messages will be left. After all, how does the secretary know to whom they are speaking?

Voice mail is dead. RIP
February 13, 2013 | Unregistered Commentereklimek
I will have to inform my staff.
February 13, 2013 | Unregistered CommenterAndris
As usual from the CPSO you get this ...

"The CPSO suggests that physicians exercise caution regarding the content of messages left for patients. While it is acceptable for these messages to contain the name and contact information of the physician/physician’s office, the College advises that messages should not contain any personal health information of the patient."

So you can call and say you called.... That's it?

So you reach a real person. Do you know it's Ms Smith and tell her about her appointment?

What if the person (not Ms Smith) says, sure ... I'll take a message?
February 13, 2013 | Unregistered Commentereklimek
Watching the Westminster dog show last night...the Portuguese water dog got first in class , our Sophie was very pleased.

The OMA should have been entered, it is very obedient and rolls over on command.

....Good one. That wins Post Of The Month, Dr L.
February 13, 2013 | Unregistered CommenterBigDuke6
More ideological garbage from the CMAJ editors...note the rebuttle from a number of distinguished and highly educated individuals:


I'm a supporter of vaccines as prevention of serious disease and as major contributors to quality of life, but let's be real about the benefit in some cases and stop suggesting that having a substance injected into you is the same as wearing a mask.

As for requiring health care workers to take the vaccine, I don't support this measure.
February 13, 2013 | Unregistered CommenterMerrilee Fullerton (realist)
I note George Smitherman in the online Canadian healthcare network giving launching bouquets to the OMA for having bonded with Deb Matthews.

He seems to think that Deb Matthews is to be congratulated for coming close to his 56 months as Minister of Health. Oh, the narcissism...sigh...

Nothing really surprises me anymore.

I watched Deb Matthews on the Agenda the other night with Dr. Sinha talking about the Aging at Home Strategy and how this was going to provide "value for money". When Steve Paikin suggested it had the potential to aggravate access to care (MDs, NPs, etc out in the community would not be available in office to see more patients/time), Dr. Sinha appeared irritated and gave a fairly terse reply with the usual jargon.

I sense there is attraction to the accolades.

It is disconcerting to see how various MDs align themselves politically and any real healthy skepticism disappears.

Times are going to get much tougher in health care for patients and providers but the politically oriented MDs will benefit.
February 13, 2013 | Unregistered CommenterMerrilee Fullerton (realist)
"Matthews, with three years plus at the helm of health, may yet challenge my tenure of 56 months. As I predict that Premier Designate Wynne will be skillful in avoiding an election, at least through the spring of 2014, it seems likely that Matthews will get awfully close. She deserves to stay on.

At a recent Canadian Club speech, Matthews seemed to be enjoying her post and I would say also was enjoying the relief that comes when you have achieved an agreement with the OMA, especially after you have been fighting with them. Joined at the head table by the president of the OMA, the lighthearted references to the bruising battles just recently ended were offered and received in kind.

I think the apparent reparation of the working relationship is a very good sign for the OMA. By becoming part of the solution in finding savings and efficiencies they gain tremendous power in shaping changes in delivery. This is a sea-change for the OMA and it makes them even more powerful.

Back when we began the process of delegating responsibilities for decisions locally with the LHINs (local health integration networks), the OMA was awfully suspicious of what that would do to its power. I would say in the less than 10 years since, the OMA has figured out how to roll with transformation and position itself very well.

It now has the chance to work with a minister doctors know and with a new premier, the daughter of a physician." -George Smitherman

I believe that some friction and discomfort would have created a productive working environment between the OMA and the MOHLTC. When things get cozy, complacency reigns.

Ontario MDs would do well to avoid getting comfortable and complacent...and their leadership as well.
February 13, 2013 | Unregistered CommenterMerrilee Fullerton (realist)
This article on medical tourism shows how complicated the health care situation is becoming.

It is not possible to simply "ban" people from participating in medical tourism nor is it ethical for MDs to deny care to patients returning from attempts to improve their lives.

February 13, 2013 | Unregistered CommenterMerrilee Fullerton (realist)

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