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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Medical Tourism in Ontario

There could be real innovation in Ontario health care if the "Anti-change" groups would stop their obstructing. Most recently, the cries from Ontario nursing unions and Canadian Doctors for Medicare have resulted in response to new funding streams being generated from medical tourism efforts at Toronto area hospitals.

Both the CMAJ and the Toronto Sun had recent articles on this. The Globe and Mail reported on this earlier in the year. I will post the links in the Comments section.

Let's face it. Ontario is strapped for cash. Thousands and thousands of Ontario patients are waiting in queues while ORs sit idle for weeks every year and while beds exist on wards but are neither staffed nor funded. Medical tourism could contribute to helping hospitals provide more services and care to Ontario patients.

Doris Grinspun, as usual, speaks against any such option. Apparently, she would rather see patients wait in  queues than get the publicly funded services they need. The fact that hospitals are finding their budgets squeezed by Ontario's financial circumstances seems to be completely missed by her. Medical tourism has the potential to provide more income to the hospital thereby allowing it to provide more services to Ontario patients through the public system. It should be a Win-Win situation but somebody did not invite Ms Grinspun to the decision-making party. She is not happy.

Patients coming from abroad would provide income to hospitals who will use idle infrastructure and unused specialist time to provide the care. Ontario patients would not be "bumped" because of medical tourism. On the contrary, the additional revenue stream from medical tourism would be advantageous to Ontario patients. This new funding stream does not necessarily fit with Doris Grinspun's rigid ideology but it is a necessary step in a new and innovative direction.

Canadian Doctors for Medicare appears to be fixated on a single payer system at some level of unattainable purity. Dr. Dutt suggests that allowing medical tourism would cause specialists and surgeons to work "part time". She appears to avoid the harsh reality that despite less than developed world per capita physician average, Ontario is unable to employ 16% of graduating specialists in their area of expertise.

Dr Dutt should be reminded that surgeons train many years to hone their skills. They need operating room time to preserve them and can use medical tourism opportunities to continue to serve patients. The revenue provided by medical tourism could also assist more Ontario patients to benefit from the skills of these same physicians lessening wait times and creating a more productive population.

The Ontario public needs to understand how medical tourism can be helpful in making more services available to them.  Nursing unions and Canadian Doctors for Medicare should get a grip on reality or get out of the way. Patients are waiting.





Reader Comments (401)

One must truly question the morality, ethics, and quality of a system that says if you have resources we have the expertise and infrastructure to look after you, as long as you are NOT a canadian resident or citizen. If you are you CANNOT access these services.

Canada, the country thats bans it citizens from accessing services available to non canadians, in their own country.
August 21, 2014 | Unregistered CommentermovingforwardOntario
The fear mongering from Doris Grinspun is unhelpful. Does she fear she will not have her previous level of power should more options be made available to patients?

But her position is correct. If patients in Ontario can buy care, why can't anyone, thus defeating centrals desire to own the power.
August 21, 2014 | Unregistered CommentermovingforwardOntario
Dr. Nizar Mahomed, managing director of “UHN International,” said he does not consider what the University Health Network is doing to be medical tourism.
“This is about people who cannot get access to care” in their home countries,” he said. “I don’t think it has anything to do with two-tier (medicine).”

And now this is about people who can not get access to care in their home province of Ontario, while nonresidents can. Both ready willing and able to pay, but only one can buy it. Stepping off a lane with a foreign passport permits the purchase of a service that is illegal for a resident.
August 21, 2014 | Unregistered Commentereklimek

The irony, and deception, is actually now humourous. Residents of Canada and canadian citizens can not access medical tourism in canada, they may only access medical tourism outside of Canada.

Hmm. Maybe we should consider that prostitution is illegal to residents of Canada and canadian citizens, but non residents and non Canadian citizens can access prostitutes within Canada.

It is now just silly. The system is broken.
August 21, 2014 | Unregistered CommentermovingforwardOntario
It has been silly for some time.
Let us hope that Dr Day's efforts in BC are successful. The "leadership" in organized medicine is generally unhelpful despite what they profess.
August 21, 2014 | Unregistered CommenterMerrilee Fullerton

It is unlikely that much will change. Too much is based on maintaing the status quo.
August 22, 2014 | Unregistered CommentermovingforwardOntario
The status quo is an illusion, trying to maintain it in a rapidly changing world futile and dangerous.
August 22, 2014 | Unregistered CommenterAndris
Let me know when I can stop laughing!

So, for decades, through tax resources we preferentially fund high end hospitals so they can provide high end care when we need it. We have for decades allowed them to violate the Canada Health Act by using resources for a hand full of compassionate care case from third world countries, and actually encouraged it because when the newspapers are notified we all feel good.

Now the high end hospitals have extra capacity, they wish to use but need money. They still have waiting lists, but because we have "institutionalized" waiting lists, central can't provide them more money. Thus central, rather than providing resources to address waiting lists, would prefer them "sell" their extra capacity to get the revenue. Yet, the sale can only occur to non residents and non Canadians.
August 22, 2014 | Unregistered CommentermovingforwardOntario
Yes. Laugh on.
August 22, 2014 | Unregistered CommenterMerrilee Fullerton
Well at least we are mailing progress. Used to be that only animals could be medical tourists, accessing hospital diagnostic services for a fee. We have progressed to human, non citizens. This should eventually evolve to Canadians in about 10 yrs, once current crop of trough feeders die off.
August 22, 2014 | Unregistered CommenterConnie LHINgus
Good to hear from you Connie...

"once current crop of trough feeders die off"

Where do you think most of the trough feeders are?
We can't wait another 10 years. By then it will be 2024 and the demographic situation will be much worse. It will take another 10 years to create anything resembling private options. To be ready for 2024 we need to start NOW.
One thinks Connie's position is valid. We are making progress. First animals can be medical tourist. Next, humans, but must be non resident, non canadian. Next one would think would be illegal resident, non canadian.

Isn't this fun?
August 22, 2014 | Unregistered CommentermovingforwardOntario
The trough feeders are those supporting the status quo because to do otherwise and support any change to our current health system would negatively affect their influence and income. You can look to leaders in Ontario public unions and healthcare associations, public sector consultants, heck most anyone drawing a salary from the public sector.
August 22, 2014 | Unregistered CommenterConnie LHINgus
Thanks for clarifying. The entrenchment stymies necessary change and all the while the "defenders of Medicare" pretend to be acting in the interests of all Canadians when they are really acting in self-interest.

You think we have silos in health care? I suggest public fortresses is a better description.

I hear through the grapevine there may be a delay in the BC charter challenge. Hmmmm.
Move over big pharma rather just ensure that patients are eating the right food in order to drive their gut microbiome to a more favourable profile of disease fighting bacteria.

Have a look at this Australian documentary "Gut Reaction Part 1" where asthma in mice is treated with vinegar and increased fibre, and COPD might respond to fecal transplants from non-COPD patients (similar to C. diff treatment).

And if some of that research is not 'wow' enough for you this article on how our gut microbiome might be altering our moods is pretty science fiction.

And finally if you would like to know how your gut microbe profile stacks up against other Americans or against those on specific diets (i.e. low carb, paleo, vegan, etc) there is an open source Human Microbiome Project where one can get a poop analysis done for $100 (similar logistics to Nat Geo's Human Genographic Project).

I think I'll go out and purchase some chick peas and balsamic vinegar dressing today.
August 25, 2014 | Unregistered CommenterCanary in a Coal Mine

p31. Our members work at 470 participating employers
across the province, including hospitals, Family Health
Teams, Community Health Centres, Foundations and
other healthcare service providers.

So FHTs get the benefit of defined benefit pension plans.

No wonder everyone is so happy.

You have to like summer, no issues, no work, no crises.

All works as it should.
August 26, 2014 | Unregistered CommentermovingforwardOntario
I'm not sure that MDs get the pension benefits from HOOP while in the FHT.
Can you confirm or deny this mfO?
All salaried members of the FHTs are eligible for HOOPP.
August 26, 2014 | Unregistered CommentermovingforwardOntario
The strategy for the next year. It is all the feds fault. They are not doing their national duty to lead the country, even though Canada is a federation, not a republic. Anything to keep the focus off the province.
August 26, 2014 | Unregistered CommentermovingforwardOntario
mfO, I think you have identified the provincial strategy: Promise the electorate what taxpayers can't afford and then blame the Federal gov't.

In the end, tax payers get nailed either way. They don't seem to have figured that out yet or maybe they is the non-tax payers who have figured it out perhaps...

Ask the same MDs clamoring for more federal dollars for additional benefits for refugee "claimants" if they will donate their own money to support their cause and the answer is routinely, "no way" but the same salaried MDs working in a variety of gov't supported settings will take time to protest. Ah, the waste of misplaced pity.

That is the provincial policy. Blame the Feds for everything. It will work. Most of the public do not understand that we are a monarchistic federation, with control resting with the province, not the federal system. Canada is not a republic.

If one waits for care in Ontario, it is Ontario's decision, not Ottawa's.

Thus, the safest provincial strategy is to blame someone else. Health problem, it is not Ontario, it's the feds they won't lead, even though, by law, they can't.

Be prepared. It is all Ottawa's doing.
August 26, 2014 | Unregistered CommentermovingforwardOntario
Yes, I'm prepared but somewhat disappointed in my fellow citizens. Maybe we're wrong.

It is nice you still recognize that it is the voting citizens of Ontario who control this. However, it is important to recognize that most do not understand that health is a provincial matter. The system works relatively well, but the shortfalls that exist are provincially determined.

Arguments about the need for a national plan are diversions allowing the province to delay making changes. However, it is good politics as it takes the pressure off the local politicians.

Now we will hear that the Ontario economic issues, and the Ontario health issues, are the fault of the feds.
August 27, 2014 | Unregistered CommentermovingforwardOntario

How right you are.

When Quebec is seen by the feds as being reasonable and that negotiations are possible when compared to have a real problem. IMHO even the OTHER provinces often see Ontario as a whiny complaining child, which is likely why there really hasn't been a provincial gang-up on the feds.
August 27, 2014 | Unregistered CommenterOutpatientPharmD

In every province revelling in good fortune stands a government prepared to take the credit. This precludes giving Ontario a pass on its mismanagement.

There will be no infusion of money from the feds.The lack of previous favour is being repaid.
August 27, 2014 | Unregistered Commentereklimek
The current government is in a bad spot, and it knows it. The assurance of a balanced budget in 4 years is going to be tough. It can occur only through raising revenue and/or cuts. Tbus the easiest route is to blame the feds for not providing sufficient revenue, even though the issues truly are provincially driven. Since the majority of the public do not understand that canada is a federation, they can be persuaded that it is a federal issue of underfunding. It is however, bad politics, in that it creates a divisiveness that is unneeded.

However, this is the world we live in.
August 27, 2014 | Unregistered CommentermovingforwardOntario
The Feds throwing money at the provinces for health care with no strings attached only enabled the status quo for the last decade. Now with transfers tied to nominal GDP in 2016 the squeeze will really begin and force the petulant provinces to make the needed tough decisions regarding how to finance their HC systems.

From the Liberals huge cash dump under Martin to Harper maintaining 6 percent increases in the CHT until 2016 there will be no argument the province of Ontario can make that will appear reasonable to the electorate when the Feds have been more than reasonable. Rather Ontario will be seen as the whiny child with very little to show for those Federal health transfers.

I guess though we did get the family heath teams and EHR subsidies with Martin's cash dump.

I think the rest of the country will tire very quickly of Ontario's complaining that it is not getting a fair shake when most know that this is the land of milk and honey when it comes to public sector wages and benefits in the health care sector.

Plus the Feds can point out that they only contribute 20 percent to health care and have for a long time therefore it was Ontario that mismanaged the other 80 percent using their own funds.
August 27, 2014 | Unregistered CommenterCanary in a Coal Mine
The public is extremely financially illiterate.
Some even believe that raising corporate taxes is the way forward. I sure hope we don't have to have more pain before the electorate figures things out.
When Ontario requires businesses to fork out 1.9% of wages as a match for the ORPP, get ready for layoffs, business closures and stagnant wages.
More pain to come. Just keep voting in the " promisers".
August 27, 2014 | Unregistered CommenterMerrilee Fullerton
The public is extremely financially illiterate. Realist

And will only get worse in Ontario as the next generation of students is increasingly innumerate. These atrocious provincial math results should be a call to arms to throw out the Discover Math curriculum flakes at OISE and the MOE.

Dumb down the populace and keep them sedated with boos and pot in order to maintain the financial fantasy world we have in this province.

"Over the past five years, the proportion of Grade 3 students who meet provincial standards on math tests has dropped to 67 per cent from 71 per cent. At the Grade 6 level, the proportion has fallen to 54 per cent from 61."
August 27, 2014 | Unregistered CommenterCanary in a Coal Mine
The Ontario math curriculum is a failure. I've had three kids go through it. They all did well but 2 were math brained and the other worked very hard and had a Chartered Accountant parent with an Honor Math Degree from Waterloo sitting in the next chair for about 2 hours a night.
Brains mature with time but without the right "input" early it seems that the process of using the information is lacking. For an 8 year old kid to have to explain why 2 plus 2 is four seems ridiculous to me. It is 4. That's all. Move on.

We should call the Ontario math program the Ontario Math judging curriculum...cuz it's not teaching.
For perspective - GM in St Catharines. Used to be 5,000 jobs here alone. Now there's 10,000 across Canada (according to GM website). My patient says 26 years of seniority is needed to keep the job.

To stem the tide the article estimates 1,000 jobs in Windsor takes $348 million in government money.

When do we stop spending tax money to create sheltered employment that is otherwise uncompetitive on the global stage? Have we not learned that subsidizing cucumbers to make pickles doesn't work?
August 27, 2014 | Unregistered Commentereklimek
"When do we stop spending tax money to create sheltered employment that is otherwise uncompetitive on the global stage? "

This is s tough call. Once, out we are out forever. However, it may be necessary to leave now. It may be time to recognize we can't compete against Mexico and ca't support the targeted tax support.
August 28, 2014 | Unregistered CommentermovingforwardOntario
These security breaches just keep occurring again and again. Why is it that the banks can keep their data systems more or less secure but in the health care system it seems there are recurrent serious breaches almost monthly now.

I realize the benefits of electronic records in the hospital setting but in the good old days of paper-based records no employee would ever have gained access to thousands of records without going to a lot of trouble which likely would have been detected along the way.

"Lawyer Michael Crystal, who launched a $412-million class action lawsuit on behalf of the Centenary patients, said he expects the filing will be expanded to include the Ajax and Pickering patients. The lawsuit has not yet been certified.

"In another privacy breach, Rouge Valley said a baby photography service working in the birthing centre of both Centenary and Ajax and Pickering was inappropriately provided a daily list of information about new mothers, which included the patients’ name, room number, age, gender, physician name and length of stay in hospital, and in some cases type of diet, type of room accommodation in hospital, and reason for admission to hospital."
August 28, 2014 | Unregistered CommenterCanary in a Coal Mine

For those expecting privacy in today's world, they are deluded. Each time you provide information, it is stored and transmitted. Additionally, with all of central's registries, lists exists of those with specific medical conditions. All that can be done is a legal settlement as the breaches occur.

Let's see, the taxpayers pay for the secure EHR system, and then pay for the legal costs of the failed security.
August 28, 2014 | Unregistered CommentermovingforwardOntario
Privacy breaches paid by taxpayer. This parallels the costs incurred by inadequate access to care that results in legal action. If government were actually liable they would divest themselves of the Ministry of Health after the first law suit. It borders on the absurd to have management aloof from the results of implementation.
August 28, 2014 | Unregistered Commentereklimek
The last several posts speak to the complexity of what has been created...not only in health care and EHRs but in government in general.

The Ontario population doesn't seem to care is promised all kinds of free things on the backs of weak economy and on the backs of a future generation being delivered from the expensive education system ill prepared in math and financial literacy.

The solution, according to the left and now the "centre" parties, appears to be to up taxes and fees. Blame profitable companies...yeah, that's it.

As more of the information comes out on the complexity of international tax flow, the pressure on the Ontario government builds.
August 28, 2014 | Unregistered CommentermovingforwardOntario
Care to elaborate mfO?
Just to recap an ongoing issue, about the personal health record of new born deliveries class action law suit at Rouge Valley

please recall ...

"In 2007, the government announced that it would develop an Electronic Health Record for all Ontarians by 2015. The 2009 Ontario Budget also provided approximately $2 billion over the next three years to allow the province to move ahead in a co-ordinated and meaningful way."
August 28, 2014 | Unregistered Commentereklimek

Very simple. Raising corporate tax rates is a sensitive matter in these competitive times. The current government is in a tough spot and needs revenue, however globalization makes corporate taxes tough to fool around with.
August 28, 2014 | Unregistered CommentermovingforwardOntario
Are Ontarians magpies and attracted to the shiny objects the government places in front of them?
August 28, 2014 | Unregistered CommenterConnie LHINgus
Hows the OMA contract coming?

"The province says its agreement with the Association of Management, Administrative and Professional Crown Employees of Ontario includes a wage freeze in the first two years and a 1.4 per cent wage increase in each of the third and fourth years.

The accord follows a two-year deal that included no wage increases in both 2012 and 2013, totalling four consecutive years without an increase."

Any bets?
August 28, 2014 | Unregistered Commentereklimek
The facilitator's term is almost up, and no agreement yet. Soon to go to arbitration.

With CMPA rates going up 20%, and supplies up 3-5%, most OHIP based physicians are now seeing true decline in income.
August 28, 2014 | Unregistered CommentermovingforwardOntario

One could swear several y eras ago, lots of experts were assuring everyone that aging populations were not going to be an issue.

Taxes going up.
August 28, 2014 | Unregistered CommentermovingforwardOntario

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