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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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Wednesday
Jan132016

Palliative Care in Canada

Way back in the 1980s it dawned on me that as a soon-to-be family doctor it might be wise to know a thing or two about Palliative Care. It seemed reasonable that I should know how to alleviate the suffering of my patients from various end stage illnesses. So I took a two week elective.

The hospital I trained at in Alberta in 1986 happened to have a palliative program and I learned about  hypodermoclysis and the like. I also learned about the staggering ability of the human body even when it is failing to tolerate ever increasing amounts of narcotics.

It was a serious topic for an elective but the staffperson in charge of the unit was a bright soul and the patients were always grateful. Physicians at the hospital knew their loved ones would get good care there. Unfortunately, the program was shut down several years later....perhaps a victim of its own success or perhaps because of the optics of having the beds filled with mostly "MD relatives".

Over my medical career I discovered that my skills in this area were not needed. The hospitals had Palliative Care teams and patients did not die at home for the most part. If that was the wish of the family there were Palliative Care MDs who would provide this service. I never did use the hypodermoclysis procedure but I did use lots of empathy.

In any case, the resurgence in interest in Palliative Care is driven not only by demographics but also by the Right To Die movement along with the Supreme Court of Canada ruling on Physician Assisted Suicide.

As hospitals are overwhelmed with Alternate Level of Care patients, the concept of patients dying at home has taken on new zeal and while the Feds plead for more time to come up with some kind of legislation to solve the murky areas surrounding PAS I wonder if legislation will ever come to be just as there is currently no legislation for abortion.

I do believe that more access to robust palliative care can be a real solution to alleviating suffering of patients rather than resorting to Physician Assisted Suicide. More training of family doctors will be required and more funding for access will be needed.

It is worth noting that caring for patients in their homes is a relatively inefficient use of medical services. This access to care will require time and the skills of physicians. It will impact availability of health professionals for other areas of care. There will be trade-offs.

It is time to understand again what was understood thirty years ago. Palliative Care is an important part of compassionate care. Too bad it took so long.

 

 

 

Reader Comments (390)

Despite the need for more home care, long term care, and palliative care, Minister Hoskins sticks with "patient-centred" care which has diluted to mean almost nothing.
And he's looking for input! I suspect the solution has already been defined.
http://www.health.gov.on.ca/en/news/bulletin/2015/docs/discussion_paper_20151217.pdf?platform=hootsuite
January 13, 2016 | Unregistered CommenterRealist
"Our group of doctors applied for funding to be on-call 24/7, 365 days per year for palliative patients in our community. But we were denied. It feels like our patients were denied the extra care they need and deserve by the government."
January 13, 2016 | Unregistered CommenterRealist
I am an RPN 25 yr. front line worker, I just survived a 5 year medical nightmare, I am so glad to have found you. I want to participate in change. I have great insight into change's that can be made to improve thing's yet suspect it would be like pulling teeth to make it happen. In the meantime would you be my doctor? I cannot take anymore of this being bounced from pillar to post and having to save myself lol.
January 14, 2016 | Unregistered Commenterkim
Also, I want to know if anyone has been treated badly by doctor's and healthcare professional's because they have asserted and advocated for themselves and have told the truth even if the truth hurts, I have and it is downright scarey. It makes you feel like you are digging your own grave. It makes you feel helpless and hopeless and it makes you wonder if you will be penalized with a back lash for speaking your truth and the truth. I wish we could just get on with solving these problems. I have many Idea's. Just no energy to present them.
January 14, 2016 | Unregistered Commenterkim
Kim,
Depending on where you live you have different options to become more involved. If your primary concern is finding an MD you may want to consider contacting your local hospital or do online search for physicians in your area.
You could also check to see if there is a community advisory committee for the hospital in your area.

Ontario did have HealthCareConnect although it may not be operational now. I've lost track.

Take care.
January 14, 2016 | Unregistered CommenterRealist
On another note, readers interested in the measuring and monitoring going may find the following article refreshing:

http://newsatjama.jama.com/2016/01/13/jama-forum-if-you-cant-measure-performance-can-you-improve-it/
January 14, 2016 | Unregistered CommenterRealist
http://www.nugget.ca/2016/01/15/worst-of-liberal-legacy-yet-to-come



Opinion Column
Worst of Liberal legacy yet to come
Stephen Skyvington, Guest Columnist

Friday, January 15, 2016 1:10:23 EST AM




Worst. Government. Ever.

That'll be the legacy of the McWynnety Liberals when we finally get around to tossing them out the door on June 14, 2018, which is when the next provincial election is scheduled to take place here in Ontario.

Whether it's the New Democrats led by Andrea Horwath, or the Progressive Conservatives led by Patrick Brown, you can pretty much bet the farm that one of those two parties will replace the Liberals and form a majority government, once the dust settles.

Much like what just happened federally with Justin Trudeau, I suspect voters will size up their two choices, and then settle on the leader and party with the best chance to knock off the incumbents. No way anyone here is going to want to risk splitting the vote again, and accidentally elect Kathleen Wynne to another four years of trying to tax and spend her way to Nirvana.

Although, in fairness, I do have to give the premier credit. She seems to believe in what she's doing, and always manages to stay on message.

Now, if only Wynne wasn't heading up perhaps the most incompetent — if not corrupt — government I can recall, outside of Italy, in the last 100 years, I wouldn't be nearly so upset. But the truth is, the Liberals have ruined our province and put the future of every man, woman and child living within its boundaries at risk.

Now, in case you think I'm being too hard on Wynne, let me remind you of the following.

In the 12-plus years they've been in power, the Liberals have increased the provincial debt to something north of $300 billion, blown a further $9 billion on failed green energy projects, and managed to drive hydro rates through the roof, while rationing health care and alienating doctors.

Over that same period, tens of thousands of manufacturing jobs have been lost here in Ontario, which has led to our province having a jobless rate higher than the national average for the past seven years.

Oh, and did I mention there are currently four ongoing OPP investigations looking at Liberal government wrongdoing, as we speak, and that two of former premier Dalton McGuinty's top aides are facing criminal charges for ordering hard drives in the premier's office be scrubbed clean of any potentially incriminating evidence that might pertain to the politically motivated cancellation of those two gas plants, just before the 2011 provincial election?

McGuinty, a man who's been so hard to find, until recently resurfacing following the publication of his memoirs, that he might just have well been in a witness protection program, has stated that he and his closest advisors never put anything in writing once a decision had been made. This was his way to justify the deletion of all those gas plant emails, during his appearance before the legislative committee looking into the events surrounding the $1.1-billion boondoggle.

But what really worries me, if I'm to be honest with you, is not what the Liberals have done to us since 2003. It's what they might do to us in the remaining two-and-a-half years of their mandate — especially if they read the writing on the wall and realize there's not a chance in hell they can possibly win the next election.

Think they've made a mess of things to date? You ain't seen nothing, baby. Here's just a small sampling of the types of damage Wynne and her band of merry men and women could do in the next 30 months . . .

• Introduce province-wide HOT lanes on all 400-series highways. Got a little extra change jangling around in your pockets? Good. Who better to give it to than the Liberals. While the current plan calls for the introduction of High-Occupancy Toll lanes on just a 16.5-kilometre portion of the QEW, you can bet your bottom dollar that it won't be long before these cash-starved pirates start picking our pockets on every 400-series highway in the province before long.

• Actually move forward with the ORPP, their job-killing pension plan. Want to make sure Ontario remains a "have-not" province for the foreseeable future? Implement the Ontario Retirement Pension Plan. This unprecedented cash grab will cripple small businesses and result in even more job losses. All so the Liberals can have a chance at balancing the books before the next election.

• Force every Ontarian to register with their local LHIN, who would then assign them a family doctor. You're going to think I'm making this one up, but this nutty plan is very much in the works. Basically, you and your family members would have to sign up with your Local Health Integration Network group in order to get a family doctor. Sounds great in theory, until you realize this system is modelled on how our school boards are set up, and we all know how well that works. Better not get sick.

I could go on, but I figure I've depressed you enough. Suffice it to say, we're not going to be able to get off the McWynnety Liberals' merry-go-round anytime soon. All we can really hope for, in the end, is that the next time these guys target us for yet another emptying of our wallets, they'll prove to be as lousy with their aim as they are when it comes to openness and transparency. Not to mention ethics.

Should be pretty easy for the gang that can't shoot straight.


Stephen Skyvington is the president of PoliTrain Inc., and the former manager of government relations for the Ontario Medical Association. He can be reached at politrain@sympatico.ca
January 15, 2016 | Unregistered CommenterStephen Skyvington
R

Home palliative care is reasonable. Unfortunately, the structure of families is shifting. There are fewer and fewer nuclear families around. Building a home care system as a solution will fail because the future looks as if fewer and fewer families will exist to support the system.

Palliative home care works, and is good care, but needs a supportive 24 hour in house family support to have it succeed.
January 15, 2016 | Unregistered CommentermovingforwardOntario
<<Palliative home care works, and is good care, but needs a supportive 24 hour in house family support to have it succeed.>> - mfO

So fund it. How hard a decision is that?

Presently, the continuum of hospice and palliative care programs in the province of Ontario range from some that are exceedingly well resourced (primarily from hospital operations allocated in the days before the introduction of cockamamie, soul-sucking funding formulas) and community fund-raised activities all the way to Mom-and-Pop community operations that run almost entirely on volunteer fumes and scone-sales with little, if any funding support from their LHINs.

I have heard anecdotally that more than a handful of the latter programs once had some LHIN funding, but returned the funding because the accountability reporting requirements that came with the funding were found to be so excessive that it was not worth taking the money!

To be fair, there are many within these two extremes but it is very safe to say that everyone involved in hospice and palliative are dedicated, hard working folk who want nothing more than to make living (and respectfully dying) in their communities better places.

This is yet another example of where Central excels in just getting in their way.
January 15, 2016 | Unregistered CommenterExecutive Lead Blogger
Governments drain the soul out of those volunteers who are presently " running on fumes" as ELB puts it.

I love Reagan's quote on the governments view of the economy:

If it moves, tax it.

If it keeps on moving , regulate it.

If it stops moving, subidize it.

Reagan also stated " the most terrifying words in the English language are " I'm from the government an I'm here to help you"....the Ontario government is going
to " help" to fix everything in regards to palliative care, home care, long term care and primary care
January 15, 2016 | Unregistered CommenterAndris
With the plight of the dollar worsening, and the abandonment of oil as a component of a future economic tool for growth, things seem to be moving in a very bad direction. We all may be needing our palliative care sooner than we were planning.
January 16, 2016 | Unregistered CommentermovingforwardOntario
Next week will be tough. Hope these economists and politicians can figure this out for Ontario. I'm planning on dollar at 66 cents by end of the week. The OMA contract issue has disappeared. Not even an agenda item at central it is so low on the pile of issues.
January 16, 2016 | Unregistered CommentermovingforwardOntario
With the decision made that oil, and other non renewable resources, will not be used, those industries are moribund. Other industries in Ontario are absence, to a large degree. There fortunately money coming in to select urban areas in housing, as security for those living in unsecure countries. It is going to be a tough future for Ontario for awhile, except in a few select urban areas.
January 17, 2016 | Unregistered CommentermovingforwardOntario
With Iranian oil about to hit the market...the price of oil looks bleaker....the C$ looks lower...the cost of imports will soar...pity that we have gutted the industries that could have benefited from the low C$...the provincial and federal governments will become even more desperate....and desperate politicians do desperate things with the rich targeted , in particular " rich " doctors who aren't.

One can expect an escalation of bankruptcies amongst those in the real economy, not blessed with guaranteed governmental salaries, benefits and pensions.
January 17, 2016 | Unregistered CommenterAndris
Interesting reading in the Financial Times.

In Russia the working population is shrinking by a million people per year with the pensioner population increasing by 400,000 per year expecting it to be a million a year by 2030...the Russian economy is shrank 3.5% in 2015, wages dropped 10%, real incomes shrank by 5%....in cities such as Novosibirsk elderly pensioners arrived to collect their social security benefits to find a note stuck on the door of the post office that " payments for January 2016 will not be made until cash flow is restored".

What are the equivalent figures for Canada/ Ontario one wonders?

If the Canadian/ Ontario economy shrinks as the markets indicates that it will ...could we expect a Rusian type consequence ?

The Russian government exacerbated matters by indexing pensions and public sector wages to inflation running at 16% exacerbating the government's financial difficulties....it plans to increase retirement age.

Interestingly the Russians believe that one requires a 5% per year growth to "build a social state"....do we require the same growth as well to maintain ours?

If it does, then our own economy requires paliative care.
January 17, 2016 | Unregistered CommenterAndris
Generally growth of 4-5% models best to support a progressive socially vibrant society. Our GDP is not keeping up (year 8). That's why borrowing money is needed. However, the rising question is can the future generation paid it off, or will they pay if off with declining lifestyle.
January 17, 2016 | Unregistered CommentermovingforwardOntario
I had two girlfriends die of cancer with no palliative care, so at home alone to the bitter end. I don't see the issue, the only time you need it is you aren't going with assisted suicide. Just skip the final 3 weeks of starvation and dehydration AKA so-called palliative care and take the nice barbiturate cocktail, that's what I will do.

If you read the Liberal discussion paper it reads "any person who wants a family doctor can have one" not that you MUST sign up with the LHIN. I live in Oakville and go to downtown Toronto for treatment. I've already complained to my MPP as I could not find a doctor who will treat me in my area. I refuse cancer screening as I suffer from GAD and cannot live life under cancer obsession, it's worse than death to me. I already have had breast cancer obsession for the last 30 years from the days when you were told to do self examination in your twenties.

If I get cancer I will refuse all treatment and choose assisted suicide. Doctors will not take me as a patient because they don't like losing cancer screening bonuses and they don't like patients who won't live to be elderly old ladies dying of Alzheimer's and being a nice cash cow for the elder care industry.

I finally found a doctor downtown out of my LHIN who will treat my migraines and the GAD but he works in a walk-in only. Without him I will get no health care and rely on street drugs until I hit 74 and forced cancer screening ends. I will not sign up for a family doctor as non would take me the last time I looked and it's not my job to find one that will treat me without hounding me for screening tests for stuff I don't want to be screened for.

I'm not the only person who resorted to walk-ins for this very reason. I've had the same doctor at the same walk-in for 20 years and if they close them up, then boom, I will go to the ER every time I get a migraine or GAD episode.

In fact IMHO GAD as per the Supreme Court ruling, in itself, would qualify for assisted suicide, it's extreme psychological suffering that destroys your life. Chronic pain and anything psychological are so poorly treated in this country that we may as well be dead. We're not important like say the COPD from smoking people or the Alzheimer's people like my neighbour getting treated for cancer or the non-compliant type 2 diabetics. So assisted suicide, bring it on.
January 17, 2016 | Unregistered CommenterVera
Beginning the selections;

As the massive infrastructure funding starts, watch carefully the winners and losers. There will be losers. Resource based industries will suffer. Decisions about non renewable resources have been made. Non urban areas will see less.
This is a redesign of what will be supported in the future. That is challenging for a federated country with 13 political units.
January 18, 2016 | Unregistered CommentermovingforwardOntario
"Non urban areas will see less.
This is a redesign of what will be supported in the future. That is challenging for a federated country with 13 political units."-mfO

It will be challenging to rectify this unless it begins to rectify itself as costs of living in urban areas rise. Would there have been a demographic shift by more boomers to more suburban and semi rural areas if it were not for government efforts to bolster urban areas at the expense of rural areas?
January 18, 2016 | Unregistered CommenterRealist
Ahh social engineering by central, always a bump somewhere else.

Sort of like the parking decision. Think anyone in downtown Toronto isn't going to use that deal of 10.00 a day in hospital lots to cut down costs, thus making parking harder at downtown hospitals?
January 18, 2016 | Unregistered CommentermovingforwardOntario
"Think anyone in downtown Toronto isn't going to use that deal of 10.00 a day in hospital lots to cut down costs, thus making parking harder at downtown hospitals?"
Yup.
Then the hospitals will have to hire more patrols to monitor parking!
Argghh!
Less patient care and joe and Jane public will think they have benefitted.
Sigh.
January 18, 2016 | Unregistered CommenterRealist
Parking and fertility treatment...these are our main action items.

Parking
http://news.ontario.ca/mohltc/en/2016/1/ontario-making-hospital-parking-more-affordable.html

In Ontario 45 Hospitals currently offer free parking and 54 charge $10 or less per day. It is estimated that 36 hospitals charge more than $10 a day.

Fertility treatment
http://news.ontario.ca/mohltc/en/2015/12/ontario-announces-50-clinics-offering-government-funded-fertility-treatments.html

This funding will help support over 5,000 Ontarians per year who are trying to start or expand a family.

By the way - we are living in a province of over 13.6 million people.
January 18, 2016 | Unregistered CommenterExecutive Lead Blogger
The politics of vote getting.

Capped parking fees and forced claw backs. Seen this behavior before!

Background problem created, massive incentive to use subsidized parking by others, either forcing hospital to find staff to keep others out (discriminate), or shortage of patient spots as they get filled by other.

With downtown Toronto rates at $25.00 a day, who wouldn't want to save 15.00 a day, for 200 days year.

As ELB says, there are higher priorities.
January 18, 2016 | Unregistered CommentermovingforwardOntario
"Patent advocates" are big in free parking!
It's the solution to inequality so much so that the fact nurses and beds and services will have to be cut just doesn't matter!
It's what the patient advocates say they want!
Give em what they want even though it makes no sense!

On a more serious note, I thought we were all supposed to be using public transit to save on emitting carbon and stuff like that...
January 19, 2016 | Unregistered CommenterRealist
Parking, like the OMA contract, has not been thought through. Ahh, the beauty of transparency and openness.
January 19, 2016 | Unregistered CommentermovingforwardOntario
Ontario Health Minister Eric Hoskins says scientific and policy experts are divided on the health cost impacts of an aging population, which he insists are "not at all clear."

http://www.ctvnews.ca/health/ontario-doesn-t-think-health-funding-formula-needs-changing-for-aging-population-1.2742836

vs

“high-cost users” consume a disproportionate amount of these resources. Ten percent of the population accounted for 77 per cent of spending and 1 per cent accounted for 33 per cent of spending.

http://globalnews.ca/news/2449651/a-look-at-where-ontario-healthcare-dollars-are-going/
January 19, 2016 | Unregistered Commentereklimek
Realist,

Patient advocates want free (or reduced rate) parking and exceptional patient-centered care. It is not either/or.

I suspect it won't be long before someone links the reduction in caregiving staff (holistic term) or availability of contemporary equipment to the the fact that the government has imposed parking fee reductions.

I suppose if you look at things through another rose-coloured lens, at least Ontario is messing up on many little things. Quebec, on the other hand and Montreal in particular, has apparently messed up big time on the care of a patient who presented to an emergency room with a ruptured abdominal aortic aneurysm. Undiagnosed and untreated, the patient died following transfer to another teaching facility.

Pick your poison?
And any financial assistance to hospitals facing deficits due to parking revenue reductions will be a slap in the face to those hospitals that have maintained free or close to free parking.
January 19, 2016 | Unregistered CommenterExecutive Lead Blogger
file under "how patients satisfaction scores affect care."


"resources started being dedicated towards doing things that make patients happy, as opposed to providing for little things like, you know, their health care. The most off-the-wall example listed in the article was when a hospital realized the patients were unhappy with the quality of the food (resulting in lower patient satisfaction scores). They dedicated resources to asking nurses to present the food better, rather then, you know, improving the quality of the food itself!"

http://www.huffingtonpost.ca/sohail-gandhi/patient-satisfaction-health-care_b_8950416.html
January 19, 2016 | Unregistered Commentereklimek
And one more micro-issue I had with the Minister's parking announcement.

For those who follow social media...it is national non-smoking week: http://nnsw.ca/

Consider the following:

• In my business practice, weeks begin on Monday.

• In my opinion (and I am hoping it is widely shared), that smoking cessation is more of a public health issue than the cost of parking.

• Dr. Hoskins is the Minister of Health and Long-Term Care, not the Minister of Parking Management.

So why couldn't the Minister tweet his announcement of NNSW support on Monday (or before) and delayed his parking announcement on Tuesday? Or why couldn't he have done both on the same day?
January 19, 2016 | Unregistered CommenterExecutive Lead Blogger
http://www.cbc.ca/news/canada/montreal/st-mary-s-hospital-er-vascular-surgery-barrette-1.3409464

Quebec's College of Physicians said last week it is gathering facts on what happened before it decides whether further investigations are warranted.

On Friday, the Quebec coroner's office announced it would be conducting an inquest into Blandford's death
January 19, 2016 | Unregistered Commentereklimek
One wonders with the price of buying pieces of ontario plummeting to foreign investors, perhaps we could sell ouu needed for an improved palliative care system to interested buyers?

The malaise being triggered by the economy is quite impressive.
January 20, 2016 | Unregistered CommentermovingforwardOntario
This morning, Dr. Hoskins tweeted: "This year is the 50th anniversary of universal healthcare in Canada. How will we renew its promise for the next 50 years?"

How about "stop dithering around and launch the transformational change needed now!"
January 20, 2016 | Unregistered CommenterExecutive Lead Blogger
I saw that. I also see that he's not sure if an aging population is going to be a problem or something to that effect.
Don't get me started.....

Fodder for another post!

On another note, I've been paying some attention to Davos and the World Economic Forum although I wonder if it isn't truly just a soap box for the rich and famous..

In any case, a senior diplomat was broadcast suggesting that those at Davos would find out if Trudeau was a "flake" or not...yes...you read that right.

This comment broadcast on a major television network appears to have been buried.

It's not going to be pretty...the economy or Trudeau's hair when he's done.

Hoskins and Wynne should be pleased that the federal government is occupying the stage for now. Great distraction. Won't be for long.
It is interesting to watch these conversations and how in the end it always boils down to a scarcity of money, and so the conversation veers in that direction regardless of the topic. There are solutions. Now if Trudeau would bring us these solutions then he would really be a change maker and worthy of admiration.
https://www.youtube.com/watch?v=q0f9_1XzcwA
January 20, 2016 | Unregistered CommenterQuantumleap
<<It's not going to be pretty...the economy or Trudeau's hair when he's done.>> Dr. F

I'm surprised that Las Vegas hasn't already placed odds on how gray Trudeau's hair will get by the end of his mandate.

I'm quite sure that someone who regularly reads this blog would be able to Photoshop and post something using Barack Obama's hair as a guide.

Maybe even Rick Mercer could feature this!
January 20, 2016 | Unregistered CommenterExecutive Lead Blogger
Interesting to see that diphtheria has been reintroduced into Denmark after 20+ years by unvaccinated migrants from the Middle East...I saw the last cases of diphtheria ( and rheumatic fever ) in the late 60's, it has a greyish membrane on the back of the throat.

Soon to come to Canada?

They had better get the geezers , who are familiar with many of these once eradicated diseases , out of retirement.
January 20, 2016 | Unregistered CommenterAndris
Preparing for the money dump.

All now know a record amount of money is about to be provided for infrastructure changes. Any suggestion, where, in healthcare the money should go? IT may not be directed to physicians, they are capped.
January 21, 2016 | Unregistered CommentermovingforwardOntario
How about adequately funding the care of epilepsy?

"In our setting of publicly funded universal health care, more than 10% of patients
died within 2 years of developing medically intractable epilepsy. Epilepsy surgery may be an effective treatment for some patients; however, fewer than 2% of patients who may have benefited from epilepsy surgery received it. "

Neurology® 2016;86:1–7
January 21, 2016 | Unregistered Commentereklimek
<<Any suggestion, where, in healthcare the money should go? >> - mfO

It will be interesting to see what (if any) accountability requirements the provinces will have to include with any Federal investment into health care.

This has always been a contentious issue...given the hue and cry for this much needed injection, will the Provinces relent, will they relent in unison or will there be any that absolutely refuse money with attached strings?

And Andris' important point on public health risk from refugees cannot be ignored...in fact it should have been entirely anticipated.
January 21, 2016 | Unregistered CommenterExecutive Lead Blogger
ELB,
Ditto.
We can make all kinds of suggestions about the money dump use but recall that Paul Martin's 41 Billion dollar money dump evaporated into thin air without significant improvement.

Even if the Feds were to give the provinces a Billion to divide, the chances of it making any meaningful difference once diluted is questionable. The problem is Big, very very Big...

...and I don't think JT has another 41 Billion dollars just for health care this year.

Sorry folks, making suggestions about where more Federal money with strings attached should go is like a starving person writing up recipes and pretending to make the food.

It's a pretend solution.
Big dump coming. Taxes, surtaxes, fees, are being increased.

We will spend our way out.
January 21, 2016 | Unregistered CommentermovingforwardOntario
http://www.canadianhealthcarenetwork.ca/physicians/discussions/blogs/day-time/bureaucracy-weighs-down-canadas-medical-system-43086


Bureaucracy weighs down Canada’s medical system
WRITTEN BY DR. BRIAN DAY ON JANUARY 21, 2016 FOR CANADIANHEALTHCARENETWORK.CA
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Day Time
by Dr. Brian Day

More than 60,000 B.C. residents have signed a petition against rising premiums for the provincial healthcare insurer, the Medical Services Plan (MSP). Organizers report that the wealthy pay the same fees as those earning $30,000 a year. Their point is valid.

But their anger would probably be tempered if the funds garnished from wage earners were being used efficiently.

Few are probably aware of the Medical Services Commission (MSC), an unelected body responsible for spending the $4 billion-plus in MSP premiums and other taxes. Their mandate is “to facilitate reasonable access throughout B.C. to quality medical care, healthcare and diagnostic facility services for B.C. residents under MSP.”

Hundreds of thousands of patients on B.C. wait lists know that role is not being fulfilled. The health minister and premier recently admitted that patients were waiting inappropriately long times, and a health region spokesperson reported some “life-saving” procedures were being delayed.

Provincial health commissions were the brainchild of Tommy Douglas, who believed they should be chaired by a doctor and never subject to political influence. But the Medical Services Commission is always chaired by a politically appointed civil servant.

Douglas supported premiums and felt they made the public cost-conscious, creating a sense of individual responsibility. He would never have condoned the current practices of raising premiums to compensate for fiscal failures, or reporting low-income earners, delinquent with their payments, to aggressive collection agencies.

The commission is wasting healthcare funds as it displays contempt toward taxpayers in terms of its fiscal and social accountability. Funds targeted for patient care are spent recklessly. In one example, I received cheques from MSC totalling hundreds of thousands of dollars for services on patients that I had never seen. I also received confidential personal information on hundreds of patients unrelated to me or our clinic. When informed of their error, MSC responded: “Just mail them back.” They were not inclined to investigate.

In Canada, health providers are compelled by law to share confidential patient files with government employees armed with the right to inspect and copy patients’ files. Patients’ health records are considered public property; government access cannot be blocked. Consent is not needed, and a patient is not notified when “Big Brother” is looking. Privacy rights have been legislated away.

I once witnessed a defeated provincial cabinet minister’s medical file being reviewed by a newly elected government. In the 1989 tainted blood inquiry, Justice Horace Krever was “shocked by the inadequate laws, the abuses of confidentiality, and the fact that so many people—except the patient—had access to medical records.” Little has changed.

The MSC is also charged with defining what services are “medically necessary”—and therefore publicly insured. It has arbitrarily designated essential services such as ambulance, drugs, physiotherapy, artificial limbs, and dentistry as unnecessary, creating a true two-tier structure of care for patients.

The B.C. government’s last action in delaying the Cambie Surgery Centre’s constitutional challenge on patient rights resulted from a “last-minute” discovery of 300,000 documents they were legally bound to provide. After a delay of more than seven years, the plaintiffs in the coming June trial will confirm that the Supreme Court of Canada’s 2005 finding—that patients are suffering and dying on waiting lists—applies in B.C.

Our public sector health system (the Medical Services Commission included), is grossly overstaffed with non-clinical workers. A 2011 study revealed that Canada has 11 times as many public health bureaucrats per capita as Germany, where there are no waiting lists. Canada has 14 ministries of health, each with bloated bureaucracies and commissions scavenging dollars that should go to patient care. The mentality that cost inefficiencies can be balanced by increased taxes or “premiums” is responsible for our escalating premiums and taxes.

Independent health groups in Europe rated Canada as last in value for money compared with hybrid public-private systems that have accessible public systems. The Commonwealth Fund, a non-profit foundation focused on issues affecting low-income groups, ranked Canada 10th of 11 health systems in developed nations.

What specific changes would I incorporate if I were minister of health? Apart from incorporating the best practices of other hybrid systems (including private-sector competition), I would dismantle the ministry and its committees and commissions. Then I would resign. The finance ministry could fund patients directly (thus empowering them), and also assign budgets to the newly emancipated, self-regulated health organizations, allowing them to cater directly to patient needs. Maybe our June constitutional court challenge will point us in that direction.

Dr. Brian Day is an orthopedic surgeon, medical director of the Cambie Surgery Centre in Vancouver, and a former president of the Canadian Medical Association.

This article was originally posted on VancouverSun.com

Opinions expressed in this article are those of the writer, and do not necessarily reflect those of CanadianHealthcareNetwork.ca, or its parent company.
January 22, 2016 | Unregistered CommenterStephen Skyvington
Andris and ELB

Entirely predictable....and I was scoffed at by my pharmacy colleagues. Add Pott's disease, scabies and rheumatic heart disease (some severe), all of which I have seen in recent immigrants or refugees.
January 22, 2016 | Unregistered CommenterOutPatientPharmD
What, pray tell, did the Minister's meeting accomplish?
http://www.cbc.ca/news/canada/british-columbia/health-ministers-vancouver-1.3414317

At least the CPhA has done its homework and debunks quite handily the report in the CMAJ which proposed pharmacare and touted its affordability. It is excellent reading IMHO.
http://www.pdci.ca/pharmacare-costing-in-canada-preliminary-report/
January 22, 2016 | Unregistered CommenterOutPatientPharmD
In the old days we trained on the " great imitators"....diseases that present as other diseases...TB is one of them , Pott's disease is TB of the vertebrae...the chest XRay could be clear...decades ago I had a case that looked like rheumatoid arthritis in a Pakistani gentleman....it turned out that he has TB of the intestine from drinking unpasteurized milk in his old country....unpasteurized milk can also carry diseases that cause , scarlet/ rheumatic fever , brucellosis ( also goats milk) , diphtheria not to mention salmonella et al.

Exciting times ahead...I'm almost looking forwards to it being in the disease detective business, wellness being quite boring.
January 22, 2016 | Unregistered CommenterAndris
Andris
Interesting case of M. bovis.

TB the great imitator....has any of the young ones seen a case of active TB at all?? Early in my career I took care of a patient who was misdiagnosed with Crohns but actually had intestinal TB. Steroid treatment for her Crohn's resulted in miliary TB and she succumbed. She was born in Canada, and not native but had lived on the street. I think of her often.

Wellness is indeed boring.
January 22, 2016 | Unregistered CommenterOutPatientPharmD
Thanks to all for the posts and links.
The costing of Pharmacare is definitely suspicious and thanks to OPPD for pointing us in the direction of that link.

When have you ever heard of a large government program costing as promoted?
Just asking.

Good to hear from you OPPD.
"The ministers also agreed to work on home care, mental health and innovation over the next several months."

These areas are vast vast vast..

I do get a laugh when I see policy makers and politicians saying they are working on "innovation".....which part of the innovation universe would they be starting with?

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