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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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Tuesday
Nov152016

Ontarians Should Be Very Wary of Bill 41- "The Patients First Act"

If ever there was a piece of legislation inappropriately named, it is Ontario Bill 41. If the Ontario Liberal government had more accurately named its legislation, “The Grow Bureaucracy and Invade Patient Privacy Act”, it would have garnered a lot more public and media attention. Even the Ontario Medical Association might have been forced to deal with it earlier instead of waiting until the legislation was under fire from front-line physicians.

Bill 41, cloaked in the reassuring sounding title of “The Patients First Act”, has passed second reading and is before a legislative committee. Premier Kathleen Wynne and Health Minister Eric Hoskins want to see it passed in the next four weeks.

Three things you should know about Bill 41:

1. Bill 41 gives the right to government to access your private medical records. The privacy of an individual’s medical record has traditionally been a source of reassurance and trust for patients during the medical process. For government to give itself the power to invade your privacy is as an affront to an individual’s right to have a confidential relationship with their doctor. Today, providers work in teams and more people do have access to a patient’s record now than ever before. But for government to insert itself between providers and patients has potential for negative consequences including further rationing of care and denial of government funded care-which is undoubtedly the rationale for this invasion of privacy.

2. Bill 41 will grow the bureaucracy adding more layers to the fourteen Local Health Integration Networks creating an additional eighty sub-LHINs to be filled with various personnel. Piling on more bureaucracy to the already inefficient LHINs is not the way to stretch our tax dollars to deliver more needed care. Since 2004, the growth in bureaucracy under the Ontario Liberal regime is staggering.  We have seen many layers of managers created to measure quality and wait times, while front line funding is being cut to offset the Ontario Liberals’ waste and mismanagement elsewhere.  The efficiency of the bureaucracy is not even measured. Ontarians will be paying for more managers, not more care.

3. Bill 41 empowers the Ontario Minister of Health with extraordinary levels of autonomy. This dictatorial positioning is of serious concern and raises many red flags. The legislation gives the government more power over patients and providers and it gives one individual, the Minister of Health, the power to do whatever is considered “in the public interest”. This is extraordinary power. Without ever consulting the public about its “interests”, doctors’ offices may be closed, providers may be limited in their ability to work based on geography, and various groups that exist to deliver care will cease to have a voice. Doctors and health care providers will be forced to comply with government decisions and those decisions will not require engaging the public or the medical profession in the process.

Make no mistake. The Ontario Liberals’ Bill 41, "The Patients First Act", is not about putting patients first. It is about the invasion of patient privacy, injecting the government into health care at every turn with a bulging middle management bureaucracy, and expanding the power of the Minister of Health to limit access to care and to treatments.

The public should be very wary of Bill 41. The rights and power seized with this legislation should remain with the people and not be snatched by a government to grow its bureaucracy while rationing our care. Bill 41 entrenches a heavy-handed, top down health system that no longer guarantees the trust and privacy of the doctor-patient relationship. It is truly unconscionable--even for this Wynne Government and Health Minister Hoskins. 

Reader Comments (671)

R

Bill 41 is about how central manages your health care money, on its terms, to care for your health care wants. It is the trasfer of your health care status, to the state.
November 15, 2016 | Unregistered CommenterMovingforwardOntario
<<It is the transfer of your health care status, to the state>> - MfO

Yeah, so the title "Patient's First", moniker is absolutely bang on, right?

Isn't it absolutely wonderful that the current Ontario government has actually named/enshrined common sense into two landmark pieces of legislation (Excellent Care for All Act 2010 and Patient's First Act, pending).

I think we should all feel comprehensively blessed.
November 15, 2016 | Unregistered CommenterExecutive Lead Blogger
And don't forget the Commitment to the Future of Medicare Act!
BTW
Looks like a case of selectively choosing "statistics" to cast a positive glow and the media gobbles it up blindly:
http://www.ctvnews.ca/mobile/canada/shorter-wait-times-at-ontario-hospital-emergency-departments-report-1.3161035
November 15, 2016 | Unregistered CommenterMerrilee Fullerton
This is not about patients. It is about breaking the doctors power in pieces, so that they become state workers, with first responsiblity to the state, not the patient.

Central has an ideological goal, to break the back of the doctors power.
November 15, 2016 | Unregistered CommenterMovingforwardOntario
Dr. Chris asks the Minister to formally retract his comments:

“As President Elect of the Ontario Medical Association, I stand by and reiterate all
the comments I submitted yesterday at the legislative committee on Bill 41.

The language used by the Minister in his reaction to my submission was, frankly,
unbecoming. Ontarians should expect more from their Minister of Health in his
dealings with his second most important stakeholder, after patients.

There was nothing in my submission that would have been news to the Minister had he meaningfully consulted with physicians about this legislation before he reintroduced it.

Minister Hoskins needs to understand that the patients of this province need us to
work together on their behalf, not call each other names. We share a desire to make the health care system in this province better, and I would assure him the OMA is looking for a partner who will meaningfully consult physicians. Having a high performing health-care system is simply not possible without physician input.

We ask the Minister to formally retract his statements and we hope an apology is
forthcoming.”
November 15, 2016 | Unregistered Commentereklimek
Apologize?

Never!

Hoskins can't show the slightest weakness at this moment with Bill 41 about to become law with he, himself, to become oberfuhrer of the health care system.
November 15, 2016 | Unregistered CommenterAndris
Does the OMA get it?

Central, through on line has the support to make the OMA to lose this struggle.
November 15, 2016 | Unregistered CommenterMovingforwardOntario
eklimek, source?
November 15, 2016 | Unregistered CommenterMerrilee Fullerton
mfO,
What do you mean?
"Central, through on line has the support"
"on line"?
November 16, 2016 | Unregistered CommenterMerrilee Fullerton
It is a good thing that this piece of legislation is called "Patient's First" because - once again - the vitriolic discussion here and in many other fora consistently speaks to the absolute need for the government of the day to control the physicians.

It is like using the term "primary care reform"...which quickly became secret society code for "how do we pay doctors differently".

Honestly, from the tone of the rhetoric it sounds as if the Minister had recently graduated from Trump University!

Oh yeah, I said it...too soon?
November 16, 2016 | Unregistered CommenterExecutive Lead Blogger
ELB,
"vitriolic"?
Perhaps on the low end of the "vitriolic" spectrum!

Legislating away the future of Family Practice:
http://www.cfp.ca/content/62/11/869?etoc

And in the UK NHS it has been shown that the 24 hour access drives up costs without improving outcomes....

Go figure...Ontario is lagging behind with the unhelpful decisions. One would think that if we waited and watched we could at least develop the ideas that work. Unfortunately not the case!
November 16, 2016 | Unregistered CommenterMerrilee Fullerton
Excerpt:

"Locus of responsibility

The practice of medicine has always had to adapt service to the demands of society and health systems, but professional behaviour has been guarded by traditionally sound principles. Changes should be carefully thought out, and their full effect carefully considered. I believe the current changes threaten to undermine both the traditional and the practical definition of primary care medicine. They blur the distinction between individual professional responsibility to continuity in the physician-patient relationship and the responsibility of a health care system to provide a full range of after-hours care to patients.

In my view, there is no medical condition at 2:00 am that warrants being called a primary care problem. If a patient is sufficiently concerned about a problem at 2:00 am to seek medical help, it is an emergent problem. The ultimate diagnosis or disposition of that problem is irrelevant. Shifts in patterns of those who seek out-of-hours help and the reasons for their behaviour are a genuine concern for the health system, but such behaviour shifts cannot be resolved by simply relabeling them as continuity of care. The rapid growth of urgent-care centres and emergency-like centres on both sides of the border in North America reflects the rising importance of convenience care to consumers4 and speaks to the complexity of the problem. "
November 16, 2016 | Unregistered CommenterMerrilee Fullerton
Interesting if the newly elected civil rights lawyer will vote in favour of the loss of civil rights associated with Bill 41.

Bill 41 will be passed. The Managers Rights Act.
November 18, 2016 | Unregistered CommenterMovingforwardOntario
With B41 cleared by year end, it will allow the new hires to occur to move the transformation agenda ahead. By summer 2017, all will be in place, and unrecoverable from legislature changes.

17 ADM equivalent spots. A new record.

http://www.health.gov.on.ca/en/common/ministry/orgchart.pdf


Dr. Hoskins is now the most expensive MD in the country,by overhead.

Yet . on quarter of the budget is without a contract? Hmmm, did 1/4 of the staff go under performance review?
November 18, 2016 | Unregistered CommenterMovingforwardOntario
Excerpt:

Here are some of the non-clinical jobs that doctors are doing right now, either in parallel to, or in the place of clinical work:

Management Consultant

Venture Capitalist

Financial Planner

Career Coach

Life Coach

IT Consultant

Medical Writer

Medical Advisers for Pharma, Cosmetic Industry, Film

Think Tank Expert

CEO of a Non-Profit Organization

Careers in Medical Associations:

Board Director

Senior Manager

Committee work

Practice Development Expert

Investment Club Manager

Professor

CME content creator

Media Consultant

Business Developer, e.g.,

3D Printing

Tobacco Replacement Products

Peer Assessor for Independent Medical Examinations

Careers with Regulatory Colleges:

Council Member

Peer Reviewer

Senior Management

Medical Legal Expert

Careers in Hospital Administration:

Chief of Department

Medical Program Director

VP Program (IT, Cancer Care, etc)

Chief of Staff

VP Medical

CEO

Careers in Government:

MP

MPP

Consultants

Provincial Insurance specialists

CEO

ADM Health

Minister of Health

***********************
And there are more!
November 20, 2016 | Unregistered CommenterMerrilee Fullerton
Andris,
I appreciate your knowledge of history but I simply did not have time to verify what you posted regarding all of those historic figures and more recent figures so I have had to delete the post. I do appreciate your knowledge and willingness to share it but I do know that there are people who wish to take content without context and misconstrue. Sad but true. Thanks for your contributions.
November 20, 2016 | Unregistered CommenterMerrilee Fullerton
Each and every one of them were/ are doctors...dictators, terrorists, presidents and prime ministers....anyway...they are alternate career paths.
November 20, 2016 | Unregistered CommenterAndris
Yes, I believe you. You are an avid historian! There will be people who wish to distort. Thanks for your understanding.
November 20, 2016 | Unregistered CommenterMerrilee Fullerton
R:

Since the core issue in Ontario, is the authoritarian style of government,does an alternative career within the province make any sense?
November 21, 2016 | Unregistered CommenterMovingforwardOntario
Abridged ...

The Law is whatever the nobles do.

A time will come eventually come when the tradition and our research into the law will jointly reach their conclusion, and as it were gain a breathing space, when everything will have become clear, the law will belong to the people, and the nobility will vanish.

Any party which would repudiate, not only the belief in the laws, but the nobility as well, would have the whole people behind it; yet no such party can come into existence for nobody would dare to repudiate the nobility.

The problem of our laws
Franz Kafka
November 21, 2016 | Unregistered Commentereklimek
Interesting finding that if true would make bending the curve easier in the future. No good explanation for the drop though except that a heck of a lot more people are taking vitamin B12 and D these days on a regular basis. I doubt that diets are healthier or that people are exercising more. Maybe a lot more people are speaking two languages which is protective against Alzheimers.

"The new study found that the dementia rate in Americans 65 and older fell by 24 percent over 12 years, to 8.8 percent in 2012 from 11.6 percent in 2000. That trend that is “statistically significant and impressive,” said Samuel Preston, a demographer at the University of Pennsylvania who was not associated with the study."

http://www.nytimes.com/2016/11/21/health/dementia-rates-united-states.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=second-column-region&region=top-news&WT.nav=top-news&_r=0
November 21, 2016 | Unregistered CommenterCanary in a Coal Mine
Thanks for the link CICM.
I'm always a little suspicious with these sorts of reports (like drops in ER wait times) in that the definition of the what constitutes the disease changes or that what is being measured is changed.

Still, it is good if there is improvement. But as I've mentioned, it will only take small percentage of advanced dementia patients to bring hospitals to a stand still. Without more long term care suitable for advanced dementia patients, the "good news" of dropping numbers of dementia patients will make little difference if in fact it is true.

"Even with the lower prevalence of dementia, there will be many more older people in the United States over the next few decades, especially people age 85 and older who are at highest risk. For that reason, the total number of people with dementia should rise, although not as much as had been estimated."
November 21, 2016 | Unregistered CommenterMerrilee Fullerton
We have Volume issues.
November 21, 2016 | Unregistered CommenterMerrilee Fullerton
Interesting development at the British NHS mothership...users of the services of the National Health Servce may have to present their passport as a second ID.

Imagine the reaction in Ontario if one had to present ones passport as well as ones OHIP card.

What impact would have such policy have in Ontario?

It would impact the volume issue.
November 21, 2016 | Unregistered CommenterAndris
The Ontario Liberal government is preparing the ground to have labour peace in place for the Provincial election in 2018....by resuming discussion with Public High school teachers ...three weeks after the union stated that the talks with the government had broken off.

Premier Wynne recently indicated that she was ready to loosen the purse strings.

The medical profession, in the meantime have been left to twist in the wind ....no threat there to the reelection of the Liberals...the government will only act if it sees a threat ...so far, the government feels as if , as Churchill once put it, " it has been savaged by a dead sheep".
November 21, 2016 | Unregistered CommenterAndris
Energy:

The rising costs will be solved by reducing bills to the lowest 25%, no change to the middle 50%, and increases to the top 25%. We are at the position where this could be changed into an equitable consumption tax rate system, but ideologically, we refuse to change policy. At least, there is admission the current policy is a failure.

Meanwhile, in health, 25% of the budget is off contract, and being clawed back. It is in worse shape than energy!
November 22, 2016 | Unregistered CommenterMovingforwardOntario
I think this was already suggested by erdoc

"This study suggests that insurers may want to rethink that strategy, Mehrotra said. In other research he found that about 40 percent of retail clinic visits were substitutions for primary care or emergency department visits; the rest represented new health care use that might not otherwise have taken place. In other words, if not for the convenience of a retail clinic, people might have stayed home and nursed their sore throat on their own."

Association Between the Opening of Retail Clinics and Low-Acuity Emergency Department Visits
Published Online: November 10, 2016
DOI: http://dx.doi.org/10.1016/j.annemergmed.2016.08.462
November 22, 2016 | Unregistered Commentereklimek
DrK:

Improved access, causes an increase in health care costs, without a decrease in future costs. Been known for at least 40 years, based on firm evidence.

This is all based on the ideological goal to redistribute wealth, on the belief, that that is "fairer", than wealth accumulation based on "production".

It is not dissimilar from energy. We can "socialize" the cost of energy,but then find that is not as simple as we thought, and need to find new resources to pay for the distribution of energy.

You will see bitter disappointment when the federal government officially announces its support for pipelines, by the end of next week.

As long as the PCs don't get tagged by touching any of the"toxic"topics, they have a good chance of winning Ontario in 2018.
November 22, 2016 | Unregistered CommenterMovingforwardOntario
Hmmm
Ontario Liberals are "reaching out" or at least give the optics of reaching out. Have a suggestion for them to improve health care access? Your project might get some $!
https://talks.ontario.ca/?utm_source=Twitter&utm_campaign=BudgetTalks&utm_medium=Image&utm_content=MOHLTC
November 22, 2016 | Unregistered CommenterMerrilee Fullerton
mfO, what do you mean by the budget being "off contract"?
November 22, 2016 | Unregistered CommenterMerrilee Fullerton
eHealth needs ‘to do more, faster,’ says Wynne’s business guru Ed Clark
But Clark is not recommending privatization of the controversial agency, still dogged by a scandal where private consultants earning $3,000 a day billed taxpayers for cookies and tea.

https://www.thestar.com/news/queenspark/2016/11/22/ehealth-ontario-needs-to-do-more-faster-says-wynnes-business-guru-ed-clark.html

I think it was Mr. Watson who said it best: "no shit Sherlock".
November 22, 2016 | Unregistered CommenterExecutive Lead Blogger
Patient's First Brief to the Standing Committee of the Ontario Legislative
Assembly regarding Bill 41

<<(...) we are hard pressed to find how patients are first within the actual substance of Bill 41. And, we are concerned about the bureaucratization of our health care system where decisions of care will be subject to administrative priorities and not care priorities.>>

https://goo.gl/eT3SSs
November 22, 2016 | Unregistered CommenterExecutive Lead Blogger
As hospitals do their budgets for 2017-18, there are 10s of millions of unexpected hydro costs. Lots of FTE to be dumped by April 1, 2017.

The Queens' Park question of the day, to the Minister, is "What is the estimated change in financial cost in 2017-18, to the global hospital budgets?"
November 23, 2016 | Unregistered CommenterMovingforwardOntario
Good point mfO. Consider it spread!

I see that a Fraser Institute report indicates wait times rising across Canada.
November 23, 2016 | Unregistered CommenterMerrilee Fullerton
More nursing cuts?
More cuts to care disguised as "transformation".
November 23, 2016 | Unregistered CommenterMerrilee Fullerton
For Queens' Park:

For our seniors, in many cases, on reduced fixed incomes because of the wasteful spending on the government,whom are now spending their years in long term care facilities, can the Ministry of Finance provide an estimate of the change need in the budget of all those facilities for fiscal 2017-18, as a result of this government acknowledged bungling of the energy file?

This government is losing the senior vote if one believes the internal polls, and is about to lose the youth vote with the pipeline announcement.
November 24, 2016 | Unregistered CommenterMovingforwardOntario
Funny,about to enter year 3 of clawbacks. No one aside from the MDs' cares!
November 25, 2016 | Unregistered CommenterMovingforwardOntario
Lots of office admin staff who were let go seem to care as do the downstream service providers who also saw their incomes cut. Just a small example the dry cleaner next door lost our business and we now clean our own lab coats. Those clawbacks are not an insignificant cut to provincial GDP.


So Akira is up and running and charging $49 per encounter. The MOH tuns a blind eye even though these docs are providing a private service that is offered by OHIP, namely an intermediate consult.

I suspect the grey area is the fact that an eConsult is not an OHIP covered service.

Looks like an easy way to supplement one's income from the comfort of the beach in Mexico with a high speed Internet connection.

www.akira.md
November 25, 2016 | Unregistered CommenterCanary in a Coal Mine
"I suspect the grey area is the fact that an eConsult is not an OHIP covered service."

The samples on the Akira apple app site is pretty clear example the "doctor" is a addressing a child's illness. If this is not a medically necessary convenience, what is?
November 25, 2016 | Unregistered Commentereklimek
Eklimek,

I would agree with you, but it would seem that since there is no OHIP fee code for an eConsult (nor a telephone consult) then they can charge cash for the 'visit'.

It is hard to believe (although not impossible given how Uber and AirBnB came to be) that the owners of this service did not get an opinion from the MOH before starting the service. It does make a mockery of Bill 108, but it does have the potential to shift a lot of OHIP cost for generally trivial visits (script refills, viral illnesses, rashes, etc.) from the public system to private. In other words it helps to bend the curve and likely is why the MOH will let this fly under the radar.

The patients love it as they can get seen from the comfort of their own home and not waste an hour or two sitting in a medical clinic.

It would seem that we Ontario physicians can now get around Bill 108 by hiring a physician assistant to examine patients at a designated location while we offer our professional opinions by Skype from home for a cash fee.
November 25, 2016 | Unregistered CommenterCanary in a Coal Mine
This is the Uberization of medicine.

It would be very easy, especially in downtown Toronto where there is a captive Millennial market to set up an "examination centre" with PAs or NPs trained to examine patients via video hook-up not only for family medicine visits but also for the various specialties.

The patient could walk-in say with a viral flu where the PA would transmit the vitals, live video of the patient, and electronic stethoscope findings to the remote family doc. One could even have POC routine diagnostic testing on site which the patient could access if need be. $49 for the consult plus diagnostics.

If the FP felt the patient needed to see a neurologist the neuro-trained PA would contact the neurologist for an Skype eConsult where the neuro exam could be done remotely.

Payment would be via debit or credit at whatever rate the market would bear. Apparently this is all legal now in Ontario as long as one uses the eConsult format. The doc would never have to touch the patient or leave home.
November 25, 2016 | Unregistered CommenterCanary in a Coal Mine
"The doc would never have to touch the patient"

The number one complaint to the CPSO by the dissatisfied, "He never spent 2 minute with me and never even touched me."

This is an adventure for only the most brave and foolish. It will turn into a referral to Emergency for most complaints.
November 25, 2016 | Unregistered Commentereklimek
Did Ontario Liberals plan to copy another UK NHS effort:

https://www.technologyreview.com/s/602963/is-deepminds-health-care-app-a-solution-or-a-problem/
November 25, 2016 | Unregistered CommenterMerrilee Fullerton
In anticipation of a British National Health Care system this winter....NHS hospitals have been told to discharge thousands of patients and pass over scheduled surgeries to private organisations to reduce pressure.

In the event of a winter crisis in Ontario ....?
November 25, 2016 | Unregistered CommenterAndris
Interesting that in the GTA, one can use tolls to increase access to faster traffic, but, in health care,consumption tolls are wrong. Which ideology are we following?
November 26, 2016 | Unregistered CommenterMovingforwardOntario

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