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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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)

Was out in cottage country recently and the FHT docs are angry and ready to mobilize over Bill 41. It would seem that the only allies the government has on this bill are the academic docs.
November 26, 2016 | Unregistered CommenterCanary in a Coal Mine
I'm still seeing and hearing a lot of complacency.
November 26, 2016 | Unregistered CommenterMerrilee Fullerton
Physician Leads who are compensated by government/OMA may find their drop in income from lack of committee work as problematic. While clamoring for getting back to the table and to "work together", some of them fail to understand how their compensation creates a bias.

No negotiations, no pay.
Negotiations provide them with pay.
Does the pay affect their decision making in the "transformation process"?
Does who pays them affect their decisions in the "transformation process"?

Does the paid committee work for negotiations and transformation affect the ability of the Physician Leads to be objective?

The longer the negotiations go on for, the more the pay.
The better the alignment of the Physician Lead with government agenda, the more committee work, the more the pay.


Where is the independent physician voice?

No wonder new groups have sprouted up.

Many Physician Leads still believe they are doing the noble thing.
November 26, 2016 | Unregistered CommenterMerrilee Fullerton
Energy is consuming ALL of centrals time. It is much worse that most are aware. Some debt need to be written off,but not obviously be revealed to the public. China is being looked to buy it by long term taxation reduction strategy for on shore job placement. Look for more immigration to GTA.
November 26, 2016 | Unregistered CommenterMovingforwardOntario
Mfo....migration away from the fringes and towards the GTA?

Complacency reigns...I still get puzzled looks when I mention Bill41.

FHO doctors seem to feel very particularly comfortable at present....is there something no in Bill 41 that I missed or are they just happy that the first victims to be consumed by the crocodile are the FHT's?
November 26, 2016 | Unregistered CommenterAndris
Both.More migration from dying rural areas, and migration from China.
November 26, 2016 | Unregistered CommenterMovingforwardOntario
"long term taxation reduction strategy for on shore job placement"
mfO, ?
November 26, 2016 | Unregistered CommenterMerrilee Fullerton
That migration from China and other parts of the world may come to a screeching halt if Canadian's standard of living continues to fall which is currently the case for many.

Paul Wells this week in the Star warned the globalists that the tide is starting to reverse and Trudeau had better take notice that the common folk here are as restless as they are south of the border.

It seems like Trudeau since the election has spent more time traveling outside of Canada attempting to fix global issues rather than dealing with the long list of structural problems in his own backyard.

He is about to find out we are not the "first postnational state with no core identity" as he floated last year and will come to regret saying.

November 26, 2016 | Unregistered CommenterCanary in a Coal Mine
Justin's globalist hot air balloon got pricked by Brexit...then by Trump...then by a series of needles from France to Holland to Bulgaria to Hungary...with Turkey threatening to send another 3,000,000 more economic migrants from the Middle East, infiltrated by Isis rats escaping from the Mosul carnage... the reaction in Europe will be such that the globalist balloon will come crashing to the ground.

Justin , high up in the air , with his headphones on, smoking a joint whilst taking selfies, is oblivious to unfolding events.
November 26, 2016 | Unregistered CommenterAndris
Just batten down for the energy mess adjustment, stay away from the margins, and expect no MD contract. The energy problem is far worse than being discussed.
November 27, 2016 | Unregistered CommenterMovingforwardOntario
Just batten down for the energy mess adjustment, stay away from the margins, and expect no MD contract. The energy problem is far worse than being discussed.
November 27, 2016 | Unregistered CommenterMovingforwardOntario
The lack of progress means there is no will on either party to settle. The plan in rejecting the tentative PSA was to take it to the election.

So let's count up the issues:

Sx education
Tolls on the road
Economy dire straits
Investigation into influence peddling
MD 4 years no contract

I am sure the Auditor General can add to the fire.

Note to Patrick Brown. Do not say anything. This is your time. Do not say anything. You are just fine without definitive public character. Do not say anything. Did I mention, not to say anything?
November 27, 2016 | Unregistered Commentereklimek
If the PC touch anything on the "political" third rail, they lose. If they stay solely,on the tracks, internal liberal polls show the PC win,big.
November 27, 2016 | Unregistered CommenterMovingforwardOntario

St. Joseph's Healthcare has been operating at 134-per-cent capacity for three months.
November 28, 2016 | Unregistered Commentereklimek

The answer is rather simple. When you have zero surge capacity and occupancy rates over 90%, you will have problems. Occupancy rates are routinely near or above 100% in Ontario.

The problem has not hit smaller and some mid size hospitals yet. Will ER docs preferentially start working in smaller hospitals with lower acuity and available beds, or will they leave Ontario.

This problem is not going away.
November 28, 2016 | Unregistered CommenterERDOC
<<Note to Patrick Brown. Do not say anything. This is your time. Do not say anything. You are just fine without definitive public character. Do not say anything. Did I mention, not to say anything?>> - Dr. K

Exceptional point. However, I must point out that the exact same advice was provided to his predecessor...once before the 2011 election and again before the 2014 election.

He didn't listen.

He is now reports to a provincial body of real estate agents as its provincial association CEO.
November 28, 2016 | Unregistered CommenterExecutive Lead Blogger

Maybe the sentiment will cross the border and permit a curmudgeon to be elected. In which case Mr Brown, "let her fly".

However I think a blank slate public profile is electable. Witness Niagara West-Glanbrook MPP 19-year-old Sam Oosterhoff.

"The Liberals resorted to a smear campaign on Sam, attacking him, and Sam focused on hydro. Sam focused on jobs. Sam focused on how we're going to get Ontario back on its feet."

November 28, 2016 | Unregistered Commentereklimek

No one is leaving.The money is too good.
November 28, 2016 | Unregistered CommenterMovingforwardOntario
Feedback from Council is that the establishment remains in charge...that the OMA's elite went through its pseudo remorseful mea culpae but that nothing will change....the government will have a clear run unless the grassroot Coalition takes the lead to obstruct it.
November 28, 2016 | Unregistered CommenterAndris
Interesting to see Dr Nadia Alam now working for the OMA and not the Coalition.
Is the Coalition still united or has it splintered?
November 28, 2016 | Unregistered CommenterCanary in Coal Mine
The OMA offers lucrative positions ...lots of paid committee hours...with the promise of being 'remembered' when the new top heavy health care system is established and management positions distributed to the favoured...I don't know about this particular case, but that is the pattern.
November 28, 2016 | Unregistered CommenterAndris
She was elected to the OMA board.......to think that I gave her my proxy to vote against the government's scheme last summer...no more proxies for her!

Dr. Whatley recently exhibited his integrity by resigning from that same board a short time ago....we don't know the details that caused him to resign...but whatever it was, the stench was too much for him.
November 29, 2016 | Unregistered CommenterAndris
Now, now Andris...it isn't that bad. New blood is a good thing. She will need to be vigilant or risk being absorbed. That is called "co-opting" a "No-No".
November 29, 2016 | Registered CommenterMerrilee Fullerton
Bill 41 is before the standing committee that is scheduled to read it today, my Name Day , November 30th.,....it could be passed within a week.

The OMA is a structure where integrity goes to die...and it states that it will lead the battle against Bill 41...one suspects that it will direct the membership down ineffective blind alleys where it will be mugged by the government.
November 30, 2016 | Unregistered CommenterAndris
"After an announcement on hospital funding last Friday – before the OMA passed its motions – Dr. Hoskins told The Globe and Mail there was no sign of talks resuming.

“We’re in a situation right now where the OMA really hasn’t expressed to us a willingness or an ability to come back to the table,” he said.


To my certain knowledge various groups, apart from the OMA, have expressed a willingness and asked for meetings with the Minister. How sweet. Only the OMA, the same group that wants dearly to have an agreement at any cost to the doctors, has not expressed the same.

So where is the kernel of meaning in this apparently contradictory spin?

Is the stalemate self imposed? As we approach the election of 2018, will this be resolved?
November 30, 2016 | Unregistered Commentereklimek
Pardon the interruption but...

This is a swift and solid kick in the naughty bits to every member of a health care organization's senior leadership team that has been subject to Bill 8, the Broader Public Sector Executive Compensation Act for the past five years (at least).

8,500 managers in Ontario civil service to get $125M in pay raises
It’s all because a long-standing salary freeze has left some managers earning less than their unionized staff and mandarins lagging higher-paid colleagues in the broader public sector and private business.

November 30, 2016 | Unregistered CommenterExecutive Lead Blogger
<<There could be some public backlash,” warned (Don) Drummond>> former TD Bank chief economist.

Say it with me again..."No shit, Sherlock!"
November 30, 2016 | Unregistered CommenterExecutive Lead Blogger
And speakng of the AG Reviewing OHIP



• One cardiologist worked 354 days in 2015/16 and billed the province $1.8 million - three times higher than the upper expected limit for doctors in the same category.

• One cardiologist billed $2.5 million during 2014/15, for performing more than 68,000 services - six times the number delivered by the average cardiologist.

• In 2014/15, each physician in a family health organization worked an average of 3.4 day per week, while each doctor in a family health group worked an average of four days per week.

• The “capitation,” health model, where physicians get are paid a fee for each patient enrolled, paid those doctors an extra $522 million in 2014-15, money that would not have been paid under the fee-for-service model.
November 30, 2016 | Unregistered Commentereklimek
It is noted that the CCAC's has started to ration access to Personal Support Care worker services....even to palliative care patients...all to meet the fixed budget..

Rationing, rationing , rationing....?Patients First ?
November 30, 2016 | Unregistered CommenterAndris
Office of the Auditor General of Ontario 566 Chapter 3 • VFM Section 3.11

This difference highlights that patient-enrolment modelsaresignificantlymoreexpensivethan traditional fee-for-service models. According to the Ministry’s most recent estimate, in 2014/15, a family physician who belonged to a Family Health Organization earned an annual gross revenue of $420,600, and one who belonged to a Family Health Group earned an average of $352,300. Both oftheseaveragesalariesaresignificantlyhigher than the gross billing of $237,100 physicians would earn, on average, under the traditional fee-for-service model. Yet, the base capitation payments that physicians receive before they actually see any of the patients they enroll were originally designed to be cost-neutral, or about the same as if the services were being provided on a fee-for-service basis.
November 30, 2016 | Unregistered Commentereklimek

Thank you very much for that link exposing the inherent unfairness in the family medicine payment system in Ontario. Those of us on pure FFS and wanting to keep the MOH from contaminating the doctor-patient relationship are earning close to half of what a doc on capitation does in a FHO yet we see double the number of patients per day and ICES says the patient outcomes are the same.

It sure sounds like the MOH is ignoring its own evidence and getting taken to the cleaners by those on capitation where the cash rolls in whether the patient shows up each year or not. It is little wonder when one examines those gross income discrepancies that the MOH has shut down new applications for the FHNOT positions.

So there it is in black and white. Move from FFS to FHG to FHO and you double your income more or less and half the work load.

If you look at Figure 1 it sure shows that the PEM models only make up about 30% to 35% of the total family medicine payments while FFS (PEM and non-PEM) are about 55%. That is quite different than I've see people quoting on this blog.
November 30, 2016 | Unregistered CommenterCanary in a Coal Mine
In 2014/15, the Ontario government invested approximately $1.4 billion more in patient-enrolment models than the costs would have been under the traditional fee-for-service model. The additional cost had increased by 55% from $907.6 million in 2010/11, as shown in Figure 10. In March 2016, the Ministry estimated, at our request, the additional cost of the patient-enrolment models for the fiscal year 2014/15. This $1.4 billion additional cost represented close to 35% of the total OHIP payments to all family physicians in the same year.
November 30, 2016 | Unregistered CommenterCanary in a Coal Mine
We also noted that the $522 million included base capitation payments for 1.78 million patients who were enrolled but did not visit their physicians in that year (discussed in Section 4.4.4).
November 30, 2016 | Unregistered CommenterCanary in a Coal Mine
The AG noted that the FHO's were supposed to improve access to care and eliminate the need for patients to go to the ER....it didn't happen.

Those enrolled with FHT's are routinely seen at WICs and ER's....even though they were paid to see their own patients...and the ministry made no effort to recoup the monies.

40% of those enrolled with these systems went to WICs or to FPs outside their group.

There has been no attempt by the ministry to recoup those monies.

One suspects that the MOHLTC/ OHIP will listen to the AG's remarks where health care is concerned and one can anticipate that they will enforce the rules and regulations and claw backs already enshrined in the FHNOT contracts signed off on but not enforced ..and with the imminent imposition of Bill 41 , tighten the screws on all those who signed contracts, no more loosey- goosey, with managers hovering over their shoulders .

At Council I gather that some FHTites were complaining of their troubles...no mention at all of the trials and tribulations of those FPs working in the non government favoured FFS/ WIC world so despised by the powers that be...the very FPs that are holding the whole structure upright.
November 30, 2016 | Unregistered CommenterAndris
<<It is noted that the CCAC's has started to ration access to Personal Support Care worker services>> - Andris

The practice (referred to by some as 'turning off the tap') happens earlier and earlier every year.

Of course, two things invariably happen:

◘ A public/media outcry occurs and a one-time emergency dump of Minister money occurs to resolve the situation; until

◘ the beginning of the next fiscal year when the taps are turned back on.
November 30, 2016 | Unregistered CommenterExecutive Lead Blogger
How can the Government/Ministry of Health possibly defend the mass infusion of funds into the FHNOTs now that the AG has clearly shown that the additional monies to doctors did practically nothing to enhance access to primary care?


What do the FHNOT primary care physicians have to say about this?
November 30, 2016 | Unregistered CommenterExecutive Lead Blogger
I should mention that if the FHNOTs carry out a job action to safeguard their own incomes that the non FHNOT FPs won't be supporting them.

Any job action , to be successful, would have to involve the bringing up of those FPs who were not the recipients of previous governmental largesses.

Imagine...the FHNOTs having to look after all of their patients...all the time.
November 30, 2016 | Unregistered CommenterAndris
Until the MOH/OMA primary care caste system is abolished you won't hear a Brahmin FHNOT doc suggesting that the Untouchable FFS doc should be paid better. ;)

Those FHNOT priests typically inhabit the executives of the OMA, OCFP, and academic family practice clinics where they socialize together and develop new ways to increase funding from the MOH to the capitation models but not the other models.
November 30, 2016 | Unregistered CommenterCanary in a Coal Mine
FHNOTs were often awarded to ex members of the OMA hierarchy by the Ministry...it was not done overtly...
The structure that will follow the application of Bil 41 will also allow the Ministry to reward its friends in the OMA hierarchy with sinecures.
November 30, 2016 | Unregistered CommenterAndris
Each member of a funded alphabet group, represents a purchased vote. It was an easy cost benefit analysis, and won elections.The squeeze is on now, and the alphabet groups are arguing for fee restrictions - only so many FFS codes per category per year,to cut down on FFS running patients through for unneeded fees

Just as civil servant pay rises will get votes.

One can only hope the PCs don't touch the middle rail! Just be quiet, state all quiet rationale consultations will be good, and the plan,once elected, will be good.

The current government is looking to get one of the"evil" issues to get stuck to the PCs, and drive that as the issue. If they can't get anything stuck,they have to defend their record, and the federal liberal record which is about to plummet over pipelines and native issues.
November 30, 2016 | Unregistered CommenterMovingforwardOntario
"Each member of a funded alphabet group, represents a purchased vote." Bingo

The Liberal media today were trying to bait the new PC kid Oosterhoof but he didn't electrocute himself. I'm sure he has been prepped by Brown to not touch the third rail.

November 30, 2016 | Unregistered CommenterCanary in a Coal Mine
Fee restrictions on FFS docs being requested by the FHNOT high priests,.....that is rich and made me laugh.
November 30, 2016 | Unregistered CommenterCanary in a Coal Mine
"The Ministry supports the recommendation and agrees to conduct a review of the capitation rate, including evaluation of the core services provided to patients by physicians who receive a base rate capitation payment. Adjustments to the capitation rate will require the Ministry to engage with the Ontario Medical Association (OMA) through the negotiations and consultation processes of the Ontario Medical Association Representation Rights and Joint Negotiation and Dispute Resolution Agreement (OMA Representation Rights Agreement). "

Really? Never held the Ministry back from introducing an across the board fee reduction. When did this become vital?
November 30, 2016 | Unregistered Commentereklimek
The government can do what it wants when it wants....it just wants the signature of the OMA at the bottom of the page to give it cover.

Will the OMA give its signature to the government 's document so that the politically correct FHNOTs can prosper at the expense of the politically incorrect FFS...after all , the FFS , when they see FHNOT patients, the fee charged by the FFS is supposed to be deducted from the capitation account of the FHNOTs ...hence, therefore , thus...cut the fees of the FFS and the deduction from the FHNOT capitation goes down.
November 30, 2016 | Unregistered CommenterAndris
Just reading the OMA's response to the AG.

Praising the teams of the FHNOTs ....raising the topic of underfunding...the need for a PSA ....that in its absence " doctors are frustrated that they can't contribute their innovations to the delivery of patient care or help solve the challenges in the system" etc., etc.,...touching on the health care bureaucracy.

The innovations , of course, don't include hybridization of the health care system , the development of an evidence based world class health care system ...but would contain the latest hare brained schemes that won't work from the politically correct statist mystics in the medical ivory towers...with their contempt for FFS FP' s and the degenerate deviant unwashed who work in the WIC's.
November 30, 2016 | Unregistered CommenterAndris
"the degenerate deviant unwashed who work in the WIC's" = untouchables

Except that those degenerates are the ones who look after the 'nightsoil' 5 days a week until 9 pm and on weekends 364 days a year while the high priests rest their weary fingers.
November 30, 2016 | Unregistered CommenterCanary in a Coal Mine
Exactly Canary...the whole edifice of the health care system depends on the contemptable peons at the coal face....who sees their patients when the FHNOTs roam the world and take their extensive vacations but the peons in the WIC 's , FFS FP's and the ER MD's.?

The unappreciated and much despised by the ivory towered FFS / WIC peons carry the whole health care system on their shoulders...they are the Atlases holding the Canadian and Ontario health care systems on their shoulders....if they shrug...when they shrug....then it will get very interesting.

Years ago I warned those attracted by the glittering baubles and the candy scattered by the government up to and though the doors of the abattoir not to follow them...over the years those that picked up the goodies flaunted them and mocked those who didn't...now the doors about to close .

November 30, 2016 | Unregistered CommenterAndris
Medical incorporation to likely end! This with the passage of Bill 41 will certainly get docs moving.

"But Mr. Morneau appeared to shut the door on that campaign this week during an appearance before the committee. The minister’s office later confirmed to The Globe and Mail that the government will not be making the changes requested by the medical community.

The decision has shocked and infuriated physician organizations. They had believed their inclusion in the tax change was simply a technical oversight that would be corrected."

December 1, 2016 | Unregistered CommenterCanaary in a Coal Mine
The end of incorporation is just another paper cut. It may change some business models.

It's the fundamental duplicity of the OMA in dealing with its members that is deplorable.

Whether the OMA struck a deal with government, agreed to a deal with government, of failed to object to a deal with government that created needless duplication of services and a privileged upper income tier of Family care, the OMA is caught with its hand in the cookie jar.

The membership should be repulsed at this lack of moral behaviour. If not repulsed, it too has lost my respect.
December 1, 2016 | Unregistered Commentereklimek
Fascinating that today's Toronto Star focuses primarily on the Auditor General's comments about high-billing fee-for-service physicians but makes absolutely no mention of the FHNOT commentary.

I suspect that it is easier to explain fee-for-service than FHNOT capitation and incentives to their readership.
December 1, 2016 | Unregistered CommenterExecutive Lead Blogger

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