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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?

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

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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)

Equally fascinating that Christina Blizzard (Sun Media) was able to describe it quite succinctly"

<<The province’s move to a new method of paying doctors for their services has been a disaster and has cost the health ministry hundreds of millions of dollars in payments for care of patients who never visited their doctor.

As of March 31, 2016, 8,800 of the province’s 14,100 family physicians had opted for the new enrolment model over the traditional fee-for-service model.

Under the enrolment model, doctors receive $3 per patient per month — whether the patient visited them or not.

This has resulted in higher costs without improving care.

Wait times to see family doctors are increasing. In 2015-16, 57% of Ontarians waited two days or more to see their family physician. In 2006-07, that number was 51%.

More than half of patients find it difficult to obtain care on evenings, weekends and public holidays without going to an ER — despite the fact that doctors are required under the new deal to provide coverage.

Patients enrolled in family health teams routinely seek care at walk-in clinics and hospitals — even though their family health team is being paid to care for them. And the ministry makes no efforts to recoup that money from that doctor. So we’re paying twice for that patient’s care.>>


http://www.torontosun.com/2016/11/30/ag-report-shows-system-rife-with-mismanagement
December 1, 2016 | Unregistered CommenterExecutive Lead Blogger
I don't understand the complaining about capitation and how much it costs. In reality it (capitation) - HSO system had already been rejected by a previous Auditor general in the 70's. The audits revealed doctors getting paid then for patients who had been dead for years, but of course there were no computers then. But they brought it back, only added more bells and whistles as a way to sign up (roster) patients who were complaining that they couldn't find a doctor. So it solved that issue until the new issue arose that they signed up so many that it was impossible to deal with them all. Duh!
It's still a cheap deal at approx. $150 per year per patient.. My accountant charges me $2,000 per year for doing my corporate taxes and I have to enter all the data in the program and present him with everything reconciled. Then he has some staff member do the taxes and I meet for half an hour to go over the results and get some advice here and there. He's a professional and I couldn't imagine him charging me $150 or making a living at that rate. You need volume at that rate. What's so shocking about that?
December 2, 2016 | Unregistered CommenterNew here
Centrals Agenda through January 2017:

1. Promote the lack of MD control by CPSO through "sexual" abuse claims.
2. Stress out of control billing,through leaks.
3. Pus the corporation tax use, to "avoid"taxes.

Isolate the MDs as members of society not participating under rules all others must follow.

Stress with the public the need to clampdown on the elite doctors.
December 2, 2016 | Unregistered CommenterMovingforwardOntario
Good luck with that and the lack of further fee cuts to billings clearly demonstrates that the liberals are spooked.

Go ahead hit us again because we will further adjust our practices as we see fit.

I will keep updating my initials
December 2, 2016 | Unregistered CommenterPT-ERDOC
Hammer away to create a group to blame. Adjustments affected patients, not central. More patients are affected and complain, the more blame to be transfer to the "hated" group.

This is just politics - hopefully the OMA has a political plan. For every "evil" doctor central can sell to the struggling public as a "blame', the more votes it can capture in urban areas.

Central is not spooked. Otherwise, the money dump would have occurred.
December 2, 2016 | Unregistered CommenterMovingforwardOntario
"Adjust our practice"....each member of the profession will adjust to reality as it affects him or her....each medical doctor will change his/her activities according to the new reality, they will survive....some, the true believers, the timid and the not quite with it, will succumb and acquiesce.

Old Soviet joke : How do you deal with mice in the Kremlin?
Put up a sign saying ' collective farm'....then half the nice will starve, the other half wil run away.

The Ontario government is about to put up a sign " Collective health care system"...half the doctors will starve, the other half will run away.
December 2, 2016 | Unregistered CommenterAndris
The criminalization of Ontario's medical doctors is well underway, they are the essential scapegoats for the repeated failures of government's own mistaken policies....they are the sacrificial lambs to be placed on the altar to appease the anger of the general public as they face a visibly deteriorating health care system with increased rationing.

For the political class the solution is easy , the need to expose and then eradicate fraudulent scheming rich doctors...the process is well underway and Bill41 will soon be presented as the solution...it will be well after the Liberals get reelected (so they hope) in 2018 ( post money dump) before it will become evident to the public that the supposed solution, the collectivization of the medical profession , was hokuspokus ....half of the surviving medical practitioners will practice in slow motion" they pretend to pay us and we pretend to work" ...the other half would have run away or retired.

As for the OMA...thanks to the Rand....its gonads are in the hands of the government and where the hand goes its heart and mind will follow.

One can expect a pretense of resistance from the OMA , an ineffective campaign carried out with posters and tweets etc.,...too late to do any good.
December 2, 2016 | Unregistered CommenterAndris
The OMA better figure out its political strategy, and at least behind closed doors, it is all about money,not patient care.
December 3, 2016 | Unregistered CommenterMovingforwardOntario
The OMA 's strategy seems to be to appease the government, deliver the profession hog tied and then feather its own hierarchy's nests.

There are no war drums beating....there is no hustle and bustle...no trumpets blaring.....those in the trenches know that they are not going anywhere....in the meantime the enemy advances.
December 3, 2016 | Unregistered CommenterAndris
No sign of that, no rallying of the troops, no drums beating, no trumpets blaring.

One sign of the OMA's true feelings is the fact that it has made the members' forum more cumbersome via " improvements"...the members are finding it more difficult to communicate with one another....hence the move of dissidents to Facebook.
December 3, 2016 | Unregistered CommenterAndris
There are no drums beating, no trumpets blaring, no rallying of the troops.

One sign of the OMA's true sentiment is the fact that it has made its members' forum more cumbersome via so called " improvements"....members are drifting off to Facebook.
December 3, 2016 | Unregistered CommenterAndris
For some reason my first post vanished....only to reappear.
December 3, 2016 | Unregistered CommenterAndris
Central is unrelenting.

It will, to be good social justice warriors (SJW), crush the OMA. Do not underestimate what is going on. Do not underestimate the agendas.

Central WILL control things, on its terms. You will do as you are told.
December 3, 2016 | Unregistered CommenterMovingforwardOntario
Which is why we need the COD as an alternative organization to mobilize the troops. The OMA has become a false flag operation.
December 3, 2016 | Unregistered CommenterCanary in a Coal Mine
Operation Trust , a fake anti Communist resistance organisation ,was a counterintelligence operation built by the Cheka in 1921 ....those who know the career of that brilliant British agent Reilly , know that he sacrificed himself to uncover it.

The Trust originated as a genuine anti Bolshevik group in exile, which the Cheka infiltrated and then took over...it guided anti Communist energies into a series of traps so eradicating anti Communists in exile and at home.

In a similar fashion the OMA started as a genuine organization representing its members and looking after its interests.....now it has become an arm of the government whose goal is to manouver the profession in directions that the government desires even as it harms the members own individual interests.

Stalin ordered the capture and death of Sidney Reilly ( a lot of James Bond was based on Reilly, an Ukrainian born in Odessa) and when the Trust created a false assassination plot against Stalin himself...because of the sheer fact that the GPU officers thought of it, the Trust was shut down and the officers shot.
December 3, 2016 | Unregistered CommenterAndris
Mfo,

SJW is a good description of Hoskin's mindset. Given his past career path and never working a month in his life as a doctor in Ontario none of this should surprise us. At his core he is probably a Marxist.
December 3, 2016 | Unregistered CommenterCanary in a Coal Mine
Operation Sapsford is almost complete with implementation of Bill 41.
December 3, 2016 | Unregistered CommenterCanary in a Coal Mine
Bill 41 will drive up costs and drive down productivity and drive up wait times.
Mind you, the wait times are being skewed by changing the criteria for patients to be added to the wait list.
"We can't add you to the wait list now even though you need a new knee because you are too young. You need a replacement but we'll add you in a few years when you reach 60."
December 3, 2016 | Unregistered CommenterMerrilee Fullerton
I meet MDs at the door who still support the Liberals despite Bill 41 and all their waste. I find it hard to understand.
December 3, 2016 | Unregistered CommenterMerrilee Fullerton
The governmnet is WELL supported by those whom directly share itsl largess. This is just politics - it is not health care.

If the Liberals can get one of the "toxics" stuck to the opposition, the Liberals win.
December 4, 2016 | Unregistered CommenterMovingforwardOntario
More preventative interventions are becoming possible. Add medications to the growing number of vaccines.

http://www.bbc.com/news/health-38183672
December 4, 2016 | Unregistered CommenterMerrilee Fullerton
excerpt:

"A drug that dramatically reduces the risk of being infected with HIV will now be given to patients by the NHS in England.

The health service lost a court battle in the summer after arguing responsibility for paying for it should fall to local authorities not the NHS.

Now at least 10,000 people will be given the "Prep" drug in a three-year-long clinical trial.

NHS England says this will help them understand how to offer it more widely.

Pre-exposure prophylaxis or Prep is a daily pill that disables HIV before it gets a stranglehold in the body.

It costs £400 a month per person and trials suggest it can cut the risk of being infected by up to 86%.

NHS England, which fought not to offer the drug, said in a statement there was "strong" evidence that it was effective."
December 4, 2016 | Unregistered CommenterMerrilee Fullerton
CICM,
Do we know this to be factual?
regarding Minister Hoskins: "never working a month in his life as a doctor in Ontario"

I believe he did work in Ontario as an MD but may not have been very active in clinical practice. I've tried to clarify this information but searches don't turn up much. Hmmm.
December 4, 2016 | Unregistered CommenterMerrilee Fullerton
Doesn't he symbolically occasionally ' work' , without billing OHIP, in a FHNOT run by one of his friends?

Does the OCFP allow him to register his hours working on the health care portfolio (when the Blue Jays are out of town) to achieve his CME requirements?

December 4, 2016 | Unregistered CommenterAndris
Realist,

I know that each year when I fill out my CPSO registration form they ask if I have been out of practice for more than 6 months and presumably if I ticked off yes I would be sent to some refresher course at McMaster and be subjected to some kind of CME and chart audit..

As for the quote I suppose it would be more accurate if I said " never working a continuous month in his life seeing patients in Ontario". Somehow as a busy politician he manages to keep his license active by working at this clinic on the Danforth run by a classmate Dr. H. Getu with whom he graduated with at McMaster University in 1985. (info is all on CPSO website)

Danforth-Woodbine office at 2009 Danforth Ave.
https://goo.gl/maps/6jKbZaGER182


Have a look at this quote below on Hoskins from Toronto Life. How does working episodically part-time (i.e a day here and there) at the above clinic and not charging OHIP constitute working as an Ontario physician? Something smells rotten where the Health Minister is seeing patients episodically at a clinic, but "not charging OHIP" in order to fulfill which CPSO requirements for maintaining his license in Ontario?

If one does not bill OHIP for a patient visit then there is no record within the system for that visit. I do know that when there is a legal matter with a patient (i.e. MVA) the lawyer with the patient's consent will access the OHIP computer in order to itemize all encounters with physicians in Ontario. In this case the visits with Hoskins will remain under the radar.

So the CPSO is ok with this set-up where a physican does not bill OHIP visits yet formally sees patients? And what about the CMPA? What category is he working under and receiving heavy MOH subsidy for that insurance but not recording the medical work on the OHIP database for which that insurance is meant to cover?

So I would stand by the claim that he has not worked a (continuous) month in his life seeing patients in Ontario.


"Eric Hoskins is a doctor by training, but medicine was never his true calling. After receiving his MD from McMaster, he ended up in Sudan in the late 1980s, working at the University of Khartoum’s School of Medicine. “I was the only white guy out of a student population of 25,000,” he recalls. Hoskins witnessed the military coup d’état that installed the brutal Islamist regime of General Omar al-Bashir. When the med students protested the dictatorship, al-Bashir’s men arrested dozens of them, including Hoskins’ officemate. His lifeless body was returned a week later, with his fingernails pulled out and burn marks on the corpse.

Watching such horrors gave him a stoic character, which serves him well in his dealings with outraged physicians. Hoskins is the most hated doctor in Ontario. When he was appointed health minister, a rumour immediately circulated about him in hospital hallways—and persists to this day—that he’s never practised a day of medicine in Ontario. When I asked him about it, he debunked the myth: since the 1990s, Hoskins has practised part-time at a family clinic in Toronto that serves east African refugees and immigrants. (He still does occasional shifts there without charging OHIP, to avoid any conflict of interest.)"

http://torontolife.com/city/toronto-politics/health-minister-eric-hoskins-doctors-revolt/
December 4, 2016 | Unregistered CommenterCanary in a Coal Mine
Andris,

He is the ex-president of War Child Canada which he founded with his wife (currently a full-time FP ) who is now the executive director of the organization.
December 4, 2016 | Unregistered CommenterCanary in a Coal Mine
Canary ,I knew that he had somehow achieved sainthood in the third world, outside of Canada , and as a consequence has achieved immunity against the rules and regulations of the CPSO, CCFP and likely the CPSO.
December 4, 2016 | Unregistered CommenterAndris
Of course as Health Minister he oversees the CPSO much like Wynne oversees the OPP investigating the ornge fiasco.

Draw you own conclusions.
December 4, 2016 | Unregistered CommenterCanary in a Coal Mine
"There are two distinct issues here: First, is the tax loophole that doctors want to keep justified? And, second, how should the government deal with the threats?

Let’s deal with the latter first.

There’s only one way to respond to blackmail, and that is unequivocally. If doctors are threatening to leave the country unless they get preferential tax treatment, the answer has to be “there’s the door.”"

http://www.theglobeandmail.com/news/national/some-doctors-have-tax-complaint-but-theyre-off-base/article33202350/
December 5, 2016 | Unregistered CommenterCanary in a Coal Mine
Little point in attacking beliefs about the Minister.

Central is currently an authoritarian, anti-capitalistic organization, bent on strong overt social justice programs that it will determine are worthy.

It is just a philosophy.

Interestingly, with respect to energy, which affects all on a day to day basis, there has been open acknowledgement it has failed as a policy, and billions have been lost, and 100s of thousands adversely affected.

Ye, it well continue across all Ministries, as we know what is best.
December 5, 2016 | Unregistered CommenterMovingforwardOntario
With the passage of Bill 41, make sure you are residing in a subLHIN with a teaching hospital. They will be better resourced.

Being in a "marginal "subLHIN" is going to be tough. Stay away from the expanding margins.
December 5, 2016 | Unregistered CommenterMovingforwardOntario
Andris,
I don't think Minister Hoskins is portraying himself as a saint but the terms of his clinical work in Ontario appear to be ambiguous. Perhaps some ethical reporter would like to dig them out.

Don't be too hard on Minister Hoskins Andris, he is doing Liberal "bidding". He is not calling the shots.

I keep meeting Family Health Team MDs who don't know what Bill 41 is. They vote Liberal. That is as much as they seem to want to know. Pity.
December 5, 2016 | Unregistered CommenterMerrilee Fullerton
Carefully watch the energy mess. It is worse than none and will consume a lot of the infrastructure money,just to cover occurred debt.

Energy costs are no adversely affecting growth.
December 6, 2016 | Unregistered CommenterMovingforwardOntario
mfO,
You mean "now adversely affecting growth"...
"Energy costs are no adversely affecting growth."-mfO
December 6, 2016 | Unregistered CommenterMerrilee Fullerton
R

Yes.

Now.

Things are not looking pretty. More backroom deals need to be cut, to attract growth.
December 6, 2016 | Unregistered CommenterMovingforwardOntario
It may be difficult to attract businesses with the high electrical rates, unfriendly business environment, and impending carbon tax.

New York State is still offering no corporate tax for new start-ups for a decade and Trump is going to take a hard line on any company moving north to take advantage of the Canadian peso.

https://startup.ny.gov/
December 6, 2016 | Unregistered CommenterCanary in a Coal Mine
I hear radio hosts commenting on the cost of food going up..because of high electricity and energy costs...imagine that....This should come as no surprise. It is entirely predictable.
December 6, 2016 | Unregistered CommenterMerrilee Fullerton
With GDP growth at under 2.0% for the next decade, buckle down for increase in taxes,fees, and license costs for those in the top 50%.Those aiming to retire, better add on 2 more years on work.

Stay away from the margins (which are expanding).

No OMA settlement this year! 3 years of no contract, and claw backs. The public does not care. MDs are now viewed as overpaid on the public purse.
December 7, 2016 | Unregistered CommenterMovingforwardOntario
You have to wonder if there is some of this going on in Canada. Take popular brand name drug generic in order to jack price, and then brand name manufacturer of said drug has higher revenues. At least that is what I read as happening in the UK with Pfizer and phenytoin.

It may just be some form of bias but it sure seems like the pricing of generics in Ontario is very high with the savings becoming more marginal for the government especially when some of the brand name firms manufacture their own line of generics.

http://www.independent.co.uk/news/business/news/pfizer-flynn-pharma-fined-prices-drugs-nhs-cma-a7460266.html
December 7, 2016 | Unregistered CommenterCanary is a Coal Mine
Bill 41 was passed.

A golden future, a medical utopia awaits
December 7, 2016 | Unregistered CommenterAndris
David Price and the other primary care academics must be jumping with joy.

So any predictions on who will be targeted first? My guess FHNOTs and methadone clinics.
December 7, 2016 | Unregistered CommenterCanary is a Coal Mine
Some FHT Leaders are staying very quiet, hoping the storm will pass. They may not realize what is coming or perhaps simply hold on for their own self-interest. Paid positions as physician leaders tend to create more biased thinking.
December 7, 2016 | Unregistered CommenterMerrilee Fullerton
What ever is coming down better be quick. Utilization will get a bump up after New Year and the holiday lull passes. The subLHIN will not be running and the Ministry must cap costs. Where to turn first for immediate impact? Best guess is primary care takes an immediate hit.

1- Negation of rostered patients seen by others is easy, unless the Ministry does not have records.

2 - Loss of bonuses for screening.

3 - Bumping up NP fees with reduction of MD fees.

4 - reduction in rostered fees with Discounts for rostered patients never seen.

Then caps on specialists billing fee for service. Across the board reductions have already hit everyone but specilty groups at upper end will be targetted. Geriatrics, pschiatrists , generally those earning less than FP now will be relatively spared simply bcause they are not big numbers or news worthy numbers. Frankly to not do so will imbalance the precarious service presently available.

All this by fiscal year end so that budgetary projections can be presented as an action plan. Ell ction 2018 will not be focussed on the failures of Dr Hoskins.
December 7, 2016 | Unregistered Commentereklimek
One would think that those FHNOTs ' exposed' by the Auditor General would be targeted....as was mentioned previously the planners were way ahead of the applicators...have they even started the process of creating those mini LHINs ...the ones that presumably will be the ones that will be carrying out the local managing of the widgets.
December 7, 2016 | Unregistered CommenterAndris

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