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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.

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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)

Centrals doctors agenda

1. No contract - done
2. Reduce growth - done
3. Increase taxes - done
4. Remove tax loopholes (small business) -nearing completion.
5. Pass Bill 41 -done

OMA agenda

Nothing accomplished.


Central 5, OMA 0

2017 has some good agenda items for central.
December 7, 2016 | Unregistered CommenterMovingforwardOntario
Ha!
"@picardonhealth OMA being seen as aligned with Conservative Party by the public"
December 7, 2016 | Unregistered CommenterMerrilee Fullerton
Passing legislation with a a majority government is easy - they don't them party "whips" for nothing.

Next comes implementation. Can 14 LHINs create ~80 subLHINs while on-boarding the CCACs between January 2017 and June 2018 without creating any embarrassments for the current government?

mfO, you know better than most - is there really that much money available to purchase silence/ensure compliance?
December 7, 2016 | Unregistered CommenterExecutive Lead Blogger
Sorry ... the extra works helps with clarity:

<<Passing legislation with a a majority government is easy - they don't *call* them party "whips" for nothing.>>
December 7, 2016 | Unregistered CommenterExecutive Lead Blogger
ELB,
All the tax payer $ wasted on bureaucracy instead of front line care is buying silence along with the muzzling of providers through hospital bylaws.
December 7, 2016 | Unregistered CommenterMerrilee Fullerton
eklimek,
I missed your last post.
"Negation of rostered patients seen by others is easy, unless the Ministry does not have records."
There will likely be a focus on this.
Expect FHT leaders to stay silent as long as they are paid for their "leadership".
FHTs in academic centres will also stay quiet.
Hospital based MDs and nurses will stay quiet.
Will any outgoing CEOs speak out? Not if they want to move on to other gov't agencies.
I do hear Michael Dexter from time to time. He is now at heading up a patients' group,
December 8, 2016 | Unregistered CommenterMerrilee Fullerton
sorry, that should be Decter ...autocorrect at work again.
December 8, 2016 | Unregistered CommenterMerrilee Fullerton
They are not only buying the silence of these FHNOT and academic docs but also a Liberal vote in the next election which is more important.

Let's see if the MOH has the cajones to implement full dollar for dollar negation for any FHNOT rostered patient which goes to a FFS WIC. That will finally close the circle on the capitation payment system. Only problem is the patients will just keep attending the WICs when they are told it will take a month for a new appointment.
December 8, 2016 | Unregistered CommenterCanary is a Coal Mine
The plan is done. Implementation is irrelevant. Central now owns health care, through the doctors. They will do as instructed. Those in position of power took the "king's coin" and changed the system so central can do as it wishes. This is not reversible.

The OMA will be used as agent of compliance, the CPSO, the agent of punishment for non compliance.

Imagine starting one's career in this new system.

Federal money will soon arrive to "good"players, the "bad" players will see none.

The MDs now are determining whom is in the margins.

The plan is good,for central.
December 8, 2016 | Unregistered CommenterMovingforwardOntario
"The plan is done. Implementation is irrelevant."

Precisely the attitude and process of government that is the problem. Make a pronouncement, cover legislation, make a prounc ment, pass legislation and make a pronouncement. Outcome assessment and accountability? Sorry, not our business. Failures during implementation, like hospital restructuring or any large project, is clearly no ones fault.

With passage of Bill 41, no immediate cost savings will be seen. There must be more direct action to cover cost over run. n is done. Implementation is irrelevant.

"Central now owns health care" Yes. So how to address the problem now?
December 8, 2016 | Unregistered Commentereklimek
Find the group to blame for failure to implement. The doctors.

Central has created utopia in health care, the doctors will not cooperate. The blame game starts.
December 8, 2016 | Unregistered CommenterMovingforwardOntario
A new review from the Fraser Institute shows that Canada’s public sector workers earn 11% more than their private sector counterparts.

And, in most cases, they enjoy generous, even “gold-plated” pension and other benefits relative to the private sector.

http://www.torontosun.com/2016/12/07/public-service-pay-is-unsustainable
December 8, 2016 | Unregistered CommenterCanary is a Coal Mine
In the utopia being established, we all will be fine. All resources will be pooled, collectively, and we all will draw our reasonable share to exist.

Comrades, unite. We will attend social justice for all, for in the end, we are all equal brothers and sisters.
December 8, 2016 | Unregistered CommenterMovingforwardOntario
Synaptopenics of the world unite, you have nothing left to lose.
December 8, 2016 | Unregistered Commentereklimek
Comrades

All is fine. Shoulder your new roles as servants to the state, not to the patient.

The politicians have create avhealth care utopia. Enjoy their management to improve your dedication to the common good.
December 8, 2016 | Unregistered CommenterMovingforwardOntario
Yes, it has certainly worked with Ministry of Energy, hasn't it? No reason for it not to work for health care.

Zazdarovje, comrades!
December 8, 2016 | Unregistered CommenterExecutive Lead Blogger
I don't understand the " implementation is irrelevant" part...they pass a law....and nothing happens?

Is this like the " phoney war"....the period on the Western Front after the Blitzkrieg of Poland in September 1939, when nothing happened until the 10th., of May 1940 when the German National Socialists Blitzkrieg suddenly struck Belgium, France and Luxembourg.

Are we in the phoney war at present with a Blitzkrieg expected by the end of the fiscal period...April 2017....or 2018 , the election year?
December 8, 2016 | Unregistered CommenterAndris
Implementation is irrelevant.
Bluntly, the MDs own this. No one cares what they do. The blame game starts. If it works,central wins:it fails the MDs caused it. The Queen's park finale was classic. The doctors own it,because their consultants supported the bill. That was tabled with the approval of the bill.The OMA members supported central.
December 8, 2016 | Unregistered CommenterMovingforwardOntario
"The OMA members supported central.''-mfO
What?
The tPSA was voted down. What do you mean by OMA members supported central?
Perhaps OMA Board supported Central. OMA members (physicians voted no in the majority).

OMA Board always supports Central because it has a fiduciary duty to guarantee its own existence.
December 8, 2016 | Unregistered CommenterMerrilee Fullerton
It seems we are destined for more rationing, more bureaucracy, less timely access to top quality care.
December 8, 2016 | Unregistered CommenterMerrilee Fullerton
We know that the OMA's hierarchy supports the government with the vision of future sugar plum sinecures for themselves dancing before their eyes.

They wanted the membership to rubber stamp the scheme so that the profession as a whole would coown it....it failed horribly last summer...now it has raced to the front of the crowd to try to take the lead in "fighting Bill 41"...they will, of course, try to lead the profession into blind alleys where the membership will get mugged.

So it is the OMA Board that is not so secretly supportive of the health care soon to be horror show , as are the statist collectivist Academic FHNOTs.

It is very important that the membership never forget who sold them down the drain...whose mouths were filled with gold ( Aneurin Bevan) to betray them , whilst the membership's pockets got picked.

When the Ontario health care system disintegrates ...the fingers must point in the appropriate direction...towards the guilty parties...the government, its pointy headed health care " experts" , the silver spooned Kantian academics....and the Quisling OMA Board members.
December 8, 2016 | Unregistered CommenterAndris
Andris, you do have your own style of describing things...
I'm not sure blaming will be helpful as the decline occurs.
How do we move forward?

Anyone know of this group:
http://www.healthcare-informatics.com/article/patient-engagement/canada-specialist-care-provider-harnesses-digital-health-advance-diabetes
December 9, 2016 | Unregistered CommenterMerrilee Fullerton
R

The Hansard record is clear of those members of the OMA whom supported the legislation. Central was clear to get that in the record. All claims different, will be referred back to that record.
December 9, 2016 | Unregistered CommenterMovingforwardOntario
how does one obtain the summary alluded to in this ...

http://www.ontla.on.ca/web/committee-proceedings/committee_transcripts_details.do?Date=2016-11-02&ParlCommID=9004&BillID=&Business=Subcommittee+report&locale=en&DocumentID=31193

The Clerk of the Committee (Mr. Trevor Day): Very quickly: In the subcommittee report, what we didn’t discuss is research’s role in a summary of presentations. If it is all right with the committee, we would suggest that research have a summary ready by the Friday following the last day of public hearings at about 4 or 5 o’clock. Does that work for everybody?
December 9, 2016 | Unregistered Commentereklimek
The faster way is to get your MPP to provide it.
December 9, 2016 | Unregistered CommenterMovingforwardOntario
"Laws are like sausages, it is better not to see them made".
(Bismarck).
December 9, 2016 | Unregistered CommenterAndris
With friends like the OMA who needs enemies. If that is the case where the OMA supported Bill 41 yet they are engaged in a phony war against the bill, rapidly depleting the membership's hard earned resources, then the president should be removed as soon as possible.

Where is the COD to confirm or refute this potential act of OMA treachery?
December 9, 2016 | Unregistered CommenterCanary is a Coal Mine
The record is recorded in hansard as the bill was passed.
December 9, 2016 | Unregistered CommenterMovingforwardOntario
Bill 41 is an attempt to control all aspects of a physician's career and day to day working life. The final result will not be unlike what Ontario teachers experience working for heavy handed schoolboards and the newly spawned sub-lhins will provide the necessary bureaucracy for the micromanagement.

We are about to see the last vestiges of physician professional autonomy extinguished once and for all in Ontario yet we have the current OMA executive participating in the snuff movie of their very own profession. Shame on them.



"Regardless of how we fund healthcare, doctors must be free to meet patient needs. Doctors need to be rewarded for meeting those needs in proportion to the effort required and value added in doing so.

And patients need to be free to see whichever doctor offers the best service and quality. Utopian designs like Bill 41 will never put patients first."

http://shawnwhatley.com/manage-doctors/#more-4696
December 9, 2016 | Unregistered CommenterCanary is a Coal Mine
Central believes markets in healthcare are wrong. All healthcare must be rationed as central sees fit, otherwise some will do better than others.
December 9, 2016 | Unregistered CommenterMovingforwardOntario
But markets in all forms of education are ok in Ontario?
December 9, 2016 | Unregistered CommenterCanary is a Coal Mine
No one ever stated that central needs to be consistent. When the prime goal is social justice, rational thought frequently gets left behind.
December 9, 2016 | Unregistered CommenterMovingforwardOntario
http://www.ontla.on.ca/web/house-proceedings/house_detail.do?Date=2016-12-07&Parl=41&Sess=2&locale=en#P217_13292



just want to respond to the member opposite with regard to the consultation. I don’t generally like to read litanies, but I think this is important to read into the record. This is in reference to the consultations we had with the Ontario Medical Association. In April 2015, the ministry presented to and discussed with the OMA executive the Price-Baker report, from which many of the key concepts for the Patients First strategy emerged.

In June 2015, we met with the physician services committee to further discuss the report.

January through March: The ministry had significant physician engagement through discussion paper consultations led by the ministry in LHINs. This included over 6,000 individuals and organizations and nearly 200 formal submissions, including physicians and physicians’ groups.

In February 2016, there was a round table on Patients First where the OMA staff were present and participated. Also in February, we received the OMA’s formal submission on Patients First.

On May 30, the ministry met with the OMA CEO and president to provide advance notice of the tabling of the Patients First Act.

On June 3, we met with OMA staff and legal counsel for a detailed discussion on the components of Bill 210.

On June 8, the deputy minister and ministry officials met with the OMA primary care advisory group to further discuss Bill 210.

On July 7, the ministry provided assistance to OMA staff in answering Bill 210 questions.

On September 26, we presented Patients First to the Coalition of Regulated Health Professional Associations, and the OMA was present.

On October 13, we requested to consult on the clinical leadership components of Patients First.

There is a standing meeting that occurred at least six times between the OMA CEO and the deputy minister to discuss Patients First.

So the accusation that there was no consultation is simply not true. I want to make sure that that’s on the record.
December 9, 2016 | Unregistered CommenterMovingforwardOntario
Moscow Central also thought that market forces regarding agriculture , food production was wrong.....so they replaced it what sounded good to Marxist Leninists...Central planning and collectivization ....Lysenko ( Price Baker ) in particular sounded good to Stalin...so there was forced collectivization ( Bill41) and a class war against Kulaks ( Fee for Servce MD's and non state employed MDs) ) ....agricultural production collapsed , food shortages occurred and food imports had to occur to prevent mass starvation and yet another Revolution ....since the government and its brilliant planners could not be possibly guilty of the shortages..the weather was blamed...global warming likely would be these days...skapegoats had to be found, saboteurs and wreckers exposed, purges carried out, so depleting even more the number of those working in the fields who recognized what a shovel and manure looked like....as their numbers diminished the number of those supervising and managing them increased....the same will happen in Ontario's health care system...those at the coalface will be blamed for all of the system's ills, there will be purges...the number of those supervising those at the coal face will increase.

Sowell again " socialism , in general, has a record of failure that is so blatant, that only an intellectual could ignore it or evade it".

" Much of the social history of the Western world, over the last several decades, has been the history of replacing what worked with what sounded good"...Bill 41 sounds good.
December 9, 2016 | Unregistered CommenterAndris.
Central has taken the advice of the MD consultants (all OMA members). They have advised more management is needed at the coalface. Bill 41 permits that. The record shows the OMA was involved in the process. The rural areas will feel the impact first.

Stay away from the margins.
December 9, 2016 | Unregistered CommenterMovingforwardOntario
Rural...impact to be felt first by the FHNOTs or the FFS solo kulaks and voluntarily cooperative group FFS FP's?

Stalin would go after the last two first.
December 9, 2016 | Unregistered CommenterAndris
Just don't be a patient.It is not going to be pretty. One can just pity the EDs as this unfolds.
December 9, 2016 | Unregistered CommenterMovingforwardOntario
All will be fine. Patient care groups will be set up by the 80 or 90 subLHIN, MDs enrolled, and all needs will be met,eliminating all the SDOH issues. Utopia is here. Any need you have will be provided by the government.

Next guaranteed basic income.

Physician contracts signed and managed by LHINs, minimizing mobility, without a contract,no income.
December 10, 2016 | Unregistered CommenterMovingforwardOntario
The plan is good.
December 10, 2016 | Unregistered CommenterMovingforwardOntario
The next decade:

Setting up the forms and data collection system so the MDs entered the needed information so the population health managers so track things better.
December 11, 2016 | Unregistered CommenterMovingforwardOntario
How did the MDs so quickly acquiesce to giving their power away?

As a political story, it is amazing how badly the MDs handled all this.

Certainly, I would agree the majority of MDs I now meet are demoralized.
December 11, 2016 | Unregistered CommenterMovingforwardOntario
The era of box ticking medically trained , data collecting, bureaucratic social workers is on us ....with life and death decisions taken away from individual doctors and transferred to so called teams and their managers....as a British neurosurgeon stated, abandoning a 30 year career in the NHS to move to Ukraine , " it felt like swimming in treatle, bringing intense frustration to doctors and danger for patients "( Henry Marsh).

Dr. ( in the UK Mr) Marsh stated that leadership had once been provided by medical doctors...now they have been displaced but not replaced....there is no longer any leadership in the health care system ...only a permanent state of disarray.

Box ticking etc., ruined the British National Health Care service....it will most certainly ruin Ontario's....let's hope that the other provinces wait, observe and learn....in the meantime, US's Obamacare , already tottering held together only by Executive Ordered sticky tape, will be replaced....call me a dreamer...by an evidence based hybrid system???

As for how it happened...the medical schools have been overtaken by Kantian ideologues...the OMA signed onto the RAND formula, in so doing its alliegance was transferred from the membership to the government....then, the old Aneurin Bevan formula, " I'll stuff their mouths with gold"...its hierarchy will reappear in various ' leadership' sinecures within the new structure...the Order of Ontario will be handed out like candy.
December 11, 2016 | Unregistered CommenterAndris.
DrL:

Certainly, a clear view from you.

Sadly, I believe you are mostly correct.

I pity the young ones, many whom will unhappy in their work careers. Patients will be, whom experienced the old "ways", sad. The younger patients, will expect all their needs to be dealt with, or complaints will occur, and "discipline" will occur on those providers, making them even more frustrated.

There will be a backlash.
December 11, 2016 | Unregistered CommenterMovingforwardOntario
mfO and Andris,
All this is likely to come at great cost without evidence of improved medical outcomes. The bureaucracy is being grown creates more government dependency while creating a greater burden on tax payers and private businesses. I don't see how this is helpful to Ontario's economic or health "condition".
Very concerning indeed.
Look below the surface folks. You have to know the sustainability is being further eroded.
December 11, 2016 | Unregistered CommenterMerrilee Fullerton
How did the MDs so quickly acquiesce to giving their power away? Mfo

That is an excellent question and I am sure one the medical historians will tackle at some point in the future academically but we should look at it now.

I agree with much of what Andris wrote above, however if the decline in power was strictly due to the 'box-ticking' SDOH curriculums of the last several decades then we should in fact not see the same decline in power across jurisdictions which did not make these changes yet we do albeit less marked.

The real driver for the loss in power, and it may be politically incorrect to say so, has been the high proportion of women in medicine. Patients seem to prefer female physicians in primary care and it is is well known that women are now more successful at gaining entrance to medical school in Canada and the USA than are men, however with this change in demographics has come a loss of power.

"Women docs 'weakening' medicine
More women than men are entering medicine
A top female doctor has warned the medical profession's influence could be damaged by the number of women choosing to be medics.

Women doctors are expected to outnumber men within a decade.

But Professor Carol Black, president of the Royal College of Physicians, told the Independent that could affect how the medical profession was seen."
http://news.bbc.co.uk/2/hi/health/3527184.stm


Women practice a different style of medicine than men which often means putting family before medical practice and as such there are fewer women likely to enter leadership roles in the profession.

"If not, medicine is threatened with becoming a “pink ghetto,” experts worry. Because women work less, they might avoid taking on leadership roles in the profession, and won’t be taken seriously as policy-makers as a result. “When it’s a male-predominant profession, society perks up its ears and pays attention,” says Dr. Shelley Ross, secretary-general of the Medical Women’s International Association. But the way things are going, women doctors “run the risk of losing influence, losing value, [and the] ability to influence where dollars go.”"
http://www.macleans.ca/society/health/adding-fuel-to-the-doctor-crisis/

On top of this add in the softening of medical education (fewer call nights, more attention to trainees mental health, etc.) and the bad decision to train family physicians to share decision making with NPs, naturopaths, chiros,etc.,.. and we end up where we are today with many primary care docs not having a strong self-identity of where they fit into the overall health care system.

And for years we've had a provincial MOH aided and abetted by our very own OMA which continues to weaken the profession with divide and conquer tactics to undermine the profession's power, and lately uses the politics of envy to stir up more anti-physician feelings in the public. What you end up with is where we are today with a demoralized leaderless profession suffering from learned helplessness.
December 11, 2016 | Unregistered CommenterCanary in a Coal Mine
It is great to see Shawn Whately, ex-OMA board member, finally speaking openly about what we have been saying on this blog for a decade now. The only way to salvage the OMA is to de-RAND the organization. Only then will it begin to serve the membership's interests rather than the self-serving corporate OMA's interests.

http://shawnwhatley.com/earn-respect/
December 11, 2016 | Unregistered CommenterCanary in a Coal Mine
Methinks it is more related to the confusion of "equity of access" versus "equity of success". It is more than reasonable to strongly support the social justice agenda of "equity of access". However, it is unreasonable to argue that those whom have succeeded must be brought down to average because they have succeeded.

The politics of population health is regression to the mean, at the expense of success. Those at the top end of "health" are prevented from further improvements in health because pooling of insufficient resources, means resources are disproportionally needed for chronic diseases, not usually amenable for "cure".

Energy is about to be added into the mix,as that issue affects us all. Do all of us get equal carbon footprints based on an equitable tax per unit consumed, or do those with chronic disease get preferential carbon footprints to be "socially just".
December 11, 2016 | Unregistered CommenterMovingforwardOntario

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