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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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Thursday
Sep082016

B.C. Courts will bring into Focus the Hard Questions about Canada’s Health Care System

 

Canada’s health care system has been called many things including a “jewel” and “the very essence of what Canada is all about”. It has also been called “sclerotic”, “archaic” and for politicians it has become “a sacred cow”. For many Canadians, our health care system has become a mirage. Aside from the illusory notion that our health care is “free”, many cannot explain how it works and how it is financially sustained. Many cannot access the care they need.

However, this mirage is going to be drawn into clear focus in the weeks and months ahead as the B.C. Court is hearing a case put forward by surgeons and patients that accuse the B.C. government of denying them their rights to timely medical care.

Perhaps the B.C. case will allow Canadians to begin the necessary discussions about how our health care must change to address the serious systemic shortfalls within it. We have a strained health care system due to an increasingly aging population, more pharmaceutical options, more medical technology with associated potential interventions, and emerging science that requires more medical research and money.   

For people waiting for care, or denied care, or whose disease is treatable elsewhere but not here, the limitations of our current system have become numbingly clear.  We should walk a mile in patients’ shoes to understand the importance of the B.C. Charter Challenge for those who have been denied timely care. While the outcome of the case is important at an individual level, it will also resonate at a societal level – throughout our country.

Some people choose to frame the case as a “private vs public” health care battle and foresee the destruction of Medicare if B.C.’s provincial health care service loses the case. However, at a foundational level, the case is a challenge about the rights of Canadian patients in a system that denies timely care.  What rights does a patient have? What recourse should a patient have? What suffering can the government health insurance plan fairly impose on an individual patient, if any?  (In a country that has recently witnessed the Supreme Court of Canada rule in favour of an individual’s right to die, one might expect that it would also rule in favour of an individual’s right to live.)

Now is the time to ask the difficult questions about what we want from our health care system that was designed for another era and which, despite transformation, is a laggard in the developed world. Many of us who have been part of the on-going debate about patients’ rights and the short-comings of the system recognize that we can and must preserve what is fair and equitable about Canada’s health care system and move forward to improve what is not.  

There are some important questions that must be fully discussed.

Must we pit patient against the system? What is more important, the patient or the system? Can we not all agree the system must exist for patients? So, the question then becomes “How to provide more care to more patients?” In that context, how is it ethical to preserve a system that cannot meet patient demand despite almost fifty years of trying?

How comprehensive a system can we afford? Do Canadians want modern health care that keeps up with change, or do they want an archaic system designed for fifty years ago? As pharmaceuticals become more and more prominent in treatment options, many Canadians want to include pharmacare in our country. However, the cost of Canada’s government funded system makes it difficult to move forward in publicly funding other areas of care such as eye care, dental care, and newer pharmaceuticals for cancer and other previously untreatable diseases.  How can a better balance of services be achieved that will meet our expectations for an advanced health care system?

There’s the important issue of “Universality”. Do Canadians want universal health care coverage in theory or in reality? The term “universal” does not mean “government funded”. It simply means coverage for everyone. There are many ways to provide coverage for everyone in a truly universal system that creates access instead of imposed rationing. Many other countries have hybrid systems for medically necessary care and manage to achieve universality at lower cost and with better outcomes. Why aren’t we looking at and learning from other better performing systems? And, what of portability of care in Canada? Do Canadians want a system that provides similar services across the country, or do they want the system to be determined simply by the degree of rationing required in each province?

What is to be done about the under-utilized infrastructure and medical workforce? What do Canadians want, more government rationing of care or more ways for more patients to access care? Canada has less than the average number of physicians per capita compared to many developed countries yet we cannot fully employ our medical workforce due to costs associated with utilization of government funded services. Operating rooms and surgeons sit idle, hospital beds may exist but are “unfunded”. Hybrid systems of other developed countries have more providers, more hospital beds, and better access to medically necessary care at lower cost than Canada’s health care system.

Canadians must have this honest and difficult discussion about our health care system if we are to create a truly universal system with quality health care that addresses patient need. I believe the B.C. Charter Challenge will help in this dialogue. Contrary to rhetoric about the case being an attack on Medicare, it is not. Given the history of our country, Medicare will continue, but we must acknowledge its faults. A more robust health care system is needed, one that is truly universal, comprehensive, and accessible and not so negatively impacted by government short comings both in funding and in vision.

The B.C. case will bring our health care system into much clearer focus. It will drill to the core of the debate. If we are to give patients the dignity and respect they deserve, then we must acknowledge that they are part of the solution and give them the necessary freedoms that are currently lacking.

Reader Comments (556)

<<Remember this is about maintaining power, not health care.>> - MfO

Aye, 'tis the Golden Rule. Thank you for that reminder.

Anyone going to comment on awayforward.ca and its five principles?

With close to 400 signatures at the time of this post, it seems that it is gaining momentum.
October 5, 2016 | Unregistered CommenterExecutive Lead Blogger
Thanks for the insightful comments on Bill 210. How can Bill 210 be stopped. Can it be reversed or eliminated with a change in government?

awayforward.ca ??

Not on my radar. What is it? Or is it a typo?
October 5, 2016 | Unregistered CommenterMerrilee Fullerton
It all fits nicely....prorogue....then, the Premier, much like Alexander the Great, slashes the health care Gordian knot with her OIC sword....timed to coincide with a Federal government Health care helicopter money drop to cover all the politically correct, ivory towered approved topics such as pharmacare....and the amnesic and gullible citizenry of Ontario vote the government back in in 2018.
October 5, 2016 | Unregistered CommenterAndris
DrL;

It may not work. Even in the urban areas, the distrust of central is palpable amongst many of those whom "work" for an income,across all sectors. Central's polls are VERY worrisome. Of interest, it shows those ancillary workers, dependent on "happy" MDs, re very concerned as the frustration at the MD level is filtering through to the ancillary services dependent on "happy" doctors.
October 5, 2016 | Unregistered CommenterMovingforwardOntario
MFO, this is so interesting. Might this mean that Central will actually avoid further unilateral cuts as this could turn up the anger of the MDs and the concern of the ancillaries?
October 5, 2016 | Unregistered CommenterConcerned
If I was the Premier and the polls revealed the filtration of physician frustration into the ranks of the ancillary services I would make lemonade out of the lemon..

I would try to boost the morale of my battered vassal , the OMA, building it up by making a concession to it and the membership , giving full credit of the concession to the OMA's leadership, pretending that the tough OMA wrestled the concession from me.

A revived OMA could be used at a later date to deliver the reconciled membership lambs to the slaughter house.
October 5, 2016 | Unregistered CommenterAndris
Concerned:

It is just cautious politics.

Central has no rush to do anything if it further destabilizes the possibility of maintaining power. Remember this is REALLY about maintaining power; budget control and health care are tertiary concerns.Power is the PRIMARY issue.Central has a careful 18 months of political manipulation to deal with. First step needed,is the federal money dump. That deal is close. Clawing more back is easy, but unneeded if the money dump is properly designed. The money dump should have sufficient strings attached such that a "subtle" claw-back continues.
October 6, 2016 | Unregistered CommenterMovingforwardOntario
So Bill 210 just morphed into Bill 41 and was reintroduced today....the game begins.
October 6, 2016 | Unregistered CommenterAndris
Not a game.a slow plodding effort to assure what should be done,as we see, will be done.We know what is best. First,must have access to all patient files and information. Done. Second,allow our experts to review and approve or restrict access to services ( we will "choose wisely" for you) -done. Third, determine whom are the "chronic users" and assign them "navigators" to assure appropriate use of centrals resources.Assure they are well versed in the need for MAiD!.

The plan is good. We do know what is best for you. Trust us.
October 6, 2016 | Unregistered CommenterMovingforwardOntario
These are moves on a chess board...Bill 41 is introduced...is an OIC next?
October 6, 2016 | Unregistered CommenterAndris
The end of freestanding independent practices was initiated yesterday. MDs will now work for the state, not the patient.
October 7, 2016 | Unregistered CommentermovingForwardOntario
http://www.ontla.on.ca/web/bills/bills_detail.do?locale=en&Intranet=&BillID=4215

The Minister now will run health care. The plan is good.
October 7, 2016 | Unregistered CommenterMovingforwardOntario
Here it is folks......

(c) at any time more than 30 days after giving notice under clause (b), if the local health integration network and the provider have not negotiated a service accountability agreement or amendment, as the case may be, the local health integration network may, if it considers it in the public interest to do so, deliver an offer of a service accountability agreement or amendment on the terms and conditions that the network determines, which shall be deemed to be the service accountability agreement, or amendment as the case may be, between the local health integration network and the provider; and
(d) the network and the provider shall comply with the terms and conditions of the agreement or amendment as set out in the offer under clause (c).

Definition

(3) Paragraph 11 of the definition of “health service provider” in subsection 2 (2) of the Act is repealed and the following substituted:
11. A not for profit entity that operates a family health team.
12. A not for profit entity that operates a nurse-practitioner-led clinic.
13. A not for profit entity that operates an Aboriginal health access centre.
14. A person or entity that provides primary care nursing services, maternal care or inter-professional primary care programs and services.
15. A not for profit entity that provides palliative care services, including a hospice.
16. A person or entity that provides physiotherapy services in a clinic setting that is not otherwise a health service provider.
17. Any other person or entity or class of persons or entities that is prescribed.
October 7, 2016 | Unregistered Commentereklimek
Bases on these definitions, those of us in FFS don't seem to be included? It appears that anyone in the alphabet soup is about to get owned...anyone know what percentage of GPs are in teams, I assume enough have taken the bait to make it worth the MOH's while ?
October 7, 2016 | Unregistered Commenterdocinthepark
7. Any other person or entity or class of persons or entities that is prescribed.
?
October 7, 2016 | Unregistered CommenterMerrilee Fullerton
# 7 sounds as if it includes the kitchen sink.

The OCFP states that the Bill does not regard a FP as a health service provider....

Are FHT FPs defined as being HSP's under Bill 41whilst the other FHNOT FP's as in FHO's and CHC's and independent FFS FP's are not?

#7 could include all and sundry.
October 7, 2016 | Unregistered CommenterAndris
Andris good questions. For someone like me who deals with acuity, no e-health emr, and couldn't care less about preventive care bonuses, not sure what they can really enforce or snoop into? Come check on my once per week after hours office, it's running...
October 7, 2016 | Unregistered Commenterdocinthepark
In theory and practice, each institutional provider must fill each quarter a report on why they fail to meet MOHLTC guidelines, re:wait times.

None have been filled. None.There is no accountability, and the Minister knows this.If waiting times are not hitting standards, what is the CEOs documented response to the failure to meet the standards?
October 7, 2016 | Unregistered CommenterMovingforwardOntario
As one observes the Ontario Hydro train wreck...coming right behind it, at high speed, is the looming Primary care reform train wreck...the governmental arrogance, chutzpah and misplaced confidence that led to the first train wreck will lead to the second.
October 8, 2016 | Unregistered CommenterAndris
And here's the common link between the MOH and hydro one, another bank buddy :
http://www.cbc.ca/beta/news/canada/toronto/ontario-wants-banker-who-pushed-hydro-one-selloff-to-assess-ehealth-1.3797238

I've been explaining for years to my patients why I'm not part of e-health when asked if I can see all their records. Between corporate take overs of EMR companies and this, it's a scary world. I like how Hoskins refers to patient records as "assets" , a sense of ownership is implied from the choice of words, interesting..

If I were part of COD, I'd have the lawyers all over this one.
October 8, 2016 | Unregistered Commenterdocinthepark
Behind the scenes,patient data is an asset, and being regularly mined. Have to find those "chronic" consumers,to"improve"their lives.
October 8, 2016 | Unregistered CommenterMovingforwardOntario
(5) A health service provider shall comply with every directive of a local health integration network.

Shall comply!

Bill 41 is really authoritarian command and control.
October 9, 2016 | Unregistered CommenterMovingforwardOntario
Some very reflective contemplation is needed as the new command and control structure is put in place. It is not reversible.

MDs now will respond to the state, not the patient.
October 9, 2016 | Unregistered CommenterMovingforwardOntario
With oversight comes responsibility. It remains to be tested if immunity for the flow of patients through the "system" entirely avoids the relative weight of responsibility after untoward outcome.
October 9, 2016 | Unregistered Commentereklimek
"A health care provider shall..."

Superficially , according to the definition of HCP given...a FP isn't a HCP....the Ontario College of FPs emphasizes the point " A FP is NOT considered to be a health service provider".

Then we have , in the definition ,# 17 " any other person or entity or class of persons or entities that is prescribed".

On some of the boards I look at there is complete silence....mass confusion?
October 9, 2016 | Unregistered CommenterAndris
Manipulation of the FHTs and hospitals may be enough for them to control the budget and they should be easy to squash given the salary or money dump model and nature of what is provided for that salary/money dump.

As for FFS FPs providing focused ER service, ansethesia, psychotherapy, sports medicine, vasectomies, skin procedure clinics the list is endless and the MOH will be unable to corral them all into providing "primary care". Yes they can try to limit the number of licenses and hammer the fee schedule, but they won't necessarily see these docs miraculously reappearing in northern Ontario to setup comprehensive care practices.

I like the litigious and antagonistic tone of the CODs in their recent emails. The OMA and MOH will need to be on standby, I've got my popcorn ready, I anticipate some fireworks and escalation as this starts to roll out. I expect the OMA will bear the brunt of the suppressed physcian anger initially. Once the OMA is taken down or reorganized from the inside, the MOH will be next in the crosshairs, at which point we may see some physician job action.
October 9, 2016 | Unregistered Commenterdocinthepark
Still a mystery to me as to the status of FP's...presumably the FHT FPs are defined as being HSPs....what about the other FPs in FHNOTs, CHC's FHO's?

Presumably the independent FFS FPs will have their fees suppressed even as they are driven to provide government approved comprehensive primary care ...the ER and Anaesthetic FP's aside...those doing psychotherapy and other less vital extremely focused practices will likely be forced to increase the focus of their practices with the College demanding that they do more CME s and Practice under supervision ....as for the Botox FPs , it would seem that they will come under pressure as well.

Confusing times for FPs of all ages...to stay or not stay, that is the question.
October 9, 2016 | Unregistered CommenterAndris
From

https://www.ontario.ca/laws/statute/06l04#BK3

Same, exclusions
(3) The following are not health service providers:

1. Any of the following individuals when they provide, or offer to provide, health services to individuals within the scope of practice of their profession:

i. A member of the College of Chiropodists of Ontario in the podiatrist class under the Chiropody Act, 1991.

ii. A member of the Royal College of Dental Surgeons of Ontario under the Dentistry Act, 1991.

iii. A member of the College of Physicians and Surgeons of Ontario under the Medicine Act, 1991.
October 9, 2016 | Unregistered Commentereklimek
Thanks Ed...then what are we?
October 9, 2016 | Unregistered CommenterAndris
Widgets.Under the control of "health service providers".

Shows how far the system has moved,in that MDs do not count as health service providers,in the Ontario Health Care system!
October 9, 2016 | Unregistered CommenterMovingforwardOntario
"What are we then?"
Professionals.
October 9, 2016 | Unregistered CommenterMerrilee Fullerton
Professional interchangeable widgets?
October 9, 2016 | Unregistered CommenterAndris
Under a totalitarian authoritarian government,you are widgets. You will do what you are told to do.
October 10, 2016 | Unregistered CommenterMovingforwardOntario
The impact of this social engineering is going be very disruptive.
October 10, 2016 | Unregistered CommenterMovingforwardOntario
FP widgets are " prescribed persons that are to provide information subject to regulations to the LHINs " under the supervision of LHIN health service providers so that the overseers could , using the data provided, to better plan the organization of local services....to ' better plan' , one or more governmental investigators, will have the ability to access FP patient health records held in FHT's, CHC's, NPLC's EMR systems ' in the public interest' ....having been redacted in some way by the LHIN, another arm of the same government.
October 10, 2016 | Unregistered CommenterAndris
Very pleased to be using an EMR off the grid . Heck maybe I should go back to handwriting. If it comes down to them wanting access, they can come comb through the charts patient by patient. With dozens of FFS encounters per day it'll take them awhile...
October 10, 2016 | Unregistered Commenterdocinthepark
Then there is the College that defines the ' standard of care'...it is gradually nudging older doctors via its auditing process into utilizing EMR ...and from encrypted cursive to typing.
October 10, 2016 | Unregistered CommenterAndris
As the "distributive fairness" policies are rolled out, those not providing uniform care, and delivery of services, will be sought out as disruptive.

The LHIN resources will be pooled with the "social justice"monies,and a committee will decide the local priorities.
October 10, 2016 | Unregistered CommenterMovingforwardOntario
"Uniform care"....means that many with over focused practices will have to expand their spectrum of care...which will be difficult for many having grown rusty and behind the times in the areas outside their original area focus.
October 10, 2016 | Unregistered CommenterAndris
As central has been advised that over 80% of the issues in Ontario are due to social determinant of health, the existing,and expanding use of the state's resources will be diverted to SDOH, away from acute care. About 80 to 120 LHIN will be created as community communes, dealing with the unfairness of life. Resources will be socially redistributed from those are in the top, to those whom aren't in the top. Additionally,those LHINs (or community committees) with insufficient resources, will be provide with resources from the "rich" LHINs. We will extract the resources from the corporate world, and the wealthy elderly. You will not redistribute to your children, you will redistribute to the needy,now.
October 10, 2016 | Unregistered CommenterMovingforwardOntario
We are becoming an imperfect society in which resources are redistributed without regard to ownership from the source to the collective for the greater good. This is step from utopian socialism obliterating economic inequality as a social determinant of health.

The perfect state collapsed when ownership of the means of production also reverted to the state.
October 10, 2016 | Unregistered Commentereklimek
Collectivization is the root of all evil.
October 10, 2016 | Unregistered CommenterAndris
mfO,
About a decade ago I considered the role of SDOH. I believed they could be helpful in controlling health care costs but the closer I looked and the more I studied the complexities of these efforts, I realized that addressing the social determinants of health will be an even greater expense than health care.

Attempts to address SDOH are noble but they will not result in any cost savings overall and they are unlikely to address a great chunk of inequality since complex issues are at work on complex beings. This makes for lots and lots of complexity for which there is no identifiable solution.
So, to be clear, we can still try, it's just that addressing SDOH is unlikely to reduce health care costs but is likely to add to overall costs.

Even if addressing SDOH could lead to increased productivity and greater tax revenue and better quality of life, it will still cost a huge chunk of change--what will we measure to know if the spending is effective?
R:

You don't seem to clearly get,central has been advised,and is being advised, that resources must be poured into dealing with SDOH, in that by dealing with that, solves all the issues. For the next years,money will flow into SDOH, at the expense of acute medical services. The resources will come by borrowing, and increased taxation of those whom have the wealth..
October 11, 2016 | Unregistered CommenterMovingforwardOntario
"One of the truisms of Canadian political discourse is that the federal government grossly underfunds health care. Ottawa’s health transfers, the argument goes, only cover about 20 per cent of medicare spending.

This year, the cash transfer for health is $34-billion; the provinces and territories will spend $155-billion in public money on health – or 22 per cent. (Total health spending, however, will be $219-billion; 30 per cent of health spending is private.)

When medicare began, the argument continues, Ottawa committed to pay 50 per cent of health spending. Ergo, the provinces are being ripped off big time."



http://www.theglobeandmail.com/opinion/cutting-through-the-numbers-on-health-care-funding/article32314839/
October 11, 2016 | Unregistered CommenterCanary in a Coal Mine
"Bait and Switch: Waste and Stewardship

Champions of stewardship trick us into thinking that stewardship is just like avoiding waste.

Pro-stewardship advocates hijack the anti-waste movement. They promote popular campaigns, like Choosing Wisely, to gain the moral high ground.

That would be fine, if they stopped there. Instead, they leverage anti-waste thinking to promote their ideas about doctors as stewards of public spending on healthcare.

They take something good — being anti-waste — and use it to promote something anti-patient."

http://shawnwhatley.com/stewardship/
October 11, 2016 | Unregistered CommenterCanary in a Coal Mine
<<The LHIN resources will be pooled with the "social justice" monies,and a committee will decide the local priorities.>> - MfO

Until Central gets pressured by a particularly vociferous external group and the issue makes its way to a front page or to Question Period. Then Central will over-rule the LHIN committee decision entirely for political purposes.

Not like that has ever happened in Ontario before.
October 11, 2016 | Unregistered CommenterExecutive Lead Blogger
ELB:

It is all politics. It is interesting to see the lobbying between the haelth group, the housing group, and the social assistance groups, all arguing for a bigger slice of the pie.Surprising how much the salaried MD consultants are welling to give away from the acute care pie.
October 11, 2016 | Unregistered CommenterMovingforwardOntario

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