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. 






Medical Tourism in Ontario

There could be real innovation in Ontario health care if the "Anti-change" groups would stop their obstructing. Most recently, the cries from Ontario nursing unions and Canadian Doctors for Medicare have resulted in response to new funding streams being generated from medical tourism efforts at Toronto area hospitals.

Both the CMAJ and the Toronto Sun had recent articles on this. The Globe and Mail reported on this earlier in the year. I will post the links in the Comments section.

Let's face it. Ontario is strapped for cash. Thousands and thousands of Ontario patients are waiting in queues while ORs sit idle for weeks every year and while beds exist on wards but are neither staffed nor funded. Medical tourism could contribute to helping hospitals provide more services and care to Ontario patients.

Doris Grinspun, as usual, speaks against any such option. Apparently, she would rather see patients wait in  queues than get the publicly funded services they need. The fact that hospitals are finding their budgets squeezed by Ontario's financial circumstances seems to be completely missed by her. Medical tourism has the potential to provide more income to the hospital thereby allowing it to provide more services to Ontario patients through the public system. It should be a Win-Win situation but somebody did not invite Ms Grinspun to the decision-making party. She is not happy.

Patients coming from abroad would provide income to hospitals who will use idle infrastructure and unused specialist time to provide the care. Ontario patients would not be "bumped" because of medical tourism. On the contrary, the additional revenue stream from medical tourism would be advantageous to Ontario patients. This new funding stream does not necessarily fit with Doris Grinspun's rigid ideology but it is a necessary step in a new and innovative direction.

Canadian Doctors for Medicare appears to be fixated on a single payer system at some level of unattainable purity. Dr. Dutt suggests that allowing medical tourism would cause specialists and surgeons to work "part time". She appears to avoid the harsh reality that despite less than developed world per capita physician average, Ontario is unable to employ 16% of graduating specialists in their area of expertise.

Dr Dutt should be reminded that surgeons train many years to hone their skills. They need operating room time to preserve them and can use medical tourism opportunities to continue to serve patients. The revenue provided by medical tourism could also assist more Ontario patients to benefit from the skills of these same physicians lessening wait times and creating a more productive population.

The Ontario public needs to understand how medical tourism can be helpful in making more services available to them.  Nursing unions and Canadian Doctors for Medicare should get a grip on reality or get out of the way. Patients are waiting.






Ontario Election 2014

I must admit that it is somewhat mindboggling how the Liberals might still be in power June 13....but it will be Friday The 13th by the time the scandal-riddled-Liberals limp over the finish line with a little bit of doping from the Unions. If they manage a minority then let them wear their mud a little longer. If they manage a majority then the unwitting public is in for a big painful surprise as credit rating agencies begin to flex their muscles. The Liberals won't be looking very fresh at that point.

For the PCs, a win  will be a double-edged sword. The loud mouth unions will be out in full force at every turn. If the garbage truck is late, it will be Tim Hudak's fault. If a storm knocks out the electrical grid, that will be Hudak's fault too and if the growing ranks of people with acute on chronic disease show up in droves at the ER, that will be Tim's fault too...

It almost makes me think that a couple more years of the Wynne government would be worthwhile only if it is to show what a terrible muddle she and her big spending government have created. The downside is that Ontario will be driven further into debt and further hardship for Ontarians will be the result and I have difficulty supporting that.

What is striking in this election is the level of disengagement of the electorate. Advance poll numbers were down by about 6%..and with the first game of the FIFA World Cup on the tele I expect many areas of Toronto and Ottawa will have low voter turn-out numbers.

What kind of society do we create when the Union propaganda successfully deceives and the self-indulgence weakens the electorate?

What kind of society believes that the best election platforms are the ones that promise it goodies without any trade-offs?

Somehow, a culture of complacent, non-voters has been created. Their usual excuse is that it doesn't matter which party takes over, the result is the same. Why bother? 

How wrong they are.

I hope you manage(d) to vote today or in the advance polls and I thank you for your ongoing support!



Courageous People Changing Health Care

While union backed protesters decry the end of the Health Council of Canada and complain that the federal health transfers are not sufficient to provide the provinces with what they need to fulfill their political promises, other people are working hard to create more sustainable change.

I'm not talking about the individuals who are entrenched in more bureaucratic and systemic convolutions that add to the cost of care by creating expensive and more complex coordination such as Family Health Teams and Health Links.  I'm talking about people like Dr. Robert Bell of the University Health Network in Toronto and Dr. Brian Day of the Cambie Surgical Centre in Vancouver.

Dr. Bell has  recently been appointed as Deputy Health Minister in Ontario and is leaving a hospital network that encourages medical tourism, allowing patients from other countries to be treated at UHN by paying for their own care. This makes a lot of sense. Currently there are unemployed and underemployed specialists to the tune of approximately 16% of all new graduates. There are operating rooms that must close for weeks at a time to allow hospitals to balance their budgets to meet provincial accountability agreements and hundreds of thousands of patients across Canada waiting in queues.

The revenue generated by having out of country patients pay for procedures and care at the UHN allows hospitals to spend resources on patients who are not paying. This has a certain symbiosis that could be a win/win/win, for out of country patients, for Canadian patients and for employment at many levels for Canadians. Despite this, various groups are already lining up to request that this service be stopped. Not only should it NOT be stopped, I believe it should be made available to Canadians as well so that both health human resources and infrastructure can be used maximally as well as creating a source of revenue for hospitals and even for government, not to mention the primary goal of allowing more patients to get the care they need.

Dr. Brian Day is another health care expert who is courageous in his attempts to advocate for vulnerable patients forced to wait in Canada's failing single payer system. He is bringing a legal challenge to the laws that prohibit individuals from paying for medically necessary care. You can find more information at the following site:

  Charter Health

 As our aging population requires more services and more care and with relatively fewer workers to provide the tax base in the future, we need to be open minded about how to allow more people to access more care in ways that are acceptable to them.

There are times when the unions and the media and the "entrenched" drown out reasonable voices on health care change. I hope that the voices of Dr. Bell and Dr. Day will be heard at many levels, and that change will occur to support sustainability of a Hybrid health care system that combines a robust public system with private options for medically necessary care.

It is challenging to stand out from the crowd to say and do what is necessary. Please support sustainable change where you can. Thank you.



Hospital Mergers and Transformation-Who Should Pay?


With permission from ELB, I introduce our first Guest Journal Entry:

Even Donald Trump would say that this is "huuuuuge".

Money woes disrupt Scarborough-Rouge Valley hospital merger
A $3-million grant from the province falls well short of what Scarborough Hospital and Rouge Valley Health System say they need to cover upfront merger costs

In short, the hospitals believe that the integration would cost about $30M. The Minister of Health and Long-Term Care offered $3M. The same Minister who just bailed out Thunder Bay on Friday to the tune of $14M.

Honestly, if you were looking for transformation, wouldn't the Scarborough-Rouge Valley merger look borderline orgasmic? And from a political perspective, without doing the formal research I am confident in saying that there are more seats in GTA East than Northwestern Ontario. Heck there are less the 250,000 people in the whole region. That fits on one Scarborough RT train - or at least feels (and smells) like it!

But I digress.

So mfO, riddle me this one: since when is Scarborough on the margins and Thunder Bay is at the core? Or does this officially mark the beginning of silly season?

And finally, a similar merger happened not too long ago in GTA West, i.e., Trillium Health Partners (Credit Valley Hospital, Mississauga Hospital, and Queensway Health Centre). There must have been some government support for this transformation: either from the Ministry or the LHIN.

Can someone explain why Central is not giddy with excitement and tripping ll over themselves to make this happen?


■ Does Central think that this is nothing but a cynical hospital cash grab?

■ Are there not enough Liberal seats to maintain or win or is GTA East hardened PC territory?

■ The Liberals had the chance to support this and hesitated. Which party jump out on Monday morning and declare that if elected they will support this?

Would love to see the Minister's briefing note on this one.

That's enough for now.



Private Health Insurance in Sweden, Unemployed Canadian Specialists, and the Rand 

Rigid health care zealots full of intolerance for the needs of people who do not fit their definition of "vulnerable" are damaging the lives of Canadians across the country.

These are the single payer supporters who would have you believe that they are noble supporters of the public, the poor, and the sick. They are not. They perpetuate the status quo that is leaving many people behind including autistic children, elderly dementia patients, and patients waiting years for elective surgery.

The truly vulnerable amongst us who need public health care support are being denied timely and appropriate care while the Unions maintain their self-serving power and workers are forced to join their ranks only to be out of jobs as the economy fails to support ever increasing Union demands.

Despite Paul Martin's Federal Liberal Party's attempt at a "Fix for a Generation" a decade ago and 41 Billion dollars later, patients continue to languish on wait lists.  Despite Premier Wynne professing "fiscal" responsibility, the Ontario Liberal Government has misspent billions of tax payer dollars on eHealth, ORNGE, gas plant cancellations, and failed green energy initiatives. And on and on it goes.

The social responsibility that is so deeply ingrained in Canadian culture is being distorted. We spend more and more on measuring and monitoring in accountability agreements in attempts to respond to government need to demonstrate "efficiency" which remains sufficiently elusive so as not to make a dent in waits or budgets.

Meanwhile, front line care suffers as funds are shunted to providing government optics. Even "value for money" will be an ethereal goal since value very much depends on evidence which is never complete and on the perspective of the evaluator--patient or politician or provider.

Don't misundertand me. I do believe in accountability but only the real kind.

So what does this have to do with Sweden, unemployed Canadian specialists and the Rand?

Canada is the last remaining country in the world to cling to a single payer health care system. It has some of the worst indices in many comparisons with other developed countries. Even socialist Sweden permits is citizens to purchase private insurance. 

From "The Local-Sweden's News in English":

* One in ten Swedes has private health insurance with some giving the reason that this makes more sense than waiting in long public queues for care.

* The insurance plan guarantees that the patient can see a specialist within four working days, and get a time for surgery, if needed, within 15.

In Canada, graduating surgeons including orthopedic surgeons are unable to find OR time to provide much needed service to patients waiting in long queues measured in months and years. Despite having less than the OECD average of physicans per population, Canada is graduating many kinds of specialists who cannot get work in their area of expertise due to lack of public funding and lack of public health care infrastructure.

News of Canadian surgeons travelling to the Turks and Caicos with their patients to access OR time and surgical care requirements has emerged recently from Alberta. Lack of Operating Room time, hospital beds, and nursing and tech support are discussed publicly.

Sixteen percent of graduating Canadian specialist physicians are essentially unemployed in their fields despite growing demand for care due to an aging population with all of its associated health issues and due to a growing population from immigration. Some of this specialist/infrastructure mismatch is due to older physicians staying on longer but the real issue is an infrastructure short fall for ORs and hospital beds and also lack of long term care beds.

Consultants call for more measurement and more coordination/integration within the health care system but the system is already brittle with inherent interdependency that stymies innovation and flexibilty. More coordination is unlikely to work in a complex system such as health care. We need resiliency in a new health care system that can be enabled to adapt quickly to unprecedented change and uncertainty.

There are some simple approaches that can be taken to allow resiliency to develop.

The first is to remove or change legislation that prohibits private provision of medical care such as Bill 8 in Ontario.

The second is to "de-Rand" the Ontario Medical Association. Even though the OMA acts more as the right hand of government nowadays to implement government policy, it does have a role in fee setting which it has less capability to do as funding models become more complex and removed from fees. It is no longer fulfilling its role as negotiating body for all physicians.

Innovation in health care funding that can provide more care to more people in a timely way will only happen when people are given the freedom to change. We have a decade left to move to a Hybrid health care system. We need to start now.

I'd also like to thank all the very supportive contributors here who have kept the discussion going. I am learning first hand about the lack of resources in the community to deal with dementia patients and sometimes my efforts are spent elsewhere.

I'm looking forward to a smoother 2014! Best wishes to All and many thanks!



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