Karen Born & Andreas Laupacis

Karen Born is a researcher-writer with the Li Ka Shing Knowledge Institute of St Michael's Hospital, focusing her work on projects related to public engagement and education around health care policy. Karen is a PhD candidate at the Institute of Health Policy, Management and Evaluation (IHPME) at the University of Toronto. Karen has worked across Ontario facilitating citizen engagement processes for the Ministry of Health and Long-Term Care, LHINs and hospitals. Karen has an MSc in International Health Policy from the London School of Economics, and an Honours BA in Political Science from McGill University. Follow Karen on Twitter @BornK Dr. Andreas Laupacis is the Executive Director of the Li Ka Shing Knowledge Institute of St. Michael's Hospital and a Professor in the Faculty of Medicine at the University of Toronto. He is a general internist whose interest in health care is driven by his experiences as a consumer, practitioner, researcher and involvement in health care governance. He is currently the Chair of the Board of Health Quality Ontario and a Board Member at Cancer Care Ontario. He holds a Canada Research Chair in Health Policy and Citizen Engagement. He is convinced that the health care system would be better if there is more informed input from citizens. Follow him on Twitter @AndreasLaupacis


Articles and Opinion Pieces by this author

Patient-oriented research in Canada: what progress has been made?

The governments of Canada and the United States have patient-oriented research initiatives underway, which share the goals of supporting research that will improve health care systems and directly benefit patients.  However, the mandate, structure and funding of these initiatives differ significantly, with the United States accomplishing a great deal in a relatively short period of…

How ‘public’ are hospital performance ratings?

Although there is lots of talk about making measures of health system performance available to the public, the reality often falls short of the aspirations. Not only are these measures often difficult for public users to understand and access; evidence suggests that they have little impact.  In April of this year, the Canadian Institutes of Health…

Is Ontario health care ready for ePatients?

In the internet age there is an unprecedented amount of information available to anyone with access to the web.  In health care, this is slowly shifting power dynamics, with patients taking increased responsibility and ownership of their health.  What needs to be done so a health care system built in the 20th century can address…

Should clinical practice guidelines consider value for money?

In Canada, doctors’ associations regularly incorporate new evidence about medications into clinical practice guidelines that are intended to influence patient care. The Ontario Ministry of Health and Long-Term Care reviews the same evidence to decide which medications it will pay for, and often comes to different conclusions. This results in doctors recommending medications which are…

Are Ontario’s primary care models delivering on their promises?

In the last decade, efforts to improve access to primary care in Ontario have led to major changes to how family doctors practice and are paid.  A recent report suggests that these newer models of primary care are not meeting the needs of vulnerable populations, and that Community Health Centres (an older model of care) do…

Controversies about Community Care Access Centres and home care

Shortened hospital lengths of stay, and a growing number of people living with chronic diseases has meant that more Ontarians than ever are receiving health care services in their homes. In 2010, the Ontario Auditor General raised concerns about the quality and value of home care services, some of which remain outstanding. Resolving these issues…

How does Canadian health care compare?

A recent report describes how Canada’s healthcare system performs compared to 13 other countries.  Canada ranked at the bottom in access to care and use of electronic health records, and in the middle regarding costs and health outcomes. Thirty-eight percent of Canadians felt the system works well, 51% thought it needs fundamental change, and 10% believed…

Managing conflicts of interest in research

There have been a number of recent reports of conflicts of interest in medical research. There are at least two types of conflicts of interest – financial conflicts, where researchers stand to gain financially from their work; and intellectual conflicts, where researchers stand to gain professionally. Ensuring that all conflicts of interest are declared and…

Weighing the harms and benefits of mammography

Healthydebate.ca has run a series of stories on breast cancer screening mammography, stimulated by the recent guidelines from the Canadian Task Force on Preventive Health Care.  This last story focuses on how women and policy makers must balance the benefits and harms of screening mammography. The issues raised in this series are relevant to screening…

Did mammography save her life?

Some breast cancers detected by screening mammography are cured and would have led to death had they not been detected early. Other breast cancers detected by screening can be treated just as effectively if diagnosed later, may not have needed treatment at all, or may be so advanced that treatment does not prevent death from…

Interpreting randomized trial evidence around mammography

The Canadian Task Force on Preventive Health Care recently released recommendations about screening for breast cancer.  These recommendations have been criticized by some because they emphasize the results of randomized trials.  This article explores the advantages and limitations of randomized trial evidence regarding screening mammography.  The recent recommendations by the Canadian Task Force on Preventive…

Presenting the benefits of mammography

The results of research on screening for breast cancer with mammography can be presented in ways that make the benefits seem larger or smaller  Similarly, the benefits can be described as avoiding deaths from breast cancer or avoiding deaths from any cause Part of the debate about the benefits of screening mammography may be related…

What is driving health care costs?

A recent report by the Canadian Institute for Health Information provides information about the major drivers of health care costs in the past decade, which include growing salaries for health care workers and greater intensity of treatment.  The report suggests that the aging population is not a major contributor to rising health care costs. These findings clash…

Should health care workers be required to get the flu vaccine?

Each year several thousand Canadians die from influenza. Vaccinating health care workers against flu reduces transmission and would protect patients who are most vulnerable.  However, only about 40% of hospital staff in Ontario were vaccinated last winter. Is it time for Ontario to make the flu vaccine mandatory for health care workers? Explaining the influenza…

Charging patients for services: much confusion, little consensus

The Ontario Health Insurance Plan (OHIP) does not cover all health services that can be provided by a doctor. These “uninsured” services include telephone renewal of prescriptions, writing sick notes for work or school and transferring medical records. Doctors can offer patients the option of paying for a set of uninsured services with a single…

Hospital accreditation and quality improvement

Hospital accreditation is a process that assesses a hospital’s performance against a set of standards. This process is done differently across provinces and countries. In Canada, most hospitals go through an accreditation process conducted by Accreditation Canada. The accreditation process could be more transparent and provide more information to the public about the quality of…

Accessing primary care in Ontario

Increasing access to primary care providers, such as family doctors or nurse practitioners, has been a government priority. Better access to primary care is also associated with improved population health. Although the percentage of Ontarians with a regular primary care provider has increased in recent years, fewer than half can see their primary care provider…

Why does the government appoint hospital supervisors?

In August 2011, a supervisor was appointed at the Niagara Health System to “restore public confidence” in the hospital.  The Ontario Public Hospitals Act  allows the government to appoint a supervisor to take over the administration of a hospital if it is considered in the public interest to do so.  While appointing a supervisor happens…

Making sense of Ontario’s fee codes

Most of Ontario’s doctors bill the Ontario Health Insurance Plan for their services on a “fee for service” basis. The amount doctors are paid for each service is established through negotiations between the Ontario Ministry of Health and Long-Term Care and the Ontario Medical Association. Although fees are reviewed every few years, there is disagreement about…

Improving access to trauma care in Ontario

An integrated, coordinated system of trauma care has been shown to reduce injury-related deaths by improving timely access to specialized care  There is, however, wide variation in how long it takes to get a severely injured patient to a trauma centre in Ontario. Trauma systems improve by systematically assessing performance and outcomes.  Ontario does not…

Accessing trauma care in Ontario

Every year nearly 5,000 Ontarians are injured through trauma and require specialized trauma care, which has been proven to save lives. Many Ontarians think that they can access specialized trauma care at their local emergency department. This is not true.  Timely access to specialized trauma care does not always occur in Ontario.  Melanie Carter was…

Public and private payment for health care in Canada

It is inaccurate to say that Canada has an entirely publicly funded health care system.  While often described as a publicly-funded system, only about 70% of health care costs are paid for publicly, with the remaining 30% paid for privately.  In Ontario, medically necessary hospital and physician costs are entirely covered by the public health care system.…

The risks of emergency department overcrowding

Each year one in five Ontarians visits one of the province’s 163 emergency departments.  A recent study has shown that those who present to emergency departments when waiting times are longer have worse outcomes. Since 2008, Ontario has spent a lot of money and effort to reduce waiting times and improve the quality of care…

Why isn’t there a system of integrated maternity care in Ontario?

Midwives provide high quality care for normal, low risk pregnancy and child birth, but provide this care to relatively few women in Ontario. The demand for midwifery services is outstripping capacity.  The philosophy and actual practice of care provided by midwives and obstetricians is different. Obstetricians deliver many more babies, but obstetrician-led care is more…

Complementary & alternative medicine in practice and policy

Complementary and alternative medicine is a billion dollar business in Canada.  Complementary and alternative medicine is rooted in different philosophies and standards of evidence than mainstream medicine.  Many patients use both systems of medicine.  Complementary and alternative medicine is defined as any medical system, product or practice that is not thought of as a standard…

A ‘death denying society’: why aren’t more Ontarians using palliative care?

There is a striking paradox: while most Ontarians prefer to die at home, around 60% die in hospital.  Only 30% of Canadians near the end of their life use palliative care services.  Many experts believe that providing greater resources for palliative care does not currently appear to be an Ontario or federal government priority. Roger…

Will the aging population bankrupt our health care system?

Many politicians, doctors and the public believe that aging of the population is the main cause of increased health care costs. If this is true, this paints an exceptionally worrying picture about the sustainability of health care in the future. However, somewhat surprisingly, the majority of researchers don’t believe that aging plays a major role…

Should patients have better access to their medical records?

Patients are increasingly interested in reading the information in their own medical records. Canadian laws and existing technologies support this in principle. However, most patients are not yet easily able to access their medical records in practice. Canadians today have easy access to a range of systems that store their personal information. The difference between…

Reducing ‘unnecessary’ blood glucose test strip use

Blood glucose test strips are the third most expensive cost for the Ontario Public Drug Program. A study released in 2009 suggests that the Ontario government is unnecessarily spending between $19 and $42 million per year on glucose test strips. However, no changes have yet been made to reduce the use of blood glucose test…

Gridlock in Ontario’s hospitals

About one in six beds in Ontario’s hospitals are occupied by patients who no longer need hospital care. These beds are called Alternate Level of Care (ALC) beds. Because ALC beds are not available for sick patients in the emergency department, ALC beds are an important cause of emergency department overcrowding. The term ‘gridlock’, used…

Citizens participate in hospital restructuring processes

Northumberland Hills Hospital in Cobourg, Ontario was facing a significant deficit. The hospital convened a citizens’ panel to advise the board about which services could be removed from the hospital. The experiment was successful – should it be used by other hospitals? Healthydebate.ca took to the street in December 2010 to gather some opinions about…

Focus on quality for Ontario’s pathologists

Important medical errors in Ontario have occurred in surgical pathology. A report commissioned by the Ontario government recommended an overhaul to the quality management system of surgical pathology. The recommendations for surgical pathology might have implications for other aspects of medicine. Because of public concern about reports of errors in surgery and pathology, the Ontario…

Do lessons from the fight against smoking apply to reducing obesity?

A multi-pronged strategy was needed to significantly reduce smoking rates across Ontario over the last few decades. Obesity is a current and worsening public health threat.  The obesity epidemic may also need to be attacked from many angles, but may be harder to effectively fight than smoking. Healthydebate.ca took to the street in December 2010…

Are hand washing rates posted by Ontario hospitals believable?

Ontario’s hospitals are required to publicly report how often staff wash their hands. There is large variation in hand washing rates between hospitals. This variation more likely reflects how hospitals measure hand washing, rather than the frequency of hand washing itself. Ontario’s hospitals are required to publicly release information about how often staff wash their…