Category: Cost of Care

Paying for plasma – Canada’s double standard?

Plasma

Sandra Duvlock was 58 when she was diagnosed with dermatomyositis. The gradual inflammation of her muscles had gotten to the point where she was unable to walk, clean or feed herself. When this relatively rare disease was diagnosed, Duvlock was prescribed intravenous immunoglobulin (IVIG) treatment and long-term physical rehabilitation. IVIG is a blood product that uses plasma proteins…

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Andreas Laupacis healthy debate editor in chief

Why Healthy Debate? We founded Healthy Debate with a simple goal: to create a destination where Canadians can go for credible, unbiased information about their health care system, and where patients, health care professionals and policy makers can come together and debate the challenges facing our system. We now need your support to continue to achieve our…

The controversy over “pay-at-risk” for hospital executives

The controversy over “pay-at-risk” for hospital executives

“Pay-at-risk” became a political flash point in Alberta last month when Health Minister Fred Horne fired the Alberta Health Services board when it didn’t agree to withhold the at-risk part of the compensation package for about 100 executives. Alberta Health Services (AHS) had introduced pay-at-risk for health care executives in 2009. With pay-at-risk — also…

Access to expensive drugs: greater demand, improved transparency

Access to expensive drugs: greater demand, improved transparency

Each weekday, staff at the Exceptional Access Program (EAP) of the Ontario Ministry of Health and Long-Term Care receive between 250 and 300 requests for special prescription medications. These prescription drugs—typically expensive medications that are felt to be cost effective only when used to treat selected patients with specific problems—are not on the province’s regular…

Does evidence support expanding telehomecare in Ontario?

Telemedicine

Telehomecare programs offer remote monitoring for people living with chronic diseases, linking patients to providers without requiring an in-person visit.  Ontario is currently developing a number of large-scale telehomecare programs with the promise that they are patient centred, cost effective approaches to care. While there is great enthusiasm for telehomecare programs from patients, providers and…

Money matters: does ‘pay-for-performance’ improve quality?

Ontario physician payment "Ontario Medical Association" OMA Ministry of Health Negotiations health policy health care

In Ontario, new ways of paying doctors have been introduced in an attempt to improve the quality of their services.  One approach is pay-for-performance, which pays doctors for meeting certain treatment goals. However, there is little high quality evidence that pay-for-performance improves the quality of care, and it appears to have had limited impact in…

Does more care mean better care?

Canada United States Health Care Reform Health Care Policy

A recent study found that Ontario hospitals that used more resources and spent more money had better outcomes for acutely ill patients than hospitals that used fewer resources.  These findings go against a previous study that looked at the same question in the United States and found that more resources didn’t impact outcomes.  A better…

Should clinical practice guidelines consider value for money?

clinical practice guidelines cost effectiveness health care economics health care policy

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…

Charging patients for services: much confusion, little consensus

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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…

The future of the federal health transfer

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With the expiry of the Health Accord in 2014 looming, the debate about the role of the federal government in paying for health care is once again taking centre stage.   The School of Public Policy and Governance at the University of Toronto hosted a roundtable on the future of how the federal government transfers…

Need & access to bariatric surgery in Ontario

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The frequency of obesity has skyrocketed across Canada, and its treatment is a major challenge to the health care system.  Bariatric surgery is an effective treatment for obesity that appears to be good value for money.  Although Ontario is expanding bariatric surgery capacity, some are concerned that capacity remains below current needs.  What is bariatric…

Public and private payment for health care in Canada

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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.…

National pharmacare: who are the winners and losers?

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The Canada Health Act includes public coverage of services provided in hospitals and by doctors, but not prescription medications taken outside of hospital. Most provincial drug plans do provide some public coverage, but many Canadians lack drug coverage. In the last 25 years, prescription medications have become both more important and more expensive. Bringing prescription…

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

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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

Integrative cancer care

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…

How should hospital doctors be paid?

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Doctors are a significant portion of the costs for the health care system. In 2009, almost a quarter of Ontario’s health care budget was spent on paying doctors. Most doctors who work in hospitals are not paid by the hospital directly, but by the Ontario Health Insurance Plan, which pays doctors for each procedure and clinical service.…

Direct-to-consumer genetic testing comes to Canada

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Genetic profiles are being offered directly to consumers online for relatively reasonable sums of money. These websites are not yet widely known to Canadian consumers.  Doctors and the public need to be educated to better understand what the results of these tests mean.  E-commerce has exploded over the past decade, and now you can buy…