Category: Politics of Health Care

How far along are we in making hospitals more ‘senior friendly’?

senior friendly hospitals

Being hospitalized can have dramatic impacts on seniors’ wellness, and time spent in hospital contributes to loss of important functions such as strength and mobility – critical to their independence and wellbeing. Camilla Wong, a geriatrician at St. Michael’s Hospital in Toronto says “hospitalization robs us of the things that are really important for older…

Regulating the ‘wild west’ of e-cigarettes

eCigarette

E-cigarettes have exploded onto the market in recent years and there are multi-billion dollar questions swirling around them. Advocates say that they offer a safe and effective smoking cessation aid while opponents are concerned that they may erode the success of decades of tobacco reduction efforts. E-cigarettes have the appearance of tobacco cigarettes and simulate…

Missing the target on health care performance?

TargetsiStock_000004380091Small

Setting targets has long been a mechanism in industrial psychology to motivate managers and workers to achieve specific organizational objectives. In the last decade, targets have become important methods of driving performance improvement in health care. However, deciding where and when to set targets is a challenge facing health care decision makers. Politics of performance…

Integrating Physician Assistants in Canada

physician assistant

After several decades working in the Canadian military, Physician Assistants (PAs) are being introduced into provincial health care systems. This year, Alberta launched a two-year demonstration project to integrate PAs into selected clinical practices. About a decade ago ago, PAs were introduced in  Manitoba and Ontario. In Ontario, PAs were part of Ontario’s broader health human resources…

Decades of restructuring hurts morale of Alberta’s health care professionals

Effect on health care restructuring on Alberta's health care professionals

This is the second of a two-part series on Alberta’s health care restructuring. This article examines the impact of constant change at the highest levels of administration on those who work within the health care system. Alberta Health Services (AHS) is the largest health care delivery organization in Canada. AHS provides health care to nearly…

Restructuring Alberta’s health system

A brief history of restructuring in Alberta's care health system.

Alberta Health Services has had a tumultuous summer. There have been major changes at the highest levels of administration and governance of the province’s health system. A review of the recent history of restructuring in Alberta’s health system might be helpful to understand the recent changes. Moving towards health regions Alberta was part of the…

Family Care Clinics – filling a gap or costly duplication?

Family Care Clinic

During her campaign for reelection in 2012, Alberta premier Alison Redford promised to create 140 Family Care Clinics (FCCs) over three years. She articulated a vision of primary care that would be one-stop, with many different health care providers under one roof. These clinics would have expanded hours to improve patient access, and would focus…

How much interaction should medical students have with industry?

Is there any role for industry in medical education?

A drug company sales representative stands in front of a class of University of Toronto medical students and delivers her well-rehearsed sales pitch about the benefits of her company’s birth control pill. Hold on: Isn’t this sort of interaction between the pharmaceutical industry and med students supposed to be forbidden because of concerns about conflicts…

Ontario Citizens Council: a failed experiment or a success in the making?

Ontario Citizens Council: a failed experiment or a success in the making?

Decisions about health policy often involve difficult trade-offs. This is especially true when assessing new health technologies and medications, where funding one item can mean not being able to fund another. These decisions often force policy makers to go beyond scientific considerations of a drug’s effectiveness, and address broader ethical and social considerations. Recognizing that…

What does the government’s tentative agreement with doctors mean for Ontario’s health care system?

What does the government’s tentative agreement with doctors mean for Ontario’s health care system?

Last week, the Ontario Medical Association and the Ontario government announced they had reached a tentative agreement that they hope will end their current dispute. The tentative agreement, which will run until March of 2014, will affect doctors in a number of ways and also has implications for the wider health care system. In this article,…

Expert advice for Ontario Ombudsman on his bid for jurisdiction over hospitals and long term care facilities

Expert advice for Ontario Ombudsman on his bid for jurisdiction over hospitals and long term care facilities

Ontario Ombudsman André Marin’s bid for jurisdiction to investigate complaints about patients’ experiences at the province’s hospitals and long-term care facilities has support from a wide range of patient advocacy groups. Marin stresses that his counterparts in all the other provinces have jurisdiction to investigate these types of complaints, although the scope of their powers…

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

PCORI, SPOR, Patient oriented research

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…

Approaches to Improving access to specialists in rural regions: Ontario & Germany

GermanyOntario

In Ontario, specialists are concentrated in larger cities, and Ontarians living in smaller cities and rural regions have challenges accessing specialist services. In Ontario, Local Health Integration Networks (LHINs) use non-financial incentives to try to attract specialists to practice in hospitals that serve rural areas, and provide telemedicine and outreach clinics for patients. In contrast,…

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…

Head first: birth centres in Ontario

Integrated Maternity Care

Ontario recently announced funding for two birth centres that will be led by midwives. The government has indicated it is opening birth centres partly to move care out of hospitals and save money. Although birth centres are probably safe and may improve maternity care, it is less clear whether Ontario’s birth centres will indeed reduce…

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…

Managing conflicts of interest in research

conflict of interest health care intellectual conflict financial conflict COI

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…

How specialty positions are allocated for medical school graduates

CaRMS How Specialty Positions are Allocated for Medical School Graduates

Each year thousands of medical students across Canada apply for, and are matched to, residency positions in a variety of medical specialties.  The allocation of residency training positions among the various specialties is largely decided by academic doctors involved with medical education. Some experts believe that health system decision makers should exert greater influence over…

Who controls how patient information is shared in Ontario?

Privacy of Medical Records in Ontario

Ontario’s Information and Privacy Commissioner recently ordered Cancer Care Ontario to stop sending paper copies of screening reports containing personal health information to physicians.   However, a massive amount of personal health information is mailed or faxed every day in Ontario.  The implications of this order to information sharing and transfer across the health care…

Weighing the harms and benefits of mammography

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?

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

Interpreting Randomized Trial Evidence on 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

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…

The mammography controversy

Mammography controversy

In medical journals, doctors and scientists continue to debate the relative benefits and harms of breast cancer screening for women who are at average risk of developing breast cancer. This debate is not always reflected in screening programs, most of which strongly recommend mammography to average risk women within a certain age bracket. Some experts…

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

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…

Are bedbugs a health problem?

Bed Bug

The past ten years have seen a surge of bedbug infestations across North America, with many cities across Canada affected.  Although they do not cause or transmit disease, bedbug infestations are often perceived to be a health problem. An effective and efficient bedbug strategy requires coordination among various sectors, including public health, housing, community and…

Charging patients for services: much confusion, little consensus

Credit Check 1

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

CloudyParliamentiStock_000006302940Small

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…

Hospital accreditation and quality improvement

white notebook

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…