Cost of Care

The future of the federal health transfer

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

House calls and Ontario’s election

In the run up to the Ontario election, the Liberal party has promised $60 million to support physician house calls. The number of doctors who make house calls has declined markedly over the past fifty years, and only a small proportion of Ontario family doctors currently provide ongoing care to patients in their homes.  What

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

Need & access to bariatric surgery in Ontario

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

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?

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

LHINs and the governance of Ontario’s health care system

In many provinces across Canada the authority and governance of health care has been moved to regional authorities, based on the belief that local authorities can better integrate and coordinate services, and contain costs. Ontario created 14 Local Health Integration Networks (LHINs) in 2006, with the mandate to plan, fund and integrate health care services

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

The role of nurses in Ontario’s colon cancer screening program

Colon cancer screening is more effective than breast cancer screening, but uptake in Ontario is still low. Screening more individuals each year would prevent many needless deaths. Nurses can safely and effectively screen patients for colon cancer. Despite this, efforts to increase the number of screening procedures performed by nurses in Ontario are not widespread. 

Doctors & drug reps: prescription for trouble?

New drugs are developed every month, and doctors are continuously bombarded with information. Much of this information is provided by pharmaceutical sales representatives who visit doctors’ offices, sponsor lectures and give out medication samples. Are these encounters in the best interest of patients and the health care system? We went out to the street and

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

Achieving better health for the homeless

Walking through the streets of any large city, one sees many homeless people. Nearly two in three have a history of some form of mental illness. Hospitals have become the place where homeless people with serious mental illness go during a crisis, but hospitals are poorly equipped to meet their needs. How can society improve

Federal health spending without accountability

The 2004 Health Accord agreed to a total transfer of $41 billion of federal money to the provinces and territories for health care over a ten year period. This transfer ends in 2014 when the accord expires. The legacy of the Health Accord is mixed. There have been improvements in wait times for some operations

How should hospital doctors be paid?

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

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

Waiting for long-term care in Ontario

Waiting for long-term care in Ontario

The Ontario Health Quality council reported in 2010 that wait times for a long-term care bed in Ontario have tripled since 2005.   A substantial number of people who are waiting for long-term care – and some who are currently in long-term care – could be cared for at home or in “assisted living” facilities

Reducing ‘unnecessary’ blood glucose test strip use

Diabetes test strips

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

Citizens participate in hospital restructuring processes

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? took to the street in December 2010 to gather some opinions about