Why business hours are bad for hospitals
Tag: health care costs
Palliative care access still lacking
Palliative care improvements still in their infancy.
Should markups on high-cost drugs be capped?
Is robotic surgery worth the cost?
Are disposable hospital supplies trashing the environment?
Election 2015: The Health Care Debate
Telemedicine on the rise across Canada
It’s still far from routine, but telemedicine is quietly growing across Canada. Last year, a pilot project with a portable robot was launched in Saskatchewan. And telemedicine programs in Ontario have been growing by around 30% per year for the last several years, according to David Jensen, spokesperson for the Ministry of Health. Telemedicine can…
Can financial incentives help patients be healthier?
When Egon Jonsson was thinking about how best to support alcohol-addicted pregnant women, he thought of a controversial solution: paying them not to drink. The idea was inspired by studies that have offered shopping vouchers to pregnant women who succeed in giving up cigarettes. But when Jonsson and his team at the Institute of Health…
Ontario’s private outpatient lab sector needs overhaul, say critics
Ontario’s system for funding private medical laboratories has been controversial since it was set up almost two decades ago. Now, facing critics who have only gotten louder, the government may be considering reform. In her mandate letter after last year’s election, Premier Kathleen Wynne asked Health Minister Eric Hoskins to “explore opportunities to optimize quality…
Regulators grapple with Canada’s first generic biologic drug
Biologic drugs have revolutionized treatments for diseases from cancer to multiple sclerosis. But because they’re developed out of living organisms, they’re more expensive than conventional drugs, adding to the strain on publicly funded drug plans. Fortunately, a new shift should make them cheaper. Many biologics will soon have their patents expire. That means Subsequent Entry Biologics (SEB) – which are…
Slowing growth in health care spending: temporary blip or permanent gain?
For years, health care spending in Canada (both public and private) grew much faster than the economy. Until very recently, this trend was expected to continue, casting doubt on the sustainability of Canada’s health care system. However, recent data from the Canadian Institute for Health Information shows that growth in health care spending in 2013…
Canadian provinces take first steps towards lower drug prices
Prescription drugs provide important benefits to patients, and are an essential component of the health care system. They also have significant costs: Canadians spent roughly $35 billion on drugs in 2013, or about 16% of total health care spending. Drug costs have put significant strain on provincial budgets. In response, most of Canada’s provinces and…
From the factory floor to the emergency department: Hospitals explore Lean method
Can health care learn from assembly lines? Manitoba’s St. Boniface General Hospital thinks so. It’s been using Lean, a system inspired by Toyota, on processes around the institution. Last year, one of its projects was to reduce wait times for CT scans. Staff ran a Rapid Improvement Event, where a team mapped out patient flow and…
Should the public know how much doctors are paid?
The United States began releasing the Medicare payments it made to individual doctors on April 9, a move that sparked sensational headlines and debates about privacy. The data offer insights into the $77 billion paid by Medicare’s fee-for-service program to more than 880,000 health care professionals in 2012. Should Canadian provinces follow the U.S.’s lead and publicly…
Pulling back the curtain on Canada’s rising C-section rate
Caesarian sections (C-sections) are among the most common surgical procedures performed on women of child-bearing age. Canada’s C-section rate has increased dramatically in the past two decades. The national C-section rate has increased from 17% of all births in 1995 to nearly 27% in 2010. In Ontario, nearly 29% of births in 2011/12 were by C-section, with a similar rate in Alberta of…
Non-invasive prenatal testing and chromosomal microarray: changing the landscape of prenatal genetic testing
Prenatal testing is a routine part of pregnancy care in much of the world. Every pregnant woman in Canada is offered blood tests and ultrasounds to evaluate the health of her pregnancy. When testing suggests potential genetic abnormalities, doctors offer a further test such as amniocentesis to make a definitive diagnosis. While amniocentesis is very…
Should HPV vaccination programs be expanded to boys?
Vaccination programs are based on the old adage that an ounce of prevention is worth a pound of cure. Since 2007 Canada has had a vaccination program for the Human Papillomavirus (HPV) administered to girls, although the age of vaccination varies by province: Grade 5 in Alberta and Grade 8 (with catch up until Grade…
Cord blood banking in Canada
Minutes after giving birth, blood from the umbilical cord is collected and sent off to a central cord blood bank to be cryogenically frozen. Years later this cord blood could be used to cure some cancers and treat rare diseases. While to some this sounds like the stuff of science fiction, the use of cord…
Family Care Clinics – filling a gap or costly duplication?
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…
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
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…
Will more finance reform improve quality in Ontario’s hospitals?
After a decade of focusing on access to health care services, the Ontario government appears to be turning its attention to improving the quality and costs of these services. At the moment, there is considerable variation in how health care is delivered in Ontario’s hospitals, so patients with the same diseases are receiving different qualtiy…
Health Links: Ontario’s bid to provide more efficient and effective care for its sickest citizens
Ontario’s Health Links initiative is a “big manoeuvre” in a complex provincial system, acknowledges Helen Angus, associate deputy minister with the transformation secretariat of the Ministry of Health and Long Term Care (MOHLTC). The initiative aims to facilitate coordination of care at a local level for high needs patients. It comes in the wake of…
There are hidden costs of moving care out of hospitals
Connie’s story Connie is a Personal Support Worker (PSW) who cares for seniors and people with dementia in their homes. She is a graduate of George Brown College’s PSW program and has been working in home care for the last 10 years. She makes $16 per hour, but rarely gets paid for more than four…
Hospital crowding: despite strains, Ontario hospitals aren’t lobbying for more beds
Patients languishing on stretchers in hospital hallways, hospitals issuing capacity alerts when they can’t take more patients, tension in emergency departments as patients wait hours and even days to be admitted. That’s too often the reality in our hospitals. And, given the statistics, you’d think that hospital executives—especially in Ontario—would be pushing hard for more…
COPD outreach program pays dividends in reduced hospital costs, improved quality of life
Denise Nauss credits the in-home support that she received from a team of health professionals for prolonging the life of her beloved mother, Joyce Mason, by almost two years. Mason, who suffered from chronic obstructive pulmonary disease (COPD), died in Halifax this past May at age 73. COPD is a long term, progressive lung disease,…
Changes called for as 1% of population accounts for 1/3 of health care spending
Ontario’s Health and Long-term Care Minister is calling for a change in how health care costs are scrutinized in light of research showing that a tiny proportion of the Ontario population accounts for a very large proportion of health care expenditures. “We need to shift our focus” away from line-by-line scrutiny of hospital, drug and…
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,…
Can Canada pay less for generic drugs?
Generic drugs may seem cheap, at least in comparison to brand name drugs. But Canadians pay more for generic drugs than people who live in many other countries. Last summer, the premiers of several provinces announced that they would attempt to take advantage of competition between generic manufacturers to drive down prices. The generic manufacturers’…
Improving the appropriateness of diagnostic tests
The number of diagnostic imaging tests performed on Canadian patients has been increasing rapidly in recent years. Although the cost of each test is small, the aggregate costs add up quickly. The costs have become sufficiently large that both doctors and the government have raised questions about whether all the tests that are being performed…
Lower pay hampers nurse practitioner recruitment in primary care
Nurse practitioners are a key plank of government efforts to improve access to primary care. However, a continuing gap in pay and benefits for nurse practitioners who choose to work in primary care compared to those who work in hospitals, limits recruitment and retention to community settings. From a zippy online campaign to an economist-authored…
Perspective on payment negotiation for Ontario’s doctors
The Ontario Medical Association (OMA) and Ministry of Health and Long Term Care negotiate fee schedules on a four year basis. This year, the process has garnered a great deal of attention as negotiations broke down, and the Ministry of Health unilaterally imposed fee reductions in some areas. Understanding the history of bargaining between doctors…
Does more care mean better care?
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
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?
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…
Is Drummond realistic? The challenge of achieving zero increase in physician compensation
The Drummond Report recommended no increase in total compensation for Ontario’s doctors. A number of factors affect how much Ontario pays doctors including the number of doctors in practice, how many patients they see, and how much they are paid for each service. Achieving zero growth would require difficult decisions and trade-offs. The February 2012…
Ontario hospital funding: confusion for 2012/2013?
The Ontario Ministry of Health and Long-Term Care is changing the way it funds hospitals for the upcoming fiscal year, which starts on April 1. The new funding formula is intended to improve efficiency. However, many hospitals are unprepared for the change. We spoke with hospital executives and other experts to better understand what is…
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…
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…
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…
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…
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…
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…
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…
What is the federal government’s role in health care?
Polls suggest that health care is the most important issue to Canadians in the upcoming federal election. However, in Canada, health care delivery is largely the responsibility of the provinces and territories. The 2004 Health Accord invested $41 billion of federal dollars in health. What were the outcomes of this federal investment in health? History…