Kishore VisvanathanIt must be a tough time to be an American astronaut. Since the US Space Shuttle program shut down a year ago, their opportunities for spaceflight are limited to hitching a ride with the Russians. It must be incredibly frustrating. Consider the years of training, childhood dreams, and self-sacrifice – all for naught. That …
Recently I had a discussion with some physician colleagues about the Ontario Medical Association (OMA) campaign and specifically the principle of communicating non-neutral, political information to our patients. The campaign to which I am referring is that seeking to solicit the support of Ontario patients for physicians who are trying to get the government back …
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 …
There are three options when a service or product costs more or is perceived to cost more than it should – agree to pay more, find a similar product for lesser cost, or refuse to purchase. All of these options are valid in health care, including the last one – with funders deciding that some …
Here’s a startling but true story. In 2008, the Ontario Ministry of Health and Long-Term Care paid about 10 million dollars for 13 million blood sugar test strips. They were used by 49,000 Ontarians aged 65 or older who had diabetes. What’s so startling about that? The people who used the strips were not receiving …
The fiscal health of the province should not be cured by detrimental changes to the health of Ontarians. The rhetoric of rising health care costs and a population aging ‘crisis’ are a means by government, health service providers, and even the consumer to obscure reality. The main crisis facing Ontario is a debt crisis. The …
When I present my research, a question I often get asked is “When will Canada support the pharmaceutical industry?” What do they mean? With sales of $41.3 billion in 2009 and net revenues of $1.3 billion, the industry would in all accounts appear healthy. Furthermore, employment in the pharmaceutical industry has increased by 12% in …
If I harm a pt by making poor surgical decision for which evid was available to guide me;there is recourse. How is gov’t different? #onpoli — Dr. Shady Ashamalla (@AshamallaMD) June 1, 2012 Evidence-based policy. For those of us in the healthcare field, it resonates as an ideal. What better way to allocate resources than …
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 …
If I were a respirologist, I would receive many referrals from family doctors asking me to determine whether patients with shortness of breath have asthma or chronic obstructive pulmonary disease. I would take a history from each patient and conduct a physical examination. Depending on the situation, I might occasionally order some blood tests or …
It looks like much of the next decade or so will be taken up with managing record levels of government and household debt and spending. With an aging population requiring health care how are we going to continue to pay for necessary health services that we want and need? Thankfully, advances in telecommunications and computer …
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 …
We struggle in health care now as much with the system as we do with patient care. Fiscal pressures, mounting demands for treatment, new innovative treatments – all form an ever increasing set of expectations of and by patients, funders, and providers alike. We are being challenged to be more productive. To do more with …
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 …
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 …
In an old episode of the Simpsons, Homer walks into a car lot and announces how much money he has to spend. After, a highly gratified dealer quickly inverts a 6 into a 9, a deal is made and off Homer goes to face further mishaps. This scene clearly illustrates how a consumer will always …
I applaud Helen Walsh for her recent post about walking away from yet more invasive testing. Her post made me reflect on recent cases of medical expense from my own practice. Patient details have been altered to protect their identities. One patient has an annoying condition that gives him pain with some activities, related to …
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 …
This year I did not achieve Elite status on Air Canada/Aeroplan. For the first time in a decade, I am without status on a major airline. No number to call, no priority service, no lounge. I will probably have to wait in line. As you probably know, Aeroplan has Prestige, Elite, and Super Elite levels …
I’m not an expert on health care in Ontario – I still live in Alberta – but from afar the health chapter of the Drummond Report looks good. I think they got the diagnosis right! The health care system isn’t a system, there are inefficiencies, and the system needs to be reoriented. The prescription is …