If you could design a health care system from the bottom up, odds are that you would create one that would focus on the comprehensive health care needs of all citizens, from disease prevention to chronic disease management to palliative care. Innovation would be rewarded. There would be fewer hospital and long-term care beds and …
Five years ago, researchers in Ontario raised concerns about access and quality in privately owned clinics that performed colonoscopy, suggesting that the quality in these clinics was significantly below the standard of care in public hospitals. Privately owned clinics can be either for-profit or not-for-profit. Medical services provided at these private clinics are paid for …
Primary care is the foundation of Ontario’s health care system and more than 137,000 patient care visits are made every day to primary care providers – family physicians, general practitioners and nurse practitioners – in the province. However the quality of care that patients receive in primary care is largely unknown. Even primary care providers …
If you came here from another country and opened a newspaper, you might well come to the conclusion that Ontario’s health care system is falling apart. It seems that every day there is a headline about a scandal in one part of the health care system or another. An Auditor General’s report is released criticizing …
Over the last year, reports have suggested some of Ontario’s new primary care models, which are significantly more expensive than older practice models, have had limited success in improving access and quality. In response, the Ministry of Health and Long Term Care is conducting a review of these models, and had recently instituted a temporary …
This past spring, I was sitting in a reception area at the Scottish Ministry of Health. On the wall next to me was a poster on which the indicators by which the Ministry was going to be judged were clearly outlined. I was so surprised that I literally got up from my chair to get …
Last week, the family that owns Shouldice Hospital announced that it would like to sell its facility to Centric Health, a for-profit company traded on the Toronto Stock Exchange. Shouldice, a facility renowned for its care of patients with hernias, was founded by a surgeon in the 1940s and allowed to continue as a private …
An interesting story came across my desk recently. Apparently, some states in the U.S. have moved towards a punitive model in trying deal with medical errors and adverse outcomes – this particular story describes how Utah will no longer fund healthcare providers and hospitals for dealing with illnesses that resulted from avoidable errors and infections. On …
Recently, I had the experience of sitting with a family member who had undergone surgery in a large academic health sciences centre. The staff and the care were excellent. However, I couldn’t help but notice the nearly relentless quest of staff searching for supplies and equipment. Supply carts were everywhere – lined up in hallways, …
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 …
Although there is lots of talk about making measures of health system performance available to the public, the reality often falls short of the aspirations. Not only are these measures often difficult for public users to understand and access; evidence suggests that they have little impact. In April of this year, the Canadian Institutes of Health …
Recent media reports have highlighted the problem of neglect in nursing homes. Reports from the long-term care sector, in response, have focused on how the quality of care in nursing homes could be improved. However, measuring the quality of nursing home care can be a challenge. Rob Sargeant is a general internist at St. Michael’s …
There’s been a seismic shift in health policy taking place in Canada that has been largely ignored by the mainstream media and gone unnoticed by the general public. Provinces are starting to change the way they fund hospitals. This is no small change and will directly affect the care patients receive — potentially improving access …
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 …
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 …
No one speaks of health care at the moment without talking about quality – better quality, quality measures, pay for performance, quality metrics, publication of quality data, accreditation – the list goes on and on. But, what do we mean by quality? It is my observation that we are running into problems in the discussion …
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 …
The statistics are well known: 7-10% of hospitalizations include at least one “adverse event”, a broad definition including a variety of mishaps ranging in impact from the relatively benign to a lethal outcome. Health care systems have been late adopters of proactive policies in the area of patient safety. This delay can be partly attributed …
In the last decade, efforts to improve access to primary care in Ontario have led to major changes to how family doctors practice and are paid. A recent report suggests that these newer models of primary care are not meeting the needs of vulnerable populations, and that Community Health Centres (an older model of care) do …
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 …