Canada's Crumbling Medicare System

[styky]

Morphine shortage painful for dying Calgary man

By Bill Kaufmann ,Calgary Sun

First posted: Monday, March 05, 2012 05:14 PM MST | Updated: Monday, March 05, 2012 05:21 PM MST
Dying from cancer, a Calgary man is wondering why he’s having to endure his final days facing a shortage of injectable pain-killer.

And Alberta Health Services said morphine’s not the only pain-reducing product in short supply in the province — epidurals commonly used to smooth childbirth are also on the list.

Curtis Ouellette and his wife Tara said they’ve been searching for a supply of injectable morphine after being told last week the supply from Quebec-based manufacturer Sandoz Canada was being squeezed.

“It came with very little warning ... I’ve got a week’s supply and then it’s gone,” said Ouellette, 41.

Alternative forms he’s been using don’t work as well and have resulted in some side effect issues, he added.

And Ouellette wonders why there wasn’t a better strategy to head off the shortage when the operations of the single source — Sandoz Canada — was disrupted when the U.S. Food and Drug Administration warned them their process wasn’t up to standard last November.

“They knew this could happen for years and nobody seemed to plan any kind of backup,” he said.

“Most fast food suppliers, when they know they can’t provide a certain pattie have an alternative set up.”

His wife, Tara, said her husband has been told he has a “limited prognosis” left and should be comfortable in what time he has left.

“These are people who deserve better — why is there only one supplier?” she said.

“Our homecare nurse is quite traumatized because she has to tell her clients about this.”

It could be at least another year before Sandoz is fully operational, said James Silvius, pharmacy medical director for Alberta Health Services.

“We’re banking on this not being a short-term thing,” said Silvius, adding epidurals are also in dwindling supply, though not yet at a critical shortage.

“If use continues at previous rates while the factory isn’t producing as much, the curve is going to converge.”

The AHS is still receiving drugs from Sandoz on a weekly basis that will prevent supplies from becoming critical, he said.

Corporate consolidation means fewer companies produce certain drugs, said Silvius, making Sandoz a sole source.

AHS is now developing contacts with out-of-country suppliers to ensure a proper stockpile of critical drugs, he added.

“A number of things have been done that are going to take a little time to put into place,” he said.
http://www.calgarysun.com/2012/03/05/mo ... algary-man

[Soulforger]

A huge step in fixing healthcare in Canada will be to take all the Pharma tech companies that exploit our system to court for compensation. For far too long we have allowed those companies to exploit our citizens with off label prescriptions like Gabapentin etc.

This is not the case in the USA and we should follow suit. The money won from these lawsuits should go to compensate both families of victims and our nation’s healthcare.

[styky]

A huge step in fixing healthcare in Canada will be to take all the Pharma tech companies that exploit our system to court for compensation. For far too long we have allowed those companies to exploit our citizens with off label prescriptions like Gabapentin etc.

This is not the case in the USA and we should follow suit. The money won from these lawsuits should go to compensate both families of victims and our nation’s healthcare.

It's tax time so I have my figures handy and this year I spent just shy of $4000. on meds. That's crazy.

[styky]

Coincidentally in the US news today......Drugmakers Have Paid $8 Billion in Fraud Fines http://www.usatoday.com/news/washington ... titialskip

[Shaktipat]

In Toronto my daughter has spent 5 months unsuccessfully trying to get a family doctor. All she could do is go and catch diseases at emergency for 6 hours waiting to see someone. I got my company to pay for her to go to a private clinic, and they had an appointment for her almost immediately. The good thing is that private alternatives are now available, and we don't have to put up with second-class citizen status any more. As more people like me take advantage of the new health care services, there should be less pressure on the socialist system.

[styky]

This doesn't surprise me in the least. After hubbies recent stay it was my observation that the Tim Horton's washroom cleaning staff could teach the hospital staff a thing or two about cleaning. What a filthy despicable place.


Halifax's hospital says birthing equipment wasn't sterilized


By Gabrielle Tieman, Postmedia News March 15, 2012

A children's hospital in Halifax is warning dozens of women who gave birth this month that equipment used during their delivery had not been properly sterilized.

The IWK Heath Centre issued a statement this week saying "birth-related equipment was cleaned, decontaminated but not sterilized prior to being sent to the birth unit."

Read more: http://www.canada.com/life/Halifax+hosp ... z1pKv7AlfS

[firefox007]

Hi, fellow conservatives!

This is my very first post, I just found this site by accident.

It is so great to finally see that I am not alone, in an ocean of Canadian socialists & Communists! A great feeling.

I look forward to be able to converse with so many intelligent, like-minded patriotic Canadians!

Thanks for this good site.

[styky]

WRHA defends Seven Oaks in wake of recent headlines
http://www.winnipegfreepress.com/breaki ... 00906.html
By: Larry Kusch

Posted: 03/23/2012 12:44 PM | Comments: 40 (including replies) | Last Modified: 03/23/2012 1:43 PM | Updates
Winnipeggers needing to visit a hospital emergency room should still feel comfortable about attending Seven Oaks, says the boss of the Winnipeg Regional Health Authority.

Arlene Wilgosh said the city’s second busiest ER provides "safe, quality care."


In recent weeks, the Seven Oaks General Hospital’s ER has been making headlines for all of the wrong reasons. The stories have included that of:

*A Winnipeg woman who launched a lawsuit against Dr. Werner Van Dyk, a Seven Oaks emergency doctor, alleging his misdiagnosis was responsible for the death of her 33-year-old sister two years ago. Read more on this story.
*68-year-old Heather Brenan, who died in late January when she was sent home from the hospital’s emergency ward alone in a taxi and collapsed on her doorstep. The WRHA has labelled her death a critical incident and is investigating. Read more on this story.
*68-year-old Steven Spence, who suffered a second stroke last Saturday within hours of being sent home from the hospital ER. He had his first stroke earlier that day. His family says the hospital should have monitored him for 24 hours. The WRHA is investigating the complaint. Read more on this story.

By one measure, Seven Oaks is one of the top-performing emergency rooms in the city, Wilgosh said in an interview. Next to Concordia Hospital, it has the second fewest number of patients requiring a follow-up visit to ER or admission to hospital, she said.

And it sees a lot of patients — 47,215 in 2011 — second only to the 54,525 seen at the emergency room at Health Sciences Centre.

The Seven Oaks ER is also known to be "fairly progressive in their processes," taking a "multidisciplinary team approach" to patient care, the WRHA president and CEO said.

However, Wilgosh said the WRHA is taking the recent incidents seriously.

"We’re reviewing our policies and our processes, our procedures," she said. "We’ve actually had meetings with the physicians and the staff in the emergency department. And we are encouraging them to err on the side of caution (when releasing patients)."

Wilgosh said the Seven Oaks ER is not understaffed.

She has not ordered an overall review of the hospital’s emergency department. Instead, she will await the results of reviews of the Brenan and Spence cases.

"If there is something that comes forward in those specific cases that speaks to the need to do a more formal review of the entire department, then that is something that we will consider at that point," she said
http://www.winnipegfreepress.com/breaki ... 00906.html

[T.G.]

http://news.ca.msn.com/top-stories/mark ... or-problem

By CBC News, cbc.ca, Updated: March-23-12 12:42 AM
Marketplace finds poor hospital cleaning a major problem

The health of hospitalized Canadians and their visitors is being seriously put at risk by hospitals that have cut corners in cleaning budgets to save money, a Marketplace investigation has revealed.
The program took hidden cameras inside 11 hospitals in Ontario and British Columbia. What they found in many of them were surprisingly inadequate cleaning regimens – in short, dirty hospitals that could make you sick.
In many hospitals, Marketplace staffers applied a harmless gel to places that many people would touch – hand rails, door handles, light switches, elevator buttons.
The gel glows when seen under an ultra-violet light. But most of the time – and this was true in every hospital where Marketplace carried out gel tests – the gel was still there more than 24 hours later, meaning the surfaces had not been cleaned at all.
The program talked to cleaners, supervisors, nurses, doctors, and hospital administrators to get a handle on what has become a major problem at Canadian health-care facilities – a shocking number of hospital-acquired infections.
While Canadians love to crow about their first-rate health-care system, it also leads in one area that doesn't get the same glowing reviews.
About 250,000 Canadians come down with life-threatening infections while in hospitals every year. That’s the highest rate in the developed world. As many as 12,000 people a year die.
Denise Ball's husband Gary became one of those statistics last year.
He was admitted to Niagara General Hospital for treatment of pancreatitis. While there, the 63-year-old retired school teacher contracted C. difficile – a life-threatening superbug that is all too common in Canadian hospitals. It ended up playing a role in his death a few months later.
Denise Ball remembers the cleaning regimen in her husband's room was less than adequate, saying the cleaners would spend only 10 minutes on a room everyone knew was infected with C. difficile. She says a proper cleaning would have taken much longer.
"This has to stop," she says. "This is Canada."
More with less
Time and again, hospital insiders told Marketplace that cleaners were being asked to do more with less. "We used to have one person to one wing of a hospital to clean," one cleaner said. "Now, we have three floors to clean."
A cleaning supervisor at one hospital told Marketplace host Erica Johnson that it's "common practice" for cleaners not to change the cleaning solution in the bucket when mopping up. "They just don't have the time," the supervisor said.
Sometimes there aren't enough cleaning supplies. A nurse, whose identity Marketplace protected, said she's seen a cleaner mopping common areas after having mopped the rooms of infected patients because she didn't have enough mops to change. "She's just cross-contaminated the whole area, so there's no area that was actually clean."
Sometimes, only one cleaner would be on staff in an entire hospital during night shifts. "That kind of day-night difference is very common, and it makes no sense," says Dr. Michael Gardam, an infectious disease expert at the University Health Network in Toronto.
Gardam has seen enough in his time looking at hospital cleaning practices to know that some hospitals are worse than others – much worse. "Some hospitals are a real freaking disaster," he told Marketplace."They've been told to actually cut their number of housekeeping staff by outside auditors who are trying to help them balance their budgets."
In recent years, many hospitals have cut the portion of their budget that is devoted to cleaning. Sometimes, they've done that by contracting out cleaners or their management.
C. difficile outbreaks common
It's not like we haven't seen the devastating results of hospital-acquired illness. Newscasts and newspapers have been filled with stories of hospitals under quarantine because of C. difficile outbreaks. In the last decade, outbreaks have hit hospitals in most provinces. A huge outbreak in 2003 and 2004 led to as many as 2,000 deaths in Quebec.
Last year, there were outbreaks in at least 10 hospitals across Ontario alone. One of the worst was the Niagara Health System in Ontario. More than 100 cases were diagnosed and the infection was a factor in the deaths of 37 patients, including Gary Ball, the patient mentioned earlier in the story.
The man appointed by the Ontario government to get the Niagara outbreaks under control, Dr. Kevin Smith, denies that hospitals have been cutting back on cleaning. "I think they're experimenting with new models of cleaning," he says.
When informed that workers in the Niagara hospital system told Marketplace that they still don't have the time or resources to do an adequate cleaning job, he says, "I haven't heard that message," saying "everybody" feels rushed in health care these days.
The outbreaks are officially over in the Niagara Health System. But when Marketplace showed Smith several areas where researchers had applied test gel in three hospitals he supervises, most of the surfaces showed no evidence of cleaning. The ultra-violet light showed uncleaned hand rails outside an isolation room, uncleaned support rails in a public washroom and uncleaned hand rails in a ward with highly contagious patients.
"I'm obviously very disappointed to see that. That is a less than optimal cleaning opportunity. We need to fix it," Smith said.
There's something else that some observers think is helping to drive the pressure to skimp on cleaning. In Ontario and British Columbia, for example, hospitals are given bonuses for turning over beds quickly – hundreds of extra dollars each time a hospital gets a patient out of a room before a certain time. More money is dangled for quickly transferring a patient from the emergency ward to a room. Hospital CEOs, already well-paid, receive bonuses that depend, in part, on reducing wait times.
While the goal of such rewards may be admirable, critics say the actual effect has been to speed up cleaning to an unhealthy degree.
"They just don't get it," says Denise Ball. "And maybe until one of their loved ones that went in healthy and … a few months later ... they're going to their grave. Maybe that's what will wake them up."

[styky]

How could this be possible that is unless that what you're saying is that "all" Canadians are not treated equally and the poor have different treatment than the well to do? Is that what they're saying?



Toronto doctor worries budget cuts will affect poor patients the most
‎
Toronto Star -
Niamh Scallan Staff Reporter Related Public servants hit with wage freeze Critics call for more jobs, less spending VIDEO: Ontario budget: What does it all ... linked thru google

[T.G.]

http://www.therecord.com/news/local/art ... ency-staff

• Johanna Weidner, Record staff
• Fri Mar 30 2012
Hospitals investigate ‘inappropriate’ video by emergency staff

KITCHENER — Kitchener’s two hospitals are investigating a video made by local emergency department staff that parodies patients and was filmed in Grand River Hospital without permission.
“It did not happen with hospital knowledge and we’re very concerned about it,” said Grand River spokesperson Mark Karjaluoto. “It just clearly does not reflect how we see the care we provide to patients at the hospital.”
The video was made for the annual Tri-City Emergency Medicine Conference, an independent event run by staff at Grand River, St. Mary’s General Hospital, Cambridge Memorial Hospital and Guelph General Hospital for people practising in the field of emergency medicine. This year’s event was held in Waterloo on Wednesday, although the video causing concern was created for a previous conference.
The Record was alerted to the video by a Grand River employee Thursday morning. Shortly after the hospitals were contacted, the video was removed from YouTube by the user. Later the entire conference website disappeared.
The video features doctors, nurses, other hospital staff, ambulances, paramedics and hospital security inside and outside Grand River.
Staff dressed in costumes portray emergency room patients, who are identified by captions such as “drug seeker,” “promiscuous girl” and “constipated old lady.” The elderly woman is shown behaving erratically with her underwear around her ankles.
Other characters depicted include “I need a drive to the liquor store,” “Ready to stay at the ER hotel,” “3 a.m. rash” and “I was here first” woman complaining about the wait. There are numerous mentions about rectal foreign bodies, including an X-ray image showing a bottle in a person’s torso, as well as sexual references.
Grand River was not aware of the video until a woman called officials to complain on Thursday morning. Karjaluoto alerted the region’s other hospitals and Grand River officials, then looked into removing the video from the internet.
“Someone brought us a complaint, a legitimate complaint, about the content of the video, which we agree was inappropriate,” he said.
St. Mary’s also expressed concern about the video after learning about it Thursday. It’s being investigated by the chief of staff’s office to determine if any of the behaviour in the video is contrary to its codes.
Hospital president Don Shilton said in a written statement: “St. Mary’s in no way condones this video and finds it to be contrary to our mission and values. None of the footage was shot at St. Mary’s and none of our staff was involved. This production does not reflect the behaviour we expect of our people.”
Cambridge Memorial did not want to comment until they looked further into the matter.
Disciplinary measures may be considered as Grand River’s investigation continues, Karjaluoto said.
Conference organizers said the video was intended only for those interested in the conference and not to be posted online for the public to see.
“I can understand how certain elements of the video could offend, but it wasn’t our intent,” said Dr. Adam Shecter, an emergency room doctor at Grand River.
Videos were posted on the conference website, but Shecter said the committee was not aware the person managing the site also put them on YouTube.
Another video called “Beat It,” also shot in the hospital, imitated a Michael Jackson music video. In this case, the choreographed dance video depicts a rivalry between staff from the operating room and emergency department.
“The videos themselves really aren’t meant to portray how we actually see patients,” said Dr. Inderpal Saluja, another conference organizer and Grand River emergency physician.
The doctors said the videos, created by the committee, were started years ago as a lighthearted look at emergency care in order to bring humour to the conference and build camaraderie among staff during the filming.
Staff members in the videos were not on work time and shooting was confined to off-hours in areas where there were no patients, they said. Some scenes were shot outside the hospital.
“We didn’t want to interfere with patient care or inadvertently disrupt anything,” Shecter said.
He said they will reconsider the context of videos in the future and be careful about how they’re shown and distributed.
“We realize now someone was offended and we feel bad about that, but it certainly wasn’t our intent,” Shecter said.
The woman who contacted The Record, and did not want to be named because she was a hospital employee, called the video offensive to patients and embarrassing to all hospital staff because it’s unacceptable for health-care professionals to act that way. She said people will think twice about going to the hospital for treatment out of fear they’ll be made fun of or mocked by staff.

http://www.therecord.com/opinion/column ... ital-video

• Luisa D’Amato
• Fri Mar 30 2012
D'Amato: Not much funny about contemptuous hospital video
By Luisa D'Amato

Kitchener’s two hospitals are investigating a video made by local emergency department staff that parodies...
Next time I fall down the stairs, I think I’ll just stay home and bleed to death.
After all, why would anyone go into an emergency room at a local hospital, knowing the contempt that some emergency doctors and nurses have for their patients?
Local medical professionals produced what they’re calling a “lighthearted” video for the annual Tri-City Emergency Medicine Conference. The video was part of the 2010 conference, but has only now come to light.
Hospital officials called this video “inappropriate.” I thought it was repulsive in its sexism, its racism and in the way it callously sneered at people who go to hospital for help. The video had been posted on the conference’s website and also on YouTube. It has since been removed, but I saw a copy of it.
In one segment, called “Promiscuous Girl,” a woman says “I fell on it,” and then an X-ray shows a bottle rammed into a pelvis. Is that supposed to be funny?
In another, a doctor advertises his “Rectal Foreign Body Clinic” in a newspaper ad with the slogan: “If it’s up your crack, we’ll get it back.”
He pulls out a feather duster from between a patient’s legs and gives it an appreciative sniff.
And a janitor spills something on the floor and calls out: “Code Brown.” Three South Asian hospital workers come running to his aid. “That’s not exactly what I meant,” says the janitor, looking sheepish.
There are scenes entitled “911 — I need a Drive to the Liquor Store” and “911- Erectile Dysfunction.” And “Constipated Old Lady” is, of course, an object of disgust and ridicule.
I’m sure that working in an emergency room is stressful, and we all know that humour is a good way to relieve stress. But we also know that jokes often hide a kernel of truth and can disguise a core of hostility. Is this really what doctors and nurses think of the rest of us?
Two of the doctors who organized the conference said they were sorry that people were offended, and they hadn’t meant it to be posted online. That shows a surprising naïvete about the lack of privacy on the internet. And it also misses the point.
People are at their most vulnerable when they’re in emergency rooms. They’re either badly injured or very ill. They might have a baby screaming in pain and not know what’s wrong. They wait for hours, often frightened and disoriented, completely at the mercy of the men and women in green uniforms who decide when they get seen and what will happen next.
They deserve all the kindness, sympathy and professional concern that the medical profession can muster — not this mean-spirited, failed attempt at comedy.
I hope the people who participated in the video remember the Hippocratic Oath, which guides the principles of modern medicine. Within it is a promise to “never do harm to anyone.”

[styky]

Website rates treatment record for Canadian hospitals


By Sharon Kirkey, Postmedia News April 4, 2012 1:28 PM

For the first time, Canadians across the country will have an online tool to help them figure out which hospitals have stronger track records for treatment after major surgery, heart attack or stroke.

A new interactive website produced by the Canadian Institute of Health Information will allow patients to compare how their local hospitals are performing on different measures of patient care. These include in-hospital death rates after major surgery, acute heart attack and stroke; re-admissions following hip or knee replacement; and even the incidence of bed sores, falls and other "nursing-sensitive adverse events."

The web-based tool — the first of its kind in Canada — covers more than 600 acute care hospitals across the country and four years worth of data, and while the results show that hospitals nationwide are reporting fewer deaths after major surgery, heart attack and stroke than in 2007, and fewer re-admissions, their performance varies widely.

For example, among large community hospitals, mortality rates within five days of major surgery ranged from 2.2 per 1,000 at Winnipeg's Concordia Hospital to 16.5 per 1,000 at the University Hospital of Northern B.C. in Prince George — an almost eight-fold difference.

The national overall re-admission rate — which measures the rate of unplanned re-admission within 30 days after discharge — ranged from one per cent to 18.5 per cent. The national average was 8.4 per cent.

This is the first time this level of information is being made available to Canadians — a move CIHI says "increases the accountability and transparency of the health-care system, full stop," said Kira Leeb, director of health system performance.

Canada's health system is taxpayer-funded, "and it's important that Canadians know the information and know what care is being provided," she said.

"There are better performers and poorer performers . . . and that's something hospitals are going to have to grapple with."

CIHI says it intentionally avoided ranking hospitals, which would be "blaming and shaming" but not helping hospitals improve, Leeb said.

"But if I knew I was going in for a hip or knee replacement, and I knew which hospital I was going to go to, I could look up and see what the readmission rates were, or if I was going to have a baby and wanted to know what the caesarean-section rates were, those are all important things for me to know," Leeb said.

The report covers teaching hospitals to small community ones. Hospitals were assigned to "peer" groups so that large hospitals could be compared with large ones and small ones with small.

"Almost 60 per cent of hospitals in Canada are smaller facilities, and up until now there has been minimal information available to them about how they are performing in relation to their peers," said Cecile Hunt, CEO of Prince Albert Parkland Health Region in Saskatchewan.

Overall, the website reports on 21 different clinical "indicators" covering access to care, appropriateness, effectiveness and patient safety. In addition to death and re-admission rates, the data includes rates of in-hospital hip fractures in the elderly, the use of angioplasty after a heart attack, vaginal births after C-sections and hip fracture surgery performed within 48 hours.

The site features a map screen of the country; users can select an "indicator" (for example, the 30-day in-hospital mortality following a heart attack) and then drill down to individual hospitals. A ticker tape or roller provides all the risk-adjusted rates for that particular hospital, as well as the national and provincial averages.

Overall, no one hospital performed consistently above average on all measures of patient care. Cases were adjusted for age, gender, underlying health conditions, resources available to the hospital and other factors. The goal was to make them as comparable as possible.

According to the latest data from the Canadian Hospital Reporting Project:
The average national five-day death rate following major surgery was 9.26 per 1,000 in 2010-2011.
7.6 per cent of patients who suffer an acute heart attack die in hospital within 30 days. That captures death from any cause, and not just heart attacks. Four hospitals had mortality rates following heart attack that were significantly below the Canadian average: Saskatoon's Royal University Hospital; Rockyview General Hospital in Calgary; Thunder Bay Regional Health Sciences Centre; and Valley Regional Hospital in Nova Scotia.
About 15 per cent of patients die within 30 days of suffering a stroke; in-hospital mortality following stroke has fallen 15 per cent over the past four years.
About 10 per cent of heart attack patients are re-admitted within 28 days of being discharged from hospital; about seven per cent of stroke patients are re-admitted. Re-admission rates after heart attack have fallen 11 per cent over the past four years.
About three per cent of patients are re-admitted to hospital following hip or knee replacement.
Despite efforts to lower it, the national C-section rate is holding steady (26.8 per cent in 2007-2008 and 26.9 per cent in 2010-2011).
Overall, Ontario and Quebec had lower re-admission rates for all patient groups and Saskatchewan higher.
It costs, on average, about $5,000 to treat an acute care patient, regardless of hospital size.
In 2010, most hospitals within the same regions had death rates following a heart attack similar to the Canadian average. One exception was the regional rate for Edmonton-area hospitals, where the rate was significantly lower.
Smaller proportions of hospital budgets are being spent on administrative costs. Ontario had the highest administrative costs as a percentage of total costs (5.9 per cent) and Alberta the lowest (3.5 per cent).

While stroke care is generally improving, among teaching hospitals there was up to a three-fold difference in re-admission rates following stroke.

The type — and severity — of stroke strongly influences death from stroke, said Dr. Moira Kapral, an associate professor of medicine at the University of Toronto.

People with a hemorrhagic stoke, or a bleed into the brain, can have more severe strokes, and worse outcomes, than those who suffer an ischemic stroke — strokes caused by a blood clot in a vessel in the brain.

But patients who receive high-quality stroke care — rapid access to brain scans and drugs that break up clots to reduce brain damage — "in theory, should have better outcomes," Kapral said. Ontario, she said, has seen "dramatic" improvements in stroke care, with more hospitals having specialized stroke units or providing clot-busting drugs.

The CIHI website doesn't cover rates of hospital-acquired infections such as C. difficile.

Winnipeg's Concordia Hospital, which saw the lowest five-day in-hospital death rate after major surgery, is a centre of excellence for orthopedic surgery. A significant proportion of all major surgery done at the hospital is related to hips and knees.

"I think there's plenty of scientific evidence that if you concentrate high volumes of particular types of procedures into one centre, you get lower mortality and you get better outcomes," said Dr. Michael Moffatt, executive director for research and applied learning at the Winnipeg Regional Health Authority.

"In some ways it's the Cadillac orthopedic centre of our region. What they do, they do very well," Moffatt said.

Read more: http://www.canada.com/health/Website+ra ... z1r7D9J7JV

[styky]

Paying our hospitals: Let’s get it right
http://www.torontosun.com/2012/04/05/pa ... t-it-right
Colin Busby, Guest Columnist

First posted: Thursday, April 05, 2012 08:25 PM EDT | Updated: Thursday, April 05, 2012 08:28 PM EDT

The Ontario government recently announced plans to radically change the way it pays hospitals. The plan is to gradually move from a system of lump-sum budgets to a system that pays hospitals according to patient needs.

Change is overdue: Most advanced countries have already developed consumer-driven payment models for more timely patient care. But Ontario’s hospital payment plan must get the incentives right to encourage innovation, maintain quality and curb the growth in health costs.

Hospitals were paid roughly $17.6 billion, or 36% of the overall public health budget, by the province of Ontario in 2011. That’s by far the largest slice of the health care pie, making hospitals an obvious target for improved healthcare efficiency.

Ontario has traditionally paid hospitals a lump-sum annual payment based upon past budgets, regardless of the volume, mix and costs of services that the hospital actually provides. Under this system, hospitals have no financial incentive to take on more patients, to deliver fast and efficient care, or discharge patients quickly.

Instead, under a patient-based funding model, hospitals are paid according to patients’ health needs. This creates incentives that encourage hospitals to take on more patients and compete for patients with nearby hospitals. Citizens would become choosing customers, not simply patients, in the health system.

Over time, Ontario is planning to reduce the lump-sum budget share of hospital pay from 100% to around 30%, with the remaining 70% dependent upon the services provided to patients. Patient-based payments will increase with the complexity of patient illnesses treated, and hospitals will be paid fixed fees for the number of patients they treat for selected procedures, such as hip and knee replacements.

These are welcome changes, but they face some challenges.

A payment mechanism based on the number of patients treated should produce a more efficient pattern in hospital care: some hospitals would treat only patients with uncomplicated problems, while complex problems would be treated in a small number of specialized institutions.

Some hospitals, however, may fail to respond to the new payment model. In such cases, they must be allowed to struggle with the new financial realities, without the support of government.

Under the proposed reforms, it is not clear if hospitals would keep the increased revenues from efficiency gains and reinvest these funds as they wish. If hospitals are not free to decide how to spend new revenues, the benefits of the new plan would be watered down.

Another criticism is that hospitals would have the incentive to overcharge. “Upcoding” patients would enable hospitals to characterize patient needs as being more dire than they are, and hence more financially valuable — to the hospital — to treat. This means that excessive patient-based funding, coupled with a rising volume of services, can result in the government losing control of the overall health budget.

What about the quality of care?

International evidence shows that for many illnesses, the expected outcomes are generally better in hospitals that treat a large number of patients with similar conditions. There are a few examples of quality deterioration, though this problem could be mitigated with patient monitoring after hospital treatment.

The reform has been a long time coming. In a better world, the province might, years ago, have started test runs in selected hospitals to learn what works and how to get the incentives right. The shift, however, shows change is possible.

— Busby is a Senior Policy Analyst at the C.D. Howe Institute in Toronto

[styky]

Marni Soupcoff: The government screws up everything — even paying for poor people’s prescription drugs

Marni Soupcoff Apr 6, 2012 – 9:35 AM ET | Last Updated: Apr 5, 2012 4:45 PM ET


Looking for one more reason to be wary about pursuing a national pharmacare plan, anyone? It’s right here in a freshly released annual Fraser Institute study about Canadians’ access to new medicines.

In Access Delayed, Access Denied 2012: Waiting for New Medicines in Canada, Mark Rovere and Brett J. Skinner found that “on average, only 23% of the new drugs approved by Health Canada each year from 2004-2010 were eventually covered by provincial public drug programs as of January 1, 2012.”

Yet, as of the same date, private-sector drug insurance programs had “provided reimbursement for 84% of new drugs approved by Health Canada from 2004 to 2010.”

And the private plans were quicker to cover the drugs than the public plans to boot.

As a result of these observations, Rovere and Skinner make the sensible suggestion that the provinces replace “existing public drug programs with a means-tested subsidy for people with catastrophic drug costs relative to income, which can be used to purchase a drug insurance plan of their choice in a competitive private market.”

In other words, give people who can’t afford private insurance a pharma-voucher to be used with any insurer they like, rather than relegating them to the slower and significantly spottier coverage inherit in a public system. Bonus: Provinces could dismantle the bureaucratic apparatuses necessary to keep the inefficient public plans going.

The good news is that at present there is an efficient private market in which Canadians can take refuge — and receive reasonable coverage of the prescription drugs they need. If we move to a national pharmacare plan, there will be no nowhere to turn when we find that less than a quarter of the drugs out there are being covered as long as two to eight years after their regulatory approval.

Want to maximize Canadians’ drug coverage? Maintain and make use of private drug plan competition.
http://fullcomment.nationalpost.com/201 ... um=twitter

[styky]

The elderly among us sometimes face a merciless health care system
Posted on April 4, 2012
http://lifestyles55.net/2012/04/04/the- ... re-system/

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Let’s review for a moment, though, a few of the disturbing stories we’ve been hearing about abuse of the elderly in hospitals and patient care facilities:

It will be the end of April before we get what should be the full story on the death of Anne Rostecki, 98, in Seven Oaks General Hospital on Aug.31, 2009. Rostecki had suffered a severe stroke 45 days earlier and, notably, her family was warned on her arrival at the hospital that she was certain to have a second stroke and it would kill her.

What followed was a series of shockers: unbeknownst to her daughter, Rostecki was given no food for the next 15 days, not even through a feeding tube; she was not bathed for 36 days after being admitted to her fifth floor hospital ward; when tube feeding was at last launched, Rostecki was left lying flat on her bed, despite requirements that the bed be elevated to 35 degrees to allow the food to go down. She developed black sores on her tailbone and blackened skin – one of many problems not reported to her family.
Her daughter Rozalynde suspects a second stroke killed her.

Lillian Peck, 93, was living at the Sharon Home’s Saul and Claribel Simken Centre in October, 2010, when her skin became infected by her own feces and later ruptured. A health department report noted the nursing home had no documentation on the basic nursing care or assessment and treatment she received, and that neither she nor her daughter, Marsha Palansky, knew about the wound. The staff weren’t sure how to treat it.

When Peck’s health deteriorated, she was transferred to a hospital, where staff put out an alarm. “The skin was black,” her daughter later reported. “One of the doctors thought she might have a flesh-eating disease.” She died from renal and heart failure two days after arriving in the hospital.

Heather Brenan, 69, had been sick for a month and unable to swallow, and for the last four days had been in Seven Oaks Hospital waiting for tests. She was sent to Victoria General Hospital Jan. 27 for a gastropscopy but doctors, finding her too weak to undergo the tests, returned her to Seven Oaks to get her strength up.

That same night, at 11 p.m., Seven Oaks discharged her, leaving a phone message for a friend that said she was being sent home in a cab. The friend got to Heather’s home first, just ahead of the taxi and just in time to see Brennan collapse on her doorstep. Paramedics returned her to Seven Oaks, where she died the next day.