Reneging on Contracts in New Brunswick
New provincial health ministers are popping up across the country including in New Brunswick, and Nova Scotia and British Columbia but in Ontario, we're hanging on to David Caplan for a while longer at least.
Why the changing of the guard in other provinces?
Clearly, the provinical health portfolio is a toughy and not for the faint of heart. The complexities of the health care system are vast and attempting to solve one problem undoubtedly ends up with others springing up like bad weeds. There are just so many groups that are accustomed to having their usual share of the pie that creating any kind of unknown such as more options for self-pay just seem to shake the foundations of their existence. This is unfortunate since we do need to boldly go where others have gone already but perhaps with a slight Canadian twist.
Looking at the push for the US to spend over a trillion dollars in the next 10 years on developing a more universal system, the billions we spend here in Canada seem relatively less significant. But careful with this thinking because as a much less populated country with a potentially shrinking tax base we are heading for much more difficult times. This is my way of saying "you ain't seen nothin' yet".
This is quite possibly why we will see provincial health ministers changed on the fly....except in Ontario where we apparently like to keep them around for as long as we can. It helps deflect blame from those at the real helm and changing too quickly could create the appearance of indecision I suppose. But government really has no solutions anyway in my opinion, so maybe it really doesn't matter who gets made the scapegoat in the end as long as somebody takes the fall.
Mary Schryer has taken over from Michael Murphy and she will have her hands full trying to patch up the mess that has been created by the government"s unwillingness to honor its deal with physicians there. The New Brunswick Medical Society has threatened to take the Government to court over its refusal to follow through with the negotiated contract.
Her background is as a financial planner and director on the board for the Atlantic Health Sciences Corporation. Sure will be interesting to see if the docs let the government off the hook or if the new Minister can manage to smooth things over. It will be a dangerous precedent if negotiations in good faith stand for nothing.
In Nova Scotia, Maureen McDonald takes on the Health portfolio....a former social work professor at Dalhousie. Evidently, governments shy away from having physicians as health ministers...better to let every other group have a stab at it. Has a physician ever been a Health Minister in Canada? Don't think so.
And last but not least, BC's Kevin Falcon steps into the fire and hits the ground running even if it is with his foot in his mouth. Comments he made about private care have quickly been "clarified" and he speaks of the need for innovation in health care......I hope this doesn't mean just switching to superboards with multi-million dollar deficits as in Alberta....because I have a secret for you: this isn't a solution.
The more things change the more they stay the same and nobody, well almost nobody, has the guts to tell the public that they must have a greater part in making sure we have a strong public health care system which includes allowing more options for self-pay.
Merrilee Fullerton
64 Comments
Reader Comments (64)
http://www.nationalpost.com/related/topics/story.html?id=1734552
This is not about health care, this is about health costs and who controls the pot.
The plan is good
Well....wrong about Turnbull being next after Ouellette....Anne Doig is next and Turnbull may be challenged from the floor....
Saying Turnbull is next is wrong and presumptuous.
http://healthcare-economist.com/2009/06/22/healthcare-economist-manifesto/
http://www.cmaj.ca/cgi/content/full/180/12/1185
This is so very true. While working in rural Ontario I must have been part of a half dozen pilot projects all of which seemed like very good ideas and most showed improved outcomes and/or reduced costs. That was about ten years ago and none of these programs ever found their way into the mainstream. What this approach really does is to create cynical physicians and one clinic now flatly refuses to be part of any further pilot projects. The docs who put inordinate amounts of their unpaid time and goodwill into these projects often feel used and abused when the positive pilots end up on the shelf year after year.
Health Care Options Medical Services Directory
"The Government of Ontario makes no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the website or the information on any services contained on the website for any purpose."
Well we are here all summer even though the session is over. EHealth has really affected things. Additionally, more bunkers are being staffed by opposition parties which are tracing the exposures from eHealth deep through the government. The seamy underside got leaked and they are out for victory. Buerocrats within the MOHLTC are spilling their guts.
EHealth will heat up some more but worse are the other areas that are being finally documented. They will be held until nearer the election. The upcoming election is going to be nasty. Lots of really good dirt on the Liberals (and it will be on the liberals because they have had the "power"), and the Cons have an experienced leader. Of course, federal politics will cloud all this, but most now believe it's a good chance for a conservative majority in Ontario. Change of course will be tempered by how much money the Liberals can throw around before, and that's not looking good as the recession is stretching out now to 2012.
Interesting in health that new arguments are circlulating on the ideological side. With eHealth, it's has become clear that the argument for "public" versus "private" is being hurt. Public apparently now just means you get control of the public purse to fund publicly accessible care, so that those in charge of the public purse can, behind the scenes, assure that the public money can be privately distributed to one's friends.
Hopsitals, CCACs, etc get their public money and public control of service, and then establish monopolies that then can charge extra because there is no allowed competition - applies to parking fees, MRIs, CAT scan, lab tests, and in patient services. So we now have established that "public" care in Ontario is merely a way of establishing monopoly that can then charge as much as the want for 'ancillary services". Interesting change is starting that those ideologues who claim "public" good - "private" bad are being looked at more and more as individuals /groups who may be hiding what they are personally "getting" from the public system they so strongly advocate for - be that direct kickbacks, pensions, etc.
Why eHealth - very clear EHealth stumbled because of the key relationship between the Premier and some of eHealth leaders who had been arrogant and offensive. So much hatred had built over the years, it was bound to have spilled. Clearly, several years of oppressive leadership had caused this. The steam hasn't yet all been released.
The politics is going to be tough and dirty - nothing will chnage but we will have high entertainment value.
yes, mfO....the "public" system is only a way of controlling the diversion of funds to one's friends or to those groups willing to play the political game. Very sad indeed. The biggest opponent of private care are of course the unions who don't want to give up any power. The distraction they use is to say that if private care is allowed that providers will abandon the public side of things and patients will be left without care. How silly is this attempt to cloud the issue when patients can't get the care they need as politically motivated decision makers give lots of services to the Toronto area and less to others who have less impact on the party's political future.
Yes, health care has become a political tool of the worst kind.
It is time for the public to take back its own health care system and strangely enough that means more private options.
Canada Health Infoway should have some serious scrutiny....over a billion dollars in funding and only 17% of providers with EMR. Not a big bang for one's buck...and it is estimated that 10 or so billion more will be required to come close to 50% by 2016. Fat chance.
Canadian doctors are extremely poorly compensated, during and after their careers, in contrast to doctors working in the superior and more effective health care systems of this world....that knowledge will permeate our medical communities as time passes and each time the political bureaucratic class squeezes them as opposed to themselves...another migratory surge of doctors out of those Canadian communities/provinces to more appreciative professional climates are to be expected...just as the demographic wave hits in conjunction with the economic/fiscal Tsunami.
The refusal to protect the medical profession and their staff and loved ones from the possibility of the consequences of a pandemic is symptomatic of the indifference shown towards them by the politico/bureacratic class...in the UK the medical profession was willing to go on strike for such pandemic guarantees...so should we in Canada.
Letter highlights hurdles in digitizing health records
The key reason the nation's electronic health system is so far behind comes down to
economics, said Blackford Middleton, chairman of the Center for Information
Technology Leadership at Partners Healthcare System, a leader in health information
technology.
"He who pays is not he who gains," Middleton said
Within the civil service that is possibily true. But with change in governemt dirty laundry is washed and hung out to dry. Cronyism affects the incumbent, and it should cause the cash infusion into the black hole of eHealth to be reconsidered. As the post previous suggests, a more measured step forward is possible.
It compares daily billings among sections and corrects for non-ffs, overhead, training and arrives at an adjusted net daily billings. It then aims to correct the undervalued sections towards the mean of $1100 adjusted net daily billings. It doesn't adjust for complexity, stress, or risk but neither did RVIC. One wonders how Ontario will compete for neurosurgeons and cardiovascular surgeons as they can expect no meaningful increases for a few decades while everyone else catches up.
Of course when the government reneges on the contract it will all be meaningless.
The fee setting by the OMA should be secondary if physicians could actually bill what they were worth. As Andris points out, docs in the UK have pensions etc. Hey, here's an idea...maybe the neurosurgeons can make a cool $350,000 plus a la Dr. Hudson political gamesmanship ploy.
As for savings with EMRs.....not very likely despite what experts say...
"Obama has said that electronic records could help save close to $80 billion a year by reducing administrative burdens, avoiding costly mistakes, and preventing duplicate tests." Hmmmmm.
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"People with no income don't care about income tax cuts. They do care about the harmonized sales tax the Liberals are slapping on every necessity of life.
That and the shocking eHealth boondoggle, with millions going to fatcat consultants as ordinary workers were laid off, will also lose the Liberals votes.
Those people who voted Tory in vast numbers 15 years ago have matured -- aged -- if you will. They're looking at a manufacturing sector that has been destroyed.
They've had their life savings decimated by an economic meltdown. People who thought they had a pension suddenly find it has evaporated.
As governments pour billions of dollars into bailouts for private corporations, the little people -- the ones who paid for the bailouts -- have lost out big time. "
......
http://www.stcatharinesstandard.ca/ArticleDisplay.aspx?e=1634230
Perhaps. A couple of more years for things to fester or heal before much can really be planned I would suppose.
The Tories have done themselves no favours this past weekend with the election of Mr. Hudak as their leader. His plan to fold-up the Human Rights Commission (does need some tuning to be sure) will be sold so as to scare the bejeepers out of many minority groups. These groups are the key to winning many urban ridings which the Tories need to crack in order to win government.
Hudak's conservative fiscal policies may be appealing to many in the ethnic business slice but will be heavily offset with the message perceived re: tolerance, sensitivity, etc.
The Liberals will run on a fiscal package much closer to centre-right than at present (cast as a stimulus spending balancing plan)to take wind out of Hudak's adantage sails.
The Tories would have been wiser to have elected Ms. Elliot I think. She would ahve helped in any number of ways, not least with women voters who tend to care more about human rights/social issues in general terms regardless of party affiliation.
The election is not yet in full swing and, as slick Willy said, "It's the economy stupid". A recession is more persuasive than platform or personality. If the good times return so will the incumbents. If it does not then the dog is there to be kicked.
The Fiberals have a history of morphing and back tracking. Add cronyism and corruption and the election is Hudak's to lose. He need only replay the recent events and avoid flying to Argentina.
Yesterday in the office, despite the warm weather and school now having ended, a third of the patients had H1N1 and again most are in the 2 to 30 year old range. It appears that the urban and rural summer kid camps will sustain this infection through until fall.
"And with this new flu, a small subset of people gets very, very sick. Their lungs are overwhelmed by an aggressive viral pneumonia one doctor described as looking like a "white out" on an X-ray. A number of hospitals are struggling to keep these people alive.
Generally much younger than the typical hospitalized flu patient, many of these people have been on ventilators for weeks. And every day, officials in some part of the globe announce that a 15-year-old boy, a 24-year-old woman or an otherwise healthy pregnant woman in her third trimester has lost the battle.
"When you look at those things then you begin to say 'Well, is it really accurate, is it really fair to say that this is a mild phenomenon?"' says Dr. Keiji Fukuda, the World Health Organization's top flu expert."
http://www.google.com/hostednews/canadianpress/article/ALeqM5iAoEUVF-HGgwkV9aNLSv17OAY64A
http://corner.nationalreview.com/post/?q=OGFhMTM4Zjc5N2RlZWRhZTFmYjYyOWUxNTllMGYyNWI=
Bottom line (IMHO)...we do not have two years to wait until the next election and a year of regime change stabilization or glad handing should the Liberals win. My apologies to the NDP but, uh, how can I should put this...you're not "on" for October 2011.
This is no time for the current government to turtle on health care - we need to incite the start of steady improvement immediately.
Regretfully, at best this will mean the continued and now tiresome rumour about LHIN reconfiguration (MESSAGE TO THE MINISTRY: ENOUGH ALREADY! WE DON'T NEED ANY MORE OF THIS KIND OF USELESS DROSS - WE NEED MEANINGFUL CHANGE).
Yes, it is going to hurt but not as much as the automotive sector bail out. And at least we'll be incenting the right actions.
Let's start right now!
We have elections to win - and we can't win them by doing the "right" thing. We can only do the right political thing.
Doing the right thing would mean actually planning health services based on true need and rationing care based on ability to pay. We're not going to do this.
By the way, revenues are hitting new lows in June, tax base continues to decline, and, wonder of wonders, we just scrapped our energy plan.
Health now isn't our worst problem.
"We trained hard...but it seemed that every time we were beginning to form into teams, we would be reorganized.
I learned later in life that we tend to meet any new situation by reorganizing. And what a wonderful method it can be for creating the ILLUSION OF PROGRESS while producing CONFUSION, INEFFICIENY and DEMORALIZATION".
[Gaius Petronius Arbiter First Century AD as cited in Satyricon.]
The "perpetual pilot projects"...FHNOTS...e Health...LHINs...the constant reorganisation to create the illusion that they know where they're going when they are as blind as bats with their radars malfunctioning...they will eventually do the right thing health care wise...but only after having tried every possible alternative....and there are so many more disastrous alternatives available...happily they will run out of money before they can try them all.
You're right...what was I thinking. How could I ever believe that doing the right thing cover ever keep a party in power? Foolish, immature, idealistic me.
Of course, the energy announcement today was completely serendipitous. Of course, with manufacturing in a death spiral in Ontario, we really don't need the power anyway. That and you cannot trust AECL to fart after a meal of bangers and mash let alone produce safe nuclear power on budget and on time.
Plus the Ontario government just became significant investors in the North American automobile market at at time when Tata and Geely and Chery (heard of them yet?) will likely overwhelm with the hemisphere with cheaper more efficient vehicles.
I personally think that the taxpayers will never see any payback on the investment in GM and Chrysler.
Let's just call a shovel a shovel, re-centralize health care like they have done in Alberta, New Brunswick, and many European countries, get to the point where we can say regionalization does not work unless we can get the power AND the money for EVERYTHING (that will never happen) and get on with it.
Feed central and all will be good. Trust them.
Ontario Health Care Light, Dirty and Absolutely Centralized.
ABSTRACT
Background In the spring of 2009, an outbreak of severe pneumonia was reported in conjunction with the concurrent isolation of a novel swine-origin influenza A (H1N1) virus (S-OIV), widely known as swine flu, in Mexico. Influenza A (H1N1) subtype viruses have rarely predominated since the 1957 pandemic. The analysis of epidemic pneumonia in the absence of routine diagnostic tests can provide information about risk factors for severe disease from this virus and prospects for its control.
Methods From March 24 to April 29, 2009, a total of 2155 cases of severe pneumonia, involving 821 hospitalizations and 100 deaths, were reported to the Mexican Ministry of Health. During this period, of the 8817 nasopharyngeal specimens that were submitted to the National Epidemiological Reference Laboratory, 2582 were positive for S-OIV. We compared the age distribution of patients who were reported to have severe pneumonia with that during recent influenza epidemics to document an age shift in rates of death and illness.
Results During the study period, 87% of deaths and 71% of cases of severe pneumonia involved patients between the ages of 5 and 59 years, as compared with average rates of 17% and 32%, respectively, in that age group during the referent periods. Features of this epidemic were similar to those of past influenza pandemics in that circulation of the new influenza virus was associated with an off-season wave of disease affecting a younger population.
Conclusions During the early phase of this influenza pandemic, there was a sudden increase in the rate of severe pneumonia and a shift in the age distribution of patients with such illness, which was reminiscent of past pandemics and suggested relative protection for persons who were exposed to H1N1 strains during childhood before the 1957 pandemic. If resources or vaccine supplies are limited, these findings suggest a rationale for focusing prevention efforts on younger populations.
A very different story than the mantra emanating from PHAC and the MOHLTC which was designed to protect the economy rather than reduce morbidity and mortality from H1N1. They had better retune their message with the current facts which show this is NOT just another seasonal flu, most of the deaths did not involve a co-existing condition, and that parents of children with H1N1 flu symptoms should present at the first sign of any distress.
The group who did have a pre-existing condition would have been only 28 percent if one removes those with hypertension. Now what percent of Canadians have hypertension,..hardly a serious pre-existing condition.
http://content.nejm.org/cgi/content/full/NEJMoa0904252
Dealing with the political facts:
1. We have one of the worst publicly funded systems in the OECD - high cost and low value.
2. Major criteria to measure "value" of system is life expectancy and infant mortality. Our "life expectancy" is high because our infant mortality is low. Our infant mortality is low (but not low enough) because of clean water, free action to abortion, etc., not "excellent health care.
3. We are a technology late adopters as a matter of policy.
4. Our EMR/EHR adoption is politically controlled.
5. We are just reaching bottom in the global recession, and we don't know how long it will go on. Our getting out of the recession is dependant on the US public buying stuff, and they are not. Even the OECD has recognized this.
6. Auto compnaies in Ontario (us) will not be profitable. We had to get into that business for votes by the unions, and, if we did not the US would have pull those limited jobs all back into the US. We will not be getting that money back.
7. Our energy policy has been completely wiped out. We are dependant on coal and conservation for at least 2 more decades. Manufacturing jobs require cheap energy and we won't have any.
8. Ideology not facts, drives health care within the bureaucracy. Fear drives the public response (if you don't accept our run health care, the american system will get you - they are no other options.)
9. Central first uses money for its own purposes. The left overs go to health. Publicly funded health as a business is now one of Ontario's biggest employers. All employed don't want to be unemployed. Our current leaders have been proven to be lacking in ability not to abuse the system.
By the way - week two of public workers strike in Toronto.
Welcome to the big leagues of politics.
Ontario Health Care Lite - love it or leave.
And good to hear from you ELB. I always enjoy your "spicy" perspective.
Now a few comments from David Caplan from Parkhurst exchange..I'll draw your attention to one particular comment almost near the end of the Q & A...and it tells us pretty much where we are headed: into oblivion...sorry to be so stark.
I'll copy the particular part I'm referring to but here is the link for your reading pleasure:
http://www.parkhurstexchange.com/node/5439
PE Are we to expect, then, if we look back at the year since the Local Health Integration Networks have been permitted to allocate money themselves, that we're going to have actually saved some money?
DC I think what we'll see is greater sustainability. I think there's still a long way to go, and obviously we're going to pick the low-hanging fruit first. But if people have confidence they can have some ability to lend some shape over healthcare decision-making and healthcare delivery in their local community, they'll buy in to it, and I think we have a much greater chance of success on sustainability than if it was driven centrally from very good, very well-intentioned, but people who are only in an office building in downtown Toronto.
PE I notice you were careful not to mention the word "private" when you discussed controlling the health ministry's spending. Can the public system maintain its quality and at the same time control spending without passing on some of the costs to patients either through higher taxes or through some variety of private financing?
DC I think that the public healthcare system can in fact improve the quality. That's the focus I have had. What I want to do is raise the quality of the healthcare experience, of healthcare service, because all of the literature I've read says that when you increase quality you increase efficiency and you increase sustainability and cost-effectiveness. That's the real way. The mistake I think governments have made in the past is they've tried to contain costs first and what you've seen is a degradation of quality. If you raise quality, and that's the goal, almost by definition it will logically follow that cost-effectiveness will result.
Ahhhh Yesssss....so simple...why didn't we think of this before!
ARRRGGHHHH.
Leads to the next question:
Who gets to define "Quality"?
http://www.ottawasun.com/news/ottawa/2009/06/29/9975246.html
Saying he didn’t order the tests “just for the hell of it,” O’Shea believed both patients, who had fevers and respiratory problems, could have the H1N1 virus."
And so the issue is: if we can't know who has the virus, how do we prevent the spread? I guess we don't and just keep using hand sanitizer.
The Minister had been advised not to say that stuff. Raising quality raises cost. Well known business premise and fact. Can't believe he let that out. Raises cost because shortfalls are quantified which then need more money from MOHLTC to fix shortfalls. Waiting times best proven example - waiting times created by underfunding. Quality review shows that waiting time is a "quality" issue which needs more money - voila 2 billion flows. Cost effectivness actually goes down.
Sometimes Central just loses it. This is one example. too much stress.
Must mean new quality expenses are about to be identified to be drawn out of health budget. Not more front line care - more administration costs coming.
Fortunately since we were and still are the epicenter of this outbreak (saw another 15 cases tonight) PCR swab testing was available from the start of the epidemic which allowed us to gain knowledge and confidence early on in what the signs and symptoms of the disease were. Arriving late to the party as the Ottawa docs have had to do without testing would have made the anxiety levels much higher for us.
Early in the outbreak we watched the number of seasonal influenza A cases decline to zero and the swine H1N1 skyrocket. In was actually very interesting to have access to the testing in order to observe in real time what was happening as the outbreak evolved. At the start when the first positives started to arrive there was a lot of anxiety and public health would call each and every positive case personally.
This all changed when the decision was clearly made at a political level to not try and contain the disease, but rather let it run full throttle. I don't remember the exact number but when 120,000 people arrived back in the GTA from Mexico the reality likely was that containment would be impossible, but certainly closing the schools would have slowed progression.
Canada, in particular Ontario (again) does have the highest per capita rate of H1N1 and this is clearly not some artifact as suggested by PHAC, but due to the fact that such a huge number of infected people returned from Mexico all at once, there was no attempt to contain the spread in the schools, and the authorities "don't worry, be happy" initial dogma where the use of antivirals which may have limited spread was also officially discouraged. Come this fall we may regret these decisions as the virus may have gained such a foothold in the country that it will take off again before we have an effective and efficacious vaccine available. Countries who have tried containment measures (i.e. southeast Asia) will have bought additional time to react. I am sure a cost/benefit analysis was done and it was decided to be too expensive given the fact the horse was so far out of the barn to try and put the viral genie back in the bottle.
Initially the school principals were being notified by public health of positive cases in their schools but once there were hundreds of cases in all the schools this policy was reversed by public health much to the consternation of the teachers employed in these schools some of whom had "pre-existing conditions" and wanted to know if their students had swine flu. It was at this point two weeks ago that we were told also that there was to be no more testing for routine community cases, however we had had three weeks of real-time testing before this decision was made to be reassured that all these cases of fever and cough clearly were H1N1.
I can certainly appreciate the Ottawa docs frustration with not having access to routine testing but at this point one just makes the clinical diagnosis and moves on as you would treating malaria in West Africa. The number of cases now is just so huge that community testing is no longer wise both from a logistical and cost standpoint. That being said we are still able to get testing on our dialysis, HIV, SLE, RA,etc. patients simply by stating this on the form.
Fourteen patients with H1N1 tonight were kids and teens. The fifteenth was a parent of three of the kids. One kid had been to the ER twice with shortness of breath but sent home. She is seven years old and perfectly well coming up to the six day mark where most of the Mexican cases were admitted for ventilation. I am always very nervous seeing patients who have been to the ER two times and told all is well but the mother seemed reliable enough to return should the kid take a turn for the worse. The buck stops with the docs on these clinical decisions which is difficult when flying so blind as to who will spend three days in bed and who will crash.
The disease is sustaining itself here through summer school courses, year round college, camps, and sport tournaments.
I'd be looking at renting small houses for individual teams and likely put my athletes on prophylactic Tamiflu should a vaccine not be available during a pandemic even if mild.
Could the games be deferred a year due to a moderate to severe pandemic?
It seems reasonable that the laboratory guys are asking the primary care clinicians to really think twice about this, given the need to allocate scarce resources appropriately, said Levy.>>
This is where the rationing of medicine debate begins?
Seriously?
There are so many places we can/should have started this debate but the direction from the province to their medical officers of health suggest we start at H1N1 testing?
Forgive me for being so naive, but how much does this test cost "all in"? And without the test, what treatment options are available for clinicians?
BTW - Canary raises a great point about the Vancouver games. What a humongous public health risk.
http://www.reuters.com/article/scienceNews/idUSTRE54B6VU20090512
The other real issue was that during the surge in cases the turn around time for the test was advertised at 5 business days but became 10 business days as the one provincial lab could not keep up with the demand. By that point the patient was either better or in hospital so the reporting of the test did not change clinical management.
Many clinics charge patients for the rapid strep test so if a cheaper H1N1 point of care test does become available one could offer this to the patient for rapid POC testing. I know Roche had such a product for seasonal flu but a specific antigen assay would have to be made for H1N1.
At this point in time there are really only two treatment options. One is to let nature heal the disease and the other is to put the patient on one of two available antivirals either antiviral Tamiflu (oseltamavir) or Relenza (zanamivir). Cost of the 5 day course of Tamiflu is about $70.
It is interesting to note that using the most recent Canadian data the case fatality rate is running at 0.4 percent which consistent with those rates in other jurisdictions in the north hemisphere. Hospitalization rates in Canada are running about 7 percent of cases. In Argentina where they are now closing schools and possibly sports events the CFR has jumped to 1 percent and the hospitalization rates are running at 5 percent.
Do the math for the Canadian population over a two to three month window this fall/winter assuming these rates hold and the health system will be rapidly overwhelmed.
Things are very hush hush on Bay St. about this practice. I know at a family member's firm antiviral drug has been purchased for all essential employees and they have figured who can work from home and who cannot. Automated Purell dispensers have been installed at all door exits over the last few weeks. Clearly business sees the serious potential manpower issues here but I am not so sure that PHAC or the MOHLTC does.
When did that become the standard of patient care in Ontario?
And as always, thanks for the very pertinent posts.
Yes, resources will be short.
We still have individuals and groups that whine and carry on as though money grows on trees...but maybe if we didn't squander it on eHealth extravaganzas we might have enough to spend on urgent life saving care:
http://www.vancouversun.com/Health/Eggen+Alberta+government+going+wrong+health+care/1717124/story.html
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Obama restates opposition to malpractice caps
ANNANDALE, Va. (AP) — President Barack Obama is standing by his opposition to caps on jury awards to people who successfully sue for medical malpractice.
But Obama also told a town hall meeting on health policy that he is sensitive to the complaints of doctors and other health care professionals that the threat of lawsuits is harming the profession and driving up costs.
The president said Wednesday that the specter of lawsuits has forced many in the medical community to practice "defensive medicine," saying doctors often order up excessive tests just to cover themselves.
Obama told his audience: "What I have said is that I don't like the idea of an artificial cap on somebody if the doctor of [sic] the hospital was really negligent."
This may come as a surprise to Canadians. It's not the kind of No. 1 ranking that government or public officials like to draw attention to, let alone brag about.
http://www.theglobeandmail.com/life/health/time-to-draw-up-a-better-plan-of-attack/article1203547/
Nearly two-thirds of Canadians hospitalized due to swine flu, and half of those who have died, had no underlying health conditions.
Experts do not yet understand why the new strain affects some healthy people so severely, ravaging their lungs with an aggressive pneumonia and forcing them to spend weeks in hospital, attached to breathing machines.
"They are ending up on ventilators and it can last from weeks to months," said Michael Gardam, director of infectious diseases at the Ontario Agency for Health Protection and Promotion. "I would like people to be concerned about H1N1, without panicking. More concerned than they are about seasonal flu."
http://www.theglobeandmail.com/news/national/swine-flu-hits-young-healthy-adults-hard/article1203826/
From May 19/09
Dr. David Butler-Jones said Monday it appears that spread of the virus is waning. "It looks at this point like we're over the worst of it in Canada for this season," he said.
I'm not sure why Picard has said the antivirals are in short supply as all my patients have been able to purchase Tamiflu this week without issues. There were supply problems initially when there was a run on the drug, but the pharmacies in the west GTA seem to have been restocked.
This is the real issue for docs on the front line as there are no markers or risk factors yet to indicate who will require hospitalization and who will not:
"According to the Public Health Agency of Canada, two-thirds of 94 hospitalized cases where information was available showed the patients were perfectly healthy before being admitted."
Unfortunately I think the about face from "dont' worry, be happy" tune to yes this is a serious problem has really undermined the messanger's credibility with the public.
As one of the excellent earlier articles point out if 20 percent of the population is infected as a low estimate (some have said attack rate will be closer to 30 percent) that will be six million Canadians. Currently hospitalization rates are running at 7 percent which will require over 400,000 hospitalizations many of which will require ventilation (some patients have been on ventilators for weeks). Of that six million 1200 to 2400 mainly young adults will die over a possible 8 to 12 week window.
It is time for PHAC and the provincial public health agencies to get their act together before the cold weather hits and school restarts. The mortality rate may be low compared to past pandemics, but when the deaths are concentrated in previously healthy young adults and over a short time interval the potential for serious societal disruption is real.
Let's hope the vaccine arrives on time.
Assuming a case fatality rate of 0.2 to 0.4 percent the number of fatalities of mainly young adults would be 12,000 to 24,000 people not 1,200 to 2,400 assuming an attack rate of only 20 percent and population of 30 million.
for your interest..OECD health indicators for 2009 (don't see the number of ventilators per 1,000 population...)
http://www.oecd.org/document/16/0,3343,en_2649_34631_2085200_1_1_1_1,00.html
Canada slow in improving physician supply
Canada is a big spender on health care compared to the international average – spending almost a third more per capita as well as a higher proportion of its Gross Domestic Product on this service – yet it lags in terms of the supply of physicians, nurses and hospital beds, as well as high-tech diagnostic equipment.
In its Health Data 2009 report this week, the Organisation for Economic Co-operation and Development said Canada spent 10.1 per cent of its GDP on health care in 2007, more than a percentage point above the average of 8.9 per cent for 30 OECD countries. This placed Canada sixth on the list with the U.S. miles ahead of everyone else at 16.0 per cent.
Canada ranked fifth on per capita spending in 2007 at $3,895 U.S., on a purchasing power parity basis, compared to the OECD average of $2,974 – trailing only the U.S., Norway, Switzerland and Luxembourg.
But Canada was fifth last in the supply of practising physicians at 2.2 per 1,000 population in 2007 – well below the OECD average of 3.1 – and our physician situation has barely improved since 1990 (up only 0.2 per cent) while it has expanded by two per cent elsewhere.
The explanation for this can be found in that Canada has the third-lowest proportion of medical graduates per population, and has made much less use of foreign-trained physicians to boost supply.
Physicians trained in other countries contributed to just eight per cent of the growth in the number of physicians practising in Canada between 2000 and 2007.
This trailed all nine other countries in an OECD comparison, with Ireland making almost exclusive use of foreign physician resources in the period, and even the U.S. finding over half (55 per cent) of its new physicians from outside its borders.
The discrepancy in nursing supply is not as pronounced. There were 9.0 nurses per 1,000 population in Canada in 2007 compared to the OECD average of 9.6. But the number of acute care hospital beds was again much lower than the international average: 2.7 versus 3.8 beds per 1,000 population.
The supply of sophisticated diagnostic equipment has increased in Canada, but it is still substantially below the OECD average.
There were 6.7 MRI units per one million population in Canada in 2007 compared to the international average of 11, and 12.7 CT scanners versus 20.2 internationally.
More information at http://www.oecd.org/document/30/0,3343,en_2649_34631_12968734_1_1_1_37407,00.html. HE
there are worrying signs that the health of Canadians is deteriorating.
High blood pressure affected 16 per cent of Canadians over the age of 12 in 2008, up from 13 per cent in 2001. The prevalence of diabetes climbed from four to six per cent. Obesity, commonly linked to diabetes, is also on the rise. Fully 17 per cent of Canadians aged 18 or older were obese in 2008 compared to 15 per cent in 2003.
The proportion of Canadians over the age of 12 diagnosed with a mood disorder stood at 6.8 per cent in 2008, up from 5.3 per cent in 2003.
More information can be found in Statistics Canada’s Daily for June 25 and 26 (www.statcan.gc.ca/dai-quo/index-eng.htm) as well as at its Health in Canada module www4.statcan.gc.ca/health-sante/index-eng.htm.
http://www.ottawasun.com/comment/letters/2009/07/01/9996116.html
Re: “Patients left in dark by lack of flu testing” (June 30). Your article stated, “(Ottawa’s medical officer of health Dr. Isra) Levy said family doctors are now faced with a broader societal responsibility beyond the patient right in front of them.”
When did that become the standard of patient care in Ontario? You should ask your doctor if your interests come first?
E. Klimek, MD
St. Catharines
http://www.google.com/hostednews/ap/article/ALeqM5hsf2UAZB7Mf3uiufAFktOwi1zmsAD995VQH02
I'm sick and tired of faxes coming in to my office from 'up there' telling me what to do without giving me the tools.
"Broader societal responsibilities beyond the patient sitting before me"...whazzat?
My responsibility IS towards the patient sitting in front of me...and as it is I'm fighting in the dark with the powers that be in this dysfunctional health care pontificating their banal platitudes at me...still waiting for my supply of Tamiflu for myself and my staff and loved ones...still waiting for assurance that my loved ones will get looked after if I kick the bucket in the front lines or compensation if I'm unable to continue due to a work related disability such as H1N1.
This is just early summer...the faeces will hit the fan in the autumn and winter...