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Showing posts from January, 2012

Lowest rated P3 ever goes to market (& costs rise)

The largest public private partnership (P3) bond financing in Canada has raised $1.37 billion for a new Montreal hospital. It is for what must be one of the longest P3 deals as well -- a 38.8 year deal to build, finance, and maintain the Centre hospitalier de l'Université de Montréal (CHUM).

The National Post reports that the four equity partners in the P3 deal are all European corporations. Canadian and Quebec partners were squeezed out once again, it seems.

The P3 financing deal is also the lowest-rated one ever to come to market. The Post reports that the bonds came with a 6.721% coupon.
"Part of the difficulty attracting buyers was the credit profile of the investment. The issue was rated BBB (high) by DBRS, one notch higher than the Baa2 assigned by Moody's Investors Service Inc. Every single P3 that has been broadly marketed so far in Canada has enjoyed an A-level rating." The Post goes on to note:

"If the CHUM deal proved one thing, it's that issue…

$15 to $22 million in hospital cuts forecast

Hamilton Health Sciences is warning that it will have to cut costs by $15 to $22 million, the Hamilton Spectator reports.  The range in cost cutting is based on funding increases in 2012-13 of either 0% or 1%.  


The hospital expects about 140 jobs will be affected, but says its goal is to accomplish the cuts  through attrition rather than layoffs. 


The hospital Executive Vice-President, Murray Glendining, told the Spectator that  he is getting“a little nervous” the hospital won’t get the 1 per cent increase.

Privatization works! More Americans lack health insurance

Gallup reports that the percentage of American adults without any form of health care insurance has reached the highest level since they began tracking coverage in 2008.

In 2011, 17.1% of adult Americans had no health care insurance. That is up from 14.8% in 2008.  The percentage insured has declined every year since the report started.

Gallup reports that it asks 1,000 American adults each day about their healthcare coverage and reports monthly, quarterly, and annual averages. In December 2011, the monthly percentage of uninsured adults increased to 17.7%, tying July 2011 for the highest on record.

The USA is leading example of health care privatization in the developed world.

High P3 maintenance costs shortchange patients: Conservative MP

More complaints about the high cost of basic maintenance in "public private partnership" (P3) hospitals are coming.


This time, Dr. Dan Poulter, the Conservative Party British Member of Parliament for North Ipswich and Ventral Suffolk, has complained about the costs of "odd jobs" in the local P3 hospital. P3 hospital deals typically require the contracted private company to provide maintenance in the hospital -- rather than regular public hospital staff.

EADT24 reports that the hospital paid £120 ($190) for contractors to assess a door which had given someone a static shock. After investigating, the maintenance firm said the door was not its responsibility, but the hospital was still forced to pay for the call-out.  Since 2008 there have been 14 call-outs to replace the glass on a fire alarm costing £1,680 ($2,650).

Dr Poulter said: “Patients are being short-changed because of this, money which should be being spent on them is being spent on these fees. It is cripplin…

911 EMS calls get a lot longer: Hospital offload delay cited

Paramedics are spending 10 minutes longer on emergency calls in 2011 compared to 2010 in Hamilton.  EMS Director Brent Bowett told the Hamilton Spectator that time is mostly spent off-loading patients at hospitals.




Hospital bed overloads ultimately back up in emergency rooms, forcing paramedics to wait until hospital staff can assume care for ambulance patients.  


Hospital restructuring and a growing demand for EMS are also cited as reasons for the growing strain on the EMS system. 


Mario Posteraro, the head of OPSEU local that represents paramedics in Hamilton, told the Spectator, “Clearly there’s a need for additional front-line services. I think we’ll be back before council asking for additional resources".



Hamilton city councillors want the province to provide an additional $585,000 for an extra ambulance crew to be on call 12 hours a day, seven days a week.  That would cover 100% of the extra costs.  (Typically the province pays 50% of approved costs only.)


The province, however,…

Health care spending crisis? Not really. Is Don Drummond listening?

Carol Goar at the Toronto Star demonstrates that health care spending has actually shrunk as a percentage of total Ontario government program spending. It has fallen from 46% to 42% of program spending over the last ten years. This despite repeated claims by Ontario finance minister's that it would increase.

Don Drummond, who is preparing a report on public services for the Ontario government, has also made dire forecasts about health care spending as a proportion of the provincial budget (claiming it will hit between 70% and 80%).

Unfortunately there is little likelihood that the reality of health care spending will impact Drummond's report. He is a man on a mission -- too bad for health care.

Goar's article, "Health budget math doesn't add up" is available by clicking here.


Drummond Commission: Cross province public hearings?

Don Drummond continues to speak to all and sundry media about the approach his Commission into Ontario public services will propose.  A Mop and Pail columnist suggests that at "the heart of the new spending model would be a much tighter clampdown on health costs than Dalton McGuinty’s government has previously forecast."


The current funding plan from the government is to increase health care funding by 3% per year.  


Drummond told TheToronto Starcolumnist Martin Cohn:  “There are going to be a ton of things in our recommendations that the government is not going to be pleased with.   And the public should also brace for bitter medicine: “There will be lots of negative reaction, lots of anger.”


Cohn suggests Drummond may propose health care funding increases be scaled back to 2.5%, instead of 3%. As for the other parts of the public sector -- well they face deep cuts, according to Cohn.  


Cohn also suggests that Drummond wants have public hearings on his proposals around the prov…

£1,942,842 spent on routine maintenance for P3 hospital

Here's a report on a recent investigation into spending for routine maintenance at a British public private partnership (P3) hospital:
"The North Cumbria Hospital Trust has paid £466 to replace a light fitting, £75 to install an air freshener, £184 to have a bell put into a reception area, £977 to install six double sockets, £110 to fit a shelf... and so it goes on. It goes on to the tune of £1,942,842 spent on routine maintenance in 2010/11. This from a debt-ridden trust haemorrhaging £1.2 million a month."£1,942,842 is over $3 million.  The investigation into the P3 was done by the British Conservative Party, hardly a bastion of anti-privatization bias. A number of the British P3 hospitals are so weighed down by the cost of their P3 deals that they have asked government for special compensation to help them pay their bills.  Here is the conclusion reached by the editorialists at one local British paper:
"Ministers are urgently considering this which will, of course, …

Hospitals embracing new levels of openness? I wish.

The Ontario Hospital Association today claims that "Ontario hospitals have been a driving force behind the extension of FIPPA (i.e. freedom of information legislation) to their organizations and are embracing the new levels of openness that the legislation is bringing to their organizations."


This is laying it on pretty thick as the OHA, along with the insurance industry,  helped secure an amendment from the government earlier this year to freedom of information legislation that  allows hospital CEOs to deny requests from the general public for access to an array of information regarding quality of healthcare in hospitals.  

As Ontario Health Coalition Director Natalie Mehra observed at the time:  “Today, (the government) undid a substantial portion of its own legislation passed last fall to expand hospital accountability in the wake of the e-Health scandal.”


It would be nice to think the hospitals might become more open and transparent, but it is hard to believe.  Time will te…

No ambulances available for 911 calls

A shortage of hospital beds led to 32 Code Reds in February 2011 in Waterloo Region, The Record reports. "Code Reds" occur when no ambulances are available to take 911 calls. One Code Red lasted four hours on Feb. 14.

A shortage of hospital beds is forcing paramedics to wait in emergency rooms to hand over patients to hospital staff, the Record reports.

Regional politicians are being asked to hire five more paramedics to improve EMS response times. In effect, hospital shortages are driving up municipal costs.

Waterloo Region ambulances reach 90 per cent of emergencies within 12 minutes and 32 seconds, up 33 seconds over 2010. The legislated response time is 10 minutes and 30 seconds.

The Director of the Waterloo EMS told the Record that off load delays fell in October and November after the service started taking patients to a less-busy hospital even if the hospital was not designated for the patient’s symptoms. “It was safer for a patient to be in the wrong hospital, than it…