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Showing posts from February, 2012

Hospitals under attack in every which way

The Drummond Commission into the reform of public services in Ontario has proposed the province shrink and privatize hospital services. 

Funding:  Drummond has recommended that health care funding be limited to 2.5% until 2017-18.  This is considerably less than the 3.6% increase proposed by the Liberals not long before the election.  Notably, even that proposal caused the Auditor General to observe in his pre-election review of Ontario's finances that $1 billion in hospital savings would have to be made (in addition to a two year wage freeze). This would be a drastic reduction in health care funding increases, which have averaged 7% since the Liberals came to power eight years ago.  Health care costs are driven by inflation, population growth, and aging.  Together these factors are significant cost drivers, likely over 4% per year.  But costs are also driven by a public that wants new health care services. When new services become available that prolong or improve their quality of…

Drummond: More Mike Harris than Mike Harris

As expected, the Drummond Commission has proposed the province shrink and privatize hospital services.

Drummond has recommended that health care funding be limited to 2.5% until 2017-18.  This is considerably less than the 3.6% increase proposed by the Liberals not long before the election.  That proposal caused the Auditor General to observe in his pre-election review of Ontario's finances that $1 billion in hospital savings would have to be made.

The main target for Drummond cuts in health care spending are hospitals.

Drummond is recycling ideas from the Harris era, when the government justified hospital cuts with the claim that they would improve care in the community.  Eventually, after repeated crises, the Harris government quietly changed their policy and began funding hospitals again.

Initially, Drummond had tried to distance himself from the Harris policies, but today he only noted that the cuts would be longer than in the Harris era.

Like Harris, Drummond suggests more…

Privatization is paying off big time (for the bosses)

Corporate health care bosses are making out like bandits in the homeland of health care privatization - -the USA.  Healthcare and pharmaceutical executives were four of the top 10 best paid executives in the United States in 2010, the British Medical Journal (BMJ) reports.   John Hammergren, chief executive of the drug distributor McKesson Corp, was the top earner, with total remuneration of $145 266 971 (US).  If he were to be fired, he would receive $469m in severance pay.  That might make up for the shock.

Number two was Joel Gemunder, chief executive of Omnicare, a geriatric pharmaceutical care company.  He earned $98, 283 242 when he retired in 2010. With an income like that, it's OK to be number 2.  

Fifth highest paid boss was Thomas Ryan, head of the CVS Caremark pharmacy chain. He received $68 079 823. Ninth in pay was Ronald Williams, chief executive of the Aetna health insurance firm, who squeaked  into the top ten with a final pay cheque of $57, 787 786. Poor guy. Overall, …

Drummond report tomorrow: what is the real end game?

The Drummond report on public services is coming out tomorrow (Wednesday) between 2:25 pm and 3 pm, reportedly.

Drummond has said that many of his proposals will not be supported by the government.  So some of the proposals are non-starters right from the get go.  But they may provide cover for the Liberal government when they come in with their own package of cuts.

Drummond is being used to set the government up as the voice of "moderation" I reckon.

Incredibly, Mop and Pail columnist Andre Picard suggests that the objections to these proposals from some (like the Ontario Health Coalition) are based on "mock outrage".  Does Picard actually believe the outrage is mock?  No doubt his comment pleased Picard's editors' at the Globe, but it is far from the truth.

It is not 'mock outrage' that is driving the Ontario Health Coalition (OHC) and others to work so hard to respond to Drummond.  It is real fear about the future of public healthcare.  The OHC…

LHINs to decide which surgeries should be moved from hospitals

Health Minister Deb Matthews signalled that the LHINs would decide which surgeries and tests should be shifted from hospitals to clinics, the Ottawa Citizen reports.  "We will expect the LHINs to do the work to determine what, if any, procedures there are that could be better delivered in the community," Matthews said.

Moving work out of hospitals is a major policy direction for the Ontario Liberal government.

LHINs are, of course, supposed to integrate health care (their full name is Local Health Integration Network) so it is amusing that they are now supposed to fragment health care by moving work to new providers.  (Oh what a tangled web we weave...)

The Citizen also reports Matthews hinted that she would be open to having the Ottawa Hospital's cataract clinic spun off as a stand-alone corporation, if health officials can demonstrate that such a move "would provide high-quality care at a lower price."  Currently, the Ottawa Hospital clinic provides all cataract…

P3 profits too large (and risks quite limited) - New report

The National Audit Office (NAO) in Britain finds profits for investors were expected to exceed the target of 12% to 15% in 84 of the 118 public private partnership (P3) projects that it analyzed. Instead, investors regularly see profits of between 15% and 30% by selling their equity in the secondary market. The government responded to the report by stating the analysis “needs to take into account a wider range of issues that together contribute to the overall economics of a transaction, rather than merely looking at equity returns”. For its part, Construction Newsconcludes  "the root cause (for the high profits) is that civil servants are not sufficiently competent to stand up to bankers on complex financial issues."
I'd say even 12% to 15% percent  is a pretty good return (never mind 15% to 30%) --  especially when  the investors are dealing with a pretty safe credit risk -- the government. 
The NAO report itself concludes, "investors bear some risks, particularly in th…

McGuinty offensive on public sector wages

Premier McGuinty returned to the issue of public sector wages in a talk to an elite Ottawa audience: 

"We can't tackle the deficit without tackling public sector wages and salaries. That accounts for one half of all government spending -- about $55-billion. It is simply not possible to reduce spending without addressing salary expenditures...I cannot guarantee there will be no interruption in public services. But I can guarantee our government will negotiate fairly and firmly to a result that keeps us on a sure and steady path to eliminate the deficit... I’m sending a message to our public sector partners . . . there are legitimate public expectations that we’ll do everything we can to eliminate the deficit as quickly as we can."

When asked, McGuinty did not rule out job cuts and wage reductions, saying only that details would be spelled out in the provincial budget -- which is usually released in March.

Inflation is currently running at 2% in Ontario.

AAA credit rating may fall under weight of P3 debt

The conservative newspaper The Telegraphreports that an economic think-tank, The Integenerational Foundation, has found that the total cost of  British P3s (public private partnerships) has reached such great heights that it is threatening Britain’s AAA credit rating.

The credit rating determines how cheaply the Government can raise money on the international markets. The lower it goes, the more it costs the government to borrow money.

The think tank reports that the P3 debts are £239 billion ($380 million), 80 per cent higher than the report of £131.5 billion in P3 debts released this week by the government in its new "Whole of Government Accounts".

The think tank warned the cost of P3s has been under-appreciated. “Such build-ups clearly put Britain’s AAA credit rating at risk by adding over a quarter to the country’s £1 trillion national debt,” said Angus Hanton, co-founder of Intergenerational Foundation.

Reportedly, P3 debt is up to £13,000 per taxpaying household.

A …

Will LHINs actually have much control over the doctors?

A lot has been made about the announcement in the Ontario Health Action Plan that the Local Health Integration Networks (LHINs) would expand their role to include the doctors.

But in the fine print, the government did not actually promise to hand over funding responsibilities for the family doctors to the LHINs. Au contraire, they specifically promised  that the government would continue to have a funding role for the doctors.

The government only promised to 'integrate' family health care into the LHINs, and then mumbled something about identifying some model that brings planning and accountability "for the full patient journey" under the LHINs.

Well, as the LHINs have done not too much planning for any health sector, this may not amount to much.  The LHINS most powerful tool has been money.  The government has kept the major portion of the new health care cash for itself and passed on only scraps for the LHINs to dish out to the hospitals and other health sectors.  …

More money for Ontario docs?

The new Ontario Health  Action Plan puts a lot of emphasis on primary care.  Changing the way the doctors practice in order to divert patients from hospitals seems to be a major goal.  
But how is the government going to do this? It's unlikely the doctors will agree to change their practices simply to keep the government happy.
In the past we have seen a lot of efforts by the Liberal government to change primary care practices. The establishment of Family Health Teams (FHTs) come to mind.  But a recent study indicates the doctors who made the switch to FHTs saw WHOPPING big increases in their incomes. And certainly government funding for the docs has gone, way, way up.  
Negotiations between the doctors and the Ontario government are upcoming.  The Health Minister recently suggested to the Ottawa Citizen editorial board that the doctors will take zeroes. We will see if that is the whole story, or just for the fee schedule. 

Privatized P3s make up lion share of "ticking time bomb" of debt

British "taxpayers face a £200bn ticking timebomb from long-term spending commitments that have not been properly costed," the Independent reports. "The Commons Public Accounts Committee criticised the Treasury for not keeping a grip on the 'staggering numbers'  involved in 'spend now, pay later' projects which are a storing up massive bills for future generations."

Most of the debt (£131.5 billion) is for privatized P3 (public private partnership) projects, primarily hospitals and schools.   The P3 debt is "four times more than the assets secured by the deals".

The other £70 billion of unaccounted debt is for decommissioning nuclear power stations and outstanding claims for medical negligence.

The government promises to end P3s "as we know it" (although the changes the Conservative government will implement will almost certainly be less than one might hope). 

Ontario merrilly continues with its own P3 program for hospitals, even as …

Rising hospital bed occupancy and rising superbugs

Dr Charles Saunders, deputy chair of the British Medical Association Scotland, recognizes that Scotland has made progress fighting hospital acquired infections, but flags the threat rising bed occupancy now poses:

"There is pretty good evidence that once you get high bed occupancy rates then it is very difficult to stop a lot of HAI. Part of that is because you don't have time to get things properly cleaned and partly it is because once you get to those high rates, you tend to move people around hospitals a lot. So they get admitted to one ward and maybe go through three or four different wards in the next few days. If they have anything when they come in, they have an opportunity to spread it quite widely and they also obviously increase the opportunity they have to pick up stuff by being in different wards."
Yet, Scotland has more than twice as many hospital beds per capita compared with Ontario.  -- Ontario has one of the highest hospital bed occupancies in the deve…

Fewer layers of administration in Ontario health care?

One interesting line in the Ontario government's new "Action Plan":

"In addition to integrating family health care into LHINs, we will introduce further reforms to promote more seamless local integration, with fewer layers of administration, to ensure we have a system truly structured around the complex needs of an aging population." What might "fewer layers of administration" mean?  That is unknown, at least to this writer.  But some have pointed to the oddity of the Ministry of Health and LTC funding the LHINs, the LHINs then funding the CCACs, and the CCACs then funding the contracted home care providers. Especially as the CCACs have been restructured so their boundaries coincide with the LHIN boundaries.

Other thoughts?

Privatized P3s need $2.4 BILLION MORE from taxpayers

Privatized P3 (public private partnership) hospitals in Britain are proving so expensive that seven of them will get £1.5 billion ($2.4 billion)  in emergency funding from the government to help them avoid cutting patient services, the Guardian reports. 
The hospitals will be able to access the £1.5 billion over the next 25 years, until their P3 contracts end. Andrew Lansley, the British health secretary, said he had been forced to use taxpayers' money because certain hospitals could no longer afford their P3 deals.

The Conservative health secretary blames the previous Labour government for bungling the P3 deals, although critics of  P3s had long claimed that the deals were far too expensive.  
"The problems facing some parts of the NHS left to us by Labour now have to be sorted out. Tough solutions may be needed for these problems, but we will not let the sick pay for Labour's debt crisis," the Conservative health secretary claimed.  
The Guardian notes that w…

60 hospital beds closing -- 62 layoff notices

Health Sciences North in Sudbury has issued layoff notices to 62 staff as the hospital moves to shut down 30 beds March 31, 2012. Another 30 are scheduled to shut March 31, 2013. All 60 beds are at the hospital's Memorial site.

The Hospital defends the cuts, arguing that ambulatory clinics will replace the beds, the Sudbury Star reports.
But Dr. Stephen Kosar, president of the Sudbury and District Medical Society is skeptical, adding that he is hoping for a stay of execution: "Maybe the governor will make a call before they walk down the green mile."
The beds to be closed are serving alternative level of care (ALC) patients. There were 43 ALC patients in acute-care beds at the main hospital and 61 at the Memorial site on Thursday. The Star reports that the "hospital has fewer beds than planners wanted and they said it would only be large enough to serve the community -- and the region -- if it had no ALC patients."

EMS costs up and ambulances delayed. More to come?

The overload on hospital beds is catching up with Windsor/Essex Emergency Medical Services (ambulance services).
The Windsor Star reports that the time spent by EMS paramedics waiting in hospital emergency rooms has increased 350% since 2009, increasing from 2,653 hours in '09 to 9,557 hours in 2011. EMS paramedics can't leave a patient at a hospital until the hospital takes over care, but sometimes hospitals are so backed up they have no room for new patients.
The dramatic increase in "off-load delays" has driven up EMS costs, the Star reports.
But, aside from driving a cost explosion, the off-load problems are also delaying EMS response time. "We have a limited amount of ambulances in the county," EMS Chief Randy Mellow told the Star. "There are times when we delay non-emergency calls sometimes up to an hour if we don't have an ambulance."
The off-load delays stem from a bed shortage in Windsor that spiked after a "public private partn…

Ontario Health Action Plan does not add up

The Ontario government's Health Care Action Plan, announced yesterday, will mean less public health care.

As has been the constant refrain for decades, the official plan is to move patients from hospitals to home care. The idea is that hospitals are expensive and home care is cheap.
But the plan does not add up. The home care hours promised - 3 million -- mean spending about an extra $75 million, based on government figures.
That's a tiny drop in the bucket of the government's $47,139,590,260 ($47 billion) health care spend: less than 2 tenths of one percent. It may make up for population growth this year. It may even make up for the aging population (this year). But is it going to also reduce the 10,000 person home care wait list, divert people from ending up in long term care facilities, or offset hospital cuts? No way -- it's a pathetically small increase by any standard, never mind by what the government says it is doing.
As in the past (with the Mike H…