Canada Healthcare 2015-17

Written by  //  February 16, 2017  //  Health & Health care  //  No comments

healthcare issues word cloudAndré Picard: The real challenge to Canada’s health system is not wait times
Canada has some of the longest waits for medical care in the developed world. Same-day or next-day appointments with a doctor are difficult to get – and in the evening or on weekends, fuggedaboutit. Waits in the ER can be seemingly endless. Referrals to specialists result in lengthy waits. The wait for elective surgery is often painfully long.
These badges of shame are laid bare once again in a new report from the Canadian Institute for Health Information.
Worse yet, the CIHI data barely scratch the surface. The wait to see a doctor in the ER may stretch for hours, but if you need to be admitted to hospital, it can jump to days. The wait for home care services often stretches for months, and a patient needing a long-term care bed can languish in limbo for years.
Canada’s health-care system suffers from what experts call “code gridlock” – provision of care moves at a glacial rhythm because of clogs in the system.
Long-term care and nursing home beds are full. Home care hours are limited. As a result, thousands of patients who no longer need care can’t leave hospital, a reality so common we have an Orwellian term for it – alternate level of care. Because these patients are not discharged and beds are scarce, elective surgeries are cancelled, and those waiting for admission spend days on gurneys in the ER. The congestion this causes means that ambulances sometimes can’t off-load patients. Providing care to those in hallways slows provision of care to those in the waiting room. And many of the patients in the waiting room are there because they are unable to see their doctor promptly.
The solution to problems like waiting times is not always to do more of the same. For example, the CIHI report notes that Canada relies on doctors to provide care more than any other country; in other words, we underuse nurse practitioners, occupational therapists and the like.
More than anything else though, what Canada needs to fix its systemic health-care woes is to create a semblance of a system.
What distinguishes the countries that have markedly better results than Canada – like the Netherlands and the Nordic countries – is the cohesiveness of the system, and the emphasis on primary care.
Every Dutch citizen must register with a general practitioner, who acts as navigator and gatekeeper for the system. Furthermore, the roles and responsibilities of all the key players in the system – practitioners, insurers and government – are clearly defined, and complementary. Better still, politicians do very little micromanaging of the health system because that is not tolerated. In the Nordic countries, in addition, there is a particular emphasis on the socio-economic determinants of health, in tackling inequality, but spending more on education and social welfare, and less on health, with impressive results.

2016

18 November
Why Canada’s assisted dying law is confusing doctors—and patients
Canada’s Justice Minister says the law provides ‘maximum flexibility’ to health-care professionals who assess patients. But doctors are unclear on who qualifies for assisted dying.
(Maclean’s) From the time it was introduced last spring, one of the most contentious aspects of the federal government’s assisted dying legislation was the requirement that in order to get a doctor’s help to end their lives, a patient must not only be suffering from a “grievous and irremediable” medical condition, but their natural death must be “reasonably foreseeable.” Critics of that clause argued it was unconstitutional, because the Supreme Court decision that struck down the ban on assisted dying did not limit it to those already near death. Julia Lamb, a 25-year-old British Columbia woman with a muscle-wasting disease, has already launched a court challenge to the law on those grounds.
In a backgrounder on Bill C-14, the Justice department noted that the legislation does not limit assisted death to people dying within a given timeframe, such as six months, but it does “require a natural death to be foreseeable in a period of time that is not too remote.”
Now, five months after the law came into effect, there is enduring confusion—among patients, their families and the doctors handed responsibility for assessing who qualifies—about what exactly that means and who meets that bar.

28 September
Provinces push for more federal health spending as senior population grows
(Globe & Mail) Provinces with older-than-average populations are pushing Ottawa to boost health transfers based on demographics as part of a new national health accord.
But provinces and territories are also expressing increased frustration with the federal Liberals over an apparent unwillingness to discuss increased federal spending on health.
Preparing for a rise in health-care costs as baby boomers retire is shaping up as a key point of contention as federal Health Minister Jane Philpott prepares for an Oct. 18 meeting with the provinces and territories on health-care reform.

28 August
Premiers send Trudeau letter demanding meeting on health care
In lieu of meeting, provincial leaders say federal government should extend increased health transfers

Report of the Advisory Panel on Healthcare Innovation
Canadians working at all levels of healthcare observed that innovations of proven worth were not being scaled up and spread across the nation. For their part, entrepreneurs asked why it was harder to penetrate the Canadian healthcare market than to sell their ideas, products, and services abroad. While the Panel did hear complaints about the levels of funding available for healthcare, a surprising number of stakeholders echoed the growing public sentiment that a lack of operating dollars was not the primary problem.
On the positive side, as already indicated, there was an extraordinary consistency of resolve that real change in healthcare was greatly overdue. Front-line healthcare leaders, policymakers, and other stakeholders across the country were utterly consistent in this regard. While no one offered up a simple recipe for an excellent healthcare system, many themes recurred. (July 2015)
Universal drug plan would save billions, UBC researchers say
Government plan could save billions of dollars while keeping drug costs affordable, study suggests
Canada is the only developed country with universal health insurance coverage that does not also offer universal prescription drug benefits. (March 2015)

28 August
B.C. seniors build a new way to age in place
(CBC) It started with a meeting in 2010. Five years and twelve million dollars later, 44 people, from their late 40s to their 90s, moved into Harbourside Seniors Co-housing last winter.
Among them, a retired school bus driver, a mountain guide, a teacher, a hard-living old American DJ, a bunch of nurses, a biochemist-turned-potter, and — vital to any social experiment — an anthropologist.
Five years ago they didn’t know each other. Now, they are a tribe – neighbours prepared to live together and look after each other, with any luck, till the end of their days.

2015

13 October
André Picard: Nobel-worthy drugs, virtually unseen in Canada
Why are ivermectin and artemisinin, drugs that are on the World Health Organization’s list of essential medicines, not readily available in Canada – at least for humans? (Ivermectin is widely prescribed by veterinarians to treat parasitic worms in pets and farm animals. Some savvy consumers even use their dogs’ medicine to treat their kids’ head lice.)
The simple – and absurd – reason is that it is not worth the drug maker’s time, effort and expense to have these world-beating drugs approved for sale in a market as small as Canada.
What these examples tell us is that the drug regulator, Health Canada, needs to be more flexible and less bureaucratic. There is no reason that these drugs, which have been approved by the U.S. Food and Drug Administration and have been used safely on millions of people, cannot be rubber-stamped and made available to Canadian patients in need.
These neglected, Nobel-winning drugs also remind us that Canada doesn’t have a coherent policy on how to approve and fund so-called orphan drugs (those used for rare conditions, and for which there is a desperate need but no profitable market). The federal government unveiled an Orphan Drug Framework in 2012, but still hasn’t implemented it.
Finally, that we actually need ivermectin and artemisinin in Canadian health practices is a sobering reminder that the world is getting smaller, and that tropical diseases are not just in the tropics.
12 October
Canada Needs a National Dementia Strategy
Mimi Lowi-Young, CEO of the Alzheimer Society of Canada.
(HuffPost) Our Beyond the Ballot series is deep diving into three major problems facing Canadians: climate change, housing insecurity, and elder care.
Statistics Canada recently released new data which, for the first time in Canadian history, shows that seniors outnumber children aged 14 and under.
Dementia is not only a costly disease that will continue to cut a deep swath across our country, but its causes continue to baffle researchers despite scientific advances. No new drug for treating dementia has been approved in 12 years and a cure seems years away.
The Pan American Health Organization (PAHO), of which Canada is a member, has just adopted a Regional Plan of Action to curb the impact of dementia that affects 9.4 million people in the Americas today and is expected to grow to almost 30 million people by 2050. PAHO says that national dementia plans are “the single most powerful tool” to transform national dementia care and support and prepare for the rising numbers.
That’s what Canada needs: a pan-Canadian response. While each province and territory provides dementia treatment and support services, more can be done under the framework of a national dementia strategy. Other member countries of PAHO — including Argentina, Mexico and the U.S. — have implemented national strategies.
6 October
HEALTH CARE: FOUR THINGS TO KNOW BEFORE YOU VOTE
Doctors, health advocates and the provinces fear that caring for Canada’s aging population will be a big challenge in the years to come. What are the major parties’ prescriptions for change? Here’s a primer
Canada is the only developed country that has universal health insurance without universal prescription drug coverage.
As of July 1, 2015, Canada had more seniors than children aged 14 or under.
Legal, physician-assisted suicide is supported by 77 per cent of Canadians, according to a recent Forum Research poll.
When medicare was introduced in 1957, Ottawa paid for half of the provinces’ health-care costs. That’s decreased over the decades, and now it’s only about 20 per cent.
5 October
Why the TPP is such a big—and good—deal for Canada
(Maclean’s) … one will also no doubt hear that TPP will increase drug costs. This is false, but there was indeed the potential that this could have been true. One of the main sticking points, primarily between Australia and the United States, was the length of monopoly status afforded to prescription drug companies when they bring out a new drug. For a drug to receive government approval, it must submit a large quantity of data. This data is useful to competitors, such as generic drug companies, when they produce competing drugs. So-called “data protection periods” prevent these competitors from using the original data. (A great Bookings Institute backgrounder on Prescription Drugs and the TPP is here.)
In the United States, this period is 12 years. In Canada, it is 8. In Australia, it is only 5. The US wanted longer periods, while most other countries wanted shorter. The longer the period, the longer the monopoly status of the original drug manufacturer, the longer the drug’s price remains high, and so on. There are some who label the exclusivity periods the “Death Sentence Clause.” That is a little over the top, but it would have certainly increased healthcare costs.
What does TPP do? The countries agreed on a five-year period, as Australia was demanding. As Canada already has a longer period than this, the TPP doesn’t change much at all from our perspective.
23 September
Drug price regulations need overhaul to protect consumers, experts say

System to ensure Canadians don’t overpay for pharmaceuticals no longer works in today’s market
Critics railed this week against the drastic price jumps of two medications. The price of cycloserine, used to treat a rare and dangerous form of tuberculosis, went up by 2,000 per cent overnight after its rights were sold to a for-profit company. Daraprim, a drug for certain patients with compromised immune systems, soared by 5,000 per cent.
Experts say both drugs are good examples of a crack in Canada’s drug price regulations.
Neither is usually available in Canada, but they, and other drugs, can be imported through a special federal program.
The Special Access Programme (SAP) lets in drugs that are not approved for sale in Canada when there is a special medical request to give them to specific patients with serious or life-threatening conditions, “when conventional therapies have failed, are unsuitable, or unavailable,” according to Health Canada’s website.
But drugs imported under the SAP are not subject to any of Ottawa’s usual price controls.
7 September
MUHC launches action plan to fix blocked sewage drains at superhospital
“Since the opening of the Glen site’s facilities (in April), a high volume of ‘code flood’ calls have occurred,” [the executive director of the McGill University Health Centre] Normand Rinfret said in his first statement on the flooding of sewage water in patient rooms and hallways, including in the birthing centre and the breast clinic.
“This situation has been not only a source of concern for everyone in our community but also disruptive for our staff and health-care professionals.”
Although SNC-Lavalin has blamed part of the problem on visitors, staff and patients flushing dressings and tampons down toilets, sources say that during some unclogging of pipes cement and construction material have come up.
26 August
Raw sewage backups at MUHC superhospital test relations with SNC-Lavalin
Black sewer water that “smells worse than rotten fish” is backing up drains and pooling in patient bathrooms at the new Montreal Children’s Hospital, angering staff who say the problem is widespread and keeps popping up despite the fact that plumbers are called in regularly to snake the drains.
The plumbing problems are the latest in a series of glitches — as many as 14,000 — that continue to plague the $1.3-billion superhospital of the McGill University Health Centre, and are sorely testing relations between the MUHC and design-build contractor SNC-Lavalin.
The superhospital was built as a public-private partnership, with the Quebec engineering firm acting as the lead partner in a private consortium that is the landlord of the property. Unlike the Old Montreal Children’s where the MUHC could do what it wanted with the building as the sole owner, SNC-Lavalin is responsible for maintaining the superhospital and fixing plumbing, electrical and other problems.
But the MUHC has been at loggerheads with SNC-Lavalin over a wide range of “deficiencies” — from faulty wiring to leaking ceilings — since before the superhospital opened at the Glen site in the spring. The public-private partnership was supposed to transfer the risk of any cost overruns from the public sector to the private partner, but SNC-Lavalin is nonetheless seeking more than $172 million in “extras” from the MUHC over the construction.
13 August
Cuts to MD/PhD funding greeted with ‘horror’ by medical scientists
Federal funding cuts threaten ‘endangered species’ of physician-scientist
Canada’s medical research community is reacting with shock and disappointment to the cancellation of a 30-year program to train doctors who see patients and work as scientists searching for new treatments.
The Canadian Institutes of Health Research is the federal government’s major health science research organization. Its MD/PhD program was launched in the 1980s out of concern over the lack of specialists who could move easily between the lab and hospital. … Cancelling the program will save about $1.8 million a year. The concern is that without a replacement program Canada will lose critical expertise and leadership.
The Canadian Institutes of Health Research invests $1.2 billion a year from Ottawa to support the training of health researchers. Funding under the MD/PhD program will continue for the next six years until 2021, a spokesman said in an email.
28 July
Quebec orders hospitals to cut $150 million in direct care to patients
The Quebec government is ordering hospitals and other health facilities to slash $150 million from their budgets for medical tests, imaging scans and procedures to patients that it has judged are not “pertinent to care,” the Montreal Gazette has learned.
In total, the Health Department is aiming to chop $583 million in spending through so-called optimization measures. And in a bizarre twist, the government has decided that it won’t provide hospitals funding for next year’s leap year day, Feb. 29, which will fall on a Monday, saving it $64 million.
It’s up to hospitals to cover the shortfall on that day out of their own already diminished budgets.
One of the biggest cutbacks will take place at the McGill University Health Centre, which last year was forced to cut $50 million from its operating budget. It must now reduce its spending by an extra $21 million.
25 July
New superhospital ER overcrowded while occupancy rate drops at other hospitals
In the past six weeks, the average daily volume of patients has jumped by at least 20 per cent in the ER at the Glen Site of the McGill University Health Centre, compared with the emergency department at the old Royal Victoria Hospital. The ER on University St. closed on April 26 and the new one opened the same day at the Glen location in Notre-Dame-de-Grâce.
The MUHC has responded to the higher volume by setting up a “rapid response team,” but some patients have complained of waiting for hours to be seen, while others whose cases are more urgent are stuck in the new ER receiving treatment for more than 24 hours because no beds on other floors are available for them to be admitted.
The Jewish General encountered a similar rush of patients after it inaugurated its expanded ER early last year, especially after it promised patients would be seen by physicians within 20 minutes. The ER volume quickly tripled, and the hospital was compelled to drop the 20-minute promise.
Meanwhile, the pediatric ER in the new home of the Montreal Children’s is busy, but not overcrowded. But some parents have complained about having to wait for hours in the new Children’s ER — especially at night — and having to leave in frustration before being seen by a doctor.
11 July
“Big Data” study discovers earliest sign of Alzheimer’s development
Research underlines importance of computational power in future neurological breakthrough
(Montreal Neuro) Scientists at the Montreal Neurological Institute and Hospital have used a powerful tool to better understand the progression of late-onset Alzheimer’s disease (LOAD), identifying its first physiological signs.
Led by Dr. Alan Evans, a professor of neurology, neurosurgery and biomedical engineering at the Neuro, the researchers analyzed more than 7,700 brain images from 1,171 people in various stages of Alzheimer’s progression using a variety of techniques including magnetic resonance imaging (MRI) and positron emission tomography (PET). Blood and cerebrospinal fluid were also analyzed, as well as the subjects’ level of cognition.
The researchers found that, contrary to previous understanding, the first physiological sign of Alzheimer’s disease is a decrease in blood flow in the brain. An increase in amyloid protein was considered to be the first detectable sign of Alzheimer’s. While amyloid certainly plays a role, this study finds that changes in blood flow are the earliest known warning sign of Alzheimer’s. The study also found that changes in cognition begin earlier in the progression than previously believed.
Late-onset Alzheimer’s disease is an incredibly complex disease but an equally important one to understand. It is not caused by any one neurological mechanism but is a result of several associated mechanisms in the brain. LOAD is the most common cause of human dementia and an understanding of the interactions between its various mechanisms is important to develop treatments.
7 July
Jacques Turgeon quits the CHUM for good
More turmoil at the CHUM this summer as the French-language university health complex finds itself without an executive director once again, with the news on Tuesday that Jacques Turgeon is leaving his position — for the second time in four months.
5 July
La Marche de la dignité
Comme rien ne s’améliore dans les conditions de vie des personnes qui vivent en CHSLD et en résidences privées, j’ai décidé d’organiser une marche. Cette manifestation aura pour but premier de dénoncer les conditions de vie indignes et irrespectueuses offertes dans certaines institutions où le budget passe avant l’être humain et ses besoins. The cost of health cuts: Orderly can’t answer every call
Orderly Jean Bottari starts his evening shift by distributing nightgowns on his ward at a Montreal rehabilitation centre. He has 22 patients in his care and before he’s said “hello” to a quarter of them, he’s being summoned by multiple alarm bells.
22 June
André Picard: In pursuit of ‘superhospitals,’ the public interest came last
On the weekend, the McGill University Health Centre celebrated the inauguration of its “Glen site,” a spanking new 500-bed hospital.
Normand Rinfret, president and chief executive of the MUHC, hailed the facility as a “shining icon for Montreal, for Quebec and for Canada.” He also thanked those who envisaged, designed, planned and managed the project and carried out the construction – and he did so with a straight face.
As hospitals go, it’s nice, especially compared with the decrepit, crumbling institutions it’s replacing, but it’s hardly iconic. It also comes with a whole of lot of baggage that can’t be conveniently overlooked.
The MUHC saga is a shameful example of the worst of petty politics and spineless policy-making, a two-decade-long debacle featuring corruption, bribery, petty politics and incompetence on a scale rarely seen in Canada.
Walk to celebrate MUHCSo, everyone paid $5 to walk to the MUHC and enjoy a fiesta while the PPP is charging the volunteer organizations who raise money for the hospital $60K p/a rent? And parking fees are almost $50 per day? I think there is something VERY wrong with this picture.

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