The Liberals in British Columbia were re-elected in Tuesday’s provincial election, a surprise turnaround from a few weeks ago when the opinion polls suggested the NDP would win in a landslide.
While the Liberals have actually been able to pad their majority in the legislature, their victory came at the cost of both Premier Christy Clark and Health Minister Dr. Margaret MacDiarmid going down to defeat in their respective Vancouver ridings.
Health care was not a prominent issue in the campaign despite it being the second-most important concern for voters next to the economy (33 to 18 per cent), according to an Angus Reid online survey two weeks ago.
The only health-care topic to get any attention during the leaders’ radio debate at the end of April was the Liberal government’s 2010 decision to cancel funding for the Therapeutics Initiative, a UBC drug-review body. The NDP vowed not only to reinstate the funding but double it.
A few days later, during the one and only leaders’ TV debate, health care was not raised at all.
In its campaign platform, the NDP made more funding commitments for health care than the Liberals — $254 million versus just $4 million over three years — but this clearly did not sway voters.
Instead, the Liberals touted their $8 billion investment in health-care infrastructure since being first elected in 2001 and with projects worth $2.3 billion to be built over the next three years. They also referenced the recent budget with $2.4 billion in new health-care funding over the next three years. This works out to an average annual increase of 2.6 per cent.
However, the budget documents show some significant differences in the rate of growth among health services. Physician and drug plan expenditures will get an average annual increase of just 1.1 per cent. Even health authorities, which will get a 4.3 per cent funding boost in 2013-14, will be transitioning to the use of performance-based patient-focused funding incentives in their base budgets this year and are headed for a 2.9 per cent increase in 2014-15.
Achieving these changes in “bending the cost curve”, as the budget described them, will be the task of the new health minister.
Other initiatives in the platform for the new minister to implement include continuing the $132.4 million “GP for Me” program — ensuring every British Columbian who wants a family doctor is able to access one by 2015, as well as increasing the number of new hospice spaces, providing 450 automated external defibrillators in community centres, arenas and other venues across the province, as well as partnering with United Way to provide additional support for seniors through the “Better at Home” program. HE
Ontario NDP Leader Andrea Horwath has made another demand of the minority Liberal government in order for her party to support the recent budget. She wants the province’s ombudsman to have oversight of the health sector.
“Ontarians told us they want clear, concrete change in health care. They’re tired of the Liberal government saying ‘just trust us’,” Ms. Horwath said last Friday. “Asking Ontario’s Ombudsman to have oversight into the health care sector is a fair and reasonable way to start building trust.”
Last September, NDP Health Critic France Gélinas introduced a bill giving the ombudsman the authority to investigate hospitals and other places where health services are delivered. Ontario is the only province where the Ombudsman does not have such powers.
Ombudsman André Marin has also been after such powers for some time. In April last year, he noted that his office received some 375 complaints about hospitals in 2011-12 but he was unable to act. However, a spokesperson for one Ontario hospital told the CBC at the time that all facilities are required to have a patient advocate under the province’s Excellent Care for All Act which came into law almost two years ago.
Mr. Marin has reported on other health-care matters including long-term care, drug coverage, and the community-engagement obligations of Local Health Integration Networks. HE
Ontario is spending $25 million to replace outdated mammography equipment. The announcement by Health Minister Deb Matthews was made Tuesday following release of a study by a Cancer Care Ontario scientist showing that direct radiography (DR) mammograms and screen-film mammograms are better at detecting breast cancer than computed radiography (CR) mammograms.
DR technology can detect 4.9 cancers in every 1,000 images compared to 3.4 for CR technology which is used for approximately 20 per cent of mammograms in Ontario.
The Ontario Association of Radiologists immediately issued its own news release Tuesday sharply critical of the government’s “band-aid solution.” It said it had recommended in October 2010 that the government shift to DR mammography, but this advice was ignored. It said the province lags the rest of the country in the adoption of digital mammography services, the result of chronic underfunding. They also point out that there are 40 or more hospitals that are still using analog equipment.
However, Ms. Matthews rejected radiologists’ criticisms. She told the National Post that the 2010 report dealt with efficiency issues not the effectiveness of the different machines which was revealed for the first time in the new study. She also said radiologists want to move to digital technology because it is faster and will make them more money.
She suggested that any woman concerned about the accuracy of a mammogram done with CR equipment ask to be retested. HE
People in Prince Edward Island will have a catastrophic drug plan as of October 1 this year, covering prescription drug costs over a certain percentage of their family income.
In making the announcement last Friday, Premier Robert Ghiz said the program is about providing coverage for any Islander whose drug costs are becoming a financial burden. PEI and New Brunswick are currently the only two provinces without such a drug plan. New Brunswick is working on one, but no implementation date has been set.
PEI’s catastrophic drug plan will use an income-based approach: families will pay prescription drug costs up to three per cent of annual income if they earn no more than $20,000. This rises to five per cent for those earning between $20,000 and $50,000, and eight percent for those earning from $50,000 to $100,000. Above that amount, the maximum contribution is 12 per cent.
There is no premium or fees to enroll, and there is no ceiling on drug costs or limits on participation. In fact, the catastrophic drug plan formulary will be broader than the current PEI Pharmacare formulary, and approximately 60 new drugs will be added immediately. An expert panel will manage the formulary, and Health Minister Doug Currie said almost every new drug recommended by the national Common Drug Review and pan-Canadian Oncology Drug Review will be covered. HE
Quebec’s health and wellness commissioner, Robert Salois, has been asked by Health Minister Dr. Réjean Hébert to review the province’s subsidized assisted reproduction program. His work began without fanfare last month, and was brought to light by Le Devoir this week.
The program was implemented by the previous government almost three years ago, providing coverage of up to three cycles of in vitro fertilization, but putting a limit of one embryo implanted per cycle in order to cut down on multiple births. While it has achieved this goal — reducing the rate from 28 to just five per cent — it has come at an expense. No spending cap was ever put on the program, and it cost $60 million last year to subsidize about 8,000 cycles.
Dr. Hébert says the three-year review of the program is a normal procedure, and there is no question of the government abandoning the policy. However, he has asked Mr. Salois to look at whether some of the standards should be tightened up to deal with ethical issues.
Questions about the screening of patients were raised after the McGill University Reproductive Centre had to ask the youth protection agency to place one baby after a young mother was found to be unfit.
Liberal Critic Dr. Yves Bolduc, who started the program when he was health minister, has suggested that Dr. Hébert may also be interested in introducing user fees to defray some of the government’s expenses.
In a letter to stakeholders soliciting input, Mr. Salois said his review will cover a number of bases from clinical to ethical, organizational to economic. There is no timetable set for the completion of the review, but Le Devoir said stakeholder consultations were to conclude May 20 and public input would be collected until June 17. HE
Health PEI has published its new strategic plan for 2013-16. The plan has three goals pertaining to quality, access and efficiency. There are four key strategic dimensions: a renewed model of home-based services – to support Islanders to remain home longer and return home sooner; a renewed model of community-based primary health care; health-care system enablers – focused on improving the efficiency of resources, processes and support services; and, integration of acute and facility-based care – focused on ensuring the most effective use of beds and facility-based services. The plan can be found at www.gov.pe.ca/photos/original/hpei_stratpl_16.pdf.
Only the most affluent Canadians contribute significantly more to health care than they receive, a study from the Canadian Institute for Health Information has found. For $3,400 in average annual health care costs, the top 20 per cent of earners pay $8,700 in taxes. For other income groups, there is less of a difference although those in the lowest 20 per cent earning group consume an average of $4,200 a year in health costs while paying $1,000 in taxes toward these services. The study found that those in the highest income group contributed 8 per cent of their total income toward publicly-financed health care compared to 6 per cent for the lowest income group. The study, Lifetime Distributional Effects of Publicly Financed Health Care in Canada, is at www.cihi.ca.
Ontario is beefing up the inspection powers of the College of Pharmacists to allow it to inspect premises where pharmacists and pharmacy technicians engage in or supervise drug preparation activities. The government has provided direction on the type of organizations hospitals can purchase or obtain drugs from. The actions follow the discovery that an Ontario company was able to supply chemotherapy drugs to hospitals without any regulatory oversight. (News release at http://news.ontario.ca/mohltc/en/2013/05/new-oversight-to-safeguard-drugs.html)
One-in-twelve Canadian hospital patients are infected or colonized by a superbug, resistant to most or all antibiotics, a November 2010 survey published Monday in the journal Infection Control and Hospital Epidemiology reveals. The article says there are two main strategies for dealing with the problem: eliminating inappropriate use of antibiotics. and ensuring high standards of infection control. (Canadian Press, May 13; the article can be accessed for a fee at www.jstor.org/stable/infeconthospepid.ahead-of-print)
There is room for improvement in the integration of cancer care in Ontario, and equity of access to services, the ninth annual Cancer System Quality Index (CSQI) from the Cancer Quality Council of Ontario says. The Index measures 32 indicators and the overall rating this year for integration and equity was “poor” and the rating for enhancing patient and provider safety as well as greater efficiency was “fair.” On the other hand, ensuring cancer services and improving access was rated as “very good.” This is despite the fact that no hospital met the provincial target of 85 per cent of patients starting chemotherapy within 28 days of receiving a consultation. (Toronto Star, May 16; News release and link to the report at www.csqi.on.ca/cms/One.aspx?portalId=89613&pageId=278894)
Manitoba’s primary care bus will be on the road by the end of the year, Manitoba Health Minister Theresa Oswald says. The concept of having a bus to tour small communities and provide check-ups, test blood pressure and blood sugar levels, and conduct basic health education and chronic disease management, was first announced in the November 2010 Speech from the Throne. However, it has been beset with some technical hurdles. The first bus will be staffed by a nurse and nurse practitioner, with two more buses planned. (Canadian Press, May 15)
Manitoba is providing seasonal agricultural workers with health coverage while working in the province, waiving wait times for eligibility. “Manitoba’s economy relies on seasonal agricultural workers and we compete with other provinces to attract them here, which is why we’re changing our health coverage, to be in line with that already offered in Saskatchewan.” Immigration and Multiculturalism Minister Christine Melnick says. (News release)
Some 300 unionized health workers protested outside the McGill University Health Centre Tuesday, angry with cost-cutting plans to balance the hospital’s books. Already 270 positions are on the chopping block, with more to come. La Presse says the second phase contains six optimization projects that will help the hospital meet its government-imposed target of reducing expenditures by $50 million. (La Presse, May 14,15)
Pharmacist prescribing in Quebec has hit a roadblock, with negotiations between pharmacists and the government over remuneration for new services at a stand-still, the association of pharmacist-owners (AQPP) says. It wants the government to cover fees of these services for both public and private customers, something it says the government is not inclined to do. (Le Soleil, May 14)
The Saskatoon Star-Phoenix (May 14) is concerned about the shortage of pediatric specialists in Saskatchewan. It says it is “distressing” that a new $230 million children’s hospital is being built with the possibility that it will not have “enough people to run it.” It is estimated that the hospital will need another 23 pediatricians, but “there doesn't seem to be much of a plan to find them, or even an appreciation that not having enough of the specialists will be a problem.” While the health minister believes that having the hospital will help with long-running recruitment issues, the editorial is not convinced. It notes that the government will be negotiating a new contract with physicians this month, but has no control over how funding is divvied up among specialties. The editorial says the province should take a more “hands-on approach when it comes to establishing the mechanisms for recruitment and retention.”
In the House of Commons last Friday, NDP MP Djaouida Sella said the “government did not renew funding to Canada Health Infoway” in the new budget. She said many provinces “cannot afford to make the transition to electronic health records," and asked the government to provide some financial support. Health Minister Leona Aglukkaq said “this government has supported Infoway, and we plan to continue to support Infoway in the important work it is carrying out with the provinces and territories.”
In the Quebec legislature Tuesday, CAQ Health Critic Hélène Daneault picked up on a story published in that day’s Le Soleil. Health Minister Dr. Réjean Hébert told the newspaper that he had decided not to change the number of health agencies in the province. The 18 agencies operate like health regions and oversee the operations of 95 local area networks.
Ms. Daneault noted that the minister had remarked just two months ago that he thought there were too many agencies. She said the government has no problem telling hospitals to cut their administrative costs, but it does not seem “to have the courage to take its own medicine.”
Dr. Hébert said the agency review he had ordered determined that there was no benefit in restructuring the agencies, and would cause too much upheaval. However, he said work continues on streamlining the roles of the health ministry, agencies and the networks.
In the Saskatchewan legislature the Opposition has continued its questioning about staffing levels in long-term care. Health Minister Dustin Duncan has acknowledged there are concerns and has asked CEOs to tour facilities and give him a report. But NDP Leader Cam Broten said it makes no sense that there are minimal staffing levels in the event of a strike, but nothing at other times.
On Wednesday, Mr. Broten said seniors receive one bath a week while Alberta changed the standard last month to two baths a week. Premier Brad Wall said the government will look at Alberta’s decision, and what other provinces are doing. He reiterated that the government is not ruling anything out in its review of long-term care — “everything ought to be on the table,” he said.
On Monday in the Alberta legislature Wildrose Seniors Critic Kerry Towle said the government has failed to keep its two-bath-a-week promise for seniors in long-term care. She said they are lucky to get even one. George VanderBurg, associate minister of seniors, indicated that the new standard would be “resolved” over time.
Wednesday morning, before the Public Accounts Committee, officials from Alberta Health Services answered questions on the topic from committee members and said no additional long-term care beds would be built — the focus instead being on improving home care and providing supportive living options for seniors.
Later that day, during question period, Ms. Towle said the government has broken its 2012 election campaign promise to create more long-term care beds, and claimed the government plans to cut 1,700 existing beds over the next five years.
Health Minister Fred Horne responded that all new continuing care spaces being created — a thousand a year — are to the B2 building standard “which is capable of accommodating all levels of care, from supportive living right up to long-term care.”
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