Tuesday, December 20, 2016

Julie Ali The federal government raises important questions about the use of public dollars by the health care system. I believe that it is responsible of the federal health minister to seek proper use of taxpayer dollars by targeting specific areas of health care such as mental health and home care. The provinces need to be more efficient with the use of money being provided. In Alberta for example we are paying for two health authorities AHS and Covenant Health with their expensive bureaucrats and executive staffs. This is unnecessary. There could be cost savings also in the downsizing of exorbitant salaries for the executive staff as well ad decreased salaries for managers. We don't need to have zones for AHS in my opinion. One central system should suffice. The fact is that there are many holes through which money is lost in health care. How often have I seen EMTs for example forced to stay with patients at the ER? Why can't the patient transfers be fast so that the EMT staff is freed up? Why are folks with skull fractures like my mother forced to stay in emergency waiting for help? Why are seniors taken to places like Norwood with pneumonia that is only diagnosed after days of complaints? There are system wide failures, repeats of the same adverse events, no accountability and high costs for poor deliverables. Time for the provincial government to provide some accountability to someone--even if this is just the federal government.« less





ANALYSIS

Federal and provincial ministers play the percentages in health-care talks

They say they're focused on people, not percentages, but both sides have a number in mind

By Aaron Wherry, CBC News Posted: Dec 20, 2016 5:00 AM ET Last Updated: Dec 20, 2016 9:17 AM ET
Health Minister Jane Philpott used the adjective 'substantial' four times while briefing reporters about her government's health-care funding offer for the provinces.
Health Minister Jane Philpott used the adjective 'substantial' four times while briefing reporters about her government's health-care funding offer for the provinces. (Adrian Wyld/Canadian Press)
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Aaron Wherry
Parliament Hill Bureau
Aaron Wherry has covered Parliament Hill since 2007 and has written for Maclean's, the National Post and the Globe and Mail.

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On her way into what would prove to be another inconclusive meeting about Canadian medicare, Jane Philpott felt it necessary to remind everyone that this isn't about "percentages."
"What's most important is the people," the federal health minister explained.
On this, if nothing else, there was agreement.
"We will continue to stand up for Canadians and we will push back on ultimatums being issued by the federal ministers at the expense of real people," said Manitoba Health Minister Kelvin Goertzen, leading a delegation of provincial representatives who followed Philpott to the microphone.
So yes, this is about the Canadian people and the extent and quality of the public health-care system that is available to them.
Which is to say, it's about the percentages: who pays and how much.
Finance Ministers 20161219
Manitoba Health Minister Kelvin Goertzen told reporters the provincial ministers are prepared to 'push back' against ultimatums from the federal government. (Adrian Wyld/Canadian Press)
In the beginning, several generations ago, there was an agreement that the federal and provincial governments would share the cost of medicare. And thus were the two levels of government joined together, to spend eternity bickering over how to apportion responsibility.
Provinces have suggested during this latest round of negotiation that the federal government should cover 25 per cent of the total cost of health care. But there doesn't seem to be anything particularly magical about that number.
The federal contribution last amounted to that much in 1980. After falling for the next two decades, it has since risen to 23 per cent. But the federal share could decrease again in the years ahead if health-care costs increase as expected because of an aging population.
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P.E.I. Premier Wade MacLauchlan and his provincial colleagues across the country focus on different numbers than the federal government when it comes health-care spending. (Adrian Wyld/Canadian Press)
That potential decreased share is linked to the previous Conservative government's decision that the Canada Health Transfer, the primary mechanism through which the federal government funds medicare, would increase each year by three per cent or, if higher, the annual rate of economic growth (nominal GDP), starting in 2017.
In Ottawa on Monday, the provinces proposed the annual increase be 5.2 per cent.
The Trudeau government is offering 3.5 per cent, with no adjustment for economic growth.
The Liberals would also provide $11.5 billion over 10 years for spending on home care and mental health, with some expectation that the provinces will report precisely what comes of that money.

Looking at different things

The federal government looks at recent trends in provincial spending and sees health care has been increasing by one or two per cent each year.
The provinces look at how much more money they might have to spend in future years.
The Liberals look at their own proposal and say they're offering the provinces $25 billion over the next five years.
The provinces look at the federal offer and figure they're getting $30 billion less than they need over the next ten years.
As much as the provinces might like more money, the federal government has a deficit hanging over its head.
At the end of the day, New Brunswick made a daring move to suggest it might go it alone and make a deal with the Trudeau government.
In light of all that, Conservative leadership candidate Maxime Bernier proudly pointed out on Monday evening that he's proposing the federal government get out of funding health care entirely.
6/ My plan calls for giving tax points to provinces so that they become entirely RESPONSIBLE and ACCOUNTABLE for their decisions. #cdnpoli
Alternatively, if you believe the federal government has some greater role to play in health care, you might have to put up with regular rounds of haggling.

Targeted money

Heading into Monday's discussions, Philpott described her government's offerings as "substantial" — an adjective she would utter at least four times in the course of briefing reporters. After the meeting, Finance Minister Bill Morneau would opt for "significant."
"The really exciting story today is that we are making new investments that have never been done before by the federal government," Philpott said, specifically referring to the money for home care and mental health.
Health Transfers 20161219
Finance Minister Bill Morneau and Health Minister Jane Philpott speak to reporters after the provincial ministers rejected their health-care deal. (Adrian Wyld/Canadian Press)
Unlike the health transfer, which flows into the general revenues of each province, providing targeted funds and requiring that results be measured and reported would seem like an actual federal initiative on medicare: something that could give the federal government a tangible benefit to point to.
If the transfer fails to meet provincial demands, the provinces can simply blame the federal government for any reduction in service.
'We will continue to stand up for Canadians and and we will push back on ultimatums being issued by the federal ministers at the expense of real people.'- Manitoba Health Minister Kelvin Goertzen
Asked what leverage the provinces had in demanding more money from the Trudeau government, Manitoba's Goertzen invoked the letters he receives from concerned Canadians (even if he seemed to decide halfway through his soliloquy that the term "leverage" might seem a bit insensitive).
"Our greatest leverage is [that] every man or woman here who is a health minister gets the letters, every day. From Canadians who tell them they're waiting in ERs too long. They get the letters every day from Canadians who tell them, 'I'm waiting for a test, or my loved one is waiting for a test and I'm scared.'
"Every one of my colleagues gets those letters and we read them. Is that leverage? Well, I don't want to call it leverage, but that's reality. And we will bring that message to ... the federal government. If they won't listen to us ... will they listen to the Canadians who are saying, 'This has to change, our system isn't good enough?'"
heart-surgery
Manitoba Health Minister Kelvin Goertzen says he and his colleagues get letters every day from Canadians who've been let down by the health-care system. (CBC)
To this, some, including Philpott, might argue that money won't fix everything.
But the question of percentages seems a rather significant and unavoidable part of the conversation.
The provinces, Goertzen said, want to keep talking, presumably about more money, but maybe, if that gets settled, about other things.
​"We know that we share interests with provinces in making a real difference for Canadians," Bill Morneau offered at the end of the afternoon.
His government, he said, had settled on "the appropriate amount that we can spend."
But, alas, it wasn't enough.
"My conclusion," Morneau explained to reporters, "is that the provinces were seeking more money."
So at least the day provided the federal finance minister with that insight.
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Health minister 'frankly astonished' provinces rejected deal6:58




























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    • Julie Ali
    The federal government raises important questions about the use of public dollars by the health care system. 
    I believe that it is responsible of the federal health minister to seek proper use of taxpayer dollars by targeting specific areas of health care such as mental health and home care. 

    The provinces need to be more efficient with the use of money being provided. In Alberta for example we are paying for two health authorities AHS and Covenant Health with their expensive bureaucrats and executive staffs. This is unnecessary. There could be cost savings also in the downsizing of exorbitant salaries for the executive staff as well ad decreased salaries for managers. We don't need to have zones for AHS in my opinion. One central system should suffice. 

    The fact is that there are many holes through which money is lost in health care. How often have I seen EMTs for example forced to stay with patients at the ER? Why can't the patient transfers be fast so that the EMT staff is freed up? Why are folks with skull fractures like my mother forced to stay in emergency waiting for help? Why are seniors taken to places like Norwood with pneumonia that is only diagnosed after days of complaints? There are system wide failures, repeats of the same adverse events, no accountability and high costs for poor deliverables. 

    Time for the provincial government to provide some accountability to someone--even if this is just the federal government.« less
    • 2 hours ago
    Pierce Mann
    • Pierce Mann
    @Julie Ali 
     I used to work for Alberta Health Care, and I can tell you that the regional system was the best - most efficient - we had. With only one authority it has become too unwieldy, and the system suffers from trying to shoehorn one set of policies and practices into fitting both urban and rural health care. When there was real comparison between Calgary and Edmonton the competition gave incentive for good performance. 

    As for Emergency care being slow to get out of - that is a problem for bed management. And special care beds have trouble getting emptied if there is no home care to help patients once they are healthy enough not to need a hospital bed. Home care is the most efficient health care spending - it frees up hospital beds by allowing patients to be discharged earlier.« less
    • 1 hour ago
    Julie Ali
    • Julie Ali
    @Pierce Mann 
    I don't think the regional system was the best. 

    I have looked at the payouts Albertans have made to CEOs of the health regions in the past; we lost a ton of cash. Poor decision making was also evident. 

    There should be one health authority but it should be open/transparent/accountable and complaints should be handled independent of AHS/ Alberta Health Services. 

    Emergency care is not only a problem of bed management but of intelligent management of services and care delivery methods. Not all patients will be going home to take advantage of home care services. Patients will complex care needs will need institutionalised care. Places like Michener Centre could be repurposed to provide complex care. 

    Instead, the GOA does not make specialised facilities or even long term care facilities but simply puts complex care patients into SL4 sites with cobbled together care plans. It's ridiculous. This sort of poor service delivery has nothing to do with bed management. It has everything to do with the GOA's decision to move towards lower level of care provision to seniors in the private sector. It is poor decision making that does not serve the needs of our most vulnerable handicapped citizens. 

    As for the home care being the most efficient this is fine if you have citizens who can use the home care system and if there are home care providers who are competent. In my experience, home care services were split between companies that often had high staff turnover which is a big problem for complex care delivery. 

    Home care also does not address the coming spike in dementia cases. In the next few decades, we are going to be experiencing high levels of citizens who have dementia and home care won't do according to the current services and supports paradigm.« less

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