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by David M. Kaplan – June 13, 2012 – from healthdebate.ca
The fiscal health of the province should not be cured by detrimental changes to the health of Ontarians. The rhetoric of rising health care costs and a population aging ‘crisis’ are a means by government, health service providers, and even the consumer to obscure reality. The main crisis facing Ontario is a debt crisis. The politics of blame are used by both the government and the healthcare establishment to defend their self-interests. The Ontario government had hoped to grow itself out of deficit by relying on overly optimistic projections for revenue growth. Prior to the fall 2011 election, not one political party had a frank and honest dialogue with the people of Ontario.
Prior to 2003, and aside from a brief time in the late 1990s to 2002, an increasing proportion of Ontario’s Gross Domestic Product (GDP) was spent on servicing the debt. The servicing of this massive governmental debt, caused by the operating deficits of the mid-1970’s to mid-1980’s, caused a diversion of government revenue to pay for debt financing.* The public debt was so massive that the government had been going further into deficit each year to pay the interest charges.
We should have learned from biblical Joseph even though our Premiers did not have dreams to decipher. We should have kept money back during the years of plenty (2002-2008) for these years of famine. Instead, we ate all the grain and bought even more grain on cheap credit. From 2003-2011, the Ontario government increased spending by almost double the rate of economic growth. Debt service charges (the annual interest payment on the debt) have remained about $10 billion a year only because interest rates have dropped since 1999. Debt servicing is the province’s third-largest annual expense and one of its fastest growing expenditures. To put it into perspective, the Ontario government almost spends as much on servicing the debt each year as it does on our colleges and universities.
So what do we do now? Increasing the value of our health care spending dollars (of course without increasing risk and while maintaining quality and patient experience) will only get us so far. Unfortunately, ‘bending the cost curve’ in healthcare is not the answer to the grey tsunami that will increase health care utilization in the next decade.
We need to increase our productivity to increase government revenue. If we don’t change soon we won’t be able to sustain even our current system. We need to increase the productivity of Ontarians so that companies are more successful and Ontarians are better paid. Paid citizens and financial sound corporations contribute to taxation revenue. We need to increase our per capitaGDPand lead the country in economic growth once again.
Without the existence of an astronomical debt, the graying of the population and the subsequent increase in resource utilization would not seem so much of a problem. If crises in health care continue to ‘emerge’, there are more likely consequences of a fiscal crisis and not the causes of one. Politicians need to solve the fiscal crisis. Health care providers and government need to address the broad determinants of health. Ontarians need to increase their productivity and take individual responsibility for their health. The true crisis that faces Ontario, the debt crisis, will lead to future, consequential crises in health care which we will not be able to finance out of the public purse.
*Northcott, H. “The Politics of Fiscal Austerity.” Health and Canadian Society 1(2): 347-366.
David M. Kaplan MD, CCFP, MSc (Health Policy) is an academic family physician practising in Toronto. He is an Assistant Professor in the Department of Family & Community Medicine and Joint Centre for Bioethics at the University of Toronto. Click here to read David’s Blog. Follow David on Twitter: @davidkaplanmd
TORONTO – As the debate over birth control rages in the United States, one columnist has made a suggestion that is gaining traction in Canada – make the drug available over the counter.
Columnist Virginia Postrel wrote in a March 8 post on Bloomberg.com that birth control should be made available over-the-counter because of minimal safety concerns.
“Nearly two decades later, birth- control pills look even safer than they did then, and recent research indicates that women are both able and eager to manage their own purchase decisions,” Postrel says.
Though Postrel does admit that birth control pills carry potential side effects, she notes they are not the only drug that does. Ibuprofen – a drug which is readily available over the counter – also has a significant amount of side-effects, Postrel points out.
Some doctors suggest that ibuprofen, if released today, would be only available by prescription.
Dr. David Kaplan, Deputy Chief, Family & Community Medicine at North York General Hospital, says that both ibuprofen and birth control have side effects, but only the latter requires more extensive review.
“There is some monitoring that needs to happen when we place women on birth control medications. We want to check their blood pressures, we want to ensure, based on their age, whether or not they are having annual breast exams, it is a medication that requires ongoing follow up and review,” Kaplan said.
Despite Kaplan’s hesitation about making birth control available over the counter, an editorial written by Dr. David Grimes and published in the journal Public Health Policy Forum argues that birth control is safe enough for over-the-counter sale.
“Thirty years of intense epidemiologic study have confirmed that oral contraceptives are very safe,” Grimes writes.
Read it on Global News: Global Toronto | Argument erupts over birth control being available over-the-counter
Dr. Kaplan’s interview tonight with Beatrice Politi on GlobalNews Family Health on why doctors are rethinking their approach to sinus infections.
Looming Physician Surpluses? Drs. Peter Walker & Michael Guerriere suggest conditional billing numbers – Everything old is new again
In their Longwoods publication today, Drs. Peter Walker and Michael Guerriere talk about looming physician surpluses? In the context of managing healthcare costs in Ontario they suggest that:
“There is also a serious physician distribution problem across the province, with oversupply in some locales and specialties, and significant shortages in others.
Today, newly qualified physicians receive an OHIP billing number automatically. A rookie doctor bills the same rates as a world renowned expert in an academic medical centre. Both of these policies need to be reconsidered. Perhaps new physicians should practice in areas of the province where there is a demonstrated need for their services and should receive conditional billing numbers. Differential pay based on demonstrated quality and experience would also allow the government to control cost increases while rewarding quality at the same time.”
I have argued all the way back to 1998 when I was still a medical student (having finished my graduate training in Health Policy and Bioethics under Dr. Bernard Dickens) that:
Before the government can adopt a regulatory policyof toying with restricting physician-billing numbers in over-serviced urban area or based on age, it must fully assess the ethical implications of restricting a physician’s ability to practice of medicine.
In 1998, I published the following in the University of Toronto Medical Journal (Moving Doctors north 1998 Kaplan): “Even though a constitutional right to practice one’s profession does not exist, an examination of government attempts to restrict physician billing numbers in urban areas has indicated a basis for such a moral right, at least a limited one. Employment is an essential vehicle through which society allows a person to become a constructive member of that community, and one who contributes to the overall good. While not constitutionally protected, the government must have good reasons for disregarding this moral claim. As Dr. J. Armstrong, then-President of the Canadian Medical Association (1996), put it: “The fiscal health of the nation should not be cured by detrimental changes to the health of Canadians.” According to Raisa Deber, the key problem in Canada is not the current or past fiscal austerity. The economy of Canada has been steadily collapsing since the 1960s; every year, the total GDP per capita has declined. Thus, even though health expenditures have increased, the GDP has decreased. While this ratio (health $/GDP), has become larger, closer examination of the data indicated that Canada spends less money per capita than Japan on health care. Yet, Deber (1996) asserts that, “If we don’t change soon we won’t be able to sustain our system.” The issue now is appropriateness; what are the appropriate measures that government and the medical community take in order to make the healthcare system more efficient. ‘Band-Aid’ solutions to fee-for-service medicine are inappropriate when the system has ‘cuts that needs stitches’ and ‘ limbs that need amputation’. We need to look for other forms of health care delivery; capitation, integrated system delivery or other managed care models need to be examined for their appropriateness.” It think it is time for me to revise this piece of scholarly work for 2011 (13 years later) and have it submitted for rapid publication!
reposted from http://web.nyghfoundation.ca:1001/our-stories/they-took-oath-now-theyve-made-pledge
Over the past year, our Physicians’ Campaign received widespread support from our large complement of family doctors and specialists, surpassing $1.4 million in funds raised. This is a remarkable achievement, particularly because it has encouraged clinical leaders who best understand our patients’ needs to provide much-needed resources for care and treatment.
The Physicians’ Campaign has helped to reinforce the strong culture of philanthropy at NYGH. According to the Campaign’s co-Chairs, Dr. David Kaplan and Dr. Ted Rumble, “the response from our colleagues has been remarkable, because everyone understands that strong support from physicians in the Hospital communicates that we are dedicated to the excellence care provided by our Hospital and it inspires others in the community to give as well.”
The Foundation’s Campaign Chair, Chris Tambakis, says the level of support from NYGH’s doctors “speaks volumes about their passion for the hospital, and about the level of excellence that patients can expect to receive when they are cared for at North York General.”
Donate to North York General Hospital Here