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
What would you say if something worked about 60% of the time? In medicine, 60% is pretty good when it comes to prevention!
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In one of my many ‘hats’, I chair the Research Ethics Board at North York General Hospital.We have recently instituted a policy regarding the use of the Survey Monkey for the collection of data.As many people who use Survey Monkey assume they are answering anonymously, the US government may be able to link their IP address to the data they submit under access authorized under the US Patriot Act.We have required all researchers using Survey Monkey to add the following to the first page of their survey.”No personal identifiers will be collected on the survey but it is possible that the views and opinions you expressed may be accessed and linked to you without your knowledge or consent by the U.S. government under the U.S. Patriot Act.In an effort to maintain anonymity, during the design of the this survey, the option to collect your computer IP address has been disabled.”Feel free to distribute this wording as needed.
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A few years ago, Nikolai Bratkovski decided he needed a full medical checkup, so he went online looking for a new family doctor”I thought, ‘There must be an easy way to find a doctor, right?”Except it wasn’t easy at all.According to statistics, there are barely two doctors for every 1,000 Canadians — one of the lowest ratios in the Western world.In Ontario, it’s estimated that only 10 per cent of all doctors are accepting new patients – and those that are may ask new patients to wait weeks for an appointment”If you look at the ratios, its only one in 10 [doctors] that would be taking patients,” said Bratkovski. “You might be calling 20 clinics and not getting anywhere.”Bratkovski came up with a solution. A website called Healthaware.ca.With just a postal code it can show all the doctors in a specific neighbourhood and which ones are accepting patients.Dr. David Kaplan is part of a North York family health practice which has 25 doctors serving 59,000 patients in Toronto.He says the challenge facing the health care system isn’t just a shortage of doctors.”The people who do have family physicians, a lot of them are having problems getting in to see their family doctor,” said Kaplan.It’s led doctors to consider some new initiatives including an online system for booking appointments and asking more family doctors to hold office hours on evenings and weekends.Kaplan says it’s all part of a bigger strategy, to tackle a much bigger problem.”The problem is there are roughly 900,000 to one million people in Ontario who don’t have a primary care provider.”Bratkovski also sees his website as part of the solution.Soon he’ll be adding GTA dentists and chiropractors to his siteBut unlike GPs the dentists and chiropractors will have to pay to be listed.
From the News Archive at North York General Hospital Nov 5, 2010Dr. David M. Kaplan, Deputy Chief, Family & Community Medicine Program at North York General Hospital, has been appointed to two leadership roles for the Central LHIN.Primary Care Diabetes Lead, Central LHINAs a part of the Ontario Diabetes Strategy, the Ministry of Health and Long Term Care (MOHLTC) is creating a Regional Coordination Centre (RCC) in each of the 14 Local Health Integration Networks (LHINs). The RCCs are responsible for the coordination of and improvements in outcomes for diabetic prevention, education and care within the province including both general and priority populations.Dr. Kaplan will lead regional program development from a primary care perspective. He will act a resource, leader, and advocate for primary care providers in the region. Finally, he will help address diabetes service delivery issues within the Central LHIN region, such as quality management and unattached patient management.Chair, Central LHIN Primary Care Action Group The Central LHIN launched the Integrated Health Service Plan (IHSP) 2010-2013 that outlined the LHIN’s key priorities for the next three years: 1. Emergency Room /Alternate Levels of Care; 2. Chronic Disease Management and Prevention; 3. Mental Health and Addictions; and 4. Health Equity.The Central LHIN identified primary care as a critical enabler to support an integrated health care system. To continue to move the strategy forward, Central LHIN established an interdisciplinary Primary Care Action Group to define a comprehensive primary care system vision for the Central LHIN and help improve access to primary health care for our residents. Dr. Kaplan’s leadership will help define the role of community-based primary care in these four key LHIN priorities.
Family physicians and other primary care providers are the front line of the health system – caring for patients and their families closer to home and in their own communities, and contributing to continuity of care.The Central Local Health Integration Network (LHIN) is collaborating with primary care providers to leverage resources, programs and services to enhance access to primary care for residents in our communities, with specific focus on those areas that may be underserved or where there may higher than average incidence of health conditions such as diabetes.As part of a provincial strategy to improve access to primary care the Ministry of Health and Long-Term Care recently announced that 30 new Family Health Teams and 14 new Nurse Practitioner-Led Clinics will be established throughout Ontario communities to improve access to comprehensive family health care.Three new Family Health Teams are being established in the Central LHIN – bringing the total number of teams in the LHIN to 11. Central LHIN will also benefit from the establishment of its first-ever Nurse Practitioner-Led Clinics thanks to the Ministry’s announcement of one clinic for Georgina and one for North York West.The addition of new primary care resources in Central LHIN supports our four planning priorities in the Integrated Health Service Plan (IHSP) 2010-2013, including emergency department/alternative level of care, mental health and addictions, chronic disease management and prevention and health equity. We are working with our health service providers and the community to expand services where possible, reduce health inequities and improve overall health outcomes.To help us to do this, Central LHIN recently established an interdisciplinary Primary Care Action Group, co-chaired by Dr. David Kaplan, and comprised of a broad range of primary care providers and representatives from across Central LHIN health service providers.“Engaging with the primary care providers in our LHIN through the interdisciplinary Primary Care Action Group is key to the development of a primary care system vision for the Central LHIN, and to delivering on our IHSP priorities, said Kim Baker, Chief Executive Officer, Central LHIN. “We want to advance access to primary health care for residents in our LHIN and improve the quality and sustainability of our health care system.”The Primary Care Action Group’s first meeting is in October 2010. Watch our website for future updates regarding the work of this group.Did you know? There is now an easy-to-use doctor referral program, called Health Care Connect, which helps Ontarians find family doctors and nurse practitioners in their communities. So far, the program has referred 42,500 Ontarians to a family health care provider. You can also find out more about the health care choices available to you in your community by visiting Your Health Care Options
North York Family Health Team Provides Access To Care For 57,000 Residents
- The North York Family Health Team includes 58 Physicians located in 17 clinical offices.
- Since 2003, Ontario has created 200 new Family Health Teams, including 84 in rural and Northern Ontario.
- Nurse practitioners are able to treat common illnesses and injuries, and order lab tests, X-rays and other diagnostic tests. They can also refer patients to specialists.