Ontario needs to do its health-care homework

Posted on December 7, 2011 in Health Delivery System

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TheGlobeandMail.com – news/politics
Published Tuesday, Dec. 06, 2011.   Adam Radwanski

Early in 2012, the Ontario government will begin hammering out a new deal with the province’s doctors.

It’s a pivotal opportunity to shift toward a more sustainable model of health-care spending. So hopefully, the report delivered Monday by Auditor-General Jim McCarter will remind Dalton McGuinty’s Liberals – and the health officials under their watch – to do their homework first.

Among Mr. McCarter’s various findings, the section on how the province pays family doctors stands out as a well-timed cautionary tale.

Since 2005, Ontario has made a concerted effort to shift doctors from fee-for-service to “capitation,” which sees them paid an annual fee for each patient. By providing financial incentives for doctors to join “family health teams,” Mr. McGuinty’s government has aimed both to improve access for patients and to provide itself with more cost certainty.

By some measures, the initiative has been a success. Large numbers of doctors have made the shift. And by the government’s estimate, that helped to increase by at least 500,000 the number of Ontarians who have a family doctor.

But Mr. McCarter also found some major holes in the model that the government created. Doctors are paid for patients who are “enrolled” with them, even if those patients don’t make any visits – so by the auditor’s calculation, they received $123-million in 2009-10 for treating people they never actually saw. Meanwhile, there appears to be leeway and incentive for doctors to de-enlist patients with medical conditions that require frequent visits, then shift them back to the fee-for-service model.

Examples like those help explain why, at a time when health spending is threatening to eat the rest of the provincial budget, doctors are reportedly earning 25 per cent more under capitation than they were under fee-for-service. Not coincidentally, total annual funding to family physicians went up by 32 per cent between 2006-07 and 2009-10, from $2.8-billion to $3.7-billion. And despite the higher costs and the ostensibly improved access, the health ministry was unable to provide any evidence that wait times for physicians have gone down.

None of this is to say that the shift away from fee-for-service has necessarily been a mistake. To some extent, there will always be oversights and unintended consequences that require adjustments when governments go down new paths.

But it’s not too much to ask that governments try to minimize those growing pains, by having a clear sense of what they’re aiming for and keeping close tabs on whether they’re achieving it. And that doesn’t appear to have been the case here.

By Mr. McCarter’s account, his office asked the provincial health ministry if it had conducted an “in-depth analysis of the anticipated costs” of the new funding model before entering into negotiations with the Ontario Medical Association. The ministry responded that indeed it had, but then proved “unable to locate this analysis.”

If we’re being generous, it bears noting that in 2005, economic growth was relatively strong and the province wasn’t far from budgetary balance. Improving health care, then as always, was a political imperative. But the idea that costs had to be contained, or else the entire system was in jeopardy, hadn’t yet taken hold.

But heading into 2012, the province is fast running out of room for error. The path out of a $16-billion deficit, more or less endorsed by all three provincial parties in the recent election, revolves largely around flattening health spending increases – not many years down the road, once all the kinks in new policies have been ironed out, but pretty much as soon as those policies are implemented.

In other words, Mr. McGuinty’s government had best have a clear sense of what it’s trying to achieve with the OMA this time. The room for error is shrinking fast.

< http://www.theglobeandmail.com/news/politics/adam-radwanski/ontario-needs-to-do-its-health-care-homework/article2261360/ >

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One Response to “Ontario needs to do its health-care homework”

  1. Gizem says:

    反正健保不用錢 民眾咳嗽就跑醫院 聯合晚報 記者李樹人/台北報導 2010.10.29健保局最新估算 明年度全民健保醫療支出數字再創紀錄 高達5077億元 平均每人用掉2萬2000元 今天公布的一項調查也顯示 民眾習慣浪費醫療資源 即使小感冒 也要往大醫院跑 台灣藥品行銷暨管理協會今天公布 台灣民眾自我藥療及健康管理調查 報告 國人浪費醫療資源的現象令人憂心 三分之二民眾身體不舒服 即使只是小病痛 就會掛號看醫師 中華民國藥品行銷暨管理協會會員代表 輝瑞生技公司消費保健事業部總經理葉曼青指出 民眾自己不處理小毛病 全往醫院擠 難怪國內健保醫療支出的連年赤字 財務出現赤字 變成全民的負擔 醫生開的藥真的比較有效 調查顯示 近七成受訪者相信醫生開的藥品比成藥來的有效且安全 僅二成認為成藥因為有政府核可 可放心買來吃 基於 反正健保不用錢 的心態 許多人一有小感冒 咳嗽 扭傷 頭痛 皮膚過敏等小病痛 就直接上醫院 調查發現 國人健康意識極高 超過八成四會食用保健食品 中藥補品 養身食材 甚至掛號看健康門診 平均每月花費一千多元來預防疾病 但當身體有小病痛時 卻只有三成四成的民眾會自己去購買成藥 自我藥療 葉曼青表示 由於指示藥及成藥的風險及副作用相對較低 歐美 日本 澳洲等國家都鼓勵民眾遇到小感冒 小疼痛時 購買成藥進行自我醫療 避免不必要的醫療資源浪費 調查 民眾瘋保健食品月花千元中央社 2010.10.28根據調查顯示 台灣人動不動小病就醫拿藥 主要出現專業醫師開的藥比較安全有效 看健保很省錢等理由 對於購買保健食品很大方 每月要花新台幣1000多元 中華民國藥品行銷暨管理協會今天公布 台灣民眾自我藥療及健康管理調查 結果2/3 受訪者在身體感覺到小病痛時 就會去看醫生 理由依序是 醫生較專業 醫生開的藥較安全 醫生開的藥比較有效 有健保所以花的錢少等 調查顯示 在使用健保IC卡就醫的情況下 民眾平均每月因小毛病就醫自掏腰包的費用為275.3 元 相形之下 每個月吃保健食品 中藥補品 養生食材甚至自費掛號看健康門診的花錢 平均是1030.7元 中央健保局資料顯示 國人健保就醫次數年年成長 去年每人平均約15次 全民健保醫療支出明年5077億元 平均每人要用掉近2 萬2000元的健保資源 今天這項調查顯示 國人愛拿健保卡看病 也愛養生保健 平均85% 會購買保健食品或中藥 中華民國藥品行銷暨管理協會會員代表葉曼青指出 近7成的人認為醫生開的藥品比成藥有效又安全 僅2成認為成藥有政府核准可以放心買來吃 這顯示民眾對醫生比較信心 一有小感冒 咳嗽 扭傷 頭痛 皮膚過敏等小病痛 寧可上醫院 反正健保不用錢 台北市藥師公會理事張文靜認為 民眾到藥房時 上門買藥的多 諮詢用藥的比例卻屈指可數 這是因為醫藥分業成效不彰 對藥師的角色定位很模糊 民眾只把藥師當成 發藥人 而不是令人放心的藥物安全療效守門人 這項調查是協會委託尼爾森公司進行 於9 月13日至24日電話訪問全台北中南各地1074名20至65歲男女 目的在於了解國人對藥品的認識及自我藥療的現況 以及民眾對當前藥師及藥局觀感 95% 的信心水準下 抽樣誤差為正負3個百分點 葛蘭素劣質藥案 230億元和解金創紀錄自由時報 2010.10.28 編譯陳成良 綜合報導 美國司法部二十六日宣佈 英國製藥業龍頭葛蘭素史克公司已同意支付打破歷來紀錄的七 五億美元 約台幣兩百三十億元 了結其波多黎各藥廠生產缺陷藥物的訴訟案 該公司被控出售無效抗憂鬱藥及被污染的嬰兒軟膏等藥品 7.5億美元和解金 創史上新高此外 當初揭發此事的葛蘭素史克一名前女性主管雪莉 艾克德 將可獲得其中九千六百萬美元 約台幣二十九億四千萬元 和解金 為歷來美國企業 告密者 whistleblower 所獲得的最高額賠償 告發女主管獲29億和解金檢方指控 二 一年至 五年間 葛蘭素史克在波多黎各西德拉 Cidra 的製藥廠 生產過程及產品品質發生問題 蓄意製造販售摻假的藥品 包括暢銷的抗憂鬱藥Paxil CR 另方面又向聯邦醫療保險申請高額補貼 除一億五千萬美元刑事罰款外 另外六億美元是對聯邦醫療保險藥物補貼的賠償 涉及攙入雜質的藥物 主要包括Paxil CR 治療第二型糖尿病的 梵蒂美 Avandamet 抗皮膚感染的黴素軟膏 百多邦 Bactroban 及止吐藥 康您適 Kytril 等共二十種 葛蘭素史克聲明 對旗下藥廠違反生產標準深感遺憾 並表示因西德拉藥廠生已於二 九年關廠 這些缺陷藥物迄今並未傳出對患者造成嚴重損害 此外 前葛蘭素史克全球品質經理雪莉 艾克德 二 四年向美國FDA檢舉波多黎各藥廠的生產問題 並向司法部提起訴訟 艾克德聲稱 自己因多次向上司報告該藥廠的生產問題 而於二 三年遭公司解雇 她將可獲得葛蘭素史克的九千六百萬美元和解金 對於這場鏖鬥八年 失去所有朋友 的苦戰終於落幕 艾克德坦承她心裡 有點激動


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