Monday, April 11, 2011

Which federal party will best defend medicare and look for solutions within a public model?

We're looking for your thoughts and any info you find about various party's platforms. Let's get a good discussion going!

Thursday, January 27, 2011

The OMA's policy recommendations

The OMA has released a new set of policy recommendations. Although I have a few quibbles - mostly about advocating policies for countering obesity for which the evidence base seems weak (school exercise programs) or equivocal (calories on menus, see also this article) - the report is notable for a few other reasons.

First, there is notably no call for increased privatization of the health care system. The closest the report comes is calling for "Providing funding to identify ways to reduce the administrative burden in the health-care system so that patients will have better care, and the system will operate more efficiently". That statement is so broad it could be read in many different ways. But in other sections, the report calls for more public investment in long-term care, mental health, and chronic disease management.

Second, the report embraces the concept of family health teams and calls for their expansion. This is a dramatic shift from the rather tenuous and tepid support the OMA gave such initiatives previously. However, the evidence that primary care reform has improved quality, efficiency, or equity is more equivocal.

There is also a recommendation "that all patients have equal access to publicly-funded health professionals and services regardless of their physician practice model. Examples include but are not limited to: nurses (RN, RPN, NP), dieticians, pharmacists, psychiatrists, internal medicine specialists, pediatricians and physician assistants." Note that NPs are included (in contrast to what the Ontario Health Coalition has stated), if under-emphasized. Still, this also represents a change from past perspectives.

There have recently been calls for an "adult discussion" about health care - which I think means opening the privatization debate. It's good to see the OMA's positions "maturing" in a different direction.

Monday, December 20, 2010

Pfizer and Wikileaks

Democracy Now is reporting two stories based on documents released om Wikileaks of interest to health practitioners, both relating to the giant pharmaceutical company Pfizer. The first story, from Nigeria, starts in 1996 when Pfizer conducted a clinical trial on children with meningitis, allegedly without consent or safety standards and with allegations of fraudulent documents for an FDA audit. The Nigerian government sued Pfizer. The leak states that Pfizer hired investigators to dig up dirt about the Nigerian attorney general and get him to drop the case.

The second story Is from New Zealand but is directly relevant for Canada. The leaked documents suggest that Pfizer lobbied against a U.S. trade deal with New Zealand because of New Zealand's drug purchasing policies and that "drug companies tried to get rid of New Zealand’s former health minister."

If Canada were ever to introduce aggressive drug pricing, we can be certain that big pharmaceutical companies will be working hard - and viciously - to protect their interests.

Wednesday, July 21, 2010

What Can be Better in Canada’s Health Care System?

The Commonwealth Fund has updated its ranking of health care systems. According to this fund, we have a better health care system than the United States.  We do very well when all determinants of health are considered, coming in second in the “Long, Health, and Productive Lives” category.  But overall, the other advanced market economy countries included in the ranking (Australia, Germany, Netherlands, New Zealand, and the United Kingdom) did better than Canada.  That means we finished 6th of 7, which should cause all of us to pause and think for a moment.

Where can we do better? Canada ranked last in terms of quality of care. While we did pretty well on questions such as whether the doctor asked about emotional problems (3rd place) or whether patients received advice about weight, nutrition, and exercise (2nd place), we were far behind all countries on questions about basic computerization (being able to print out a list of patients, sending reminders, printing out lists of patient medications). Indeed, almost all of the quality of care and efficiency indicators where Canada did badly focus on information systems or coordination of care.

While Canadians pride themselves on prioritizing access to care with Medicare, the Commonwealth Fund report indicates that we did relatively well in minimizing cost-related access issues but lost many marks in terms of timeliness of care.

Finally, Canada gets mid-range marks when it comes to equity measures for health but poor marks, not surprisingly, when it comes to equity in dental care or prescription drugs. Of patients with below-average incomes, one-third did not see a dentist even though they needed one because of the cost and one-fifth skipped doses or did not fill a prescription because of cost.

Of course, there are problems with such rankings. Many of the indicators are based on surveys of patients and physicians, which are prone to reporting biases (both perceptions and willingness to report long waiting times might be influenced by media reports, for example). It’s not always clear that the indicators are equally important. Some of the data is a few years old. And it is not possible using these data to differentiate between provinces to see if province-specific initiatives to reduce waiting times have been effective.

Nevertheless, the results are useful in that they remind us of the importance of constant evaluation and of the importance of international (not only U.S.) comparisons. The results are also instructive and clearly point to areas that others have identified as needing improvement – coordination of care and better communication, basic information systems, continued attention to waiting lists, public dental care, and universal pharmacare. Notably, none of these indicators would improve by establishing a parallel private system.