First step in privatizing healthcare?

[raginduck]

Doctors charging both government and patients privately in illegal double-dipping practice

Regulators are doing little to stop doctor-owned clinics from quietly making desperate patients open their wallets to bypass long lines for everything from simple appointments to major surgery

www.theglobeandmail.com

An interesting read on the subject.

 

[GreyGhost]

Doctors charging both government and patients privately in illegal double-dipping practice

Regulators are doing little to stop doctor-owned clinics from quietly making desperate patients open their wallets to bypass long lines for everything from simple appointments to major surgery

www.theglobeandmail.com

An interesting read on the subject.

Without a doubt, there needs to be a well developed framework to avoid a s*&^show. It sounds like Douggie may have skipped that step. Fingers crossed this doesn't turn into a disaster. Politicians are idiots.

 

[timtune]

Riding north of the Soo I dumped my bike and put a nasty split in my forearm. Rode back to camp and fearing they might give me something that would make me dopey a buddy doubled me for an hour back to the Soo.
When I got to the waiting room, I peeled off my jacket to expose my bloody forearm hoping it would move me up the food chain but all it did was send someone else who was waiting into hysterics.
Four hours later at 1pm we were doubling back to camp in the rain.
(an hour later we were trying to rouse the fire so we could smoke a joint by the fire instead of just smoking it in the rain)

 

[Mad Mike]

As expected unions screaming about the sky falling.

Healthcare unions call on Ford to scrap private surgery plans

Ontario healthcare unions are sounding the alarm after Premier Doug Ford revealed a plan to ramp up private surgeries in Ontario on Monday. Faiza Amin reports.

toronto.citynews.ca

That didn't take long.

Here's an example of why they are screaming. SIL worked in a Dr. Niceguy's private office as a receptionist/file clerk, paid $19/hr, about 20% above the average for her job. 40 hour week, no benefits and has to work one weekend day and one 12-8 weekday shift.

Dr. Niceguy has a bit of pull in the rural hospital, kinda likes SIL and he gets her land a union gig -- same work, answering phones and filing charts in a hospital office $34/hr + a great benefits package.

Pay goes from $40k to $68k/year, + a goody bag full of benefits for an entry-level job that has no educational or training prerequisites.

I'm not jealous, nor do I begrudge anyone for getting top dollar for their services. The part I don't like is PSUs have monopolies on gov't labour enable them to extract 50-100% more from the public purse for the same work. Privatizing some basic health care that can be done in a clinic can reduce overhead considerably, competition can take that even further to the benefit of taxpayers.

 

[Mad Mike]

Without a doubt, there needs to be a well developed framework to avoid a s*&^show. It sounds like Douggie may have skipped that step. Fingers crossed this doesn't turn into a disaster. Politicians are idiots.

Where there is suffering, there will be dirtbags ready for carpe diem.

Corruption and crimes against taxpayers should have harsh penalties, and regulators and self-governing bodies (like the College of Physicians) must do better.

 

[timtune]

and self-governing bodies (like the College of Physicians) must do better.

I honestly think this group of self serving folks is a large part of the problem. We could have more foreign trained Drs here in a heartbeat if these guys were willing to share the pie.

 

[bitzz]

I would love if our health care system gave us a receipt at the end of each doctor/hospital visit. Gives you an idea of what your ailment cost the system but balance owing is zero.

How about every OHIP account gets a yearly account statement, so you know what was billed in your name.
Years ago I needed a DOT physical, in a hurry. My doc couldn't fit me in, but got me in the next day with one of his associates.
This was in the '80s, I paid $240 for the physical, $75 for the bloodwork (OHIP doesn't cover DOT physicals).
Next time I saw MY doc, he questioned me about this, because the other doc had billed OHIP for the same services, on he same day, in my name. After some investigation, it seems the associate was doing stuff like that all the time. They closed the office soon after to avoid liability... and I lost the doctor I had been going to all my life. Now I drive 160km to see a GP.
I had an aunt that was a hot shot accountant/ tax lawyer. She got hired by a cardio clinic where her sole job was to maximize OHIP billing. I don't know what she was getting paid, but CPA/tax lawyers don't come cheap, in today's dollars I bet she could demand 150-200k easily... to review OHIP billing.
She quit when the head doctor wanted updates on OHIP billing every 15 minutes. She hated working there.

 

[crankcall]

If your a CPA/ tax specialist right now in the GTA your at $160-185k if youd like a smart fellow. More if they are a partnmer in a firm. They do not come reasonably priced, because they dont have to.

 

[GreyGhost]

Ontario is going to allow health care workers from other provinces to work in Ontario as a right. Cutting the red tape of the regulatory bodies out. Again, could be good or bad depending on implementation. Should makes regulatory bodies quiver a little. Hopefully they improve instead of the much more likely outcome of tantrums and digging in their heels.

Ontario looking to poach health-care workers from other provinces to fill shortages

Premier Doug Ford is set to introduce changes that would let Canadian health-care workers registered or licensed in other provinces start immediately practicing in Ontario.

www.cp24.com

 

[backmarkerducati]

Ontario is going to allow health care workers from other provinces to work in Ontario as a right. Cutting the red tape of the regulatory bodies out. Again, could be good or bad depending on implementation. Should makes regulatory bodies quiver a little. Hopefully they improve instead of the much more likely outcome of tantrums and digging in their heels.

Ontario looking to poach health-care workers from other provinces to fill shortages

Premier Doug Ford is set to introduce changes that would let Canadian health-care workers registered or licensed in other provinces start immediately practicing in Ontario.

www.cp24.com

As the workers are a finite resource in short supply across the poaching just makes the problem worse somewhere else, but even worse yet it will eventually just drive up wages even more as each province poaches from the others.

I am all for the portability and people having the right to work where they want with less red tape if they are qualified but right now this just makes an bad situation worse, how much worse may depend on which province you are in. With Ontario's high cost of living it may be a losing proposition here.

 

[Mad Mike]

Ontario is going to allow health care workers from other provinces to work in Ontario as a right. Cutting the red tape of the regulatory bodies out. Again, could be good or bad depending on implementation. Should makes regulatory bodies quiver a little. Hopefully they improve instead of the much more likely outcome of tantrums and digging in their heels.

Ontario looking to poach health-care workers from other provinces to fill shortages

Premier Doug Ford is set to introduce changes that would let Canadian health-care workers registered or licensed in other provinces start immediately practicing in Ontario.

www.cp24.com

Canada has national standards for licensing medical professionals moving from one province to another has a bureaucratic step that causes delays and costs money. The requirements are the same for each province with minor exceptions - it's a money grab and bureaucratic waste of money. For a nurse to move between provinces, they must pay $750-800 to re-register as in another province.

Ford is taking a step in the right direction, removing medical colleges as gatekeepers.

 

[timtune]

dofo advertises for new nurses while appealing bill 124 WTF
also decided that healthcare workers can do other jobs they "feel confident to do" ditto WTF

I think were in the handbasket headed down......

 

[Mad Mike]

dofo advertises for new nurses while appealing bill 124 WTF
also decided that healthcare workers can do other jobs they "feel confident to do" ditto WTF

I think were in the handbasket headed down......

I don't think bill 124 is specifically geared to nurses, they just happen to be part of the larger collection of Ontario PSUs, most running 50-100% above market compensation. I feel sorry for nurses, my daughter is one. That said, she has had a few breaks -- $5K bonus this year, and OT is has been all she can eat at double-time. New nurses can pick up substantial signing bonuses in underserved areas, son's GF got $25K this summer.

Another nice thing for Ontario nurses is after a couple of years of experience, they can take leave to do contract stints as travel nurses up to $1800/day in parts of Canada, and as much as $2500 (CAD) /day in the US.

That said, the system is not set up well for nurses inOntario -- a surgical nurse with a boatloads of training and lots of responsibility makes the same as a sniffle wiper in a hospital clinic.

 

[nobbie48]

If a million man hours of medical care are needed, all done in a public facility and that changes to 20% being done in private clinics there is still 1,000,000 hours needed and the same number of staff required. Theoretically anyways.

What changes is efficiency and costs.

Can private clinics be more efficient than government ones? Are huge hospitals too cumbersome for the smaller cases?

The problem I see with government endeavors is they have the taxpayers pocket to pick. Private, for profit, firms can't just add staff to puff up the ranks, the government can.

There can be downsides to private, mainly greed. The owner sees coin going out of his pocket and that could compromise quality. Owner operated firms are susceptible to tis form of greed.

I recall Holland having a well liked medicare system that somehow made it advantageous for the providers to do the best they could.

One overlying problem is the level of financial unrest on almost every side. Making medical staff interprovincial isn't going to help. Is more money ever enough?

Is going interprovincial a good idea? I cautiously say yes but there need to be reviews to make sure everyone is reading from the same book.

 

[Mad Mike]

If a million man hours of medical care are needed, all done in a public facility and that changes to 20% being done in private clinics there is still 1,000,000 hours needed and the same number of staff required. Theoretically anyways.

What changes is efficiency and costs.

Can private clinics be more efficient than government ones? Are huge hospitals too cumbersome for the smaller cases?

The problem I see with government endeavors is they have the taxpayers pocket to pick. Private, for profit, firms can't just add staff to puff up the ranks, the government can.

There can be downsides to private, mainly greed. The owner sees coin going out of his pocket and that could compromise quality. Owner operated firms are susceptible to tis form of greed.

I recall Holland having a well liked medicare system that somehow made it advantageous for the providers to do the best they could.

One overlying problem is the level of financial unrest on almost every side. Making medical staff interprovincial isn't going to help. Is more money ever enough?

Is going interprovincial a good idea? I cautiously say yes but there need to be reviews to make sure everyone is reading from the same book.

Private sector with its dirty profit motive will almost always outperform publicly delivered services. The million hours of service delivered by a public service will undoubtedly be delivered in 800,000 hours.

As for interprovincial differences, theyre are none, standards are national. It's local provincial bureaucracy, nothing more.

 

[nobbie48]

Private sector with its dirty profit motive will almost always outperform publicly delivered services. The million hours of service delivered by a public service will undoubtedly be delivered in 800,000 hours.

As for interprovincial differences, theyre are none, standards are national. It's local provincial bureaucracy, nothing more.

Sometimes in industry one finds redundant steps and procedures that are there because earlier in the procedure they were necessary. Technology changes but the procedures don't get eliminated. Pumping the gas pedal a couple of time before starting an FI car.

Smaller buildings mean smaller infrastructure costs. A general hospital is a Swiss Army knife, able to handle anything. Swiss Army knive are not as efficient as dedicated tools for a dedicated purpose. That said, a S.A. knife is easier to carry than a pocket full of more efficient dedicated tools.

Can a small community support a large number of private clinics?

How does the loss of a percentage of the work affect the general hospital? I assume some of the private clinics will rent space from some of the general hospitals, a good idea in case of things going wrong. Lots of logistics.

 

[MacDoc]

Private sector with its dirty profit motive will almost always outperform publicly delivered services.

and the moon is made of green cheese.
What the private sector will nearly always do is deliver substandard services and pay for staff while slicing out a profit and neglecting oversight.
Evidence"? Mike Harris and Walkerton

Harris ignored Walkerton's pleas in '98

The Town of Walkerton wrote directly to Ontario Premier Mike Harris in 1998, urging him to restore government control over drinking-water testing after the town discovered it had E. coli problems and feared an outbreak such as the one that has ...

www.theglobeandmail.com

Happy to let the private sector make money financing hospital and clinic gear as finance is reasonably competitive...not run the sector.
We need only to look south for proof, higher cost of care - poorer outcomes, predatory practices and a few healthcare billionaires.

 

[Mad Mike]

G

and the moon is made of green cheese.
What the private sector will nearly always do is deliver substandard services and pay for staff while slicing out a profit and neglecting oversight.
Evidence"? Mike Harris and Walkerton

Harris ignored Walkerton's pleas in '98

The Town of Walkerton wrote directly to Ontario Premier Mike Harris in 1998, urging him to restore government control over drinking-water testing after the town discovered it had E. coli problems and feared an outbreak such as the one that has ...

www.theglobeandmail.com

Happy to let the private sector make money financing hospital and clinic gear as finance is reasonably competitive...not run the sector.
We need only to look south for proof, higher cost of care - poorer outcomes, predatory practices and a few healthcare billionaires.

It wasn't the private sector thst failed Walkerton, it was a collection of incompetent locals and their hillbilly local council.

You cant look to the USA and make a broad stroke or cherry picked comparisons or to predict outcomes here - their system is far different. It's both better and worse.

How about looking at Ontarios successes in privatizing imaging, lab work, and multi doctor clinics? All of those are delivered efficiently and with innovations in cost, productivity, service enhancement... driven by competition and profit motive.

 

[MacDoc]

Mike Harris took responsibilty despite your apologetics. I'm just dissing your broad brush of private is inherently better.
How's the mess we call Ontario Hydro working out? Rogers? Private elder care?

Secondary services such as xrays and blood work are fine with proper oversight....not primary care.

Australia has a successful mix of both private and public that work together that is not likely transportable to Canada with the US companies champing at the bit to break in and leverage NAFTA as they'd love to do with water.

Australia also has a very strong union underpinning to prevent workers being exploited.

There are lots of competitive venues for private money to play.....the one I lived in for 37 years...computers....there are few that need to remain public water, education, roads, parks for instance ....and a few where a mix of private and public ...housing...is a necessity to blunt the kind of stupidity that the Toronto housing market is presenting to the world.
The first thing Canada did post WWII was build affordable housing for returning military.

The Finnish government provides funding for affordable housing nationwide. It also dictates that at least 25% of all housing in major cities must be affordable social housing, which has kept the national supply at a workable level.

Managed mixed economies like Norways are not subject to the fickleness of so called "market forces" that dominate thinking in the US.

Efficiency is in no way the purvue of private concerns and governments have learned about good business practice but governments are not businesses and have a different set of parameters.
There is room for both the post office AND Fedex et al.....both need quality management and their workers protection from predation.

 

[DownUnder]

What the private sector will nearly always do is deliver substandard services and pay for staff while slicing out a profit and neglecting oversight.

I don't feel this statement is always true. Having riden bikes my whole life in Aus and done work considered unsafe, I've unfortunately gotten to experience both public and private hospitals first hand and through friends.

The private system is "Customer Service" based. You have a choice where you want to go, and if a hospital gets a bad reputation they lose customers (money), so have a huge incentive to treat their customers well.

Where I'm from there was 2 public hospitals and 5 private (and 2-3 private day surgery hospitals) servicing about 500k people. Compare that to somewhere like Markham that has 1 hospital serving probably the same number of people.

A hybrid system can work here imo and be a benefit to the population. Average emergency wait times have gone up to nearly 23hrs. Something has to be done. People will always complain about change but not all change is for the worse.