Prime Minister Stephen Harper’s decision to cut the Health Council of Canada should clear any lingering doubts: the federal government has abandoned all responsibility for health care and is turning its back on the provinces as they struggle to pick up the pieces.

The council provided accountability and promoted consistent quality of care, nationwide. The Harper government’s rationale for axing the council is that with next year’s expiry of the intergovernmental health agreements, “there is no longer a need” for it to monitor progress. But why does Harper not intend to renew national health care agreements?

Instead of creating a new health accord, federal funds for health care will be tied to each province’s GDP. This is a familiar story: Alberta will benefit while the Maritimes bleed.

Nova Scotia stands to lose $154 million in funding per year, starting in 2016-2017. That’s the equivalent of losing three rural hospitals. The cornerstone of Canadian identity is the belief that everyone should have equal, accessible and comprehensive health care.

This federal government has betrayed those principles and abandoned Nova Scotians. It’s time for all the premiers and territorial leaders to stand up to the Harper government and send a clear message: we won’t let you bleed us dry.

James Hutt, co-ordinator, Nova Scotia Citizens’ Health Care Network, Halifax

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“The Health Network has long called for dental care to be included under the Medicare umbrella, and for children in particular. These changes will extend dental coverage to 30,000 kids. It’s great news,” says James Hutt, provincial coordinator of the Health Network. “We hope that dental care will be progressively expanded to cover 16 year-olds.”

The Mental Health and Addictions Strategy will receive an additional $2.5 million in the 2013-14 budget. While a positive step, more is needed in order to provide the level of care Nova Scotians require.

“Public mental health services are lacking in this province, and nationally. It is encouraging that the government has taken action on this and is investing in mental health and addictions,” says Hutt. “We call on the province to continue strengthening and extending this needed program.”

The Health Network had previously called on the government to invest $40 million in new community health centres; however no new funding was included in the budget. The Network applauds the government’s increased support for home care, although larger investments are needed.

“The government has been proud of the collaborative emergency centres they opened, and they are a step in the right direction. But for the tens of thousands of Nova Scotians without access to primary care, investing in community health centres is the best approach. We were hoping to see more in this budget,” says Lee Seymour, chair of the Health Network.

Seymour concluded: “This budget makes some progress but we still have much work to do to protect, strengthen and extend public health care here in Nova Scotia.”

“The Prime Minister is a known opponent of public health care, and the lack of leadership shown by his government for the number one priority of Canadians is not acceptable,” says Ian Johnson, vice-chair of the Health Network. “Instead of implementing innovative programs like a national pharmacare plan, which would save $10.7 billion and expand Canadians’ drug coverage, the government is abdicating its role in health care and gutting the care that we depend on.”

The federal government has so far refused to meet with Canada’s premiers to negotiate a health accord for 2014, and has indicated that $36 billion in cuts are on the way. Nova Scotia has long wait lists for long-term care, mental health care services, family physicians, and other medically necessary services. This budget will do nothing to reduce those wait lists.

“The government wants to leave health care entirely to the provinces and use working groups to come up with solutions. We’re getting a handful of bulk purchased drugs instead of a national pharmacare plan,” says Johnson. “The country is crying out for leadership in so many areas, and instead the government is turning its back on people’s needs. It is long overdue that a new, comprehensive health accord be negotiated.”

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For more information please contact:

Ian Johnson
Vice Chair
Nova Scotia Citizens’ Health Care Network
Mobile – (902) 476-4355

So far the Harper government has ignored the call of premiers to talk about the state of health care in Canada. Instead, Finance Minister Flaherty dictated to the premiers that the Canada Health Transfer will be cut by $36 billion after the next election (budget 2016/2017).

The 2014 Health Accord gives our leaders an opportunity to protect, strengthen and extend public health care by ensuring the Canada Health Act is enforced, sharing best practices in public health care, discuss evidence-based and innovative solutions, setting national standards on care so that every person in Canada receives quality care, and including areas that are under-served or not covered by medicare- such as home and community care, long term care, mental health, dental care, and pharmacare- and find ways to expand the medicare umbrella.

We’re asking our members, allies, and friends to help us get this message to members of parliament now, before it’s too late! We met Members of Parliament in a large one-day lobby on Parliament Hill in December 2011 and December 2012, but now we need to meet them on our turf- at home in their ridings.

With less than a year left until the 2004 health accord expires, we have a window of opportunity to push the federal government and opposition members to stand up for public health care, something that 94 per cent of Canadians believe in! We need to hold our MPs’ feet to the fire and demand a new, comprehensive 2014 Health Accord which protects, strengthens and extends public health care for everyone. On the provincial front, we need to encourage the Nova Scotia government to step up and pull Harper to the negotiating table with the other premiers. Members of the provincial legislature need to hear from constituents that we want leadership in defending public health care.

If you’re interested in joining us and meeting with your MP or MLA the week of April 8^th call or email us! You can contact johnhutton@nshealthcoalition.ca or call (902) 406-9422. We’ll get you set up with guides on the issues and tips on how to have a good meeting with politicians. You do not need to be an expert to meet with your MP or MLA.

It is disappointing that NDP Health Minister Dave Wilson has chosen to renew a government contract with Scotia Surgery. The contract, worth $1 million to the for-profit clinic to perform 500 surgeries per year, raises a lot of unanswered questions. Beyond the questionable ethics of making medically necessary care a for-profit business, one has to ask if renewing the contract, intended to reduce wait lists, is an efficient use of the public’s health care dollars. Given the poor track record of private-public partnerships in Canada, intense scrutiny and broad public consultation are warranted.

Signed in 2008 and renewed a year later, the Scotia Surgery contract is a holdover from the Progressive Conservative government of Rodney MacDonald. The for-profit facility, which focuses on oral surgery, general dentistry and plastic surgery, devotes two days per week to orthopedic surgeries from the public wait list. The doctors performing the surgeries come from the public system, while the company rents space to Capital Health and provides auxiliary staff.

To be sure, having more operating rooms for surgeries will reduce wait lists. However, any reduction in wait times would be despite the private-sector involvement, rather than because of it. Private health-care providers seek to maximize profit, which does not mean maximizing efficiency. If a clinic is making money, it is almost certainly by charging more for health services than the public sector does or reducing the quality of care.

The actual profit margins at Scotia Surgery are not available to the public, which also raises questions of accountability and transparency. Nova Scotians deserve to know how many of their health-care dollars are being pocketed as profit instead of providing care.

There is a wealth of peer-reviewed studies, Canadian and international, showing that private health care costs more. Even the Albertan government — which often favours the privatization of public services — has admitted that private care is the more expensive option. But what should really concern all of us is that these same studies have shown that the profit motive has led to a decreased quality in health care and a higher chance of dying after surgery. Our government’s short-sighted focus on spending less this year means we’re all paying more and getting less in the long term.

And what happens when private clinics close or go bankrupt, as recently happened with Calgary’s Health Resources Centre? The Alberta government relied on private clinics to deliver medically necessary services and when HRC declared bankruptcy, Alberta Health Services was forced into receivership while leaving hundreds of patients in limbo. This is only one of hundreds of public-private partnerships that have failed, been abandoned or went into bankruptcy, leaving taxpayers to clean up the mess and in many cases pay hefty legal fees.

Wait times can be reduced with improved management practices, collaboration and co-operation across the delivery path, and through the implementation of best practices that are already being successfully implemented across the country. The “small, focused” model used by Scotia Surgery and other for-profit clinics has also been used in the public sector, such as a specialized orthopedic clinic that opened in Edmonton in 2012. By reducing administrative, management and monitoring costs as well as not including profit extraction as a budget line, service is expanded and wait lists shorten. Innovation comes from the specialized, focused nature of these clinics rather than the fact that investors own it.

The most common argument for privatization is that removing patients from the public queue will shorten it. However, it also removes health professionals from the public system, slowing down public delivery and causing the queue to grow even longer. A study from the University of Manitoba found that cataract patients whose surgeons worked in both the public and private sectors waited 23 weeks for surgery, more than double that of patients whose doctors only worked publicly.

In the case of Scotia Surgery, Nova Scotians should be asking: If it is our tax dollars, our health workers, and we’re paying the rent, why do we need private owners and why can’t this type of facility be part of the public system? Private health care costs more, provides lower quality of care and does not have the transparency and accountability that we deserve and expect. Instead of endlessly signing contracts with Scotia Surgery, the government should invest in expanding public health care for the best possible value and service to Nova Scotians.

John Hutton works for the Nova Scotia Citizen’s Health Care Network, and Adrienne Silnicki is the national health-care campaigner for the Council of Canadians.

Job Posting: Provincial Co-ordinator

Formed in 1996, the Nova Scotia Citizens’ Health Care Network’s goal is to stop the privatization of the public health care system, ensure high levels of care, and create a forum for people and communities to discuss issues in health care.

The Network is a coalition of local health committees, community groups, organized labour, faith groups, women’s organizations, students, and individuals dedicated to protecting and extending public health care to include services like pharmacare, dental care, long-term care, mental health care and home care.

The Network is political but non-partisan and receives no government funding.

The Co-ordinator’s primary responsibilities are to:

• Develop and conduct Network campaigns
• Educate and mobilize members, organizations and the general public on health care issues
• Conduct research and prepare policy statements as needed
• Be a spokesperson for the network
• Prepare briefs and presentations to government committees
• Assign tasks and supervise one other staff person

Remuneration is $ 45,000 for a 35 hour work week.

This is a full time term position, for no less than 6 months beginning April 1^st or earlier if possible. There is a possibility that this position could become permanent or the term extended.

For a copy of the complete job description please contact: Adrienne Silnicki at asilnicki@canadians.org

Application Deadline February 7, 2013

Please send resume with cover letter to asilnicki@canadians.org. Only those applicants selected for an interview will be contacted.

NOTE: This is a unionized position with CAW Local 4606

Great Day for Patients’ Rights and the Future of Medicare in Nova Scotia

Halifax, NS – The new Insured Health Services Act is the most progressive change to health law in decades, says the Nova Scotia Citizens’ Health Care Network.

“Today is a great day of patients’ rights and the future of Medicare in Nova Scotia,” says Kyle Buott, Provincial Coordinator of the Health Network. “The new law bans queue-jumping while reinforcing the bans on direct billing, extra-billing and user fees in health care.”

The changes reaffirm the province’s commitment to the five principles of the Canada Health Act – Universality, Accessibility, Portability, Comprehensives and Public Administration. It creates new, though limited, appeal mechanisms for patients.  The new law will help move more physicians off fee-for-service payments and onto alternatives payment plans – this is good for both patients and physicians.

“I am very pleased to see this legislation come forward today.  In my thirty years of working to protect, strengthen and extend Medicare, this is the single most important legislative initiative ever taken by a government in this province, and long overdue,” says Ian Johnson, Vice-Chair of the Health Network.

There are several areas of the proposed bill that the Health Network believes could be further improved.  Including moving the principles of the Canada Health Act from the preamble to the body of the legislation, annual reporting of the number of uninsured services performed that patients had to pay for out-of-pocket, a legislative framework for Community Health Centres, and more action on patient involvement and engagement with the health care system. The Health Network will plan to raise these issues through the law amendments process.

“We congratulate Health Minister Dave Wilson, previous Health Minister Maureen MacDonald and the provincial government for their bold action to protect patients rights and the future of Medicare,” says Lee Seymour, Chair of the Health Network.

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For more information please contact:
Kyle Buott

Coordinator

Nova Scotia Citizens’ Health Care Network

Cell – (902) 478-0239

About the Nova Scotia Citizens’ Health Care Network:

Formed in 1996, the Nova Scotia Citizens’ Health Care Network’s goal is to stop the privatization of the public health care system, ensure high levels of care, and create a forum for people and communities to discuss issues in health care.

The Network is a coalition of local health committees, community groups, organized labour, faith groups and individuals dedicated to protecting and advancing public health care to include services like pharmacare, dental care and long-term and home care.

The Network is political but non-partisan and receives no government funding.

“If we can’t afford public care, we sure as hell can’t afford pri­vate care,” Canadian health policy expert Raisa Deber quipped during a meeting some years ago in Toronto. It is one of the few truisms in health care.

The Oct. 24 editorial “Draft health bill: NDP rewrite puts system over patient” reveals biases toward a system that cares about profits over patients.

Clearly, the editorialist has bought into the mythos of private sector as saviour. Yet, there is no peer-reviewed research to sup­port such a strong position — it is simply ideology. These notions were termed “zombies” by B.C.

health economist Bob Evans 20 years ago as no matter how often you quash a nonsensical idea, it keeps coming back.

Those who follow the health­care debate know that “patient choice” is a euphemism in the U.S. used to perpetuate bloated private administrations — all the while ensuring that a population over twice the size of Canada is under-insured or uninsured.

So, rather than playing ideolo­gical games with Nova Scotia’s health care, we should look con­structively at what the draft legislation does and discuss how to improve it for the benefit of all users of the health-care system.

Enshrining the principles of the Canada Health Act: Health­care privatization is in direct conflict with the people’s will and has no legitimate empirical support. We waste time, energy and money pandering to for­profit proponents that could be used to find real solutions.

Nevertheless, the principles of the Canada Health Act must be in the actual legislation rather than the preamble, as recent court decisions successfully argued that preambles are not part of official legislation and therefore are unbinding.

Paying doctors : The draft goes far toward finally getting doctors off the fee-for-service treadmill.

Fee-for-service is why your doc­tor is always rushing or wasting your time by having you book another appointment. Many of the problems with our health care system can be directly tied to these built-in disincentives.

Opting out : Having pay rates for physicians who have opted out set at the same rate as the public system is a good start, as it elim­inates incentive for providers to switch to the private sector. Sim­ilarly, patients who receive in­sured services from these pro­viders will not be able to get reimbursed from provincial cof­f e rs.

However, there is no ban on private insurance for publicly insured services, nor does it explicitly prohibit co-mingling public and private services at individual clinics. These loop­holes should be closed.

Extra billing & direct billing : The draft reinforces the ban on extra billing and prohibits direct billing such as the “convenience charge” for blood collection outside of the Halifax peninsula.

Queue jumping : The draft is very strong against queue jump­ing, explicitly stating that this violates the Canada Health Act and is prohibited. This reinforces the crucial concept that access to care be based on need and not ability to pay.

The legislation should go fur­ther to protect patients by prohib­iting health-care providers from receiving kickbacks or making referrals to clinics where they have financial interest.

Accountability : The legislation creates an arm’s-length appeal board that would consist of pro­viders and “lay persons.” It would be restricted to reviewing a limited set of circumstances.

Accountability in this leg­islation must be more far-reach­ing, inclusive and transparent — from planning to delivery. The Provincial Health Council, for which legislation still exists, could be easily reconstituted to improve accountability.

We should ensure that the patient has direct access to their own personal health record, with amending rights, as a further step toward real accountability.

Moreover, the reporting of all uninsured services should be mandatory in order to under­stand the true magnitude of what people are being forced to pay out of pocket. Most importantly, as the move to “patient-oriented” health care accelerates, we must ensure that actual patients have a real role in the design, co-ordina­tion and delivery of care.

Collaborative care : Family doctors are just one of the many options that should be available for patients to have real “choice.”

We must use appropriate services for the appropriate person at the appropriate time. This can in­clude self-management of chron­ic care, better access to prescrip­tions, nurse practitioners, mid­wives, asthma educators, phar­macists, support groups, etc. This legislation should make it easier for the health care system to respond to the needs of the actual users of our system.

The proposed legislation has many important features that would stop the drift to private, for-profit care, but further chang­es are needed to protect, strengthen and extend public health care.

Bill Swan is deputy CEO, Interna­tional Health Economics Asso­ciation; co-chair, National Asthma Patient Alliance; and board mem­ber, Nova Scotia Citizens’ Health Care Network.

Published in The Chronicle Herald on Sunday, September 30th, 2012

Strengthening public care

I think the Sept. 25 editorial “Health-care delivery: Flex credits” missed the point about how the government’s “Better Care Sooner” has helped to improve emergency health care.

The real value of the Better Care Sooner initiative is that its five major parts are aimed at strengthening public health care. They include improving access to health-care providers, making emergency care more streamlined, providing better care for persons with complex needs, increasing use of 811 and 911 in emergencies, and funding for quality care. They especially depend upon the dedication and hard work of health-care providers. It has not greatly relied on private-sector options to make it work.

In our view, this initiative could be even stronger if the government ended the role of private for-profit services. Instead, we think it should work to replace them with public-sector solutions. Private-sector for-profit services do not cause “the sky to fall,” but they do serve to undermine and take needed resources away from the public system.

The recently revised Health Services and Insurance Act released this summer could also greatly help to strengthen public health care. We hope it will entrench the principles of the Canada Health Act in the body of the proposed new act.

Lee Seymour, Chairperson, Nova Scotia Citizens Health Care Network

HALIFAX, NS – Stephen Harper must be brought to the negotiating table with Canada’s premiers to negotiate a Health Accord in 2014, say citizen’s groups. The Nova Scotia Citizen’s Health Care Network and the Council of Canadians will be showing a tug-of-war themed piece of street theatre to get the message across, on Thursday, September 27^th at 12:00pm in Victoria Park. Provincial and territorial health ministers will be meeting across the street in the Lord Nelson hotel.

“Stephen Harper is cutting $36 billion from public health care and refusing to sign a national accord. It’s hard to understate what he’s doing: he is destroying public health care as a national program,” says Kyle Buott, provincial coordinator of the Health Network. “He is trying to get the premiers to sign one-off agreements in place of a national accord. This will mean uneven and inferior services to Canadians. It is not acceptable.”

The Health Network and Council of Canadians are calling on the provinces to run a national public campaign to convince Stephen Harper to come to the negotiating table with all the premiers. The performance will pit Stephen Harper against Canada’s premiers in a tug-of-war. The Prime Minister is trying to drag each premier into Medicare’s graveyard, while the premiers are trying to pull Stephen Harper to the negotiating table that will lead to phase two of medicare. *Spoiler Alert* Only when the premiers all pull together can they win against Stephen Harper.

“Every province stands to lose under Harper’s plan. If they act alone, premiers will not be able to maintain portability in health care and therefore we will lose the ability to travel across Canada and receive the same level of care,” says Adrienne Silnicki, health care campaigner for the Council of Canadians. “On the other hand, as our performance will show, if they work together they can bring him back to the table and talk about the issues Canadians care about: national pharmacare, home and community care, mental health care, and dental care.”

Silnicki concluded, “A 2014 Health Accord needs to be on the health ministers’ agenda this week. The stakes have never been this high. The time for leadership is now.”

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For more information please contact:

Kyle Buott

Coordinator

Nova Scotia Citizens’ Health Care Network

Cell – (902) 478-0239

Adrienne Silnicki

Health Care Campaigner

Council of Canadians

Cell- (902) 440-4296

Twitter: @asilnicki

About the Nova Scotia Citizens’ Health Care Network:

Formed in 1996, the Nova Scotia Citizens’ Health Care Network’s goal is to stop the privatization of the public health care system, ensure high levels of care, and create a forum for people and communities to discuss issues in health care.

The Network is a coalition of local health committees, community groups, organized labour, faith groups and individuals dedicated to protecting and advancing public health care to include services like pharmacare, dental care and long-term and home care.

The Network is political but non-partisan and receives no government funding.