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Health-care in Canada needs European-inspired updates: new study

Published

11 months ago

December 4, 2023

Canada is trailing behind other Organisation for Economic Co-operation and Development (OECD) countries when it comes to both the number of physicians relative to the population, and its spending on primary care, according to a new analysis published in the Canadian Medical Association Journal.

“Health systems with strong primary care have better outcomes, lower costs and better equity,” write the nine authors of the study, “Primary care for all: lessons for Canada from peer countries with high primary care attachment.”

“Yet, even at the outset of the COVID-19 pandemic, about 17 per cent of people in Canada reported not having a regular primary care clinician.”

Meanwhile, the analysis reveals, Canada is seeing declining enrolment in family medicine as a specialty among medical students, and more graduating family physicians are choosing not to practise generalist office-based care. Post-pandemic, 22 per cent of adults in Canada—more than 6.5 million people—don’t have a family doctor they can see regularly for care.

To solve these dilemmas, the authors say Canada should learn from the successes of other OECD countries with high rates of patients enrolled with primary care clinicians.

‘WE NEED TO DO THE SAME’

The authors compared Canada to nine countries where more than 95 per cent of people have a family doctor, primary care clinician or place of care—including France, Germany, New Zealand, United Kingdom, Denmark, Netherlands, Finland, Italy and Norway—to find opportunities for improvement here. To make their comparison, they studied data from 2018, 2019, 2020 and 2021.

They found that these countries tend to spend more on primary care, that a greater percentage of their health-care is publicly funded, that they have more doctors overall and more of their family doctors are working in family practices. In Canada, by comparison, many doctors work in emergency departments or practice in a specific area, like sports medicine.

Among the nine OECD countries studied, most doctors are paid by salary or a fixed payment arrangement known as capitation, rather than the fee-for-service model common in Canada. They have organized after-hours care and few or no publicly-funded walk-in clinics. They also have smarter information systems that allow doctors to better communicate with patients and allow patients to access their own records online.

While Canada came out in the middle of the pack on health-care spending, the proportion of that spending that was public was the lowest, at 70 per cent. This figure hasn’t changed since the 1990s, the study reports.

Canada had similar numbers of family physicians per capita but the lowest number of total physicians per capita by a wide margin, at 24.4 per 10,000 people. After Canada, the country with the second-lowest per capita number was the United Kingdom, with 30 physicians per 10,000 people. Norway had the highest number per 10,000, at 50.4.

Canada also spent less of its total health budget on primary care, and spent more on private health care than any of the other countries studied.

“Other countries have designed their system so that everyone has access to primary care. We need to do the same,” wrote Dr. Tara Kiran, a family physician at St. Michael’s Hospital and Unity Health Toronto in a media release.

“At the core, we need to guarantee access to primary care and increase how much we spend on it.”

AREAS FOR IMPROVEMENT

To bring Canada up to speed with the OECD countries providing the best primary care, the authors say public health care here needs some important updates.

For one thing, most doctors in Canada are private contractors with “little system accountability,” they said, whereas the authors say they need to be bound by stronger contractual agreements and accountability to government, insurers or both. They also call for changes to the way health-care providers are paid, specifically to move primary care physicians to capitation or salary payments and away from fee-for-service.

They recommend that a higher proportion of the total health budget be spent on primary care, with medicare coverage extended to prescription medications, dental care and expanded mental health care. They say Canada also needs more physicians per capita.

“Canada should move to a model where residents are guaranteed access to a primary care practise near their home and ensure that these practices are funded appropriately,” they write.

Finally, they call for improved patient communications systems, more organized after-hours care and fewer walk-in clinics.

They acknowledge that factors unique to Canada, such as its vast geography, diverse population and proximity to the United States and its health-care system, could pose challenges to emulating its overseas counterparts.

However, they say it’s already partway there, “with respect to regional funding of physician services by governments, overall health spending” and the way primary care serves as an access point to other parts of the health system.

“Canada can learn from OECD countries such as the Netherlands, Norway, the U.K. and Finland, where more than 95 per cent of people have a primary care clinician,” they conclude. “These international examples can inform bold policy reform in Canada to advance a vision of primary care for all.”

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STD epidemic slows as new syphilis and gonorrhea cases fall in US

Published

8 hours ago

November 12, 2024

Anne Joseph

NEW YORK (AP) — The U.S. syphilis epidemic slowed dramatically last year, gonorrhea cases fell and chlamydia cases remained below prepandemic levels, according to federal data released Tuesday.

The numbers represented some good news about sexually transmitted diseases, which experienced some alarming increases in past years due to declining condom use, inadequate sex education, and reduced testing and treatment when the COVID-19 pandemic hit.

Last year, cases of the most infectious stages of syphilis fell 10% from the year before — the first substantial decline in more than two decades. Gonorrhea cases dropped 7%, marking a second straight year of decline and bringing the number below what it was in 2019.

“I’m encouraged, and it’s been a long time since I felt that way” about the nation’s epidemic of sexually transmitted infections, said the CDC’s Dr. Jonathan Mermin. “Something is working.”

More than 2.4 million cases of syphilis, gonorrhea and chlamydia were diagnosed and reported last year — 1.6 million cases of chlamydia, 600,000 of gonorrhea, and more than 209,000 of syphilis.

Syphilis is a particular concern. For centuries, it was a common but feared infection that could deform the body and end in death. New cases plummeted in the U.S. starting in the 1940s when infection-fighting antibiotics became widely available, and they trended down for a half century after that. By 2002, however, cases began rising again, with men who have sex with other men being disproportionately affected.

The new report found cases of syphilis in their early, most infectious stages dropped 13% among gay and bisexual men. It was the first such drop since the agency began reporting data for that group in the mid-2000s.

However, there was a 12% increase in the rate of cases of unknown- or later-stage syphilis — a reflection of people infected years ago.

Cases of syphilis in newborns, passed on from infected mothers, also rose. There were nearly 4,000 cases, including 279 stillbirths and infant deaths.

“This means pregnant women are not being tested often enough,” said Dr. Jeffrey Klausner, a professor of medicine at the University of Southern California.

What caused some of the STD trends to improve? Several experts say one contributor is the growing use of an antibiotic as a “morning-after pill.” Studies have shown that taking doxycycline within 72 hours of unprotected sex cuts the risk of developing syphilis, gonorrhea and chlamydia.

In June, the CDC started recommending doxycycline as a morning-after pill, specifically for gay and bisexual men and transgender women who recently had an STD diagnosis. But health departments and organizations in some cities had been giving the pills to people for a couple years.

Some experts believe that the 2022 mpox outbreak — which mainly hit gay and bisexual men — may have had a lingering effect on sexual behavior in 2023, or at least on people’s willingness to get tested when strange sores appeared.

Another factor may have been an increase in the number of health workers testing people for infections, doing contact tracing and connecting people to treatment. Congress gave $1.2 billion to expand the workforce over five years, including $600 million to states, cities and territories that get STD prevention funding from CDC.

Last year had the “most activity with that funding throughout the U.S.,” said David Harvey, executive director of the National Coalition of STD Directors.

However, Congress ended the funds early as a part of last year’s debt ceiling deal, cutting off $400 million. Some people already have lost their jobs, said a spokeswoman for Harvey’s organization.

Still, Harvey said he had reasons for optimism, including the growing use of doxycycline and a push for at-home STD test kits.

Also, there are reasons to think the next presidential administration could get behind STD prevention. In 2019, then-President Donald Trump announced a campaign to “eliminate” the U.S. HIV epidemic by 2030. (Federal health officials later clarified that the actual goal was a huge reduction in new infections — fewer than 3,000 a year.)

There were nearly 32,000 new HIV infections in 2022, the CDC estimates. But a boost in public health funding for HIV could also also help bring down other sexually transmitted infections, experts said.

“When the government puts in resources, puts in money, we see declines in STDs,” Klausner said.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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World’s largest active volcano Mauna Loa showed telltale warning signs before erupting in 2022

Published

8 hours ago

November 12, 2024

Anne Joseph

WASHINGTON (AP) — Scientists can’t know precisely when a volcano is about to erupt, but they can sometimes pick up telltale signs.

That happened two years ago with the world’s largest active volcano. About two months before Mauna Loa spewed rivers of glowing orange molten lava, geologists detected small earthquakes nearby and other signs, and they warned residents on Hawaii‘s Big Island.

Now a study of the volcano’s lava confirms their timeline for when the molten rock below was on the move.

“Volcanoes are tricky because we don’t get to watch directly what’s happening inside – we have to look for other signs,” said Erik Klemetti Gonzalez, a volcano expert at Denison University, who was not involved in the study.

Upswelling ground and increased earthquake activity near the volcano resulted from magma rising from lower levels of Earth’s crust to fill chambers beneath the volcano, said Kendra Lynn, a research geologist at the Hawaiian Volcano Observatory and co-author of a new study in Nature Communications.

When pressure was high enough, the magma broke through brittle surface rock and became lava – and the eruption began in late November 2022. Later, researchers collected samples of volcanic rock for analysis.

The chemical makeup of certain crystals within the lava indicated that around 70 days before the eruption, large quantities of molten rock had moved from around 1.9 miles (3 kilometers) to 3 miles (5 kilometers) under the summit to a mile (2 kilometers) or less beneath, the study found. This matched the timeline the geologists had observed with other signs.

The last time Mauna Loa erupted was in 1984. Most of the U.S. volcanoes that scientists consider to be active are found in Hawaii, Alaska and the West Coast.

Worldwide, around 585 volcanoes are considered active.

Scientists can’t predict eruptions, but they can make a “forecast,” said Ben Andrews, who heads the global volcano program at the Smithsonian Institution and who was not involved in the study.

Andrews compared volcano forecasts to weather forecasts – informed “probabilities” that an event will occur. And better data about the past behavior of specific volcanos can help researchers finetune forecasts of future activity, experts say.

(asterisk)We can look for similar patterns in the future and expect that there’s a higher probability of conditions for an eruption happening,” said Klemetti Gonzalez.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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Waymo’s robotaxis now open to anyone who wants a driverless ride in Los Angeles

Published

8 hours ago

November 12, 2024

Anne Joseph

Waymo on Tuesday opened its robotaxi service to anyone who wants a ride around Los Angeles, marking another milestone in the evolution of self-driving car technology since the company began as a secret project at Google 15 years ago.

The expansion comes eight months after Waymo began offering rides in Los Angeles to a limited group of passengers chosen from a waiting list that had ballooned to more than 300,000 people. Now, anyone with the Waymo One smartphone app will be able to request a ride around an 80-square-mile (129-square-kilometer) territory spanning the second largest U.S. city.

After Waymo received approval from California regulators to charge for rides 15 months ago, the company initially chose to launch its operations in San Francisco before offering a limited service in Los Angeles.

Before deciding to compete against conventional ride-hailing pioneers Uber and Lyft in California, Waymo unleashed its robotaxis in Phoenix in 2020 and has been steadily extending the reach of its service in that Arizona city ever since.

Driverless rides are proving to be more than just a novelty. Waymo says it now transports more than 50,000 weekly passengers in its robotaxis, a volume of business numbers that helped the company recently raise $5.6 billion from its corporate parent Alphabet and a list of other investors that included venture capital firm Andreesen Horowitz and financial management firm T. Rowe Price.

“Our service has matured quickly and our riders are embracing the many benefits of fully autonomous driving,” Waymo co-CEO Tekedra Mawakana said in a blog post.

Despite its inroads, Waymo is still believed to be losing money. Although Alphabet doesn’t disclose Waymo’s financial results, the robotaxi is a major part of an “Other Bets” division that had suffered an operating loss of $3.3 billion through the first nine months of this year, down from a setback of $4.2 billion at the same time last year.

But Waymo has come a long way since Google began working on self-driving cars in 2009 as part of project “Chauffeur.” Since its 2016 spinoff from Google, Waymo has established itself as the clear leader in a robotaxi industry that’s getting more congested.

Electric auto pioneer Tesla is aiming to launch a rival “Cybercab” service by 2026, although its CEO Elon Musk said he hopes the company can get the required regulatory clearances to operate in Texas and California by next year.

Tesla’s projected timeline for competing against Waymo has been met with skepticism because Musk has made unfulfilled promises about the company’s self-driving car technology for nearly a decade.

Meanwhile, Waymo’s robotaxis have driven more than 20 million fully autonomous miles and provided more than 2 million rides to passengers without encountering a serious accident that resulted in its operations being sidelined.

That safety record is a stark contrast to one of its early rivals, Cruise, a robotaxi service owned by General Motors. Cruise’s California license was suspended last year after one of its driverless cars in San Francisco dragged a jaywalking pedestrian who had been struck by a different car driven by a human.

Cruise is now trying to rebound by joining forces with Uber to make some of its services available next year in U.S. cities that still haven’t been announced. But Waymo also has forged a similar alliance with Uber to dispatch its robotaxi in Atlanta and Austin, Texas next year.

Another robotaxi service, Amazon’s Zoox, is hoping to begin offering driverless rides to the general public in Las Vegas at some point next year before also launching in San Francisco.

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