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

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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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Faith leaders call on Ford to reverse move to shutter supervised consumption sites

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TORONTO – Faith leaders are calling on Ontario Premier Doug Ford to reverse course on his decision to close 10 supervised consumption sites across the province.

A number of religious organizations came to Queen’s Park on Tuesday and said they were hopeful they could reach Ford’s “humanity.”

Last month, Health Minister Sylvia Jones outlined a fundamental shift in the province’s approach to the overdose crisis, largely driven by opioids such as fentanyl.

Ontario will shutter the 10 sites because they’re too close to schools and daycares, and the government will prohibit any new ones from opening as it moves to an abstinence-based treatment model.

Health workers, advocates and users of the sites have warned of a spike in deaths when the sites close, which is slated for March 31, 2025.

Until then, the faith leaders say they plan to pressure Ford for change.

“I’m hoping that, perhaps, if facts and figures and science and data have all failed, perhaps we have a chance to reach his humanity, perhaps we have an opportunity to try once again to convince him that we are talking about human beings who will die,” said Rev. Maggie Helwig of the Church of St. Stephen-in-the-Fields.

The faith organizations all work closely, in one form or another, with those addicted to drugs. The sites slated for closure have said they have reversed thousands of overdoses over the past few years.

“We believe that those who are visiting the sites are the folks who have the least resources, the highest need and the least access to privacy and care,” said Bishop Andrew Asbil of the Anglican Diocese of Toronto.

“We believe that the sites are in the right place, which means that they are often in places of deprivation and desolation and sometimes that also includes high crime rates.”

Rabbi Aaron Flanzraich of Beth Sholom Synagogue said the province’s decision should not be ideological.

“This is not an issue of where you stand,” he said.

“It’s an issue of where you sit, because if there are people in your family who you sit with at a table who suffer from this blight, from this struggle, you know that most importantly there should be a clear and supportive policy that makes it understandable that people are seen as human beings.”

Opioids began to take a hold in Ontario in 2015 with the rise of illicit fentanyl. Opioid toxicity deaths surged during the COVID-19 pandemic and hit a peak mortality rate of 19.3 deaths per 100,000 people in 2021, data from the Office of the Chief Coroner shows. That year 2,858 people died from opioids, the vast majority of which contained fentanyl.

The mortality rate dropped to 17.5 deaths per 100,000 people, or 2,593 people, last year, but remains more than 50 per cent higher than in 2019.

The Ford government introduced the consumption and treatment services model in 2018. At that time, the province put in place a cap of 21 such sites in the province, but has only funded 17.

Ford recently called his government’s approach a “failed policy.”

The province said it will launch 19 new “homelessness and addiction recovery treatment hubs” plus 375 highly supportive housing units at a cost of $378 million.

Jones has said no one will die as a result of the closures and Ford has said advocates should be grateful for the new model.

The government is not going to reverse course, Jones’s office said.

“Communities, parents, and families across Ontario have made it clear that the presence of drug consumption sites near schools and daycares is leading to serious safety problems,” Hannah Jensen, a spokeswoman for Jones, wrote in a statement Tuesday.

“We agree. That’s why our government is taking action to keep communities safe, while supporting the recovery of those struggling with opioid addiction.”

The health minister is encouraging existing sites to apply for the new model so long as they do away with both supervised consumption spaces and a needle exchange program.

This report by The Canadian Press was first published Sept. 17, 2024.



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B.C. ‘fell so short’ in Doukhobor pay, communication after apology: ombudsperson

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VICTORIA – British Columbia’s ombudsperson has a list of criticisms for the province over the way it has treated Doukhobor survivors months after the premier apologized for the government’s removal of the children from their families in the 1950s.

A statement from Jay Chalke says the government is being vague about who is eligible for promised compensation, and its communication is so inconsistent and unclear that survivors are coming to his office for help.

Hundreds of children whose parents were members of the Sons of Freedom Doukhobor religious group were taken from their homes more than 70 years ago and sent to live in a former tuberculosis sanatorium in New Denver, B.C.

Chalke’s statement says given Eby’s “solemn apology” in the legislature, he’s surprised the province’s follow-up communication fell so short.

He says the government has confirmed that each survivor unjustly taken to New Denver will get $18,000 in compensation, which he says is inadequate as nearly two-thirds of the $10-million “recognition package” is going to other purposes.

The province announced in February that the money would also be used for community programs and education to provide “lasting recognition of historical wrongs” against members of the religious group and their families.

Chalke says the situation is further complicated because the government hasn’t provided clear information to survivors or descendants about any financial consequences of receiving the compensation.

Many of the survivors are living on a fixed income and Chalke says the province needs to make sure that accepting the money doesn’t have negative financial impacts on means-tested programs.

“This is important to ensure that the compensation is not clawed back, for example, through reduced seniors benefits or increased long-term care fees,” his statement says.

“I call on government to develop and share with the community its plan for contacting all survivors and descendants, providing timely, accurate information about government’s compensation program and responding to their questions.”

Chalke says he will be closely monitoring the next steps the government takes and he will continue to report on the situation publicly.

This report by The Canadian Press was first published Sept. 17, 2024.

The Canadian Press. All rights reserved.



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“We have not hit the bottom yet:” Jasper council asks province for budget funding

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The town of Jasper, Alta., is asking the provincial government for budgetary financial support for the next few years to avoid drastically cutting services or implementing significant tax hikes while the community rebuilds.

The request comes as Jasper, which saw an estimated $283 million worth of property value destroyed by a devastating wildfire in July, begins to grapple with how it will manage severely reduced property tax revenue in the years to come.

“We have not hit the bottom yet,” Jasper Mayor Richard Ireland said during Tuesday’s town council meeting. “Our tax base is going to get even lower before it starts to recover.”

Town administration estimates the wildfire wiped out well over $2 million in rolling annual property tax revenue for the municipality, not including additional revenue the town would have continued to receive in future years in utility fees charged to the 358 homes and businesses that are no longer standing.

Council also approved Tuesday a property tax relief proposal for residents affected by the July wildfire.

Under the tax relief proposal, which is subject to the provincial government stepping up with financial assistance, all property owners would be given a one-month tax break for the time when a mandatory evacuation order was in place.

Property owners whose homes or businesses were destroyed would have their remaining or outstanding 2024 bill nullified, or refunded if the full year’s tax bill was already paid.

Ireland noted that four members of council, including himself, would be covered under this relief for having lost their homes.

The relief includes municipal property taxes, as well as the provincial education requisition, which would need to be refunded by the Alberta government.

The proposal means Jasper would forgo more than $1.9 million in municipal property tax revenue this year, or close to 10 per cent of its 2024 budget.

Jasper’s chief administrative officer Bill Given told council the town estimates it will miss out on an additional $1.7 million in 2024 from reduced paid parking, public transit, and utility fee revenue.

Heather Jenkins, the press secretary for Alberta Municipal Affairs Minister Ric McIver, said the ministry will consider the town’s request once received.

Given said Tuesday the town’s request is not unprecedented, as the province has previously provided Slave Lake, Alta., and the Regional Municipality of Wood Buffalo, Alta., with similar financial support after wildfires struck both communities in 2011 and 2016 respectively.

Without support from the province, Jasper could be faced with raising taxes on the properties that remain to make up for the lost revenue or cut services until the town’s tax base recovers when homes and businesses are rebuilt.

An administrative report presented to council says the first option would “cause significant strain” on residents, while cutting services “would likely both prolong the community’s recovery and damage the destination’s reputation with visitors.”

Ireland said Jasper would face “insurmountable challenges” if it doesn’t receive financial support from the province.

“We are not seeking a grant or a subsidy from the province,” Ireland argued. “I see this as an investment by the province in our tourism economy.”

“We contribute disproportionately to provincial (gross domestic product) recognized through tourism, so yes… the province can see this as an investment in its own future by supporting our tourism-based community.”

Tuesday also marked the first day of school for Jasper’s elementary, junior high, and high school students. Classes were delayed to start the year as both schools in the community suffered significant smoke damage.

The community’s transit service also resumed Tuesday.

This report by The Canadian Press was first published Sept. 17, 2024.

The Canadian Press. All rights reserved.



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