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Telus virtual health-care app touted by Alberta government sparks outcry from physicians – CBC.ca

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Some family doctors are voicing their concerns about a new Telus Health app being introduced by the province that allows Albertans online access to a doctor.

Babylon is a free downloadable app developed by Telus Health that lets Albertans meet with licensed physicians in one-on-one video consultations through their smartphone.

The app can be also be used to check symptoms — including those of COVID-19 — book appointments and get prescriptions and referrals, all covered under Alberta’s public health-care insurance.

Health Minister Tyler Shandro said Thursday the joint initiative with Telus Health comes at a time when the health system is asking people to self-isolate as a result of the COVID-19 pandemic.

But the announcement prompted many Alberta physicians to complain that the service is deeply flawed.
    
Katherine Bisby, a family physician in Calgary, said she’s not opposed to adding this tool to the mix — especially to keep patients and doctors safe during the pandemic.
    
But she said it appears to undermine family doctors who already offer a virtual service by phone — and who have been asking the government to increase their virtual billing rate, which is just $20 per call.
    
Calgary family physician Dr. Jennie Herd told CBC News in an email that the $20 per call billing rate is unfair, especially given that Babylon doctors are paid more.

“Clinic overheads remain the same at an average of $60-80 per hour per doctor. So, at four patients per hour at our current rate of seeing them we are just covering clinic costs and providing this service for free,” she said.

“I am very upset as a physician in practice for over 20 years that the government is promoting and funding a service for my patients to call an unknown physician, with no access to my patients’ charts, when I am available for the same service,” wrote Edmonton general practitioner Dr. Alice Bedard.

According to Alberta government spokesperson Steve Buick, doctors with Babylon are paid under an Alternative Relationship Plan based on the fee for a basic office visit of $38.

Continuity of care

Some doctors also said the app won’t give patients the continuity of care they would receive with their own family doctor.

Dr. Ruoh-Yeng Chang said Babylon seems like the equivalent of a walk-in clinic where whoever answers the call will not know a patient’s history.

“This is an undermining of existing family practices and the relationship between family doctors and their patients,” she said.

“We are the medical home. Patients can call us with concerns and we will talk to them. Now they are being told to call someone else instead.”

Other doctors raised similar objections.

Community pediatrician Dr. Natalie Forbes said the introduction of Babylon undermines the important goal of ensuring all Albertans have a “medical home” to receive care.

“Babylon is substandard private health care, funded by our government, putting money into the pockets of Telus,” she wrote. 

Appropriate compensation

Dr. Kimberly Dary, a child and adolescent psychiatrist at Edmonton’s Stollery Children’s Hospital, said it’s going to be increasingly important that the doctors in her field are able to continue to treat patients as the health crisis evolves.

“Right now, families are experiencing heightened anxiety, significant panic, children are not in school. There’s going to be an escalation of psychiatric emergencies,” she said.

But the emergency room is the not right place to see those patients during a pandemic, she said.

Dary said it’s vital that the government quickly find a means of appropriately compensating physicians as they are forced to move to virtual delivery of health care.

“This is not a 10-minute phone call. Our assessments and followups are very in depth,” she said. “Right now, there’s no support from the government to moving us to doing this.”

Buick said in an email to CBC News that the Babylon platform is not intended to replace the traditional family practice.

“It provides a new and convenient option for publicly funded virtual physician visits to supplement existing services,” he said.
    
Health Minister Shandro promoted the new app on Twitter, where there were also several posts critical of the service. 

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Has Russia Reached Its Limit In The Oil Price War – OilPrice.com

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Has Russia Reached Its Limit In The Oil Price War? | OilPrice.com

RFE/RL staff

RFE/RL journalists report the news in 21 countries where a free press is banned by the government or not fully established. We provide what many…

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    Russia Oil Price War

    When Vladimir Putin was given a dire forecast of the economy under the cloud of a crippling coronavirus pandemic and a sharp fall in global demand for petroleum, the Russian president was much less bullish about his country’s prospects in a price war with oil-producing rival Saudi Arabia. “For our economy, yes definitely, this is a very serious challenge,” Putin told Audit Chamber head Aleksei Kudrin on April 1, adding that the United States, which recently surpassed Russia and Saudi Arabia to become the world’s largest oil producer, would also suffer.

    It was a big step back from the line being floated just two weeks ago when, despite Russia’s economic dependence on natural resources, Moscow engaged in a bit of chest-thumping about its chances in a price war, arguing that Russia was in a stronger position than its main competitors to ride it out.

    But that was before the true impact of the coronavirus on the global economy was understood, and before Kudrin — a former finance minister and trusted ally — told Putin in a government meeting held by video that the Russian economy could decline this year by between 3 and 5 percent.

    And that was a moderate outlook, according to Kudrin, who went on to warn that the situation could be as bad as the nearly 8 percent decline the country suffered in 2009 during the financial crisis.

    When faced with slumping oil demand as the global economy suffered from the effects of the coronavirus pandemic, Riyadh’s demands for output cuts were refused by fellow OPEC+ member Moscow. After walking away from the table, the Saudis instead took the surprising route of increasing oil output, causing the largest one-day drop in prices in nearly three decades.

    Putin’s comment is one sign that Russia, which always expressed openness to continue negotiations with Riyadh, may be keen on coming to an agreement. “Today’s acknowledgement by Putin shows Russia is interested in the dialogue process and wants to go ahead with it,” Rauf Mammadov, an energy analyst at the Middle East Institute in Washington, told RFE/RL on April 1.

    High-Stakes Game

    From the beginning, the price war has raised questions about who would cave first: Moscow, Riyadh, or U.S. production, which depends on shale-oil producers that have gained market share at the expense of Russia and Saudi Arabia but require higher oil prices to stay in business.

    Russia is now preparing to ramp up spending to support millions of citizens and thousands of companies affected by quarantines and shutdowns. The Kremlin has thus far announced an increase of spending by $17.5 billion to counter the outbreak.

    Related: $1 Oil: Saudi Arabia’s Attempt To Crush U.S. Shale But according to Kudrin, the country may need to spend 5 percent of gross domestic product — or about $70 billion — to combat the impact of the coronavirus, which Russia has officially said has infected more than 3,500 people, but which skeptics suggest is a low-ball figure.

    Those costs will be difficult to cover if oil prices are low — but on April 2, the price of Russia’s Urals crude blend fell below $11 a barrel, the lowest since Putin came to power two decades ago. The international benchmark Brent crude, meanwhile, was going for just over $26 a barrel on April 2, whereas Russia depends on a price of about $40 a barrel to balance its budget.

    Russia as of March 20 had $551 billion in foreign-currency reserves at its disposal, although economists suggested that Putin would prefer not to tap into them. In just one week, however, those reserves had already fallen by $30 billion.

    Even before Putin’s government meeting, there were signs that Russia was having second thoughts about engaging in a price war with Riyadh, with Energy Minister Aleksandr Novak saying earlier on April 1 that Russia would not increase oil production in April, a reversal of earlier comments by officials.

    Analysts have said that Saudi Crown Prince Muhammad bin Salman’s surprise decision to increase oil production was intended to get Putin back to the negotiating table.

    And there is reason to believe that the Saudis might not want to keep the price war going either. Like Russia, the sharp decline in the price and volume of oil threatens Saudi Arabia’s aggressive spending programs aimed at lifting living standards and diversifying its economy.

    But Riyadh needs a much higher Brent crude price to balance its budget, nearly $80 per barrel, analysts have said. And while Saudi Arabia has $480 billion in foreign-currency reserves to lean on, it has already announced $13 billion in spending to deal with the lower budget revenue.

    “Despite the bravado that we have been hearing on both sides, this is not about who has the lowest cost of production and higher profitability. This is about funding budgets, and for both Russia and Saudi budget expansion has been significant in recent years,” Chris Weafer, the co-founder of Macro Advisory in Moscow, told RFE/RL on March 28. “The reality is that both of them need a deal to put a better price support in place.”

    Trump Wants A Deal

    The other oil-producing elephant in the room is the United States, which has seen its shale-oil producers suffer as a result of the price dispute.

    U.S. President Donald Trump, who has called the price war “crazy,” has been trying to accelerate talks between Russia and Saudi Arabia while members of Congress have been calling for sanctions and tariffs if they don’t find an agreement.

    Related: An Oilman’s Plea To President Trump

    Trump has said he recently spoke with the leaders of both countries and that Moscow and Riyadh were “going to get together” but he gave no further details. He expressed optimism on April 1 that an agreement was near.

    “I think that Russia and Saudi Arabia, at some point, are going to make a deal in the not-too-distant future because it’s very bad for Russia. It’s very bad for Saudi Arabia,” Trump said.

    The U.S. president reiterated that hope on April 2, saying in a tweet that he expected Russia and Saudi Arabia to cut 10 million barrels a day, though it was unclear if he was referring just to the two countries or to OPEC+, the alliance of two dozen oil-producing states that Moscow and Riyadh lead. It was also unclear if U.S. companies would be involved in the output cut.

    Just minutes after Trump’s tweet, Saudi Arabia called for an emergency meeting of OPEC+ members.

    Macro Advisory co-founder Weafer said he expected Moscow and Riyadh to find a short-term solution to their dispute that would get them through the crisis period.

    The Middle East Institute’s Mammadov suggested that Russia and Saudi Arabia could reach an agreement with other countries through the Group of 20 (G20) format, as it would offer both Putin and Prince Salman a way to claim victory. “It would eliminate the face-saving confrontation between Saudi Arabia and Russia because it’s not about the old OPEC+ deal” that they fought over, he said.

    Trump will meet with U.S. oil executives on April 3 to discuss measures to support the domestic market, including possible tariffs on oil imports from Russia and Saudi Arabia as well as American production cuts.

    Analysts have said that Riyadh and Moscow will want to see U.S. producers share the burden of stabilizing the market by cutting supply.

    By RFE/RL

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      Canadian banks pause payments on 10% of mortgages as they field 500,000 requests for deferrals – Financial Post

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      Canadian banks have already received nearly half-a-million requests by borrowers to defer or skip mortgage payments in just a little more than two weeks, amid the swift financial uncertainty caused by the coronavirus pandemic.

      The Canadian Bankers Association said Friday almost 500,000 requests had been completed or were being processed since lenders announced last month they would offer some financial relief, such as up to six months of deferred home-loan payments.

      Borrowers quickly tried to take the banks up on their offer, flooding their phone lines with thousands of calls seeking assistance or information. The CBA said Canada’s six biggest banks have already deferred payments on more than 10 per cent of mortgages in their portfolio.

      “The large number of customers who have been helped continues to grow as a result of concerted efforts by front-line workers, contact centre agents and operations teams working diligently,” the CBA said in a press release.

      Combining the deferral requests with reports of slower real-estate activity and of massive layoffs across the Canadian economy, the negative economic effects of the coronavirus are becoming clear. The food-service industry alone has lost an estimated 800,000 jobs because of COVID-19, according to Restaurants Canada, while the aviation and oil industry workers have also been hit hard.

      Toronto-Dominion Bank chief executive Bharat Masrani said Thursday that the lender had approved 60,000 requests for deferrals so far, which was “virtually all” of the applications.

      Asked about his confidence in borrowers being able to resume repaying their mortgages when the deferral period ends, Masrani noted the “unprecedented” levels of government support and the recent talk of the crisis easing in a few months.

      “And if that’s the case, then I think the support provided should provide flexibility to Canadians who have taken on the deferral program,” Masrani told reporters following the bank’s annual shareholder meeting, which was conducted virtually due to the coronavirus. “I would expect if this continues for a longer period, that governments will act.”

      The broad conclusion is that the Canadian banks are well positioned to weather the coming storm

      Eight Capital analyst Steve Theriault

      Meantime, some borrowers are seeing more cash flow coming their way. The CBA noted in its press release, citing Canada Mortgage and Housing Corp., that the average monthly mortgage payment for a Canadian homeowner was $1,326. In other words, roughly $663 million in cash per month could be freed up by the deferrals, which borrowers could spend on other necessities.

      “This number will increase over the coming weeks,” the CBA said.

      As these mortgage payments are pushed back, Canada’s housing market is also beginning to show signs of a COVID-19-related slowdown. The Toronto Regional Real Estate Board reported Friday that the first 14 days of March saw a 49 per cent increase in sales year-over-year, at 4,643, but sales for the rest of the month were down by 15.9 per cent from a year ago, at 3,369. Total Toronto sales for the month were 8,012, a 12.3 per cent increase compared to March 2019.

      “The overall sales result for March was strong relative to last year, but the impact of COVID-19 was certainly evident in the number of sales reported in the second half of March,” TRREB President Michael Collins said in a press release.

      Similar findings were reported by the Real Estate Board of Greater Vancouver, which saw “steady home buyer demand to begin March and a levelling off of activity as the month went on and concerns about the COVID-19 outbreak intensified.”

      Slackening demand in the housing market would be another headwind for the lending business, but the consensus remains that Canada’s banks are up for the challenge.

      Eight Capital analyst Steve Theriault wrote recently that he had examined “a reasonable worst case for credit losses and the direct impact to earnings, capital and dividend payouts,” for Canada’s big banks.

      “The broad conclusion is that the Canadian banks are well positioned to weather the coming storm,” Theriault wrote in a report. “We will not pretend to have a full view of the stresses that are sure to weigh on bank results in 2020 and 2021; however, we do believe that the group as a whole is well positioned from a capital perspective and that dividends will remain safe and equity raises unlikely.”

      • Email: gzochodne@nationalpost.com | Twitter:

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      Ontario Extends Business Closures to Stop the Spread of COVID-19 – Government of Ontario News

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      Additional Measures Necessary to Protect the Health and Safety of the People of Ontario

      TORONTO — Following the advice of the Chief Medical Officer of Health, the Ontario government is reducing the list of businesses classified as essential and ordering more workplaces to close. This measure is necessary to prevent the spread of COVID-19 and protect the health of the people of Ontario, while ensuring that necessary goods and services remain available.

      The government is ordering all businesses not covered by the updated Emergency Order to close effective as of Saturday, April 4, 2020 at 11:59 p.m. This closure will be in effect for 14 days, with the possibility of an extension as the situation evolves. Teleworking, online commerce and other innovative ways of working remotely are permitted at all times and are strongly encouraged for all businesses. All supply chains necessary for the production of vital food and healthcare supplies are being protected and remain intact.

      The updated essential businesses list can be found here.

      “We are facing a critical moment in the fight against COVID-19 and we must do everything in our power to keep everyone safe and healthy and prevent our health care system from being overwhelmed,” said Premier Ford. “Everyone must do their part to stop the spread and flatten the curve. If you are not an essential business, you need to close your doors, work from home if possible and play a role to help contain this outbreak. This is a matter of life and death.”

      As a temporary measure the Ontario government has revised the list of essential businesses. The updated list will direct additional businesses to close and restricts specified businesses to providing services by alternate methods such as curb side pick up and delivery, except in exceptional circumstances. This includes stores that sell hardware products, vehicle parts and supplies, pet and animal supplies, office supplies and computer products and repairs and safety supplies.

      “We have now reached a critical time in our fight against COVID-19.” said Christine Elliott, Deputy Premier and Minister of Health “Every step taken by the province and every effort made by each of us to avoid close contact with others are the key to our success as a province to stop the spread of this virus.”

      Only critical construction projects will continue, including industrial projects such as refineries and petrochemical plants and infrastructure projects such as new hospitals, roads and bridges. New starts in residential projects will stop, while residential construction that is near completion will continue. Business-owners with questions concerning their essential business status are encouraged to call the Stop the Spread hotline at 1-888-444-3659. The hotline is available from 8:30 a.m.― 9:00 p.m. Monday to Friday and 8:30 a.m.— 5:00 p.m. Saturday and Sunday.

       “We recognize the toll this outbreak is taking on business owners and workers,” said Vic Fedeli, Minister of Economic Development, Job Creation and Trade. “Ontario businesses are top of mind during this unprecedented time. We know that the only way to ensure the health of our businesses and our economy is to ensure the health of all Ontarians.”

      The government is implementing additional measures to protect frontline workers in essential businesses by adding more than 60 special consultants and officers and doubling the number of phone agents at its Health and Safety Call Centre to 50 to make it easier for workers to report safety concerns. Workers worried their workplaces are unsafe can phone 1-877-202-0008 to speak with an agent.

      “If you’re a worker on the frontlines of this outbreak, you should know we’re doing everything in our power to keep you safe at work,” said Monte McNaughton, Minister of Labour, Training and Skills Development. “We’re beefing up our inspectors and making it easier for you to report your concerns. We’re working around the clock.”

      Quick Facts

      • Everyone in Ontario should stay home unless absolutely necessary and practice physical distancing to reduce their exposure to other people. Avoid close contact (within 2 metres) with people outside of your immediate families.
      • If you think you may have COVID-19 symptoms or have been in close contact with someone who has it, first self-isolate and then use Ontario’s Self-Assessment Tool to see if you need to seek further care.
      • Take these everyday steps to reduce exposure to the virus and protect your health: wash your hands often with soap and water or alcohol-based hand sanitizer; sneeze and cough into your sleeve; avoid touching your eyes, nose or mouth; avoid contact with people who are sick; and stay home if you are sick.

      Additional Resources

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