CRIM 2653 Lecture Notes - Lecture 7: Canada Health Act, Ontario Health Insurance Plan

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3 May 2020

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If you"re a doctor, you get the benefits of having more patients since they don"t have to pay out of their pocket, but the amount you get from the government may be less. The provincial government is paying for it through their service plan, they can strain the incomes you make. In the us, there"s a lot less public spending and less regulation of physician prices, so doctors there are much more able to raise their income. You"re not having your income constrained by a single payer in the states, there"s a lot more bargaining power for physicians in the us than there is in ontario with. We can see before and after the canada health act (before the federal health. Both of them spend similar amount of gdp on health care, once we had a centralized payer of services, then we"re able to control our share of health care spending by virtue of having a single payer system.

Related Questions


(Please Summerize the work down below, thank you)

Political	Economic
Growing political influences on healthcare advances	Cost of living increases
Global government influence on healthcare cost	Cost of insurance prices
Government control of Medicaid, Medicare funding	Rise of forecasted interest rates
Social/Cultural	Technical or Technology
Increase average age of population	Demand on new medical treatments
Patient expectations increase	Customize treatments
Demographics are in constant change	More advance service facilities
Environmental	Legal
Growing need for green business	Constant change of government drug Regulations
Environmental agenda and community awareness	Consumer laws
	Health and safety regulations



Porters 5 forces of business model

Competitive Rivalry
Growth opportunity for healthcare companies are expected to growing the next few years
Increase in new revolutionary drugs both in and outside of the US

Threat if New Entrants
Strict government regulations
Difficult to keep up due to constant change
Huge startup cost

Substitute Products
Threat of other substituting product and service at lower cost



Bargaining Power of Customers
Generic drugs offered at large discount to consumer
Larger less customized healthcare facility with lower housing costs
Several facilities offering similar services.

Bargaining power of supplier
Medical suppliers have a large pricing power
Bargaining power of physicians and nurses is huge because of large hospital benefits

Swot Analysis

Strengths

Highly trained and capable employees

Market experience

Strong leadership

High level of organizational efficiency

Excellent facilities

Strong commitment to bettering the community

Weaknesses

Increased cost of healthcare could lower our clientele

Limited staff resources

Limited cash flow to hire and train new employees

Lack of resources

Opportunities

Fast growing technology opens new doors for using state of the art equipment to better serve the patients.

Nursing and residential care is one of the fastest growing industries

Aging population

Threats

Uncertainty in political and economic climate causes hesitation for receiving new patients.

Funding constraints

Highly competitive market

Product or Service Analysis

Our services will be used by patients who cannot afford experimental treatments and patients who have been abandoned by the system because hospitals can no longer provide medical assistance. At our facility, we will be able to work with the families and provide them with different payments options, such as low monthly payment plans. Our main goal is to be able to treat the patient at a very affordable cost; however, if any patient does not possess the means to pay for treatment, he or she would not be turned away; our facility will tap into government and private funding to cover treatment cost.

The beauty of this service is that there isnât a charge of any kind to take part in our program because it is completely funded by government grants. Individuals that would take part would more than likely not have the means to pay a monthly deductible. Due to the nature of the business listed as a non-profit agency, there is no way to make a profit of any kind, as it would jeopardize the business in its entirety.

Some of the market factors that create a demand for our services include the need of medical care after having maximized all resources, the number of low income families, and the number of patients facing health issues needed extended medical care.

Opportunities that may derive from this business is the opportunity to expand and open multiple facilities, while extending a helping hand to many more in need. The risk, however, is the unstable funds deriving from grants. This can pose a huge treat to the business, as grants often times come and go and cannot be counted on as a constant income.

After studying the healthcare system and current policies in place, data shows many individuals facing severe health issues usually go untreated and uncared for due to the outrageous cost of medical care. It is devastating to see how often people, especially the elderly, are sent home and forgotten for the mere reason that hospitals and doctors are not willing to care for patients without financial means. In fact, in 2009 Harvard news reported 45,000 annual deaths due to lack of health coverage in the U.S. alone, which is significantly higher than the 18,000 reported by USA Today in 2002.

Financial Analysis

Clermont will be a nonprofit organization, dedicated to help the most needed. To open the facility fully operational we must take in consideration some fixed expenses like the land acquisition, permits, interest, brokers, administration fees, professionals (facility setup), staff, reports (environmental, occupational, fire, FDA), electricity, water, phone, water & sewer , connections, taxes, insurance, management, security, advertising, accountants, food, lawn mowers, bank fees, etc.

The facility will need have a total value of approximately three million dollars, but if we break the price of the land acquisition in to a thirty (30) year mortgage we can star up the business with an investment of approximately $ 233,944.61 USD to cover the first month of operation including all the startup permits and connections. After the first month the fixed expenses will be $184,444.00 USD with the exception of the months were taxes are due; taxes are around $ 43,000.00 USD paid quarterly will increase the tax month (depending on the facility fiscal year) for $ 10,750.00 USD approximately. We will fund all the costs with private and public funding, fundraiser, events, raffles, and most important with the help of the community.

As we mentioned before, Clermont is a nonprofit organization and we will do everything in our power to give the relief to the families in need. No one will be rejected because they do not have the money or the insurance cannot help. No money will be required from patient and every single dollar received will be spent in the patients, and in improving our facility and our service every day.

We believe our financial even breaking point will be a year after we begin operations, and be profitable soon after. There are many patients in need, and with the government and public grants each person will receive the treatment they need, and we will become the hope of many.

CASE STUDY 7 **** WHAT DID YOU LEARN FROM THE CASE STUDY? ( ****basically just summarize what the case study is about)

Transforming the Clinical Process at Farmington Endoscopy Center William C. Kinney

Transforming the clinical work process in healthcare is not going to be a simple task, as many of todayâs work solutions are rooted in decades-long and even century-old autonomous and hierarchical structures. As mentioned in the chapter, Paul Starrâs The Social Transformation of American Medicine explained how US healthcare evolved into a system that separates the business side and clinical side of care delivery. Separating the two functions ultimately created two diverging approaches, leaving the patient caught in the middle. Regulations from both the insurance industry and federal government are trying to bring the two sides together in the interest of what is best for the healthcare system as a whole.

The IOMâs reports on medical quality highlighted the inefficiencies and mistakes that resulted from the increased complexity of healthcare. Although IT exists to change the system, it has lacked the leadership and skills needed to bring about a redesign that, in turn, could transform existing processes and structures. The IOM reports and subsequent analyses have highlighted IT as a tool to improve quality and efficiency. Clinical decision support system (CDSS), in particular, has been identified as a priority health IT, as it pushes evidence-based health recommendations that lead not only to better clinical processes, quality, and outcomes but also to lower healthcare costs. The challenge in adopting CDSS is determining where and how to apply the evidence.

This case highlights the use of health IT to transform the clinical and business processes. Readers should take note of who the relevant players are, the information needs in care delivery, and the method of leveraging information to make care delivery more efficient and effective.

Farmington Endoscopy Center

Farmington is a Midwest college town with a population of more than 100,000 and a large and productive medical community supported by a local medical school. The medical community serves not only the residents of Farmington but also the residents of the surrounding rural communities, some of whom drive more than two hours to get to their respective clinic or hospital. The limited number of primary care physicians who work in rural settings, lack of supporting facilities, and varying socioeconomic backgrounds all add to the complexities of rural medicine. Rural communities also have few manufacturers and corporations that hire employees and provide employer-sponsored, private health insurance. This leaves many rural patients no choice but to enroll in government- supported healthcare programs. Farmington Endoscopy Center (FEC) is a freestanding, physician- owned endoscopy facility that serves both adult and pediatric patients. The main proceduresâesophagogastroduodenoscopy (EGD) and colonoscopyâare performed by six gastroenterologist (the owners). Last year, it completed almost 5,000 cases, and this year it is anticipating a 5 percent growth in volume by adding a new physician. FEC is owned and managed by the physicians, but a full-time administrator is in charge of day-to-day operations, compliance with state and federal safety/account- ability standards, billing and collections, and staffing. Rounding out the staff are eight nurses, four receptionists, one billing specialist, and one certified registered nurse anesthetist (CRNA).

Patients are referred to FEC for an endoscopy procedure by the six physicians, each of whom runs a separate outpatient clinic, or by independent primary care or specialty physicians. The independent primary or specialty care physician assumes patient-management responsibilities for the results of the endoscopy, so the gastroenterologist who performs the procedure is essentially a technician whose responsibility to the patient ends at the completion of the procedure. Both EGD and colonoscopy are not painful, but they are uncomfortable and thus require sedation. Administered by the CRNA, sedation techniques range from applying topical anesthetic to running an intravenous line of light anesthesia (where the patient stays awake and can communicate) or a heavy dose of anesthesia (where the patient is unconscious and could stop breathing and may need respiratory support). The CRNA is licensed by the state but cannot act as an independent provider and must be under the close supervision of the gastroenterologist. Throughout the procedure, the gastroenterologist is ultimately responsible for the patientâs well being.

Areas of Improvement

Susan Michaels, the FEC administrator, is reviewing last yearâs reports to find ways to increase volume. Both private and public insurance have changed their rules, resulting in lower reimbursements. Meanwhile, healthcare costs continue to rise, further cutting into profits. Needless to say, the FEC physician owners are concerned. Susan identifies two problem areas in the reports:

1. The center has a day-of-procedure cancellation rate of 8 to 12 per- cent. These patients show up for their scheduled procedure only to be cancelled by the clinic because of some factors that were not known before their arrival. The top-five factors are blood-thinner usage, unidentified cardiovascular risk, failure to adhere to NPO (latin for ânil per os,â which means no food or drink hours before a procedure), improper guardianship, and lack of bowel prep.

2. Regulations have doubled the amount of required paperwork to be completed for each patient. Explanation of patient rights and privacy policies, medication-reconciliation process, deep venous thrombosis evaluation, and complication reporting are just some of the tasks or forms that must be completed before a case can be closed. The planned addition of another physician to the practice would increase the number of cases, exacerbating the paperwork problem. Susan is considering hiring another nurse to help the existing staff with the workload, a move that would enable the FEC to accommodate more patients and complete the paperwork quicker. Fortunately, Susan just returned

Fortunately, Susan just returned from a health IT workshop that presented a new logic and tools for how to define the dimensions of a problem and derive workable solutions.

Information Needs

Evaluating and managing patient health needs is about acquiring information and making a decision based on that information. A wise physician once stated that 90 percent of the information a physician consults to arrive at a diagnosis is contained in the patientâs medical history. Much of todayâs health IT efforts pay attention to the physicianâs information needs for two reasons: (1) The doctor is ultimately responsible for health- care evaluation and management, and (2) the doctor gets paid based on a certain level of information she gathers. A careful review of current EMRs shows that information is maintained in vertical silos or âbucketsâ and based on billing and collection needs. Information is compartmentalized and cannot be shared easily among all players in the care delivery process. Compartmentalization also hinders the use of the information and masks the time-sensitive value of that information. Time, in this case, is chronologic and pertains to information that must be gathered and acted upon before an event.

In the case of scheduled procedures, decisions need to be made days before the encounter. Anticoagulation therapy, for example, is information that must be relayed before a patientâs appointed surgery or intervention. Appropriately managing anticoagulation is not necessarily straightforward, and a new healthcare player (e.g., a cardiologist) may need more information or guidance. CDSS can ensure that relevant patient information, research evidence, and best practice are available at the right time, a system that is infinitely valuable to a freestanding endoscopy center or ambulatory surgery center.

Information Gathering Process for an Integrated IT

Susan decides to use IT to address FECâs two problems. She identifies the information needs of each player (i.e., physicians, CRNA, and nurses), and then she breaks down the problems into components to better under- stand the clinical processes and find ways to integrate them to improve efficiencies and patient satisfaction. The ultimate goal is to create a sophisticated data-capture and management IT with an integrated CDSS. The steps she takes are as follows:

1. List each team member involved in an endoscopy procedure. Does the team composition change according to who initiated the patient referral? What steps do the physicians follow to refer patients to FEC? The referring physiciansâ information needs must be considered so that a better request-for-procedure ordering process can be developed.

2. List the information needs of each team member, including the supporting players who perform billing, collections, and other administrative tasks. Here are a few examples of these needs:

- The gastroenterologist needs to know why the patient is there. Is this a screening colonoscopy because of a family history of colon cancer? Is this a patient with anemia and guaiac-positive stools?

- The nurse needs to know if the patient had surgery in the last 30 days, as this increases the patientâs risk of deep venous thrombosis. The nurse also needs a current list of medications to complete the medication-reconciliation process.

The CRNA needs to know if the patient is taking an angiotensin- converting enzyme inhibitor. Current recommendations are for patients to not take this medication on the morning of a procedure. The CRNA must know the patientâs cardiac history and be able to identify potential risk factors that would affect the patientâs choice of sedation.

The referring physician needs a system for telling the FEC gastroenterologist, nurses, and CRNA information on the patient, including tests, medications, and risk factors, that could affect the patientâs ability to receive the procedure on the day it is scheduled.

Scheduling needs to know which patients are scheduled for what procedure and how long the procedure is estimated to take. Scheduling staff is responsible for reminding the patient of the appointment time, date, and any preparation (such as the NPO).

Registration needs to know the patientâs demographic and social status. Is the patient a minor? Who will be present to sign the consent? If the child is in foster care, does FEC need to obtain a court order to do the procedure? If the patient is an adult, is he of sound mind and body, or does he have a legal guardian?

Procedure room nurses need to know the capability of supplies and equipment to meet the needs of the patient. Is the patient wheelchair bound, and if so, should more time be added to the schedule? Does the patient have an artificial joint, as this will affect where the electrocautery-grounding pad is placed?

Construct a timeline of the information needs across the encounter. Identify overlapping information needs between players.

As a final step, Susan determines the time component of each information need to ensure that it is available at the appropriate time, which could reduce cancellations. Susan considers available consumer technology, such as the Internet, smart phones, and apps, to enhance the IT option. Susan also looks into outsourcing.

A successful health IT solution for FEC results in a significant reduction in cancellation rates and in a faster or same-day completion of the administrative, regulatory, and nursing paperwork. Such improvements enable FEC to schedule more patients and complete more procedures.

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CASE STUDY

It used to be that epidemiologists at the CDC only knew that you had the flu when you visited your doctor and the doc- tor then reported that information to other agencies. By the time this information made its way to the CDC or state health departments, it was often several days old, which meant that the medical community was always playing catch-up. And of course, your doctor was only aware of your illness if you showed up at his office, not when you decided to tough it out at home. Nowadays, however, before you ever go to the doc- tor, you are likely to search the Internet for âflu symptoms,â tweet your suddenly declining health status, or Instagram yourself lying in bed. Study the case below, which shows how the Internet and social media have impacted the field of epi- demiology, and then answer the questions that follow.

Google Used to Predict Influenza Outbreaksâ2008

In 2008, Google launched Google Flu Trends, an applica- tion that compiles aggregated data from key word searches

for clinical terms, such as thermometer, chest congestion, muscle aches, or flu symptoms. Google reports the data on a website, which then provides an early-warning system for the locations of new flu outbreaks. Because the data are collected from searches performed each day, trends in flu symptoms become apparent much more quickly than when they are based on data reported during office vis- its or in lab reports from physicians around the country. When the CDC compared actual cases over the course of a year with Googleâs findings, the data from the two sources matched.

Initially, Google was only compiling information about flu trends in the United States and Canada. But after the H1N1 virus appeared in Mexico in 2009, the CDC asked Google to go back and look at Internet searches conducted by people in Mexico during that time. Evaluation of the data indicated that Google detected an uptick several days before the CDC did (Figure 23.1).

1,200 1,000 800 600 400 200 0

Influenza activity

1113151719212325272931 2 4 6 8 1012141618202224262830 2

Suspected Confirmed

Mar

Apr

May

Date of illness onset

Intense

High Moderate

Low Minimal

Jul Aug Sep

Oct Nov

Dec Jan

Feb Mar

Apr May Jun

Figure 23.1 2009 Inflenza activity (a) Data from the Centers for Disease Control, based on physical examination by health care providers, shows a peak in influenza cases in late April. (b) Google âFlu Trendsâ shows an influenza peak in February.

No. of cases

Case Study Exercise 23 Morbidity and Mortality Weekly Report 199

Epidemic tracking based on Internet searches reflects what is called collective intelligence. It works because indi- viduals using their personal computers tend to search for terms related to their immediate needs and intentions, and they generally do this before presenting in a doctorâs office or emergency room. The methodology used in the Google search was published in the prestigious science journal Nature, and another independent study has been published about a similar search analysis conducted by Yahoo, showing that it was effective in predicting flu trends.

Some people worry that data collected from Internet searches may compromise individualsâ privacy. However,

Google maintains that Flu Trends cannot be used to iden- tify individual users because the data are anonymous and are aggregated before being presented. Another potential drawback is that this data collection method is less likely to be useful for tracking epidemics in societies having a low percentage of computer ownership, namely, developing countries. However, considering the high stakes involved in identifying an epidemic quickly, Internet search term analy- sis holds great promise for public health. And, unlike most health innovations, itâs free!

3. How might data collected in this way not be representative of a particular population?

4. Explain why the two graphs in Figure 23.1 do not show influenza activity peaking at the same time.

6. In 2013, Google Flu Trends vastly overestimated the number of cases of the flu in the United States. One explanation for this was that there was a greater than usual number of media reports about influenza early in the flu season. Based on your knowledge of how Flu Trends works, explain why Google missed the mark in 2013

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CRIM 2653 Lecture Notes - Lecture 7: Canada Health Act, Ontario Health Insurance Plan

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