Urban Renaissance Institute

Using programs of care to achieve better health outcomes

Posted on March 12, 2004 by urbanrenaissanceinst

Insurance Bureau of Canada

March 12/2004

Mandating the use of evidence-based Programs of Care will mean that insurers, health providers, claimants and the court system will have similar expectations for the type and cost of reasonable and necessary treatment for common accident-related injuries.

Definition:
A Program of Care specifies the appropriate type and timing of healthcare interventions for a specific category of injury or disease. The prime candidate for this treatment is soft tissue injury, but as well conditions such as post traumatic stress disorder, mild traumatic brain injury, or moderate to severe brain injury where the incidence of the condition is fairly high, may also be brought into a Program of Care.

A Program of Care is based upon best practices and the most up to date scientific evidence regarding recovery patterns and effective clinical intervention. It aims to bring both quality and consistency to healthcare delivery and is intended to augment existing clinical guidelines and good clinical judgment.

The Ontario Program of Care for whiplash injuries, the Pre-Approved Frameworks (PAF) for Whiplash Associated Disorder (WAD), Grades I and II, conditions, also offers administrative savings to insurers and providers insofar as the insurer does not require prior approval in order to pay for the PAF services.

The Alberta Workers’ Compensation Board has created a made-in-Alberta solution by several Continuum of Care Models (CCM) for the following injuries:

Soft tissue injuries including whiplash
Mild to Moderate brain injuries
Moderate to Severe brain injuries
Cumulative Trauma
Consultative on-set physiological injuries
Acute on-set physiological injuriesBenefits of the Program of Care approach:
Assures evidence-based care – puts a break on over-utilization of health services, while providing appropriate care;
Reduces the incidence of treatments that are either ineffective or counter-productive to early recovery;
Provides for early rehabilitation intervention to reduce chronicity;
Provides certainty for patients and providers;
Produces administrative savings to insurers and providers;
Retains health professional’s ability to make clinical judgments based on needs of individual patient;
Through a commitment to constant evaluation and re-evaluation, the program can be improved over time – resulting in quicker and fuller recoveries.The elements of a Program of Care are typically as follows:
The maximum number of treatments allowable;
Types of treatment that will be paid for;
Duration of treatment;
Service expectations with respect to access, cycle times, reporting;
Expected health outcomes;
Expected provider participation in performance monitoring and outcome evaluation;
Reimbursement (which is typically based on the program, as distinct from the fee-for-service system which incents over-treatment).Process involved in developing a Program of Care:
Requires collaboration among experts and clinicians as well as the payers – which is a necessary pre-requisite for the parties ultimately having confidence in the care program;
Review of the relevant literature and best practices for the condition under consideration;
Development of a background paper and preliminary program of care;
Validation of the preliminary program with stakeholders;
Pilot the care model to demonstrate its effectiveness and broaden buy-in;
Roll-out the Program of Care.Conclusion:
Regardless of who the payer is, there are never enough resources to finance unlimited health services;
In the auto insurance sector as in all others, health care costs must be contained if the cost of insurance is to remain affordable;
At the same time, people who are injured in MVAs have to be able to expect that they will have the health care resources they need for recovery;
Evidence-based Programs of Care are an effective means for meeting both of these imperatives.

Posted in Automobile | Leave a comment

The rich have always been inviting targets

Posted on March 9, 2004 by Other News Sources

Lawrence Solomon
National Post
March 9, 2004

Some are appalled that Martha Stewart could be prosecuted for covering up a crime she didn’t commit, especially when prosecutors would never have bothered pursuing an ordinary person. Yet double standards against the rich are nothing new. Prosecutors and others have long made their careers by going after this very visible minority.

The greatest Western inquisition of all into socially desirable behaviour, the Spanish Inquisition, preoccupied itself with the rich in society. As renowned historian Henry Kamen documents in The Spanish Inquisition, public opinion at the time often viewed the Inquisition’s target as being less the conversos – Jews converted to Catholicism – and more the rich. Of the Seville Inquisition of 1481, a chronicler wrote: “what was noticeable was the great number of prosecutions against moneyed men.” In Cuenca, one resident observed “They were burnt only for the money they had.” Observed another: “They burn only the well-off, because they have property; the others they leave alone.” To allay a woman’s fear upon learning that the Inquisition would be coming to her town of Aranda de Duero, a neighbour in 1501 reassured: Don’t be afraid of being burnt, they’re only after the money.” In part, the Inquisition was after the money – its funding depended on confiscating the property of the sinners. But the Inquisition’s focus on a rich minority served another purpose, too: An across-the board assault across all sectors of society could have led to widespread opposition and cost the Inquisitors power and prestige.

Because few will come to their defence, the rich generally make inviting targets but the rich must be attacked intelligently. Mao Tse-tung was an expert practitioner of the calculated assault, to both tap the masses’ resentment of the rich and to divide any opposition that the rich might attempt. “Land reform in a new Liberated Area should be divided into two stages,” he wrote in one of his cunning analyses, Essential Points in Land Reform in the New Liberated Areas. “In the first stage strike blows at the landlords and neutralize the rich peasants. This stage is to be sub-divided into several steps; strike blows at the big landlords first, and then at the other landlords . . . The second stage is the equal distribution of land, including the land rented out by the rich peasants and their surplus land. However, the treatment of rich peasants should differ from that of landlords. The total scope of attack should generally not exceed 8% of the households or 10% of the population.”

Mao had learned from Stalin, who had made a similar calculation in attacking the rich kulaks. Stalin’s latter-day successor, Vladimir Putin, has also singled out the rich – the industrial “oligarchs” of today – as a means to maintain popular support.

Like Stalin and Mao, many a U.S. prosecutor have risen to prominence on the backs of the rich. New York Attorney General Eliot Spitzer, who gained fame prosecuting Merrill Lynch and others, is widely expected to run for office as Governor of New York State. Rudy Giuliani, New York’s former mayor, made his name by indicting financiers Ivan Boesky and Michael Milliken.

Saint Augustine could have been describing current attitudes toward Martha Stewart in his reflections on the story of the rich man and Lazarus. “Although the haughty and rich man who was clothed in purple and fine linen and feasted sumptuously every day, died and was tormented in Hell, nevertheless, if he had shown mercy to the poor man covered with sores who lay at his door and was treated with scorn, he himself would have deserved mercy.” The rich man’s sin, in effect, was his personality – his haughtiness and disregard for the poor, stereotypes of the rich that justify their damnation to this day.

If the rich have any consolation, it’s in knowing that they’re not alone in being singled out. The poor, too, are systematically picked on in our society, whether by being the chief targets of sin taxes, such as the visible tobacco taxes that disproportionately target the lower classes, or the invisible taxes on their accommodation – apartments are taxed at much higher rates than condos or single-family homes. Those who single out both the rich and the poor, ultimately, are the middle-class. They form the crowds that today’s politicians seek to please.

Posted in Culture, Nation states, Regulation | Leave a comment

Investing in people: creating a human capital society for Ontario

Posted on February 24, 2004 by urbanrenaissanceinst

Panel on the role of government, Faculty of Law, University of Toronto

February 24, 2004

Examining the future role of government in the context of promoting economic growth, strong communities, fiscal responsibility and accountability.

Click here to view .pdf document

Posted in City states, Cures, Municipal, Nation states, Sprawl | Leave a comment

London’s green streets

Posted on February 19, 2004 by urbanrenaissanceinst

National Post
February 19, 2004

One year ago this week, London began to charge private automobiles and commercial vehicles £5 ($12.50) a day if they either entered or left its downtown core between 7 a.m. and 6:30 pm. The reviews of this unprecedented experiment – designed to reduce traffic jams in one of the most heavily congested cities in the world – are now in, and they’re rave. The pundits who almost all predicted disaster are red-faced. London has cracked gridlock and unlocked economic efficiencies.

The £5 charge has deterred some 65,000 vehicles – 27% of vehicles subject to the fee – from the downtown area. As a result, traffic delays are down by an astonishing 30%, to 1.7 minute of delay per kilometre travelled. Before the toll came in, public opinion polls showed that more than 20% of Londoners considered traffic to be “at a critical level” and another 30% considered it “very bad.” After the £5 charge came in, the numbers dropped to a mere 5% who considered the traffic problem critical, and 10% who considered it very bad.

All told, car trips are down 30% and truck trips are down 10%. While these private vehicles have yielded a large share of the road, others – those that tend to cause less congestion and pollution, and thus less economic harm – have gained, with the most efficient transportation forms gaining the most. Motorcycle and scooter trips are up 12%. Bicycle trips are up by 20%. Taxi trips are up by 20%. Public transit trips are up by 23%.

Public transit’s gain comes only in part because the £5 charge for driving makes the bus more economical relative to the car. With buses no longer stuck in traffic, they can travel faster and better keep to their schedules. Disruptions due to traffic were down by 60% in the central area and 40% across London as a whole, reducing the excess waiting time at bus stops by 33% in the central area, and by 20% across the whole system. Taxi use is way up for similar reasons. For similar reasons, too, accidents are way down: 28% fewer cars were involved in accidents and 6% fewer pedestrians. These efficiencies translate into a £220-million a year benefit to Londoners in reduced travel time, fuel costs and accidents.

The benefits extend further, however. With the city’s downtown core functioning so efficiently, Londoners feel better about the amenities on offer. When asked about the overall “pleasantness of location” of the core’s business areas, theatre district, streets with high concentrations of restaurants, tourist attractions and the fringes of the central core, all scored higher than they had before the £5 charge was introduced. The public reported less noise, fresher air, better road conditions – improvements across the board.

With immense improvements in travel efficiency, the businesses in the London core can more easily get their employees to and from meetings and otherwise function better. A survey of businesses in and around the central core found that 70% supported the congestion charge if the revenues fund public transit, with only 20% opposed. Those in central London’s all-important financial services industry favoured the congestion charge in even larger numbers.

The 20% who opposed the congestion charge come largely from the ranks of retailers, many of whom report flat or even reduced sales. The retailers believed that the £5 charge was keeping shoppers at home. Their difficulty, it turns out, stemmed less from the £5 charge than from a 15% reduction in tourism following 9/11, mainly from free-spending Americans, coupled with the shutdown of London’s Central Line for part of the year following a derailment, which prevented some 250,000 shoppers from visiting Central London. The total number of shoppers deterred by the charge? A trivial 300 a day, out of the 4,000 fewer people a day who enter the downtown core. Now that tourism has come back and the Central Line has been repaired, year-over-year retail sales in the central area rose 4.7% for January, outpacing retail’s gain in London as a whole.

With reviewers overwhelmingly giving London’s daring gamble the thumbs up, cities around the world are planning to bring the same road show to town. According to studies by Deloitte consultants, 26 cities in 15 European countries show “significant support” for London-style road reforms, as do almost half of the cities it surveyed in Latin America. Cities in the United States – but not Canada – also have plans to introduce road pricing. The first city to follow London’s lead – Stockholm – will be starting a pilot project next year. The opportunity to clean the air, clear the streets and clean up financially is hard to beat.

The city of London, meanwhile, plans to extend its system, starting with a doubling of the area to be subject to a road charge. On the anniversary of the scheme’s introduction, the city is sending out surveys to 3.3 million householders, asking Londoners for their opinion. The city, of course, already has their answer.

Posted in Automobile, Cities, Public transit, Regulation, Toll roads, Transportation | Leave a comment

Elitist immigration policy bars poor, unskilled workers

Posted on February 14, 2004 by Other News Sources

Lawrence Solomon
National Post
February 14, 2004

“Make Manitoba Your New Home” the government Web site courting immigrants says. “Manitoba Welcomes Newcomers.” But most potential immigrants aren’t listening, and for good reason. Canada only welcomes the well-off, or the well-skilled, as contributors to the economy. Manitoba, as do other provinces, sets the bar so high for immigrants that most native-born Canadians – if they had to qualify to remain here as productive members of the economy – would be deemed undesirable and deported.

Canada’s elitist immigration policy was lamented in a 2002 brief to the federal government by the Jewish Federation of Winnipeg, which has seen the city’s once-robust Jewish population diminished by one-quarter. “The ‘pass mark’ is too high for most skilled individuals,” the federation’s vice-president, Leslie Wilder, told a parliamentary committee in an unsuccessful attempt to dissuade the federal government from introducing new restrictions that would further discriminate against all but the highly skilled.

“Our initial survey indicates that those who have already come and integrated into our community in the last several years would not pass. Most people would not qualify even though they are in fields with job opportunities in Winnipeg and have the resources to apply. Indeed many of those born in Canada with higher levels of education would also not be eligible under the new point system, even though their skills are in demand.”

Under the government’s new selection criteria, even young university graduates fluent in English and with work experience often won’t qualify to become immigrants to Canada. Most blue-collar workers are frowned upon; the unskilled need not even consider Canada, unless they’re refugees or have some other dispensation. Those who are cheerfully welcomed – specialized professionals and the monied – will tend to settle in large centres able to support professional niches. That will be adequate to ensure growth in Toronto, Vancouver and Montreal, whose high-tech, information economies already attract three-quarters of Canada’s immigrants. But the absence of a balanced immigrant workforce, able to fill bread-and-butter needs across the country, will lead to a slow death for smaller cities such as Winnipeg: Without fresh blood to rejuvenate their rapidly ageing population, these cities’ economies will decline and the cities will decay.

Barring the unskilled and uneducated from Canada harms Canada. The great waves of immigrants who came to Canada a century and more ago, making cities such as Winnipeg great centres of commerce, were mostly poor and low-skilled. Likewise, after the Second World War, waves of peasants from Italy, Portugal and other southern European countries came to Canada with next to nothing in their pockets. Seventy-five percent of these post-war immigrants filled low-income jobs – the men often worked in construction and in maintenance, the women as seamstresses and domestics. They helped build our country as they built new lives for themselves. By the mid-1980s, their children’s higher education matched the Canadian average. Today, these immigrant groups are affluent and successful – Italians have Canada’s highest proportion of home ownership at 95% – and their children have become successful businessmen, professionals and academics.

Although Canada’s history repeatedly shows ambitious, hard-working newcomers – skilled or not – have been a credit to the country, our government bureaucrats bar entry to the unskilled immigrant. In the process, the bureaucracy stunts the development of Canada as a whole and especially threatens that of our smaller centres. A ready supply of farm workers would help the labour-intensive farm belts around cities, more factory hands would help our manufacturing industries compete, more construction workers would ease shortages that delay the completion of major engineering works across the country.

Low-skilled workers also help us meet shortages in skilled occupations. A large and affordable supply of cooks, maids, gardeners, charwomen, nannies and other domestics would free up time and talent in the non-immigrant workforce: Parents would less often need to take a day off work to mind a sick child, single working mothers would have less frantic mornings without having to rush to drop their child off at the daycare each morning. The immigrants themselves, though poor, would create jobs for the native-born population: Immigrants come not only with hands that produce goods and service, they come with wants – for food, shelter, clothing and entertainment – that home-grown Canadians can satisfy.

If Manitoba really wants immigrants to make Manitoba their home, it can start by welcoming newcomers without making a diploma or a cheque book a prerequisite for applying. The Jewish immigrants that Winnipeg’s Jewish Federation would recruit would do just fine, as would the immigrants recruited by the city’s other ethnic organizations.

Give them a genuine welcome and they will come.

Posted in Immigration | Leave a comment