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CAS is a survey that asks people for their views on saving, financial planning and their priorities. Weāve carried it out in our markets since 2004 and over these last ten years weāve surveyed almost a quarter of a million people. We currently ask 11,000 people three times a year and in our most recent survey (November 2013), we asked people for their views from eleven countries: UK, Ireland, Spain, Italy, France, Poland, China, India, Turkey, Singapore and Indonesia.
Allianz International Pensions previously created the Pension Sustainability Index (PSI) following the pressure on public pension systems due to aging demographics and deteriorating government finances. The PSI combines the various characteristics of pension systems with the factors that influence them to help track and evaluate policy changes
made in different countries around the world.
David John, Senior Senior Strategic Policy Adviser at AARPās Public Policy In...ILC- UK
Ā
In July 2015, the Government began a consultation on changing how the UK incentivises private pension saving, and the Chancellor is expected to respond to this consultation in the Governmentās annual Budget in March 2016.
The Future of Private Pension Saving, kindly supported by Age UK, brought together Parliamentarians, business, academics and industry experts to discuss how best the UK Government can incentivise private pension saving.
The debate was opened by initial remarks from Angela Rayner MP (Shadow Pensions Minister), Jackie Wells (Head of Policy and Research, Pensions and Lifetime Savings Association), Sarah Luheshi (Deputy Director, Pensions Policy Institute), and Yvonne Braun (Director, Long-Term Savings Policy, Association of British Insurers).
On Wednesday 27th January, David John, Senior Strategic Policy Adviser at AARPās Public Policy Institute, and Deputy Director of the Retirement Security Project at the Brookings institute delivered a presentation on tax incentives for pension saving in the US context at an informal reception hosted by Age UK.
Discussions from this event contributed to a formal representation to the HM Treasury regarding Government policy on pensions tax relief and private pension saving.
CAS is a survey that asks people for their views on saving, financial planning and their priorities. Weāve carried it out in our markets since 2004 and over these last ten years weāve surveyed almost a quarter of a million people. We currently ask 11,000 people three times a year and in our most recent survey (November 2013), we asked people for their views from eleven countries: UK, Ireland, Spain, Italy, France, Poland, China, India, Turkey, Singapore and Indonesia.
Allianz International Pensions previously created the Pension Sustainability Index (PSI) following the pressure on public pension systems due to aging demographics and deteriorating government finances. The PSI combines the various characteristics of pension systems with the factors that influence them to help track and evaluate policy changes
made in different countries around the world.
David John, Senior Senior Strategic Policy Adviser at AARPās Public Policy In...ILC- UK
Ā
In July 2015, the Government began a consultation on changing how the UK incentivises private pension saving, and the Chancellor is expected to respond to this consultation in the Governmentās annual Budget in March 2016.
The Future of Private Pension Saving, kindly supported by Age UK, brought together Parliamentarians, business, academics and industry experts to discuss how best the UK Government can incentivise private pension saving.
The debate was opened by initial remarks from Angela Rayner MP (Shadow Pensions Minister), Jackie Wells (Head of Policy and Research, Pensions and Lifetime Savings Association), Sarah Luheshi (Deputy Director, Pensions Policy Institute), and Yvonne Braun (Director, Long-Term Savings Policy, Association of British Insurers).
On Wednesday 27th January, David John, Senior Strategic Policy Adviser at AARPās Public Policy Institute, and Deputy Director of the Retirement Security Project at the Brookings institute delivered a presentation on tax incentives for pension saving in the US context at an informal reception hosted by Age UK.
Discussions from this event contributed to a formal representation to the HM Treasury regarding Government policy on pensions tax relief and private pension saving.
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It is time to redistribute opportunity, to level the playing field, make all Americans independent. Barron Rothschild whose family founded the Banks of Europe said, "give me control of a nation's money and I CARE NOT who makes the laws." Laws should be made in Congress, not on K Street. Here is a real chance for change. Reach out!
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Comparative evidence on the receipt of minimum-income benefits discussion of empirical assessment of state dependence / "scarring effects" in benefit receipt
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A proposal to reverse the rising trajectory of Chronic Disease (overwhelmingly lifestyle related) burden using a mobile Lifestyle Assistant. Supporting proactive wellbeing and wellbeing as part of chronic disease management = Wellth.
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Date and time: 16.30-18.30, June 26th 2012
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Week 9 - eHealth in Ontario
1. Policy Issues:
eHealth in Ontario
HLTH 405 / Canadian Health Policy
Winter 2012
School of Kinesiology and Health Studies
Course Instructor:
Alex Mayer, MPA
3. Briefing Notes
Most Common Mistakes:
ā¢ Did not substantiate the problem with statistical evidence!
ā¢ Lack of specific information provided
ā¢ Saying that there is an āincrease in rates of drug abuseā is not
sufficient
ā¢ Using Fallacious Logic to say that there is a problem worth addressing
ā¢ Suggesting that āObesity is on the rise, therefore physical activity
must be decreasingā
ā¢ Suggesting that āU.S. rates are increasing, therefore there must be a
similar problem in Canadaā
4. Briefing Notes
Most Common Mistakes:
ā¢ Did not make evidence-based recommendations!
ā¢ Locked in on the ācommon-senseā option too quickly
ā¢ Made a guess as to what would work best, based on intuition rather
than evidence
ā¢ Did not try to compare the effectiveness and cost of different
approaches
ā¢ Did not present statistical evidence to prove an optionās effectiveness
5. Briefing Notes
Most Common Mistakes:
ā¢ Did not understand the purpose of a Communications section!
ā¢ This section is used to highlight a messaging strategy
ā¢ To allay potential concerns in specific segments of the population
ā¢ To promote a policyās benefits
ā¢ Should include specific talking points
E.g. āThe Liberal governmentās introduction of full-day kindergarten is a
hard-won victory for young families in Ontario! It will save parents
money, improve educational outcomes, and prime our province for
continued economic growth in a competitive future.ā
6. Last Weekā¦
Government intervention in the marketplace is
justified when there is
ā¢ Market Failure:
The market for a good or service is not resulting in an optimal gain in
societal welfare due to unequal power and/or information between
buyers and sellers, or due to the nature of the good.
ā¢ Equity Concerns:
Socially unacceptable outcome where some segment of the population is
going without an essential good or service, due to a lack of resources.
7. Last Weekā¦
5 Instances of Market Failure
o Informational Asymmetry
o Non-Competitive Markets
o Principal-Agent Problem
o Negative Externalities
o Public Goods
8. Last Weekā¦
Net Present Value and Discounting
If you are trying to assess the costs or benefits of your policy
recommendation, be sure that your analysis is making an āapples
to applesā comparison. A $50 savings in 1980 is not worth the same
as a $50 savings in 2012.
The inflation rate (CPI % change) measures the rise in the price of
a basket of goods. If the price of goods rises by 3.3% over 2011-
2012, then the relative value of money has declined by this
amount.
E.g. My grandmother likes to tip people with a couple of quarters
($0.50). This may seem rude, but in 1950, two quarters were worth
the equivalent of $5 in todayās market! So you see, my
grandmother is actually an excellent tipperā¦ Kind of.
9. Last Weekā¦
Net Present Value and Discounting
E.g. My grandmother likes to tip people with a couple of
quarters ($0.50). This may seem rude, but in 1950, two
quarters were worth the equivalent of $5 in todayās market!
So you see, my grandmother is actually an excellent tipperā¦
Kind of.
10. Last Weekā¦
Net Present Value and Discounting
Try the inflation calculator below to figure out the net
present value of a $50 savings generated in 1980.
Bank of Canada Inflation Calculator:
http://www.bankofcanada.ca/rates/related/inflation-
calculator/
11. Last Weekā¦
Net Present Value and Discounting
Inflation, however, is only one part of the equation. The other is
āopportunity costā.
Say I want to buy a TV; I have the option of paying in a lump sum
or paying the same amount but spread out over 12 monthly
payments.
In order to figure out the true cost of each proposition, I have to
calculate the āopportunity costā: The value of the next best
opportunity foregone, say by investing the money and earning
interest. O.C. = $P * (1 + r%)t
12. Last Weekā¦
Net Present Value and Discounting
E.g. Buying a $1000 TV.
Opportunity cost of TV (lump sum): Had I not bought the TV, I could
have invested that money and earned 5% interest instead!
$P (1 + r%)t = O.C.
$1000 (1 + 0.05)1 = $1050
Opportunity Cost = $1050
Opportunity cost of TV (monthly payments): If I buy the TV by making
monthly payments of $83, the opportunity cost is the foregone interest.
Month 1: $83 + $83* IR (5%/12 * 12 months) = $83 + $4.15 Diminishing
Month 2: $83 + $83* IR (5%/12 * 11 months) = $83 + $3.80 O.C. in foregone
interest
Month 3: $83 + $83* IR (5%/12 * 10 months) = $83 + $3.46
Opportunity Cost = $1023
13. Last Weekā¦
Net Present Value and Discounting
Combining these two concepts: the time value of money and
opportunity costā¦ We can come up with there following
equation.
$FV = $PV * (1 + r%)t
Where real rate of return, r:
r% = interest% - inflation%
14. Last Weekā¦
Net Present Value and Discounting
$FV = $PV * (1 + r%)t or $PV = $FV / (1 + r%)t
Where āreal rate of returnā or ādiscount rateā, r:
r% = interest% - inflation% and t = years
The Government of Ontario plans to spend $5M per year over 5 years to
build new bike lanes once Toronto finalizes its new transit investment
strategy. The Bank of Canada website says that the 3-year moving
average for inflation is 3% and the governmentās next best alternative is
not to incur debt, thereby eliminating interest on long-term bonds of 6%
per annum?
What is the net present value of this investment?
15. Last Weekā¦
Net Present Value and Discounting
$PV [Year 4] = $5M/ (1 + 3%)4 = $4.44M
$PV [Year 3] = $5M/ (1 + 3%)3 = $4.58M
$PV [Year 2] = $5M/ (1 + 3%)2 = $4.71M
$PV [Year 1] = $5M/ (1 + 3%)1 = $4.85M
$PV [Year 0] = $5M/ (1 + 3%)0 = $5.00M
$PV of Project Outlays $23.58M
So in comparing the cost of the bike lane project to the cost
of, say, building a dedicated street for cyclists for $25M this year, the bike
lane project is actually $1.42M less expensive in an apples-to-apples
comparison.
If they provided equivalent benefits, the bike lane project would be
the more cost-effective option!
17. Topics for todayās lecture:
Policy Issue #3: eHealth
ā¢ What is it?
ā¢ eHealth Ontario
o The strategy
o The scandal
o Signs of progress
ā¢ Future applications
o EMR
o RM&R
o ePrescribing
19. Definition
eHealth: (n)
āA consumer-centered model of health care where
stakeholders collaborate utilizing information and
communications technologies (ICTs), including
Internet technologies, to manage health; arrange,
deliver and account for care; and manage the health
care system.
20. Canada Health Infoway
Canadaās eHealth Story
ā¢ In 2000, the First Ministerās agreement on health sees the
forging of a federal-provincial-territorial agreement to
build up āinfostructureā in Canadaās health care system.
ā¢ āCanada E-Health 2000ā conference sees 400
stakeholders meet to discuss progress on a national
action plan for eHealth.
ā¢ In 2001, Canadaās Health Infoway is operational.
21. Canada Health Infoway
ā¢ Introduction to eHealth in Canada
http://www.youtube.com/watch?feature=player_em
bedded&v=3SYtv5jh4tQ#!
22. eHealth Consultations
Obstacles to better health care in Ontario
o Paper-based information management
o Limited integration of local applications and data
o Limited information-sharing across providers
o Varying technological capacity across the health system
o Fragmented and incomparable data
o Lack of common data and technical standards
o Underinvestment in technology
o No provincially coordinated strategy for eHealth funding and
planning!
23. eHealth in Ontario
ā¢ 2002: Creation of the Smart Systems for Health Agency
(SSH)
ā¢ 2003: SSH begins its operations with 6 key priorities
ā¢ Develop a common unique patient identifier in Ontario
ā¢ Establish privacy and security requirements for eHealth
ā¢ Design an Ontario EHR starting with Hospital-to-Primacy Care
Physician information exchange
ā¢ Initiate an ePharmacy Initiative for Ontario
ā¢ Expand on Telehealthās success and capabilities
ā¢ Evolve a Wait List Management Initiative for key health services
24. eHealth in Ontario
ā¢ 2006: Deloitte is hired to conduct an operational review
of SSHās activities.
ā¢ The final report finds that SSH has not delivered
sufficient value-for-money for the $650M invested thus
far. It recommends an aggressive agency-turnaround
plan.
ā¢ Smart Systems for Health (SSH) is reborn as eHealth
Ontario in 2008, with heavy-hitting CEO Sarah Kramer
at its helm.
26. eHealth in Ontario ā A Shift
No dedicated provincial
Funded, Cabinet approved Strategy
eHealth Strategy
Government as stewards; eHealth
Government responsible for
Ontario responsible for
Strategy eHealth
eHealth Strategy
Diffuse/competing/confusing Single point of accountability at
accountability eHealth Ontario
Provincial strategy delivered
Duplication, fragmentation and
through local, regional and
Proliferation of eHealth efforts
province-wide solutions
Health System
Technology plan
Transformation Strategy
26
27. 3 Clinical Priorities
Diabetes Management Medication Management Wait Times
ļ§Enable online prescriptions and ļ§Enable public reporting and
ļ§Monitor patientcompliance with
ļ§medication History ļ§performance management
evidence-based interventions
ļ§Provide decision support for ļ§Expedite patient referrals out
ļ§Alert physicianswhen best practices
physicians ļ§of acute care where appropriate
not being followed
ļ§ordering drugs
ļ§Divert ER visits to more appropriate
ļ§Report on care gaps
ļ§Alert of potential adverse drug events ļ§community care settings
ER length of stay
To Reduce
Wait times
ļ§ Blindness
ļ§ Adverse drug events ļ§ Focus of ERs on
ļ§ Heart attacks urgent patients
To Reduce To Reduce ļ§ Physician office visits
ļ§ Amputations To Increase
ļ§ Hospitalizations ļ§ Access to community
ļ§ Renal failure services
ļ§ Deaths
ļ§ Deaths
ļ§ % prescriptions ordered
ļ§ % patients receiving ļ§ ER length of stay
Measure Measure online Measure
best practice care ļ§ Wait for post acute
ļ§ % reduction in adverse
drug events care
28. Ontario eHealth Solutions
Diabetes Management Medication Management Wait Times
ā¢ Baseline Dataset ļ§ ePrescribing Demonstration Project ā¢ eReferral and Resource Matching
ā¢ Diabetes Registry ā¢ Drug Information System (DIS) ā¢ Emergency Department Reporting
ā¢ EMR interoperability with Diabetes ā¢ Drug Profile Viewer (DPV) System (EDRS)
Registry ā¢ Systemic Treatment Computerized ā¢ Wait Time Information System
ā¢ OLIS interoperability with Diabetes Physician Order Entry (CPOE) (WTIS)
Registry
28
29. eHealth Scandal
ā¢ 2009: The āeHealth Scandalā
A loosening of managerial policies around hiring
private-sector consultants, meant to make eHealth
Ontario more efficient, actually leads to more problems
after the AGās report finds that $1B had been spent with
little to show for it.
Oct 7, 2009. News Report (Global TV)
http://www.youtube.com/watch?v=txkoB8s5qZ8&feature=
results_video&playnext=1&list=PL9EFAFB182DCE4C29
30.
31. Doctors Use Electronic
Patient Medical Records
99 97 97 96 95
100 94 94
72
75 68
50
46
37
25
0
NET NZ NOR UK AUS ITA SWE GER FR US CAN
* Not including billing systems.
31
Source: 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
32. Third Timeās A Charm?
eHealth Reboot (Feb 24, 2012)
http://www.youtube.com/watch?v=F7kYDCtuTnQ
32
33. Diabetes Management
ā¢Baseline Dataset ā¢ Provides primary care MDs with a Diabetes
Patient List
ā¢ Testing reports inform MDs of most recent dates
for 3 key tests for diabetes patients (blood
glucose, cholesterol, retinal eye exam)
ā¢ Reports give MDs %patients whose tests were
within recommended guidelines so they can
identify care gaps
ā¢Diabetes Registry ā¢ Fancier version of the baseline dataset
ā¢ Will connect to OLIS give to notify MDs when
patients are due for tests or when lab results are
higher than normal
ā¢ Will connect to EMRs so that a new diagnosis
instantaneously gets added to a patientās
medical record and generates a care plan
ā¢ Will eventually provide patients with self-
management tools
34. Medication Management
ļ§ ePrescribing ļ§ MDs can electronically āpushā prescription
Demonstration directly to a local pharmacist
Project ļ§ Prescriptions can be printed in order to
avoid deciphering MDās handwriting
ā¢Drug Information ā¢Will allow multiple health practitioners to
System (DIS) ePrescribe
ā¢Will produce comprehensive medication
profiles and tools for predicting allergic
reactions, drug-to-drug interactions and
accurate dosages
ā¢Drug Profile Viewer ā¢Will give health providers connected to
(DPV) eHealth Ontario access to ODB claims
records so that all pharmaceuticals
consumed by elderly and welfare patients
will be visible at the point-of-care
35. Wait Times
ā¢eReferral and Resource ā¢Hospitals to plan post-discharge care for
Matching patients at the time of intervention
ā¢RM&R Solution will communicate with
community care providers to flag a patientās
discharge date to ensure that someone is
tasked with, and accountable for, providing
follow-up care
ā¢Emergency Department
Reporting System ā¢Will record and publicly report ED wait
(EDRS) times online, for both high and low acuity
patients
ā¢Wait Time Information
System (WTIS) ā¢Will record and publicly report wait times
for many types of surgeries and diagnostic
imaging, and for both adult and children.
Benefits:Reminders, alerts and reports will allow both patients and care providers to better manage diabetes in accordance with best practices, reducing complications and avoiding hospitalizations, thereby reducing costs and emergency room wait times.Where are we at right now:- In 2010, a vendor was selected in a competitive bid to produce the Registry and Diabetes Portal. eHealth Ontario is currently working with the vendor and MOHLTC to fine-tune the product as to meet the needs of Ontarioās primary care providers.