Raisa Deber - Academia.edu (original) (raw)

Papers by Raisa Deber

ABSTRACT Rationale: Some commentators on global capital and health care markets predict that glob... more ABSTRACT Rationale: Some commentators on global capital and health care markets predict that global health care firms will penetrate markets outside their main domiciles and overwhelm smaller, local health care providers, using superior access to capital, cross-border economies of scale and expertise in global competition. The physiotherapy (PT) market in Ontario, Canada, has been formally open to foreign investors under the North American Free Trade Agreement since 1994 and the General Agreement on Trade in Services since 1995, making it a good case with which to test these aspects of globalization theory. It is interesting because there is some evidence that the involvement of foreign for-profit corporate providers in the PT market has been fairly limited. Objectives: The objectives of this paper are to investigate the degree to which foreign for-profit health care corporations participate in the market, what parts of the market they are active in, and what the reasons are for the level of participation. The paper will explore whether non-tariff regulatory mechanisms help produce the level of foreign investment. Methodology: The extent of foreign corporate participation was determined from a database of rehabilitation providers in Ontario and from the results of a 2005 survey of PT providers in selected Ontario counties. The regulatory framework was analyzed through a review of relevant laws and insurer reimbursement mechanisms. Interviews with key informants in the market probed the characteristics of the market that appear to make it attractive or unattractive to foreign investors. Results: The formal entry and exit barriers are low in this market, and the very few foreign firms that have participated in the market in the past have largely departed, selling to local Canadian management. The reasons for the very low level of foreign investment are believed to be these: (1) public and private health insurers with the support of regulators exercise significant price and quantity control that limit profit opportunities; (2) the regulatory structure requires a high degree of service differentiation, making it difficult for providers to realize economies of scale; (3) fragmented demand means low potential for vertical and horizontal integration, discouraging investment; and (4) in response to the highly-regulated, fragmented demand, existing local provider firms are predominantly small and owned by health professionals who value independence and sacrifice profit levels to remain independent, making it difficult for corporate providers to compete. Conclusions: Globalization theorists assume that formally open markets are also susceptible to consolidation and ripe for efficiency gains. However, insurer power, fragmented demand and the presence of independent-minded domestic producers whose utility function includes more than profit can produce deep-rooted structural barriers that make a globally-open market uninviting to foreign investors.

University of Toronto Press eBooks, 1992

Journal of Applied Gerontology, Dec 16, 2022

Personal Support Worker (PSW) supply is struggling to match the rising demand within many countri... more Personal Support Worker (PSW) supply is struggling to match the rising demand within many countries, particularly in the home and community (HC) sector. Although care demand projections are often sector-specific, our understanding of sector discrepancies on the PSW labour supply side is limited. This paper compares PSW job characteristics by means, proportions, and tests of significance across HC, nursing and long-term care home (LTC), and hospital sectors utilizing a sample of Canadian PSWs (1996–2010). Compared to LTC and hospital sectors, HC PSWs had significantly lower average wages, labour participation levels, permanent positions, job duration, and unionization rates. Relative wage distribution graphs showed how sector wage discrepancies existed across the wage distribution. These distinctions made the comparatively disadvantaged HC PSW position particularly salient, with important labour supply implications by sector. The relative attractiveness of HC sector jobs will become more critical as the rise in HC demand is projected to continue.

PubMed, 2019

This paper outlines a framework for identifying and classifying different types of patient engage... more This paper outlines a framework for identifying and classifying different types of patient engagement tools, available on online patient platforms, according to the flow of information and patient engagement concepts. We demonstrate the application of the framework using data collected from a purposive sample of eleven patient platforms, stratified by various attributes (for-profit/not-for-profit, single/multiple conditions, different conditions). This framework can help health care organizations in better understanding the processes supported by various tools, and thereby determining better ways to engage patients using web-based Platforms.

PubMed, Feb 15, 1989

The replacement of old radiologic contrast media with supposedly safer but more expensive media h... more The replacement of old radiologic contrast media with supposedly safer but more expensive media has created a dilemma for radiologists and hospital administrators. To quantitate the nature of this trade-off we performed a cost-utility analysis using optimistic assumptions that favoured the new media. A complete conversion to the new media would result in an incremental cost of at least 65,000togain1quality−adjustedlife−year(QALY).Foraselectivestrategyinwhichonlyhigh−riskpatientswouldreceivethenewmediathecostwouldbeabout65,000 to gain 1 quality-adjusted life-year (QALY). For a selective strategy in which only high-risk patients would receive the new media the cost would be about 65,000togain1quality−adjustedlife−year(QALY).Foraselectivestrategyinwhichonlyhigh−riskpatientswouldreceivethenewmediathecostwouldbeabout23,000 per QALY gained. However, the incremental cost for low-risk patients is over $220,000 per QALY gained. Conversion to the new contrast media, although not necessarily the most efficient use of scarce resources, has already occurred in Ontario, primarily because of press publicity, pressure from insurers and a political unwillingness of policymakers to decide the fate of identifiable victims. We found that funding of a new intervention associated with a high cost-utility ratio rather than interventions with lower ratios might save some identifiable victims at the expense of a larger number of unidentifiable ones.

Page 1. Almost REFORMING HOME AND COMMUNITY CARE IN ONTARIO Patricia M. Baranek Raisa B. Deber A.... more Page 1. Almost REFORMING HOME AND COMMUNITY CARE IN ONTARIO Patricia M. Baranek Raisa B. Deber A. Paul Williams Page 2. Page 3. ALMOST HOME: REFORMING HOME AND COMMUNITY CARE IN ONTARIO ...

Archives of Biochemistry and Biophysics, Nov 1, 1986

PubMed, Jul 15, 1994

Historical views of the patient-physician relationship assumed that the physician's role was to a... more Historical views of the patient-physician relationship assumed that the physician's role was to act in the best interests of the patient and to direct care and make decisions about treatment on the patient's behalf. However, under current legal and ethical principles, beneficence is no longer sufficient; respect for autonomy is paramount, necessitating patient participation. None the less, physicians question whether patient participation is realistic in actual clinical situations. This first of two articles reviews models of the patient-physician relationship and the literature about barriers to participation, the effect of participation on patient outcome and the extent to which patients want to be informed. The image of a dependent patient who prefers to be sheltered from harsh truths is not supported. It appears that most patients wish to have information, although there is an identifiable proportion who do not. To be understood, health information must be presented in a way that is appropriate to the patient. Format, content and timing of the material are all important. Mechanisms for incorporating such information into busy clinical practices are crucial.

PubMed, Sep 15, 1982

The issue of pregnancy among adolescent women has received considerable attention from the media.... more The issue of pregnancy among adolescent women has received considerable attention from the media. Contrary to common belief, both the numbers and the rates of such pregnancies, even when data on abortion are included, have been declining. Patterns of contraception may account for some of the decrease; however, more study is required. In the past, unmarried teenagers who became pregnant either got married or put the baby up for adoption. Now they can either have an abortion or keep the baby. Solutions to the problems of pregnancy among teenagers must therefore be addressed to these altered social consequences rather than to misleading comments about "epidemics", with their suggestion of increased rates of pregnancy.

Lecture notes in bioengineering, 2021

The growth of Artificial Intelligence (AI) technologies in health care is driving a growing recog... more The growth of Artificial Intelligence (AI) technologies in health care is driving a growing recognition among policymakers, businesses and researchers that there is a need for policies to address certain potential consequences of AI innovation. In this chapter, we provide insight on several policy implications and challenges relating to the impact of AI on accuracy, fairness and transparency, data privacy and consent, accountability, and workforce disruption. These issues include: monitoring of accuracy; minimizing bias and encouraging transparency, ensuring appropriate use, assessment of who is receiving the information and how it is being used, protecting privacy through data protection requirements, enactment of laws that defines accountabilities, establishment of policies for labour disruption; implementation of professional standards and codes of conduct; adapting educational training for clinicians; and determining what technologies will be insured and funded. Additional complexities arise when AI crosses geographic boundaries. The design, development and implementation of policy and regulation should be in conjunction with a diversity of stakeholders including product developers, researchers, patients, health care providers and policymakers.

Canadian Medical Association Journal, Oct 1, 1989

ABSTRACT Rationale: Some commentators on global capital and health care markets predict that glob... more ABSTRACT Rationale: Some commentators on global capital and health care markets predict that global health care firms will penetrate markets outside their main domiciles and overwhelm smaller, local health care providers, using superior access to capital, cross-border economies of scale and expertise in global competition. The physiotherapy (PT) market in Ontario, Canada, has been formally open to foreign investors under the North American Free Trade Agreement since 1994 and the General Agreement on Trade in Services since 1995, making it a good case with which to test these aspects of globalization theory. It is interesting because there is some evidence that the involvement of foreign for-profit corporate providers in the PT market has been fairly limited. Objectives: The objectives of this paper are to investigate the degree to which foreign for-profit health care corporations participate in the market, what parts of the market they are active in, and what the reasons are for the level of participation. The paper will explore whether non-tariff regulatory mechanisms help produce the level of foreign investment. Methodology: The extent of foreign corporate participation was determined from a database of rehabilitation providers in Ontario and from the results of a 2005 survey of PT providers in selected Ontario counties. The regulatory framework was analyzed through a review of relevant laws and insurer reimbursement mechanisms. Interviews with key informants in the market probed the characteristics of the market that appear to make it attractive or unattractive to foreign investors. Results: The formal entry and exit barriers are low in this market, and the very few foreign firms that have participated in the market in the past have largely departed, selling to local Canadian management. The reasons for the very low level of foreign investment are believed to be these: (1) public and private health insurers with the support of regulators exercise significant price and quantity control that limit profit opportunities; (2) the regulatory structure requires a high degree of service differentiation, making it difficult for providers to realize economies of scale; (3) fragmented demand means low potential for vertical and horizontal integration, discouraging investment; and (4) in response to the highly-regulated, fragmented demand, existing local provider firms are predominantly small and owned by health professionals who value independence and sacrifice profit levels to remain independent, making it difficult for corporate providers to compete. Conclusions: Globalization theorists assume that formally open markets are also susceptible to consolidation and ripe for efficiency gains. However, insurer power, fragmented demand and the presence of independent-minded domestic producers whose utility function includes more than profit can produce deep-rooted structural barriers that make a globally-open market uninviting to foreign investors.

University of Toronto Press eBooks, 1992

Journal of Applied Gerontology, Dec 16, 2022

Personal Support Worker (PSW) supply is struggling to match the rising demand within many countri... more Personal Support Worker (PSW) supply is struggling to match the rising demand within many countries, particularly in the home and community (HC) sector. Although care demand projections are often sector-specific, our understanding of sector discrepancies on the PSW labour supply side is limited. This paper compares PSW job characteristics by means, proportions, and tests of significance across HC, nursing and long-term care home (LTC), and hospital sectors utilizing a sample of Canadian PSWs (1996–2010). Compared to LTC and hospital sectors, HC PSWs had significantly lower average wages, labour participation levels, permanent positions, job duration, and unionization rates. Relative wage distribution graphs showed how sector wage discrepancies existed across the wage distribution. These distinctions made the comparatively disadvantaged HC PSW position particularly salient, with important labour supply implications by sector. The relative attractiveness of HC sector jobs will become more critical as the rise in HC demand is projected to continue.

PubMed, 2019

This paper outlines a framework for identifying and classifying different types of patient engage... more This paper outlines a framework for identifying and classifying different types of patient engagement tools, available on online patient platforms, according to the flow of information and patient engagement concepts. We demonstrate the application of the framework using data collected from a purposive sample of eleven patient platforms, stratified by various attributes (for-profit/not-for-profit, single/multiple conditions, different conditions). This framework can help health care organizations in better understanding the processes supported by various tools, and thereby determining better ways to engage patients using web-based Platforms.

PubMed, Feb 15, 1989

The replacement of old radiologic contrast media with supposedly safer but more expensive media h... more The replacement of old radiologic contrast media with supposedly safer but more expensive media has created a dilemma for radiologists and hospital administrators. To quantitate the nature of this trade-off we performed a cost-utility analysis using optimistic assumptions that favoured the new media. A complete conversion to the new media would result in an incremental cost of at least 65,000togain1quality−adjustedlife−year(QALY).Foraselectivestrategyinwhichonlyhigh−riskpatientswouldreceivethenewmediathecostwouldbeabout65,000 to gain 1 quality-adjusted life-year (QALY). For a selective strategy in which only high-risk patients would receive the new media the cost would be about 65,000togain1quality−adjustedlife−year(QALY).Foraselectivestrategyinwhichonlyhigh−riskpatientswouldreceivethenewmediathecostwouldbeabout23,000 per QALY gained. However, the incremental cost for low-risk patients is over $220,000 per QALY gained. Conversion to the new contrast media, although not necessarily the most efficient use of scarce resources, has already occurred in Ontario, primarily because of press publicity, pressure from insurers and a political unwillingness of policymakers to decide the fate of identifiable victims. We found that funding of a new intervention associated with a high cost-utility ratio rather than interventions with lower ratios might save some identifiable victims at the expense of a larger number of unidentifiable ones.

Page 1. Almost REFORMING HOME AND COMMUNITY CARE IN ONTARIO Patricia M. Baranek Raisa B. Deber A.... more Page 1. Almost REFORMING HOME AND COMMUNITY CARE IN ONTARIO Patricia M. Baranek Raisa B. Deber A. Paul Williams Page 2. Page 3. ALMOST HOME: REFORMING HOME AND COMMUNITY CARE IN ONTARIO ...

Archives of Biochemistry and Biophysics, Nov 1, 1986

PubMed, Jul 15, 1994

Historical views of the patient-physician relationship assumed that the physician's role was to a... more Historical views of the patient-physician relationship assumed that the physician's role was to act in the best interests of the patient and to direct care and make decisions about treatment on the patient's behalf. However, under current legal and ethical principles, beneficence is no longer sufficient; respect for autonomy is paramount, necessitating patient participation. None the less, physicians question whether patient participation is realistic in actual clinical situations. This first of two articles reviews models of the patient-physician relationship and the literature about barriers to participation, the effect of participation on patient outcome and the extent to which patients want to be informed. The image of a dependent patient who prefers to be sheltered from harsh truths is not supported. It appears that most patients wish to have information, although there is an identifiable proportion who do not. To be understood, health information must be presented in a way that is appropriate to the patient. Format, content and timing of the material are all important. Mechanisms for incorporating such information into busy clinical practices are crucial.

PubMed, Sep 15, 1982

The issue of pregnancy among adolescent women has received considerable attention from the media.... more The issue of pregnancy among adolescent women has received considerable attention from the media. Contrary to common belief, both the numbers and the rates of such pregnancies, even when data on abortion are included, have been declining. Patterns of contraception may account for some of the decrease; however, more study is required. In the past, unmarried teenagers who became pregnant either got married or put the baby up for adoption. Now they can either have an abortion or keep the baby. Solutions to the problems of pregnancy among teenagers must therefore be addressed to these altered social consequences rather than to misleading comments about "epidemics", with their suggestion of increased rates of pregnancy.

Lecture notes in bioengineering, 2021

The growth of Artificial Intelligence (AI) technologies in health care is driving a growing recog... more The growth of Artificial Intelligence (AI) technologies in health care is driving a growing recognition among policymakers, businesses and researchers that there is a need for policies to address certain potential consequences of AI innovation. In this chapter, we provide insight on several policy implications and challenges relating to the impact of AI on accuracy, fairness and transparency, data privacy and consent, accountability, and workforce disruption. These issues include: monitoring of accuracy; minimizing bias and encouraging transparency, ensuring appropriate use, assessment of who is receiving the information and how it is being used, protecting privacy through data protection requirements, enactment of laws that defines accountabilities, establishment of policies for labour disruption; implementation of professional standards and codes of conduct; adapting educational training for clinicians; and determining what technologies will be insured and funded. Additional complexities arise when AI crosses geographic boundaries. The design, development and implementation of policy and regulation should be in conjunction with a diversity of stakeholders including product developers, researchers, patients, health care providers and policymakers.

Canadian Medical Association Journal, Oct 1, 1989