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Josée G Lavoie, Derek Kornelsen, Yvonne Boyer, Lloy Wylie
The settlement of the land now known as Canada meant the erasure - sometimes from ignorance, often purposeful - of Indigenous place-names, and understandings of territory and associated obligations. The Canadian map with its three territories and ten provinces, electoral boundaries and districts, reflects boundaries that continue to fragment Indigenous nations and traditional lands. Each fragment adds institutional requirements and organizational complexities that Indigenous nations must engage with when attempting to realize the benefits taken for granted under the Canadian social contract...
2016: HealthcarePapers
Katherine Fierlbeck
Regardless of their policy outcomes, strategies of regionalization are prevalent because they are politically useful. They permit governments to be seen addressing serious systemic problems in the healthcare system without fundamentally upsetting the face-to-face relationship between physicians and patients. They shift the responsibility for unpopular policies, including the consolidation of services, away from provincial governments. They can be part of a larger process of decentralizing power that is undertaken for larger, non-health-related reasons...
2016: HealthcarePapers
Stephen Duckett
Regionalization has strengths and weaknesses. The balance of the two will vary over time, differing in different contexts and with different implementations. Alberta's implementation of a centralized structure had some strengths: economies of scale and expertise; opportunities for province-wide learning; internalization of geographic politics; and improved geographic equity. It also had weaknesses: diseconomies of scale, remoteness from communities and politicization. In any implementation of regionalization, policy makers should attempt to realize the benefits of alternative paths not travelled and minimise the weaknesses of the chosen structure...
2016: HealthcarePapers
Yves Bergevin, Bettina Habib, Keesa Elicksen-Jensen, Stephen Samis, Jean Rochon, Jean-Louis Denis, Denis Roy
A study on the impact of regionalization on the Triple Aim of Better Health, Better Care and Better Value across Canada in 2015 identified major findings including: (a) with regard to the Triple Aim, the Canadian situation is better than before but variable and partial, and Canada continues to underperform compared with other industrialized countries, especially in primary healthcare where it matters most; (b) provinces are converging toward a two-level health system (provincial/regional); (c) optimal size of regions is probably around 350,000-500,000 population; d) citizen and physician engagement remains weak...
2016: HealthcarePapers
Tim Tenbensel
New Zealand's health system has many similarities with Canada, and also has longstanding experience with regionalization of healthcare services. Since 2001, the most important change has been the development of regional primary healthcare organizations funded according to population characteristics. This significant change has created the potential for a more integrated health system. However, barriers remain in realizing this potential. The key challenges include dealing with inter-organizational complexity and finding the right balance between hierarchical and collaborative relationships between the state and non-government providers...
2016: HealthcarePapers
Karsten Vrangbaek
Denmark is a small Northern European country with an extensive welfare state and a strong commitment to maintaining a universal healthcare system. Like the other countries in the Nordic region, Denmark has a long tradition of democratically governed local and regional governments with extensive responsibilities in organizing welfare state services. The Danish healthcare system has demonstrated an ability to increase productivity, while at the same time maintaining a high level of patient satisfaction. Ongoing reforms have contributed to these results, as well as a firm commitment to innovation and coordination...
2016: HealthcarePapers
Gwyn Bevan
Marchildon highlights the lack of evidence on policies of regionalization in Canada: with regionalization being in favour in the 2000s followed by disillusion and the abolition of regions by some provincial governments. This paper looks at evidence from the UK's single-payer system of the impacts of regions on the performance of the delivery of healthcare. In England, regions were an important part of the hierarchical structure of the National Health Service (NHS) from its beginning, in 1948, to the introduction of provider competition, in the 1990s...
2016: HealthcarePapers
Gregory P Marchildon
Regionalization is arguably the most significant health reform in Canada since medicare. Although a majority of provinces continue to have regionalized systems in Canada, the policy is more contested today than it was a decade ago. Since Ontario's implementation of local health integration networks (LHINs) in 2006 and Alberta's elimination of regional health authorities (RHAs) in favour of Alberta Health Services in 2008, Canada has had differing approaches to regionalization. However, due to the centralization of physician budgets in provincial health ministries, primary care has not been integrated into any regionalization model in Canada...
2016: HealthcarePapers
Adalsteinn D Brown, Peter W T Pisters, C David Naylor
No abstract text is available yet for this article.
2016: HealthcarePapers
Stephen Frank
"Funding Long-Term Care in Canada: Issues And Options" (Adams and Vanin 2016) is a well-argued paper that grounds its recommendations in learnings from other jurisdictions that have tried to enact major reforms to the funding approach for long-term care (LTC). In particular, the paper considers the experience in both the UK and Quebec. The paper correctly highlights the significant difficulty of implementing large structural reforms to deal with LTC funding challenges. This is not a surprising result. Structural reform in healthcare has proven challenging even when the problems being addressed are immediate and large in scale, let alone for those that will manifest themselves in increments over many years or even decades in the future...
2016: HealthcarePapers
Réjean Hébert
Funding long-term care (LTC) is a challenge under the existing Beveridgean universal healthcare system. The Autonomy Insurance (AI) plan developed in Quebec was an attempt to introduce public LTC insurance into our healthcare system. The AI benefit was based on an assessment of the needs of older people and those with disabilities using a disability scale (SMAF) and case-mix classification system (Iso-SMAF Profiles). Under the plan, the benefit would be used to fund public institutions or purchase services from private organizations...
2016: HealthcarePapers
J C Herbert Emery
Needs for non-medical residential care services, long-term care (LTC), will increase over the next 30 years as Canada's population ages. Adams and Vanin (2016) explore four options for raising the public and private monies required to meet LTC needs. In this commentary, I raise a fifth option for finding the resources to meet emerging LTC needs. An alternative approach is to divert resources from Canada's well-resourced, but inefficient, medical treatment system. The dividend of provinces pursuing long overdue reforms to medicare is the liberation of public funds to finance emerging priorities for Canadians like LTC...
2016: HealthcarePapers
Raisa B Deber, Audrey Laporte
As Adams and Vanin (2016) have noted, different ways of funding long-term care (LTC) have different implications. Because health is not just healthcare, and LTC is not homogeneous, determining the appropriate public-private mix is complex. We suggest that how issues are framed helps influence policy choices, including who should pay for what, and how things should be financed. In addition, the distribution of expenditures for some services can be highly skewed, affecting the extent to which average cost data are useful in extrapolating their costs...
2016: HealthcarePapers
Sherri Torjman
Adams and Vanin have written a timely policy paper on financing long-term care (LTC). Because the subject is so important, the paper could be even stronger in many ways. First, the Adams and Vanin paper explores the main drivers creating pressure to reform the financing of LTC. While it focuses primarily on population aging, the rising incidence of chronic disease is another crucial factor that will drive the need for LTC. This commentary next examines the relative strengths and weaknesses of the proposed policy options...
2016: HealthcarePapers
Åke Blomqvist, Colin Busby
The way in which we pay for long-term care (LTC) services is going to come under enormous pressure as Canada's baby boomers age. Once baby boomers start to turn 75, in 2021, the demand for LTC services will see a sharp upward trend. A number of independent projections have demonstrated how this will put pressure on the public finances in coming years. It should be concerning to Canadians that we have not publicly discussed how we will make the tough choices to cope with these pressures. Moreover, it's equally troubling that our provincial LTC systems already are unable to cope with the current level of demand for services, with less than a decade before the first wave of boomers enter age groups where demand for LTC is high, and alternate level of care patients, made up mostly of frail elderly, occupying over 15% of Canadian hospital beds on a daily basis as they await care elsewhere...
2016: HealthcarePapers
Michel Grignon
Adams and Vanin (2016) build a strong case for public support for private insurance in long-term care. Their main argument is that public coverage is not politically feasible. I start with summing up and criticizing their argument. The gist of my criticism is that the success of their plan requires some kind of selection (not everybody buys coverage), and selection is precisely why private insurance does not work for long-term care. I then reframe my preferred policy option: a public scheme financed out of a flat rate or sales tax...
2016: HealthcarePapers
Owen Adams, Sharon Vanin
Canada's aging population is likely to result in increased health and long-term care (LTC) costs. It is estimated that between 2012 and 2046, LTC cost liability could reach almost $1.2 trillion. Many Canadians are unaware of the potential burden of LTC expenditures, and there is no consensus on who should pay for them. There are four possible options: (1) general tax revenues; (2) social insurance (employer/employee contributions); (3) private purchase of LTC insurance; and (4) private savings. This paper reviews these options as they have materialized to date in Canada and other countries...
2016: HealthcarePapers
Adalsteinn D Brown
No abstract text is available yet for this article.
2016: HealthcarePapers
Pedro Delgado
The Atlantic Healthcare Collaboration for Innovation and Improvement in Chronic Disease (AHC) set out to achieve three aims: to create a patient- and family-centred approach to manage chronic diseases; to build a network of organizational, regional and provincial teams to share evidence-informed, systems-level solutions and work together to develop, implement and sustain improvement initiatives; and to promote the sustainability of the participating health systems. Important elements of all three aims were achieved and the synthesis provides a meaningful contribution to systems working to improve chronic care...
2016: HealthcarePapers
Kaye Phillips, Claudia Amar, Keesa Elicksen-Jensen
For the Canadian Foundation for Healthcare Improvement (CFHI), the Atlantic Healthcare Collaboration (AHC) was a pivotal opportunity to build upon its experience and expertise in delivering regional change management training and to apply and refine its evaluation and performance measurement approach. This paper reports on its evaluation principles and approach, as well as the lessons learned as CFHI diligently coordinated and worked with improvement project (IP) teams and a network of stakeholders to design and undertake a suite of evaluative activities...
2016: HealthcarePapers
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