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Access to cardiac resources in Canada: who is responsible? Who is liable?

https://arctichealth.org/en/permalink/ahliterature202874
Source
Can J Cardiol. 1999 Feb;15(2):153-5, 158
Publication Type
Article
Date
Feb-1999
Author
H E Scully
Source
Can J Cardiol. 1999 Feb;15(2):153-5, 158
Date
Feb-1999
Language
English
French
Publication Type
Article
Keywords
Canada
Cardiology Service, Hospital
Cardiovascular Diseases - therapy
Emergencies
Ethics, Medical
Hospital Departments
Humans
Legislation, Medical
Liability, Legal
Malpractice
Notes
Comment In: Can J Cardiol. 1999 Oct;15(10):1085-810523473
PubMed ID
10079772 View in PubMed
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Cardiac surgery in a fixed-reimbursement environment.

https://arctichealth.org/en/permalink/ahliterature212812
Source
Ann Thorac Surg. 1996 Feb;61(2 Suppl):S16-20; discussion S33-4
Publication Type
Article
Date
Feb-1996
Author
H E Scully
Author Affiliation
University of Toronto, Toronto Hospital, General Division, Ontario, Canada.
Source
Ann Thorac Surg. 1996 Feb;61(2 Suppl):S16-20; discussion S33-4
Date
Feb-1996
Language
English
Publication Type
Article
Keywords
Adult
Canada
Cardiac Surgical Procedures - economics - organization & administration
Health Expenditures
Humans
Income
Job Satisfaction
National Health Programs - economics - organization & administration
Patient satisfaction
Risk factors
Abstract
Hospital and physician services in Canada are funded by public (government) sources. This article will describe the practice of cardiac surgery in this setting. Federal legislation has prescribed the principles of accessibility, universality, comprehensiveness, portability, and public administration for essential healthcare services in Canada. Provincial and territorial governments are responsible for the provision of services, receiving federal tax and cash transfers that supplement provincial/territorial funds for hospital, physician, and community health services. Hospitals negotiate annually for global budgets. Physicians work as independent contractors in hospitals (and communities) and are usually paid as specified by fee-for-service contracts negotiated at intervals with governments. Cardiac surgical services have been planned conjointly with government. Forty-two centers in Canada serve a population of 28 million. All but three of these centers are located in tertiary teaching hospitals; all but one do more than 200 pumps annually. The rate of cardiac operations is 80 per 100,000 population. In Ontario, the Provincial Adult Cardiac Care Network makes recommendations to governments about the distribution of the 7,600 pumps annually (population, 11 million), rationalizing waiting lists based on an urgency rating scale. Patients requiring emergent/urgent operations are well served. The average waiting time for an elective cardiac operation is 10.5 weeks. The waiting list mortality is less than 0.5%. The Provincial Adult Cardiac Care Network also determines the placement of new programs and participates in creating hospital funding formulas developed from a combination of resource and acuity intensity weighting. Most surgeons hold full-time academic appointments but are funded largely by practice income. Surgical fees average $2,000 (Canada) per case. Overhead, including malpractice insurance, is approximately 45%. All Canadian patients enjoy reasonably timely access to good cardiac surgical care. Further constraints on physician compensation and (academic) hospital funding will compromise this balance.
PubMed ID
8572826 View in PubMed
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Federal health budget 1999: part 2--health research, health information and prevention.

https://arctichealth.org/en/permalink/ahliterature201966
Source
Can J Cardiol. 1999 May;15(5):525-8
Publication Type
Article
Date
May-1999
Author
H E Scully
Author Affiliation
Canadian Cardiovascular Society, Toronto, Canada.
Source
Can J Cardiol. 1999 May;15(5):525-8
Date
May-1999
Language
English
French
Publication Type
Article
Keywords
Canada
Health Care Costs
Health planning
Health Services Accessibility
Health Services Research
Humans
Preventive Medicine
Quality Assurance, Health Care
Quality of Health Care
PubMed ID
10350659 View in PubMed
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Surgical management of complicated acute coronary insufficiency.

https://arctichealth.org/en/permalink/ahliterature250640
Source
Surgery. 1976 Oct;80(4):437-42
Publication Type
Article
Date
Oct-1976
Author
H E Scully
J. Gunstensen
W G Williams
A A Adelman
R S Baigre
B S Goldman
Source
Surgery. 1976 Oct;80(4):437-42
Date
Oct-1976
Language
English
Publication Type
Article
Keywords
Acute Disease
Adult
Aged
Angiocardiography - mortality
Assisted Circulation - mortality
Cardiopulmonary Bypass - mortality
Coronary Artery Bypass - mortality
Coronary Disease - mortality - surgery
Female
Hemodynamics
Humans
Male
Middle Aged
Myocardial Infarction - etiology
Ontario
Abstract
Acute coronary insufficiency (ACI) has a one year mortality rate approximating 40 percent with medical treatment alone. This report reviews our experience over 24 months with preoperative intra-aortic balloon pump assist (IABPA) in 42 patients with ACI. Abnormal left ventricular (LV) hemodynamics were present in the majority of patients; the ejection fraction was less than 40 percent in 14 patients. The endocardial viability ratio (EVR) was less than 0.7 in eight patients. The mean coronary artery score was 13, compared to 9 in an otherwise comparable group of patients with stable angina. Left main coronary stenosis greater than 75 percent was present in seven patients and combined with significant stenosis (less than 72 percent) in the dominant right system in four patients. Four patients had proximal stenoses greater than 90 percent in all three major coronary arteries. IABPA was initiated in 11 patients prior to angiography because of refractory rest pain. One of these six patients died. Twenty-five other patients were supported before and six after induction of general anesthesia. Thirty-three of 36 revascularized patients survived. Of four patients with perioperative myocardial infarctions (12 percent), three had IABPA after induction of general anesthesia. Inotropic support and duration of stay both in intensive care and in the hospital were less than in similar patients treated before the use of IABPA.
PubMed ID
1085995 View in PubMed
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