Reviews the state research and technological programs on priority trends in medical science. The programs are aimed at improving the nation's health. The emphasis in these programs is laid upon prophylactic medicine and the sociohygienic approach, underlying the health status of children and adults in the country.
This article reviews health system reform in Canada and discusses how hospitals are restructuring staffing patterns and redesigning work in response to increasing budgetary constraints.
Two models for work redesign at the patient unit level are contrasted, one employing a mix of registered nurses and registered practical nurses and one using registered nurses and assistive personnel. Principles and rationale for work redesign are discussed.
Both models for patient care redesign reduce registered nurse positions and both appear to yield some cost savings. These models for patient care redesign are controversial among providers, and there is no consensus as to which model is preferable. No research has been undertaken to determine whether staffing changes and work redesign result in adverse patient outcomes.
Regionalization of hospitals is reducing inpatient capacity in Canada, although the pace of regionalization varies in the different provinces. Hospital re-engineering is designed to reduce expenditures by reducing the cost of staffing. Research is needed to evaluate the results of re-engineering on patient outcomes and their relationship to registered nurse staff reductions.
This qualitative study examined the delivery of Assertive Community Treatment from the perspective of service providers of 4 ACT teams in southeastern Ontario. Overall, providers were positive about their involvement with ACT. Eight tensions experienced in the context of delivering services emerged: negotiating governance structures; providing 24-hour coverage; balancing the clinical-administrative responsibilities of team leaders; accessing hospital beds; meeting local population needs; integrating treatment and rehabilitation; changing services to meet changes in the population being served; and implementing ambiguous ACT standards. Framing these challenges in the context of ACT structures and the broader community mental health system, the study suggests possibilities for the ongoing development of the model to facilitate the realization of the ACT vision.
A population approach and the general right to health and medical care have been important issues in the development of health policy over many centuries. However, equity is still a crucial issue in the planning and evaluation of health care. Many definitions and criteria related to equity have been formulated on the basis of conflicting theories and models. Three dimensions of fair and just resource allocation are essential when needs-based models are used: equity in access, utilization, and quality of care relative to needs. Health services research should concentrate on such outcome measures regarding equity and the effect of organizational and processual characteristics of health care systems. Prominent examples of such research efforts are presented, but, unfortunately, there are few reliable and systematic data from this kind of study. Health care researchers have a special responsibility towards the population at large to undertake qualified research on equity and to communicate the results to the general public.
