Because of the unique nature of the Canadian health-care system, postpartum home care in Canada has taken on a distinctive form. The provision of postpartum home care is the responsibility of the individual provinces, and different approaches have been developed in each location. The most commonly observed pattern of postpartum care involves publicly funded services provided by public health nurses. Health-care reform and shortened hospital stays have led to changing patterns of care. In turn, these changes have precipitated issues for the mother-infant dyad, the family, and the community.
I consider policy trends and the provision of home care for frail elderly people in four countries: Denmark, the United Kingdom, Germany, and the United States. The differing natures of the health and social services systems of each country and the welfare ideologies that underlie them have affected the expansion of home care for this group of people. Hence, Denmark--and to a lesser extent Britain--has relatively well developed networks of home care services, in contrast to Germany and the United States. However, any significant shift away from predominantly medical and institutional care to more home-based, social care is highly unlikely.
The paper discusses two reforms in Ontario's long-term care. The first is the commercialization of home care as a result of the implementation of a "managed competition" delivery model. The second is the Ministry of Health and Long-Term Care's privileging of "health care" over "social care" through changes to which types of home care and home support services receive public funding. It addresses the effects of these reforms on the state–non-profit relationship, and the shifting balance between public funding of health and social care. At a program level, and with few exceptions, homemaking services have been cut from home care, and home support services are more medicalized. With these changes, growing numbers of people no longer eligible to receive publicly funded home care services look for other alternatives: they draw available resources from home support, they draw on family and friend networks, they hire privately and pay out of pocket, they leave home and enter an institution, or they do without.
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Cites: Health Soc Care Community. 2003 May;11(3):189-20712823424
The introduction of Canada's Medicare in 1966 established precedence for a universally accessible and equitable healthcare system. Although Canada has been a leader in building the foundations of socialized medicine, it has stalled short of fulfilling a vision promulgated by its architects of a system that operates on a continuum of care. The aim of this review was to examine whether the expansion of publicly funded services under the Canada Health Act would be an economically and socially viable policy option.
A literature review of the direct and indirect social and economic costs associated with contracting out community-based services in the form of outpatient rehabilitative care, palliative care, and home care was conducted.
This article concludes that the private financing of community-based services increases healthcare costs in the long term through increased density and frequency of acute care utilization. It is associated with increased indirect costs in the form of caregiver burden and reduced labor market participation of informal caregivers. The expansion of publicly funded community-based services minimizes these direct health and indirect societal costs.
The integration of publicly funded community-based services under the Canada Health Act would ensure that the principles of Medicare in the form of equity and accessibility would be enforced while maintaining an economically sustainable healthcare system.
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Erratum In: Palliat Support Care. 2013 Jun;11(3):285
RATIONALE: Home Artificial Nutrition (HAN) has been an expanding area over the last 30 years. HAN programs have been often developed prior to the regulation by the National Health Systems (NHS) leading to different policies within European countries. The aim of this study was to compare legislation regarding HAN in Europe. METHOD: The Group elaborated two structured questionnaires (one for Home Enteral Nutrition--HEN--and one for Home Parenteral Nutrition--HPN) which were presented to all the members of the HAN-Working group and to the 21 ESPEN Council members. RESULTS: Twelve questionnaires were returned, covering for more than 375 million inhabitants. HEN: regulated in seven countries, Italy and France being the first to implement reimbursement policy in 1988. Except in France, Croatia and the Czech Rep almost any physician can prescribe HEN. NHS totally or partially fund HEN, although in Austria and Israel expenses are paid for the patients. Provision of enteral diets and equipment varies widely within countries. As in HPN, most of the countries have written guidelines for health care workers and for patients. HPN: legislated in six countries, Denmark being the first in 1975. HPN programs are restricted to a few hospitals and patients are followed by Nutrition Support Teams (NST). The budget for HPN is 100% supported by NHS. Hospital pharmacy, private pharmacists and Home Care companies are involved in a different degree in providing and distributing solutions and disposables. CONCLUSIONS: HPN regulation preceded HEN regulation by 10-20 years. Due to this longer experience and high level of care, HPN patients are usually followed by NST. Despite different policies, funding is relatively uniform, NHS supporting most of the expenses for HAN. ESPEN could play a key role developing common standards for HAN all over Europe.
