Implementing home care in Canada: four critical elements.

https://arctichealth.org/en/permalink/ahliterature184901
Source
Healthc Pap. 2000;1(4):67-73, discussion 109-12
Publication Type
Article
Date
2000
Author
B. Richardson
Author Affiliation
We Care Inc., Toronto, Ontario.
Source
Healthc Pap. 2000;1(4):67-73, discussion 109-12
Date
2000
Language
English
Publication Type
Article
Keywords
Canada
Data Collection - standards
Databases, Factual
Decision Making, Organizational
Fee-for-Service Plans
Health Facilities, Proprietary
Health Plan Implementation - organization & administration
Health Services Research
Home Care Services - organization & administration
Humans
Models, organizational
National health programs - organization & administration
Needs Assessment
Organizational Innovation
Organizational Objectives
Outcome Assessment (Health Care) - organization & administration
Patient Freedom of Choice Laws
Prospective Payment System
Reimbursement, Incentive
Abstract
While MacAdam proposes a "national approach to home care#8221; the obstacles to this are well known and substantial. They are the likely cost and the limitations of the federal government s role in healthcare. Building on MacAdam's assessment, this paper outlines four problems embedded in the various home-care service delivery models in Canada: the lack of factual client outcome information to support decision-making, the limited client choice of provider, the perverse incentive of fee for service and the bias against the for-profit provider. The paper proposes that the assessment, classification and measurement of outcomes for every recipient of home-care services be standardized using a proven assessment instrument, such as OASIS-B or MDS-HC, by healthcare professionals certified in its use. The resulting information would be captured in a regional database and available for analysis and research. CIHI would be contracted to manage a national database and to fund the training and certification of assessors. The paper proposes a new service delivery and funding model, utilizing standard client outcome information, different roles for regional health authorities and service providers, and a prospective payment mechanism replacing fee for service. A national home care program may be an elusive dream, but that shouldn't stop experimentation, evaluation and improvement.
Notes
Comment On: Healthc Pap. 2000 Fall;1(4):9-3612811170
PubMed ID
12811175 View in PubMed
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