Health Reforms: Home Care Reforms in Canada
The Canadian health care system has undergone several reforms in the last decade. In 2001 the Prime Minister instituted “The commission on the future of healthcare in Canada,” commonly known as the Romanow Commission. The Romanow report recommended improvements in primary care, home care, catastrophic drug coverage, Aboriginal health among others. Expansion of home-based care services such as palliative care, post-acute patient management and mental healthcare featured prominently among the proposed home care reforms. Accords by ministers have also backed home care services and increased funding to this sector. This paper presents the Home Care reforms at the national level and the progress of Home Care in the province of Ontario.
Home Care Reforms
Literature Review
Roy J, Romanow’s report “Health Reforms: Home Care Reforms in Canada” tackles the issues of home care and Canada’s health care status as a whole. In his report he concluded that Canadian truly needs an established national health care system that will address their primary need for comprehensive system that will improve the quality of health care in the country (Romanow, Roy J. Q.C. November 2002). According to his report the lack of budgeting results to lesser efficiency of delivering health care to the country and thus creating a long line of waiting citizens to receive the service. Through public consultation Romanow was able to consolidate the usual difficulties that Canadians experience in acquire health care because of the prevalence of a non-effective health reform. The need for strengthening provincial and territorial distribution of services should become a primary focus. That is why his 47 recommendations in the final report are designed to eliminate the problems of waiting for healthcare fulfillment, policy amendments and budget distribution (Romanow, Roy J. Q.C. November 2002).
Health Reforms: Home Care Reforms in Canada
In April 2001, the Canadian Prime minister established “The Commission on the Future of Healthcare in Canada” led by Roy Romanow to engage Canadians in a national dialogue on healthcare. Over an 18-month period, the Commission obtained thousands of views from ordinary citizens, health ministers, healthcare experts and researchers (Romanow, 2002). The final report composed of 47 detailed recommendations and implementation time frames.
Home Care was a huge beneficiary of the Romanow Commission. The commission noted that all-Canadian Provinces and territories have funded Home care programs since the 1970s. The coverage of home care has varied greatly from provinceto province. While some provinces provide extensive coverage, others limit home nursing care to a monthly dollar amount. For instance, New Brunswick spent about 10% of its total health care budget in 2000/01 on home care while Nunavut spent less than 2%. On average most territories spend between four and 5% of their total health budget on home care. Ontario spent 5% of its total expenditure on health care on home care. Provincial governments funded 76% of home care in 2000/01, the private sector funded 23% and the federal government funded the remaining 1% (Romanow, 2002). Increased funding to home care services and the need to offer therapeutic care such as caring for post-acute patients and mental health have led to more people to opt for home-based care (Tuohy, 2002).
The Romanow Commission proposed new health care transfer to include home mental health management, home care management for post-acute patients and palliative home care. The report proposed the inclusion of these services in the Canada Health Act. Home care was one among five target funds proposed to address renewal priorities. The report recommended creation of a Home care Transfer of $2Billion over 2 years to support the expansion of the Canada health Act and provide a foundation for a national home care strategy (Romanow, 2002).
The Romanow Report Summary
The efforts of Romanow evolved in the commission on the Future Health Case in Canada after inquiries made from the public. The Chretien Liberal government created the commission as part of the Prime Minister’s promise to address the sustainability of health care in Canada for in a long-term objective. One of the challenges that Canada is facing regarding health care is the long wait to become insured. Canada specifically does an impressive cost control measures when it comes to their health policies. Their government allocates specific budget to be spent for health care for an entire year and the responsibilities will be left to be managed by the system. One of the cost cutting measures they’ve done is to punt an elective surgery and turn it into a less priority subject. In the survey done by Health Affairs in 2001 revealed that 27% of Canadians is reportedly waiting for as long as four months to be able to get a surgery (Klein, Ezra April 7, 2009).
The Economic Cooperation and Development made a similar survey and found out that not all countries does not have citizens waiting online to be accommodated for a surgery procedure to happen. Furthermore, when a person cannot afford care the waiting time is constantly zero. The patient will only have his place on the line when he can prove he can afford care, otherwise the waiting time becomes infinite. The main problem is the country has an elaborate cost cutting measures which to distribute the budget to all its citizens. But the problem with this scheme is that everyone has to stand to wait for their turn in the emergency room. One of the solutions that the House of Republicans are proposing is to give a 100% equivalent of the people’s healthcare benefits and let them choose the option to bring it to any health provider they want (Makarenko, Jay April 1, 2007). This has been the issue that Medicare is also facing; the only thing that keeps this proposal at debate status is the budget. Another problem with this proposal is that when the person went over the sum and does not the money will simply stop his needed care (Klein, Ezra. April 7, 2009).
The aforementioned problem is one of the things that Romanow is trying to target in his report and recommendations. The report has two parts, one is the interim report and the other one is the final recommendation. The interim reports discussed the four substantive divisions of health care and the issues that policies hope to address. One is the basic values of healthcare, two is the stability of fiscal and funding, three is the access and quality of healthcare and lastly, the collaboration, responsibility and leadership (Makarenko, Jay April 1, 2007).
One of the most important elements of the interim report is the examination of everyday values of Canadians in terms of healthcare contexts. The commission also found out that basic concerns and beliefs of Canadians regarding the access poor society to healthcare, Canadians should not be burdened too much of the cost of getting healthcare services, needs to have to be taken into consideration when it comes to services that public health insurance should cover and lastly, federal and provincial government should work hand in hand to reform the healthcare system.
The final recommendation of Romanow’s report on the other hand was presented in November 2002 which focuses on 47 recommendations along with cost, implementation guidelines and timeframe. The basic frame work of the country’s current healthcare programs has been accepted by the commission as they support the financed and administered public system of Universal Healthcare. The recommendations also rejected the idea of healthcare privatization as adopted by the tier-type American healthcare system. However, the commission’s recommendations included comprehensive and significant reforms to the current operation and structure of public healthcare system. When making the recommendations, the commission aimed to achieve goals described in the interim report (Makarenko, Jay April 1, 2007).
Outcome Summary of the Accord on Health Care Renewal (2003
The First ministers Accord emphasized the government’s support for home care by committing themselves to ensuring that Canadians access quality and community care services (First Minister’s Accord on Healthcare Renewal, 2003). Improving home care would affirm the government’s commitment to the 5 Canadian principles on healthcare: Accessibility, Universality, Comprehensiveness, portability and public administration (Rode & Rushton, 2002). The ministers agreed that by 2006 Canadians would access nursing/professional services, pharmaceuticals and medical supplies under home-based health care (First Ministers’ Meeting, 2004).
Since Romanow’s recommendations were submitted in 2002, the 2003 Accord on Health Care Renewal were also created as a result of the meeting with the first ministers. There are some arguments whether the recommendation made by Romanow was indeed addressed, exceeded or was ignored. Since the inception of the Accord Health Care Renewal, there have been reports of progress on how the issue with healthcare was resolved. First, funding that is one of the main concerns in Romanow’s report has been fulfilled when the Canadian government allocated $36.8 billion for healthcare for the next five years which will be distributed in provinces and territories by means of increased payment transfers (Hc-sc.gc.ca. September 2004). This is one of the targeted results of Romanow’s report in his recommendation number seven. His recommendation only calls for a short-term funding plan of two years (Romanow, Roy J. Q.C. November 2002), but instead the federal government provided enough for five years. This is clear indication that Romanow’s recommendations number seven was exceeded by the Accord Health Care Renewal.
Analysis and Evaluation
It is enough to say that even though Romanow proposed a two year budget plan, the results and the initiatives of the rest of the recommendation could not be realized with such a very short period of time. The nationwide scale of change needed ample amount of time in order to expect significant results. Although there is a timeline proposed in the recommendation, it would not an easy task for the government to put everything in place especially for a wide scale reform. Since the recommendations specifically budgeting requires ratification of policies the legislative body will have to take time in order to come up with a supporting policy to push budget. And when the 2003 Accord Health Care Renewal was implemented the government targeted a five year budget plan because it is obvious that it will take so much effort again to bring up another set of budgeting and planning to conclude another term for healthcare reform. To ensure continued success of the healthcare reform a long-term strategy has to be devised in order to achieve more satisfactory improvements.
Despite the exceeded expectations on budget, one of the things that was failed to be addressed by the Accord Health Care Renewal is in relation to Romanow’s recommendation number 11 (Romanow, Roy J. Q.C. November 2002). It talks about amendments in the prevailing Criminal Code of Canada that prevents the misuse and abuse of personal health information. There is a current provision regarding this law, but according to Romanow’s recommendation it should have been strengthened to the point that the violation should be considered a criminal act. But after the reforms has been implemented and based on the Accord Health Care Renewal progress report, there were no particular mentions of any amendments made to this criminal code.
The current law where inappropriate use of health information falls under Computer and Abuse Act in the condition that the act of invasion of privacy was done through technological means and the last time it was amended was in 2001. But Section 183 of Criminal Code of Canada stipulates that storage, collection, disclosure, modification and transmission of private data do not specifically define provisions on health related records (laws-lois.justice.gc.ca N.D.). This means that recommendation number 11 of Romanow was not addressed by the Accord Health Care Renewal.
Nevertheless, the majority of Romanow’s recommendations were addressed by the Accord Health Care Renewal if the progress report is to be analyzed. Furthermore, the commitments in progress and the outstanding ones are well in line with the recommendations made by Romanow. Most of them are somewhat generalized, but the elements in which the recommendations hope to achieve is well on its way to being fulfilled.
Policy Research
Ontario Province has had several healthcare reforms recently. In June 2008, the Ontario Government tasked Health Quality Ontario (HQO) with the responsibility of monitoring the quality of long term care and resident satisfaction. In December 2008, the Ontario government again mandated HQO to monitor the quality of home care service (Ontario Health Quality Council (OHQC), 2009. In June 2010, the legislature passed the Excellent Care for All Act which expanded HQO’s roles and mandate regarding home care. The 14 regions in Ontario now have Community Care Access Centers (CCACs) to coordinate home-based care. Case managers access the needs of patients and work with health service providers. All the regions in Ontario now use a new data collection tool called RAI-HC (Resident Assessment Instrument- Health Care). 46% of home care beneficiaries in Ontario require long term care. Health Quality Ontario reports on the developments of improving health care, home care inclusive.
Ontario Health Care Development
A good basis of development went under way after Romanow’s recommendations and agreements can be observed in Ontario. The waiting problem was addressed earlier in the discussion, but after two years since the inception of Romanow recommendations and reform agreements, Ontario saw a shorter wait on the line. In 2004, a program so-called Wait Times Strategy was created specifically to resolve this problem. With the help of the new budget allocation, $1.5 Billion has been used to fund an additional two million medical procedures, bottleneck reduction and system process (Ontario.ca N.D.). This new program has greatly improved patient flow and tracking the results were made easier.
Now Ontario does not have to turn away patients because of the new development and not to mention a dramatic improvement in the quality of care that the patients are getting. In fact, the province now has the shortest waiting time for major surgical procedures than any other parts of Canada. Knee operation waiting time is usually 440 days, but it was reduce 245 days out bringing it down to 195, as with cancer related operations from 81 days it went down 24 days earlier to 57 days (Ontario.ca N.D.). The same results was realized in long-term care programs, now the waiting time have also reduced the number of days to stay in hospitals because of several choices that Ontarian’s can choose from.
Analysis and Evaluation
In 2007, aging at home strategy community programs provided support to senior citizens and caregivers in keeping the seniors healthy while living the comfort of their own homes. As a result, about 58% of Ontarians now are receiving healthcare at home since 2003 (Ontario.ca N.D.). In general, the overall healthcare conditions of Ontarians have improved since the agreements were reached in line with Romanow’s recommendations. It made a huge impact on the overall aspects of health care improvement and economic stability.
Conclusion
Over the past decade, the Canadian government made great reforms in the provision of quality healthcare to its citizens. In 2001, the government instituted the Commission on the Future of Healthcare in Canada led by Roy Romanow. In health care the commission made three key expansion areas: Home mental health management, home care services for post-acute patients and palliative home care services. The report also recommended the creation of a home care fund of $ 2 billion for 2-years periods. The First Minister’s accord lived up to the Romanow recommendations on home care by increasing funding. Ontario province has had numerous reforms in home care such as creation of Community Care Access Centers (CCACs) to coordinate home – based care through the Ontario Health Quality Council OHQC. The OHQC also monitors home and long term care and reports to the public since 2008. To date, the federal and other provincial governments continue to formulate and implement strategies aimed at improving accessibility and quality of health care.
References
Hc-sc.gc.ca (2003) First Minister’s Accord on Health Care Renewal Web Retrieved March 7, 2012 from http://tinyurl.com/2urz5u
Hc-sc.gc.ca (2004) First Ministers’ Meeting on the Future of Health in Canada Web Retrieved March 7, 2012 from http://tinyurl.com/3xum8h
Ohqc.ca (June 17, 2009) Long-Term Care Measurement & Reporting Scientific Expert Panel Web Retrieved March 7, 2012 from http://www.ohqc.ca/pdfs/ltc_scientific_expert_panel_report.pdf
Hc-sc.gc.ca (2002) Romanow Commission Report Web Retrieved March 7, 2012 from http://www.ohqc.ca/pdfs/ltc_scientific_expert_panel_report.pdf
Tuohy, C. (2002) the Costs of Constraint and Prospects for Health Care Reform in Canada, Health Affairs
21(3), 32-46.
Klein, Ezra (April 7, 2009) When it comes to healthcare, the U.S., Britain and Canada are hurting Web Retrieved March 7, 2012 from http://articles.latimes.com/2009/apr/07/opinion/oe-klein7
Makarenko, Jay (April 1, 2007) Romanow Commission on the Future of Health Care: Findings and Recommendations Web Retrieved March 8, 2012 from http://www.mapleleafweb.com/features/romanow-commission-future-health-care-findings-and-recommendations
Hc-sc.gc.ca (September 2004) The 2003 Accord on Health Care Renewal: A Progress Report Web Retrieved March 8, 2012 from http://www.hc-sc.gc.ca/hcs-sss/delivery-prestation/fptcollab/2004-fmm-rpm/fs-if_01-eng.php
Romanow, Roy J. Q.C. (November 2002) Building on Values: the Future of Health Care in Canada Web Retrieved March 8, 2012 from http://publications.gc.ca/collections/Collection/CP32-85-2002E.pdf
Laws-lois.justice.gc.ca. (N.D.) Building Part VI Invasion of Privacy Definitions Web Retrieved March 8, 2012 from http://laws-lois.justice.gc.ca/eng/acts/C-46/page-85.html#h-62
Ontario.ca. (N.D.) Wait Times and Long Term-Care Web Retrieved March 8, 2012 from http://www.ontario.ca/en/initiatives/progressreport2011/ONT05_039150.html?openNav=health_care#6.1
