Awaiting a National Home Care Program

• Abstract
• Characteristics of this policy
• Purpose and process analysis
• Expected outcome
• References

Abstract

The policy is to expand universal public insurance to cover acute home care provided after a stay in hospital (for example, for up to 14 days following discharge). This service could include needs assessment, medication management, rehabilitation services and case management. The main objective is bring post-acute home care into the basket of services for which all Canadians have first-dollar insurance coverage to meet the growing utilisation of home care services following a hospital stay.

Neue Entwicklungen

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral
current    previous

There is a fair amount of consensus about the general idea of expanding home care, including post-acute home care.  Consensus about what specific health care services are most needed or how to address barriers to reform is more elusive.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Initiators of idea/main actors

• Regierung

Stakeholder positions

As reported in an earlier survey (1/2003), the provincial and federal government leaders agreed in February 2003 to the general goal of providing first dollar coverage for "short-term acute home care" by 2006.  In the same month, the federal budget allocated funds to the provinces to pursue this and other health reforms.

The September 2004 agreement between the federal and provincial government leaders included a very similar commitment (see web link).  This reflects the fact that little in the way of actual implementation had occured during the 18 months between the 2003 and 2004 accords.

During their 2004 negotiations, it was agreed that each provicial government would develop its own plan to deliver and provide coverage for short-term acute home care including case management, intravenous medications, nursing and some personal care.

While the home care provisions in the 2003 and 2004 accords were similar, the more recent agreement provided a somewhat different rationale for expanding the use and public insurance coverage of post-acute home care.  Here, acute home care was directly linked to the agreed priority of reducing waiting times for surgical and other health services.  Providing acute care outside hospitals (where appropriate) can free up beds for those requiring in-hospital care, in particular those on waiting lists.

The Canadian Home Care Association (see web link) and other advocacy groups are supportive of an expansion of  public home care coverage and of ensuring that Canadians have access to similar types of home care, regardless of which province or territory they reside in.

Actors and positions

Regierung
Federal government	sehr unterstützend		stark dagegen
Provincial government	sehr unterstützend		stark dagegen
current    previous

Influences in policy making and legislation

As reported in the earlier survey, the Commission on the Future of Health Care in Canada recommended amending the Canada Health Act to legislate this extension of coverage.

In the two subsequent Federal-Provincial Health Care Accords, the federal and provincial governments agreed to a federal transfer of funds rather than legislative reform to bring post-acute home care under universal public insurance.

Legislative outcome

n/a

Actors and influence

Regierung
Federal government	sehr groß		kein
Provincial government	sehr groß		kein
current    previous

Positions and Influences at a glance

Adoption and implementation

In February 2003, the First Ministers agreed that the next step would be for federal and provincial Health Ministers to determine a minimum basket of services by September 2003 (see survey round 1/2003).  This was not achieved and as a result, the commitment that appeared in the September 2004 accord was largely the same as that which was announced the earlier accord.

On a related note, the federal goverment was successful in implementing compassionate care benefits for workers to leave their jobs for up to 6-weeks to care for a terminally ill relative.  This benefit came into effect in January 2004.

Monitoring and evaluation

The provincial leaders agreed to develop implementation plans for post-acute home care and to report to their citizens on their progress in relation to these plans.  The first reports are expected in 2006.

Performance reporting is the dominant monitoring mechanism in the 2004 Health Care Accord.  This approach will build on an on-going initiative whereby provinces and territories produce comparable indicators on a range of output and outcome measures so that the performance of each jurisdiction can be compared against the others.  The next set of reports is planned for November 2004.

Expected outcome

As reported in earlier surveys on home care policy in Canada, one of the key rationales for moving to put post-acute home care within the basket of services covered under the Canada Health Act is that it would "re-insure" those who have been "de-insured" due to technological advances in surgery and pharmaceutical care.  If a patient is discharged from the hospital earlier because of advances in surgical techniques and better drug care to treat post-operative infection risks, they lose the nursing, drugs, rehabilitation and personal care that they used to get in the hospital when post-operative stays were longer.  When the care is delivered in the home, patients currenly have to pay for much of that care.  Thus, covering post-acute home care would partly be an expansion of the basket of publicly insured services but would partly be "reinsurance" to cover these services rather than covering the place where the services are delivered.

It seems likely that each province and territory will continue with its current efforts to expand the use of post-acute home care and to integrate home care services with the hospital and primary care sectors.  These programs can be effective in meeting the objectives of reducing acute care waiting times, delivering certain types of care (such as post-surgical, rehabilitation, chemotherapy) in a more cost-effective way than they are currently delivered, and in responding to patient preferences to recieve care in their homes where possible.

It should be noted that the effectiveness of these programs in meeting their objectives will depend on the success and speed of reforms in other supportive areas, especially in the area of health human resources.

The 2004 accord seems to have dropped plans to develop a common basket of home care services which would be accessible in every province and territory.  Instead provinces and territories will continue to develop their own home care programs.  It is hoped that by reporting to their citizen about these plans, home care programs will develop in alignment with public preferences.  Naturally, the quaility and utility of these reports will be highly dependent on the accuracy and comprehensiveness of data available to governments.

The implementation of nationally-accessible post-acute home care is a long way off.  It is therefore difficult to comment on its impact at this point.

References

Sources of Information

First Ministers' Meeting on Health Care (September 2004)  and First Ministers' Health Care Accord (February 2003): www.hc-sc.gc.ca/english/hca2003/fmm/index.html

Canadian Home Care Association: www.cdnhomecare.ca/main.php

Commission on the Future of Health Care in Canada (Romanow Commission): www.hc-sc.gc.ca/english/care/romanow/index1.html

Author/s and/or contributors to this survey

Lisa Maslove

Empfohlene Zitierweise für diesen Online-Artikel:

Lisa Maslove. "Awaiting a National Home Care Program". Health Policy Monitor, 08/10/2004. Available at http://www.hpm.org/survey/ca/b4/3