title: Care for Canada's frail elderly population: fragmentation or integration?
abstract: Budget constraints, technological advances and a growing elderly population have resulted in major reforms in health care systems across Canada. This has led to fewer and smaller acute care hospitals and increasing pressure on the primary care and continuing care networks. The present system of care for the frail elderly, who are particularly vulnerable, is characterized by fragmentation of services, negative incentives and the absence of accountability. This is turn leads to the inappropriate and costly use of health and social services, particularly in acute care hospitals and long-term care institutions. Canada needs to develop a publicly managed community-based system of primary care to provide integrated care for the frail elderly. The authors describe such a model, which would have clinical and financial responsibility for the full range of health and social services required by this population. This model would represent a major challenge and change for the existing system. Demonstration projects are needed to evaluate its cost-effectiveness and address issues raised by its introduction.
authors.affiliation: Division of Geriatric Medicine, McGill University, Montreal. mdhb@musica.mcgill.ca
authors.forename: H
authors.initials: H
authors.lastname: Bergman
authors.forename: F
authors.initials: F
authors.lastname: Béland
authors.forename: P
authors.initials: P
authors.lastname: Lebel
authors.forename: A P
authors.initials: AP
authors.lastname: Contandriopoulos
authors.forename: P
authors.initials: P
authors.lastname: Tousignant
authors.forename: Y
authors.initials: Y
authors.lastname: Brunelle
authors.forename: T
authors.initials: T
authors.lastname: Kaufman
authors.forename: E
authors.initials: E
authors.lastname: Leibovich
authors.forename: R
authors.initials: R
authors.lastname: Rodriguez
authors.forename: M
authors.initials: M
authors.lastname: Clarfield
mesh_terms: D000368:Aged; D002170:Canada; D003153:Community Health Services / Q000191:economics / Q000706:statistics & numerical data / Q000600:supply & distribution; D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration*; D016330:Frail Elderly; D018166:Health Care Reform; D006279:Health Maintenance Organizations; D006801:Humans; D017146:Models, Organizational; D018802:Patient-Centered Care