Implementing home care in Canada: four critical elements.
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.
Richardson
B
B
We Care Inc., Toronto, Ontario.
D002170:Canada; D003625:Data Collection / Q000592:standards; D016208:Databases, Factual; D003659:Decision Making, Organizational; D018588:Fee-for-Service Plans; D006269:Health Facilities, Proprietary; D006284:Health Plan Implementation / Q000458:organization & administration*; D006302:Health Services Research; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D017146:Models, Organizational; D009313:National Health Programs / Q000458:organization & administration*; D020380:Needs Assessment; D009936:Organizational Innovation; D009937:Organizational Objectives; D017063:Outcome Assessment, Health Care / Q000458:organization & administration*; D020403:Patient Freedom of Choice Laws; D011445:Prospective Payment System; D012052:Reimbursement, Incentive