title: Should community-based services be publicly funded or contracted out?
abstract: OBJECTIVE
  The introduction of Canada's Medicare in 1966 established precedence for a universally accessible and equitable healthcare system. Although Canada has been a leader in building the foundations of socialized medicine, it has stalled short of fulfilling a vision promulgated by its architects of a system that operates on a continuum of care. The aim of this review was to examine whether the expansion of publicly funded services under the Canada Health Act would be an economically and socially viable policy option.
  
  
  METHODS
  A literature review of the direct and indirect social and economic costs associated with contracting out community-based services in the form of outpatient rehabilitative care, palliative care, and home care was conducted.
  
  
  RESULTS
  This article concludes that the private financing of community-based services increases healthcare costs in the long term through increased density and frequency of acute care utilization. It is associated with increased indirect costs in the form of caregiver burden and reduced labor market participation of informal caregivers. The expansion of publicly funded community-based services minimizes these direct health and indirect societal costs.
  
  
  CONCLUSIONS
  The integration of publicly funded community-based services under the Canada Health Act would ensure that the principles of Medicare in the form of equity and accessibility would be enforced while maintaining an economically sustainable healthcare system.
authors.affiliation: Vancouver Coastal Health Community, Vancouver, British Columbia, Canada. nl2@sfu.ca
authors.forename: Lynnette Nathalie
authors.initials: LN
authors.lastname: Lyzwinski
mesh_terms: D002170:Canada; D003284:Contract Services / Q000191:economics* / Q000331:legislation & jurisprudence; D017048:Health Care Costs; D006699:Home Care Services / Q000191:economics* / Q000331:legislation & jurisprudence; D006801:Humans; D010166:Palliative Care / Q000191:economics* / Q000331:legislation & jurisprudence; D012046:Rehabilitation / Q000191:economics* / Q000331:legislation & jurisprudence; D013222:State Medicine / Q000331:legislation & jurisprudence*