This document discusses barriers and facilitators to implementing primary care reform in Canada. It analyzes the legacy of Canada's health policy culture, the structure and design of the healthcare system, and the supports required for policy implementation. Key barriers include the long history of focusing reform efforts on changing physician payment models and paying physicians fee-for-service. Facilitators include increasing physician willingness to consider alternative payment and the common elements of provincial reform plans, such as emphasis on multidisciplinary teams, rostering patients, and health promotion. However, implementation of primary care reform in Canada has been slow.
This document discusses and compares public and private health care. Private health care has more equipped and personalized care with new technology and shorter wait times, but is limited to those with certain insurance and can refuse patients. Public health care cannot turn patients away and is more affordable and free, but has fewer medical supplies and personnel resulting in longer wait times. The document argues that private health care may be more efficient and sustainable than public health care in developing countries.
Public Healthcare vs Private Healthcare in India A Systematic Review Unnati Kalwani
Today the healthcare system stands at the crossroads. Nevertheless, the last decade has seen a bloom in the healthcare industry especially in areas like telemedicine, medical tourism.
The delivery system, both private and public remains elusive to the sections of society requiring healthcare
This presentation reflects on the current state of the Indian healthcare system.
lessons on best practices for govt hospitals from private hospitals in indiaHarsha dhulipalla
the ppt consists of present indian health care delivery system and differences between govt & private hospitals,tragedies in govt hospitals,lessons for better improvement
The document discusses comprehensive primary health care in India. It proposes making primary care universal, free, and accessible close to where people live. This would include a more comprehensive package of services addressing both communicable and non-communicable diseases. Village committees would help ensure no one is excluded and services address local health priorities. Community monitoring would provide feedback on equity and quality. Comprehensive primary health care would reduce costs and the need for higher-level care compared to the selective primary care of the past.
The document discusses the changing role of hospitals. It notes that hospitals are evolving within a new framework of healthcare management in response to internal and external changes. Some of the challenges hospitals face include uncertainties around future patient needs due to an aging population and the progression of chronic diseases. Hospitals also have to balance emergency care with planned management of patients. The role of hospitals is gradually shifting from cure-focused to more emphasis on healthcare, community care, prevention, and public health. The changing role requires hospital management approaches to also adapt.
This document provides an overview of hospitals and the healthcare delivery system. It discusses the evolution of hospitals from places where people went to die to modern multiservice institutions. Hospitals are classified by type, ownership, size and services provided. Trends include consolidation, outpatient care replacing inpatient care, and increased partnerships between hospitals and other providers. Challenges include rising costs, physician decision making, and ensuring access to care.
This document discusses the key components and factors influencing health care systems. It outlines that health care systems aim to promote, restore, and maintain health for populations. The document then discusses the historical development of health care, from only being accessible to the wealthy to reforms that aimed to provide services to wider groups. Modern health care systems reflect the values of their societies, and are influenced by changing disease patterns, demographics, technology advances, and government policies. The quality of health care systems can be evaluated based on criteria like effectiveness, efficiency, accessibility, and equity of services provided.
This chapter discusses the various types of healthcare providers in the United States, including physicians, nurses, and other roles. It outlines the history and education/licensing requirements for physicians and how they typically practice medicine. It also describes the different levels of nurses, from registered nurses to advanced practice nurses. The chapter addresses current and projected nursing shortages in the US healthcare system. It provides an overview of the complex mix of health personnel and some gaps and issues around distribution of providers across geographic areas.
This document discusses and compares public and private health care. Private health care has more equipped and personalized care with new technology and shorter wait times, but is limited to those with certain insurance and can refuse patients. Public health care cannot turn patients away and is more affordable and free, but has fewer medical supplies and personnel resulting in longer wait times. The document argues that private health care may be more efficient and sustainable than public health care in developing countries.
Public Healthcare vs Private Healthcare in India A Systematic Review Unnati Kalwani
Today the healthcare system stands at the crossroads. Nevertheless, the last decade has seen a bloom in the healthcare industry especially in areas like telemedicine, medical tourism.
The delivery system, both private and public remains elusive to the sections of society requiring healthcare
This presentation reflects on the current state of the Indian healthcare system.
lessons on best practices for govt hospitals from private hospitals in indiaHarsha dhulipalla
the ppt consists of present indian health care delivery system and differences between govt & private hospitals,tragedies in govt hospitals,lessons for better improvement
The document discusses comprehensive primary health care in India. It proposes making primary care universal, free, and accessible close to where people live. This would include a more comprehensive package of services addressing both communicable and non-communicable diseases. Village committees would help ensure no one is excluded and services address local health priorities. Community monitoring would provide feedback on equity and quality. Comprehensive primary health care would reduce costs and the need for higher-level care compared to the selective primary care of the past.
The document discusses the changing role of hospitals. It notes that hospitals are evolving within a new framework of healthcare management in response to internal and external changes. Some of the challenges hospitals face include uncertainties around future patient needs due to an aging population and the progression of chronic diseases. Hospitals also have to balance emergency care with planned management of patients. The role of hospitals is gradually shifting from cure-focused to more emphasis on healthcare, community care, prevention, and public health. The changing role requires hospital management approaches to also adapt.
This document provides an overview of hospitals and the healthcare delivery system. It discusses the evolution of hospitals from places where people went to die to modern multiservice institutions. Hospitals are classified by type, ownership, size and services provided. Trends include consolidation, outpatient care replacing inpatient care, and increased partnerships between hospitals and other providers. Challenges include rising costs, physician decision making, and ensuring access to care.
This document discusses the key components and factors influencing health care systems. It outlines that health care systems aim to promote, restore, and maintain health for populations. The document then discusses the historical development of health care, from only being accessible to the wealthy to reforms that aimed to provide services to wider groups. Modern health care systems reflect the values of their societies, and are influenced by changing disease patterns, demographics, technology advances, and government policies. The quality of health care systems can be evaluated based on criteria like effectiveness, efficiency, accessibility, and equity of services provided.
This chapter discusses the various types of healthcare providers in the United States, including physicians, nurses, and other roles. It outlines the history and education/licensing requirements for physicians and how they typically practice medicine. It also describes the different levels of nurses, from registered nurses to advanced practice nurses. The chapter addresses current and projected nursing shortages in the US healthcare system. It provides an overview of the complex mix of health personnel and some gaps and issues around distribution of providers across geographic areas.
The health care industry consists of sectors that provide medical services to treat patients. It is one of the largest industries worldwide, consuming over 10% of GDP in developed nations. The industry is divided into areas like hospitals, medical practices, and other human health services. It is further divided into health care equipment and services, and pharmaceuticals and biotechnology. The health care industry has unique characteristics like intangibility, perishability, and inseparability of services. The 7Ps of marketing - product, place, promotion, price, people, process, and physical evidence - are important factors for health care industry marketing.
The document summarizes chapters 1-3 of an introduction to the healthcare industry textbook. It provides an overview of healthcare systems, including their components, organization in the US, and management. Key points covered include the uniqueness of the US system compared to other countries, types of healthcare services and facilities, the healthcare workforce, suppliers of therapeutics, training and research institutions, and financing mechanisms. Population characteristics and criteria for assessing healthcare performance are also summarized.
The document discusses key aspects of evaluating healthcare system performance based on three criteria: quality, equity, and efficiency. Quality is assessed by examining structure, process, and outcomes at both the clinical and population levels. Equity looks at fair access and treatment across groups. Efficiency aims to deliver services at minimum cost. Data and health information technology are critical to comprehensively measure performance over time on a national scale.
The document provides an overview of different frameworks for conceptualizing health systems. It describes the World Health Organization's definition of a health system as including all organizations, people, and actions aimed at promoting, restoring, or maintaining health. It also outlines WHO's six building blocks of a health system: service delivery, health workforce, information, medical products/vaccines/technology, financing, and governance. Additionally, it summarizes key components of health systems from the perspectives of the World Bank, including financing, payment, organization of service delivery, regulation, persuasion, politics, ethics, and values.
The role of hospitals is changing from cure to health care and community care due to changes in technology, knowledge of disease prevention and treatment, and legal factors. Hospitals now provide a wide range of services including curative care, preventive care, management of communicable and non-communicable diseases, maternal and child health services, disability services, health education, and health promotion. Hospitals work within national and state healthcare systems to systematically deliver high quality services with patients and communities empowered for their health.
As a hospital administrator, their roles include planning, organizing, staffing, directing, controlling, and coordinating hospital management functions. The goal of all administrators is to maximize output through productivity and efficiency. Productivity is measured as output over input, and can be increased by boosting output while maintaining or decreasing inputs. Effectiveness means achieving objectives by focusing on outputs and outcomes. Efficiency means achieving objectives with the least amount of resources. Hospital administrators must balance roles related to patients, the hospital organization, and the surrounding community.
Improving ruli district hospital's patient referral system, final, 4.12.11Wendy_Leonard
Presentation by team of MBA students from Ross School of Business at University of Michigan. Describes recommendations for improving the referral process for rural health centers to the district hospital in rural Rwanda.
This document provides a literature review on studies related to the service quality of public and private sector hospitals. It summarizes 25 studies conducted between 2004-2013 that evaluated patient perceptions and assessments of various dimensions of hospital service quality in India. The studies examined factors like infrastructure, personnel quality, clinical care processes, communication, and relationships that influence patient satisfaction. Some findings indicated private hospitals performed better than public hospitals in most quality dimensions except reliability. The review concludes that further research is needed evaluating service quality in the understudied regions of Indore and Ujjain cities in Madhya Pradesh, India.
Ambulatory Care in the US Healthcare System, Portfolio Option #1Ricci Hayes
This document summarizes ambulatory care in the US healthcare system. It discusses how ambulatory care centers provide non-emergency care on an outpatient basis and have grown significantly since the 1970s. The Affordable Care Act has further increased demand for ambulatory care by focusing on prevention, coordinated care, and efficiency. The document outlines the historical development of ambulatory care, current models, political influences, quality and safety issues, and future challenges around continued growth and ensuring financial viability under new payment systems.
The document discusses the private health sector in developing countries. It notes that the private sector is a large and diverse group comprising formal providers like private clinics and hospitals as well as informal providers like traditional healers and drug shops. The private sector delivers a significant portion of healthcare, even for the poor. Ministries of health are increasingly recognizing the importance of partnering with the private sector to improve healthcare access and achieve health goals. Some benefits of public-private partnerships include leveraging private sector resources and expertise, expanding access to underserved groups, and improving efficiency. The document discusses various partnership models like contracting and discusses strategies for improving quality of care in the private sector through regulatory frameworks and certification programs.
Basic health issues and role of private healthcare System in PakistanDr Abdul Ghafoor
The document summarizes the structure of Pakistan's health care system and identifies basic health issues in the country. It notes that Pakistan has a poorly organized health structure without clearly defined roles for primary, secondary and tertiary care. It also highlights issues like the high cost of care, lack of health education, uncontrolled quackery, and the large role of the private sector in healthcare delivery, especially in urban areas of Sindh province. The private health sector in Sindh is described as varied without strong regulation, ranging from well-equipped hospitals to informal providers like general stores. The roles and responsibilities of both the government and private sectors are discussed to address gaps and improve healthcare access and quality in Pakistan.
The document discusses the healthcare services industry in India. It provides details on the key components of the industry including hospitals, medical insurance, pharma, diagnostics, and medical tourism. It then describes some characteristics of the hospital industry such as intangibility, inconsistency, inseparability, and perishability of services. The document also lists innovations, technologies, top hospitals in India and globally, market segmentation approaches, and the marketing mix (7Ps) framework specific to hospitals. It concludes with analyzing SWOT, problems faced by the industry, and a PESTEL analysis.
The document discusses moving towards universal access to health care in India. It defines key concepts of universal health care and outlines principles like public funding playing a central role, comprehensive services for all, and no fees at point of access. It examines issues like what services should be covered, how it will be funded through taxes or insurance, and how services will be organized between public and private sectors. Specific challenges in India like the large private sector and funding mechanisms are also discussed.
Indicators and Information Standards for Frailty ManagementAnnaSeebergHansen
Frailty is a multidimensional condition affecting older adults that can lead to frequent and complex transitions between different health care settings. These transitions often involve multiple providers but lack coordination, resulting in failures to meet patient needs and preferences. Developing standardized patient summaries that consolidate key health information may help coordinate care during transitions and improve outcomes for frail older adults.
E-Referral System: Materna Health in Mumbai, IndiaTseli Mohammed
This document discusses the development and piloting of an e-referral system for maternal healthcare in Mumbai, India. It begins by outlining the high maternal mortality rate in Mumbai compared to other areas and issues with the current referral system between primary, secondary, and tertiary care. It then describes the new e-referral software being tested, which allows electronic referrals, patient tracking, and notifications between healthcare providers. Research discussed found that strengthening healthcare systems and access is important but referral systems can also help reduce mortality and morbidity when implemented effectively. The document concludes by noting global room for improvement in referral systems and discussing the "three delays model" for analyzing areas for intervention.
A presentation to start a workshop with community pharmacists on the contribution of pharmacy to the NHS Five Year Forward View, Health and Wellbeing Strategy and Sustainability and Transformation Plan
Patients’ priorities in assessing organisational aspects of a general dental ...Axex Dental
This study aimed to identify the organizational aspects of dental practices that are most important to patients in the Netherlands. Researchers developed a questionnaire with 41 organizational aspects and distributed it to 5,000 dental patients. The response rate was 63%. Six aspects were identified as most important by at least 50% of respondents: accessibility by telephone, continuing education for dentists, Dutch-speaking dentists, in-office waiting times, information about treatments offered, and waiting lists. Patients' preferences for some of these aspects varied based on their age and education level. The findings can help dental practices provide information focused on the aspects patients value most when choosing a provider.
This document discusses the referral system in healthcare. It defines referral as transferring cases beyond a facility's competence to a higher level facility. The system is vertical, allowing cases to move from village to subcenter to PHC to CHC and so on. The purposes are to provide comprehensive care appropriately and allow access to specialized services. An effective system requires trained staff, equipment, transportation, and collaboration between levels. Nurses play a role in observing patients, identifying the need for referral, assisting with transportation, and providing follow-up care.
Leanne Wells, Chief Executive Officer, Consumers Health Forum of Australia, gave the Ian Webster Health for All Oration to the annual forum of the Centre for Primary Health Care and Equity on 13 August 2015.
This document outlines the Canadian Nurses Association's position on primary health care. It believes primary health care is integral to improving health outcomes for Canadians and that its principles, such as accessibility, health promotion, and intersectoral collaboration, are the most effective way to provide equitable healthcare. The CNA also believes primary health care and nursing are closely connected, and nursing standards and education should be grounded in primary health care principles. Adopting a primary health care approach could help address rising healthcare costs and improve Canada's performance on health indicators relative to other countries.
The health care industry consists of sectors that provide medical services to treat patients. It is one of the largest industries worldwide, consuming over 10% of GDP in developed nations. The industry is divided into areas like hospitals, medical practices, and other human health services. It is further divided into health care equipment and services, and pharmaceuticals and biotechnology. The health care industry has unique characteristics like intangibility, perishability, and inseparability of services. The 7Ps of marketing - product, place, promotion, price, people, process, and physical evidence - are important factors for health care industry marketing.
The document summarizes chapters 1-3 of an introduction to the healthcare industry textbook. It provides an overview of healthcare systems, including their components, organization in the US, and management. Key points covered include the uniqueness of the US system compared to other countries, types of healthcare services and facilities, the healthcare workforce, suppliers of therapeutics, training and research institutions, and financing mechanisms. Population characteristics and criteria for assessing healthcare performance are also summarized.
The document discusses key aspects of evaluating healthcare system performance based on three criteria: quality, equity, and efficiency. Quality is assessed by examining structure, process, and outcomes at both the clinical and population levels. Equity looks at fair access and treatment across groups. Efficiency aims to deliver services at minimum cost. Data and health information technology are critical to comprehensively measure performance over time on a national scale.
The document provides an overview of different frameworks for conceptualizing health systems. It describes the World Health Organization's definition of a health system as including all organizations, people, and actions aimed at promoting, restoring, or maintaining health. It also outlines WHO's six building blocks of a health system: service delivery, health workforce, information, medical products/vaccines/technology, financing, and governance. Additionally, it summarizes key components of health systems from the perspectives of the World Bank, including financing, payment, organization of service delivery, regulation, persuasion, politics, ethics, and values.
The role of hospitals is changing from cure to health care and community care due to changes in technology, knowledge of disease prevention and treatment, and legal factors. Hospitals now provide a wide range of services including curative care, preventive care, management of communicable and non-communicable diseases, maternal and child health services, disability services, health education, and health promotion. Hospitals work within national and state healthcare systems to systematically deliver high quality services with patients and communities empowered for their health.
As a hospital administrator, their roles include planning, organizing, staffing, directing, controlling, and coordinating hospital management functions. The goal of all administrators is to maximize output through productivity and efficiency. Productivity is measured as output over input, and can be increased by boosting output while maintaining or decreasing inputs. Effectiveness means achieving objectives by focusing on outputs and outcomes. Efficiency means achieving objectives with the least amount of resources. Hospital administrators must balance roles related to patients, the hospital organization, and the surrounding community.
Improving ruli district hospital's patient referral system, final, 4.12.11Wendy_Leonard
Presentation by team of MBA students from Ross School of Business at University of Michigan. Describes recommendations for improving the referral process for rural health centers to the district hospital in rural Rwanda.
This document provides a literature review on studies related to the service quality of public and private sector hospitals. It summarizes 25 studies conducted between 2004-2013 that evaluated patient perceptions and assessments of various dimensions of hospital service quality in India. The studies examined factors like infrastructure, personnel quality, clinical care processes, communication, and relationships that influence patient satisfaction. Some findings indicated private hospitals performed better than public hospitals in most quality dimensions except reliability. The review concludes that further research is needed evaluating service quality in the understudied regions of Indore and Ujjain cities in Madhya Pradesh, India.
Ambulatory Care in the US Healthcare System, Portfolio Option #1Ricci Hayes
This document summarizes ambulatory care in the US healthcare system. It discusses how ambulatory care centers provide non-emergency care on an outpatient basis and have grown significantly since the 1970s. The Affordable Care Act has further increased demand for ambulatory care by focusing on prevention, coordinated care, and efficiency. The document outlines the historical development of ambulatory care, current models, political influences, quality and safety issues, and future challenges around continued growth and ensuring financial viability under new payment systems.
The document discusses the private health sector in developing countries. It notes that the private sector is a large and diverse group comprising formal providers like private clinics and hospitals as well as informal providers like traditional healers and drug shops. The private sector delivers a significant portion of healthcare, even for the poor. Ministries of health are increasingly recognizing the importance of partnering with the private sector to improve healthcare access and achieve health goals. Some benefits of public-private partnerships include leveraging private sector resources and expertise, expanding access to underserved groups, and improving efficiency. The document discusses various partnership models like contracting and discusses strategies for improving quality of care in the private sector through regulatory frameworks and certification programs.
Basic health issues and role of private healthcare System in PakistanDr Abdul Ghafoor
The document summarizes the structure of Pakistan's health care system and identifies basic health issues in the country. It notes that Pakistan has a poorly organized health structure without clearly defined roles for primary, secondary and tertiary care. It also highlights issues like the high cost of care, lack of health education, uncontrolled quackery, and the large role of the private sector in healthcare delivery, especially in urban areas of Sindh province. The private health sector in Sindh is described as varied without strong regulation, ranging from well-equipped hospitals to informal providers like general stores. The roles and responsibilities of both the government and private sectors are discussed to address gaps and improve healthcare access and quality in Pakistan.
The document discusses the healthcare services industry in India. It provides details on the key components of the industry including hospitals, medical insurance, pharma, diagnostics, and medical tourism. It then describes some characteristics of the hospital industry such as intangibility, inconsistency, inseparability, and perishability of services. The document also lists innovations, technologies, top hospitals in India and globally, market segmentation approaches, and the marketing mix (7Ps) framework specific to hospitals. It concludes with analyzing SWOT, problems faced by the industry, and a PESTEL analysis.
The document discusses moving towards universal access to health care in India. It defines key concepts of universal health care and outlines principles like public funding playing a central role, comprehensive services for all, and no fees at point of access. It examines issues like what services should be covered, how it will be funded through taxes or insurance, and how services will be organized between public and private sectors. Specific challenges in India like the large private sector and funding mechanisms are also discussed.
Indicators and Information Standards for Frailty ManagementAnnaSeebergHansen
Frailty is a multidimensional condition affecting older adults that can lead to frequent and complex transitions between different health care settings. These transitions often involve multiple providers but lack coordination, resulting in failures to meet patient needs and preferences. Developing standardized patient summaries that consolidate key health information may help coordinate care during transitions and improve outcomes for frail older adults.
E-Referral System: Materna Health in Mumbai, IndiaTseli Mohammed
This document discusses the development and piloting of an e-referral system for maternal healthcare in Mumbai, India. It begins by outlining the high maternal mortality rate in Mumbai compared to other areas and issues with the current referral system between primary, secondary, and tertiary care. It then describes the new e-referral software being tested, which allows electronic referrals, patient tracking, and notifications between healthcare providers. Research discussed found that strengthening healthcare systems and access is important but referral systems can also help reduce mortality and morbidity when implemented effectively. The document concludes by noting global room for improvement in referral systems and discussing the "three delays model" for analyzing areas for intervention.
A presentation to start a workshop with community pharmacists on the contribution of pharmacy to the NHS Five Year Forward View, Health and Wellbeing Strategy and Sustainability and Transformation Plan
Patients’ priorities in assessing organisational aspects of a general dental ...Axex Dental
This study aimed to identify the organizational aspects of dental practices that are most important to patients in the Netherlands. Researchers developed a questionnaire with 41 organizational aspects and distributed it to 5,000 dental patients. The response rate was 63%. Six aspects were identified as most important by at least 50% of respondents: accessibility by telephone, continuing education for dentists, Dutch-speaking dentists, in-office waiting times, information about treatments offered, and waiting lists. Patients' preferences for some of these aspects varied based on their age and education level. The findings can help dental practices provide information focused on the aspects patients value most when choosing a provider.
This document discusses the referral system in healthcare. It defines referral as transferring cases beyond a facility's competence to a higher level facility. The system is vertical, allowing cases to move from village to subcenter to PHC to CHC and so on. The purposes are to provide comprehensive care appropriately and allow access to specialized services. An effective system requires trained staff, equipment, transportation, and collaboration between levels. Nurses play a role in observing patients, identifying the need for referral, assisting with transportation, and providing follow-up care.
Leanne Wells, Chief Executive Officer, Consumers Health Forum of Australia, gave the Ian Webster Health for All Oration to the annual forum of the Centre for Primary Health Care and Equity on 13 August 2015.
This document outlines the Canadian Nurses Association's position on primary health care. It believes primary health care is integral to improving health outcomes for Canadians and that its principles, such as accessibility, health promotion, and intersectoral collaboration, are the most effective way to provide equitable healthcare. The CNA also believes primary health care and nursing are closely connected, and nursing standards and education should be grounded in primary health care principles. Adopting a primary health care approach could help address rising healthcare costs and improve Canada's performance on health indicators relative to other countries.
The document provides background information on advancing patient-centered medical homes (PCMHs) in New York State. It discusses the current status and rapid growth of PCMH adoption in New York over the past few years, with nearly 5,000 clinicians now working in NCQA-recognized PCMH practices. However, adoption seems to be leveling off, and three-quarters of primary care practitioners still do not work in PCMHs. It notes key challenges to further expanding the PCMH model in New York, including the need for multipayer alignment on supporting the model through payment and other systems changes.
The document discusses New York State's efforts to promote the patient-centered medical home model. It notes that while New York spends a lot on healthcare, the quality and health outcomes are only middle of the pack. The Commissioner of Health believes the PCMH model can help strengthen primary care, improve chronic care management, and reduce avoidable costs. New York has promoted multipayer PCMH initiatives through legislation and programs. Initial PCMH pilot programs showed promising results, and the state has seen significant uptake of PCMH recognition across practices. Evaluations are still early, but results so far are encouraging regarding patient experience and quality measures.
Elements of health services management.pptxCheriro
The document discusses elements of health systems and services management. It outlines six core components or "building blocks" that comprise health systems: service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership/governance. It then describes Kenya's decentralized health system, which is organized into four levels of care delivered by both public and private providers at the national, county, and community levels under the guidance of the national health policy. The roles and challenges of health services managers are also examined.
The document provides an overview of Ontario's health care system. It discusses how the Ontario government operates under a Westminster system with a Liberal minority government led by Premier Dalton McGuinty. It outlines the roles of the Ministry of Health and Long-Term Care and Local Health Integration Networks in developing health policy and overseeing service delivery. It also describes how physicians and hospitals are major private providers that receive public financing in Ontario's mixed public-private system.
This document discusses the history of the healthcare system in the US and the changing role of physicians within that system. It notes that physicians originally had close personal relationships with patients but that hospitals and specialization led to more fragmented care. Government programs like Medicare and the rise of managed care further changed the physician role by increasing administrative duties. The document examines the current medical school curriculum, noting a lack of leadership and management training. It discusses some programs that do offer such training but notes they are electives, not mandatory. The document concludes there are gaps in preparing physicians for the changing healthcare system and future skills needed in areas like business, communication, and leadership.
Assignment 1Public Administration – The Good, th.docxtrippettjettie
Assignment 1
Public Administration – The Good, the Bad, the Ugly
hhhhhhh
Modern Public Administration
Prof. hhhhh
Date: hhhhh
The White House Issue: Health reforms
The Health Care Reforms are the best obsession for the United States, Majorly most of the American citizens who were responsible for originating the improvement found it helpful. Back in the year 2011, a countrywide crackdown was conducted as a way to oppose the frauds that were becoming a health concern, and the federal administration recovered almost $ 4.1 billion. The Health Care Improvement for capturing the healthcare frauds and scams allowed President Obama’s policy to enhance on strict penalties like compensation and fines. By providing the United States citizens with Patient Protection as well as, ACA (Affordable Care Act) was the ultimate presidential success for President Barack Obama (.whitehouse., 2014).
The public policy
As most of the leaders decided to adopt a firm stand with the many important issues within the American State, the essential point was the definition of the improvement of the Health Care in the United States by President Barack Obama and when discussing the fitness and care reform a lot of issues are put on focus.
The public policies are categorized into four groups which are the regulatory policy, the distributive policy, the redistributive policy and lastly the constituent policy. Every issue in the White House is organized it the way it is related to any of the four types of public systems (NCBI, 2016). The financial regime faces most of the significant issues, and many may need to be in a position to determine the problems which are related to funding system because some of these issues affect some of the American citizens.
Distributive policy as mentioned above, it is a policy that focuses on supporting the selected issues; the strategy that is behind the distributive health care is the local understanding and having a flexible organizational design. The idea of distribution is quite broad as it classifies distributive policy action towards including all the public processes that are responsible for developing as well as providing equitable access to the resources. In regards to the health issues, this may have financial aid for assisting the excluded to have access to the healthcare. Also, across funding aid to assist in the inside operations of the health institutions such as the combination of threats which enhances the inclusion of reasonably inadequate health services. Also, the appointment systems facilitate the secondary concern for the needy to access health services (Mackintosh, 2013). It also reduces the shifts regarding the fitness care regime in processes that will be able to satisfy and offer the proper access to those who are deprived by supporting the distributive promises that the government has made and having full access to healthcare services. In this kind of shift, the significant disadvantage is ...
The document discusses preventive and case-managed services offered by Nevada Medicaid. It describes how the Affordable Care Act expanded Medicaid coverage in Nevada, increasing the patient population for providers. The two main Medicaid managed care organizations (MCOs) in Nevada, Amerigroup and Health Plan of Nevada, are described as well as some of the preventive services they offer. The document recommends that the MCOs use Medicaid electronic health record incentive programs and encounter data to better monitor screening rates and identify gaps in care for populations. Using this data could help the MCOs improve outreach and preventive service delivery.
Key Element 4 Increase Upstream InvestmentsA population health .docxtawnyataylor528
Key Element 4: Increase Upstream Investments
A population health approach maximizes its potential by directing efforts and investments “upstream” to address root causes of health and illness.
What are upstream investments?
Upstream investments are interventions aimed at the root causes of a population health problem or benefit. Root causes are often identified by determining the most immediate and direct causes, and working backwards from there. In many cases, upstream action addresses social, economic and environmental conditions.
The population health approach is grounded in the notion that the earlier in the causal stream action is taken (i.e. the more upstream the action is), the greater the potential for population health gains and health-related cost savings. It is often true, however, that these root causes are more difficult to change, requiring more time, more resources and more will.
Because of this, upstream interventions may not be the most appropriate choice; the context, timing, resources, mandate and available evidence must be considered. The choice should be based on the best evidence, not just on an article of faith that “further upstream is always better.”
Resources to Increase Understanding:
What are upstream investments?
· The Case for Prevention: Moving Upstream to Improve Health of All Ontarians – Health Nexus (formerly the Ontario Prevention Clearinghouse)
Key questions
· a) What is the best balance of investments?
· b) Who will provide support and what will it be?
A) What is the best balance of investments?
A population health approach recognizes the tension between short and long term goals. Health problems have to be treated immediately, but at the same time, upstream investments are needed to keep people healthy. Furthermore, upstream investments need sustained support to have a real impact.
The population health approach strives to strike a balance between investments of three types:
· Short term, e.g. responding to citizen concerns about the quality and accessibility of health care, food and drug safety, and emergency response procedures
· Medium term, e.g. programs that favour equity, such as redistribution of resources, and programs that invest in children, such as responding to windows of developmental opportunity
· Long term, e.g. investment in alternative energy sources and other technologies that reduce stress on the physical environment.
B) Who will provide support and what will it be?
Taking upstream action on the social, economic and environmental health determinants requires influencing how multiple sectors of government assign their resources. In this Key Element, it is important to identify what investments by what partners outside health are required. To generate this list, consider all the sectors whose mandates impact upon health determinants and focus on those that are most relevant.
How are upstream investments increased?
4.1 Balance short, medium and long term investments
The decision-making fram ...
SOCW 6351 Wk 9 Discussion 1. Need Responses.Respond in one of t.docxrosemariebrayshaw
SOCW 6351 Wk 9 Discussion 1. Need Responses.
Respond in one of the following ways:
· Describe two factors that might make minority groups especially vulnerable in the Medicaid policy your colleague cited. Explain why these groups may not have a voice in the policy-making process.
· Offer examples of organized self-help and citizens’ groups as both support mechanisms and potentially powerful lobbies. Describe how these lobbying bodies can help in amending the policy your colleague described.
Support your response with specific references to the resources. Be sure to provide full APA citations for your references.
NA:
Top of Form
Medicaid is a medical assistance program developed specifically for low income individuals of any age, unlike Medicare, which is designed for those over 65 and have no income requirements (“Difference between Medicare and Medicaid”, n.d.). When health care policies are change, they affect programs such as Medicaid and Medicare. For example, when the ACA (Affordable Care Act) was implemented, it led to an increase of enrollment as it made the process easier and reached more individuals and it expanded Medicaid eligibility to low-income adults (Wachino, Artiga & Rudowitz, 2014).
In the state of Pennsylvania, a Medicaid policy that I would amend would be the Healthy PA policy, which was a Medicaid expansion that included drug and alcohol services (IRETA, 2015). The issue is the length of time it takes for someone to be admitted into a program. Whether it’s getting into an inpatient or outpatient program, the process needs to be expedited and more streamlined. Many who are suffering from substance abuse disorders struggle with finally getting themselves into a program and delaying the process could result in someone hesitating and deciding not to move forward with treatment that is crucial (IRETA, 2015).
In Pennsylvania, stakeholders include a steering committee, which is made up of hospitals, health care providers, consumers, foundations and academic institutions (“HIP”, 2019). This committee comes up with ways to improve population health and control health cost including Medicaid and Medicare. They developed a plan for heathcare delivery that will improve the quality of life for everyone, without limitations on income or background (“HIP”, 2019). This committee has 5 work groups that develop implementation plans for the goals that were developed by the committee and focus on specific aspects such as payment, price and quality transparency, population health, healthcare transformation and health information technology (“HIP”, 2019).
References:
HIP stakeholders. (2019). Retrieved from https://www.health.pa.gov/topics/Health-Innovation/Pages/Stakeholders.aspx
IRETA. (2015). Pennsylvania’s Medicaid expansion smooths the road to addiction treatment, but barriers remain. Retrieved from https://ireta.org/resources/pennsylvanias-medicaid-expansion-smooths-the-road-to-addiction-treatment-but-barriers-remain/
Wachino, V., A.
The National Council for Community Behavioral Healthcare provided comments on the Department of Health and Human Services' Draft Strategic Plan for Fiscal Years 2010-2015. The National Council represents over 1,700 community mental health and addiction treatment providers. In its response, the National Council provided feedback and recommendations for each of the plan's goals and objectives. Key recommendations included monitoring insurers' implementation of mental health and addiction equity laws, including behavioral health in health information technology and quality improvement efforts, and addressing the needs of populations with mental illness and substance use disorders.
Continuity of care at the primary health care level narrative reviewDr. Anees Alyafei
A narrative review on continuity of care at the level of primary health care, definition, types, how it could be measured, and the expected effects on the patients, health care providers, and health institutes.
Benefits of implementing_the_primary_care_pcmhVicki Harter
This document provides a review of cost and quality results from implementing the patient-centered medical home (PCMH) model of primary care. It summarizes newly reported and updated results from PCMH initiatives nationwide over the past two years. The results show that the PCMH improves health outcomes, enhances the patient and provider experience of care, and reduces unnecessary hospital and emergency department utilization, meeting the goals of better health, better care, and lower costs. The document defines key features of the PCMH model and provides data demonstrating how each feature contributes to these outcomes. It outlines growing private and public sector support for the PCMH in the United States.
http://www.wpro.who.int/asia_pacific_observatory/hits/myanmar_pns1_en.pdf
What are the challenges facing Myanmar in progressing towards Universal Health Coverage?
https://www.irrawaddy.com/specials/challenges-impede-development-of-myanmars-public-health.html
Challenges Impede Development of Myanmar’s Public Health
https://europa.eu/capacity4dev/capacity-building-in-public-health-for-development/document/health-sector-reforms-myanmar-giving-more-space-public-health-interventions-ncds
Health Sector Reforms in Myanmar, giving more space for public health interventions for NCDs
This document provides a summary of cost and quality results from patient-centered medical home (PCMH) initiatives in 2012. It finds that the PCMH improves health outcomes, enhances the patient and provider experience of care, and reduces unnecessary hospital and emergency department utilization. Major health plans like Aetna, Humana and UnitedHealthcare are expanding PCMH programs based on evidence that it meets the goals of better health, better care and lower costs. The momentum for PCMH is growing across the healthcare system, including 90 commercial insurance plans, 42 state Medicaid programs, and thousands of clinical practices nationwide.
Marketing proposal to Hartford HealthcareArchit Patel
The presentation is a brief description to the proposed marketing strategy for the Hartford healthcare specifically targeting on the New Health Enhancement Program proposed for Connecticut state employees.
The document discusses pay for performance (P4P) incentives in healthcare and their impact on quality, cost, and financing. It provides background on quality improvement efforts and defines key concepts like structure, process, and outcomes. It then outlines current legislation and initiatives like the Affordable Care Act that link reimbursement to quality metrics. P4P aims to change how care is delivered and financed to improve outcomes while reducing waste. However, it also impacts providers' finances as payments may decrease for preventable readmissions or hospital-acquired conditions.
Understanding Healthcare Delivery Systems A Healthcare Diploma Perspective.pdfHealthcarediploma
Healthcare delivery systems are complex networks of organizations and individuals that provide healthcare services to patients. These systems involve a wide range of stakeholders, including healthcare providers, payers, government agencies, and patients themselves. Understanding healthcare delivery systems is essential for healthcare professionals who wish to improve patient outcomes and promote health equity. In this blog post, we will explore the topic of healthcare delivery systems from the perspective of a healthcare diploma student.
Similar to Cprn Implementing Primary Care Reform In Canada (20)
This document provides a map showing the locations of Family Health Teams across Northern Ontario implemented in three waves:
1) The map shows the locations of Family Health Teams in various communities across Northern Ontario, grouped into large, community, small, and rural sites.
2) The Family Health Teams were implemented in three waves, with teams in different regions of Northern Ontario launching in each wave.
3) The map identifies the regions covered by each wave and provides the number of family physicians in each type of site to characterize their size.
Family Health Teams have been established across Northern Ontario in 3 waves:
- Wave 1 included large teams of 21-30 family physicians, community teams of 11-20 physicians, and small/rural teams of 5 or fewer physicians. Teams were located in communities across central, eastern, western and Champlain regions.
- Wave 2 expanded coverage with additional large, community and small/rural teams in northeast, northwest, southeast, southwest and Toronto regions.
- Wave 3 further increased access with more large teams in central, eastern and western regions and additional community and small/rural teams across the north.
This document provides guidance on managing waiting times in the NHS in Scotland. It outlines 10 golden rules for waiting time management that put the patient's interests first. It emphasizes the importance of appropriate referrals, adequate services, clinical prioritization of patients, and keeping patients informed of wait times. The document stresses partnership between primary and secondary care and accurate information on waiting lists. It discusses initiatives to treat backlogs versus long-term strategies to close gaps between demand and capacity. NHS Boards are asked to develop local plans that meet and exceed national targets through leadership, risk assessment, resource planning, and patient consultation.
This guidebook shares stories from nine Ontario communities that have undertaken healthy community initiatives. The stories describe their experiences and processes to raise awareness, build connections, and take action around health issues. Community members then reflected on these stories and identified "words of wisdom" from their experiences. Finally, the guidebook provides a framework and questions to help other communities document and share their own stories to guide their healthy community efforts.
The document provides tips and tools for registered dietitians working in interdisciplinary primary care settings. It outlines a proposed model for nutrition services with the RD responsible for overall management and the most in-depth nutrition counselling. It describes assessing community needs, nutrition screening, referral processes, nutrition advice and counselling. A typical nutrition counselling process is outlined including pre-screening referrals, initial visits, nutrition planning visits, follow-up visits and coordinating with the interdisciplinary team. Various tools developed in a demonstration project are also included to support RDs.
This document outlines a screening project conducted with primary care providers to identify at-risk women and incorporate screening tools for alcohol, smoking, and abuse into practice. It provided a screening and resource package, conducted academic detailing, and administered pre- and post-test questionnaires. The results showed increased screening rates for tobacco, alcohol, and abuse from pre- to post-test. While the response rate for the post-test was lower, providers reported increased use of screening tools and community referrals. The academic detailing approach was found useful by most providers.
This document outlines Saskatchewan's Action Plan for Primary Health Care, which aims to strengthen primary health care services in the province. It describes the vision for an integrated primary health care system delivered through networks of health care providers. The plan establishes defined roles for Regional Health Authorities and the government in managing, operating and funding primary health care. It also outlines characteristics of the new system and a phased implementation approach over 10 years to establish primary health care teams accessible to all residents.
The Role And Value Of Primary Care Practiceprimary
This document summarizes discussions from a 2002 conference on building consensus for healthcare reform in Canada. It includes summaries of two presentations:
1. Marie-Dominique Beaulieu's presentation on the role and value of primary care. She defines primary care and argues for strengthening it in Canada. She calls for changes like developing primary care teams with nurses and better information systems.
2. Howard Bergman's presentation in which he argues for strengthening and transforming primary care as the foundation of the healthcare system. He calls for an evidence-based approach and investing in primary care to improve health outcomes. Both agree comprehensive reform is needed, not just changes to primary care itself.
The document describes The Model for Improvement, which provides a framework for developing, testing, and implementing changes that lead to improvement. The model consists of two parts: 1) three fundamental questions to guide improvement work, and 2) Plan-Do-Study-Act cycles to test changes rapidly through small-scale trials. Using this approach can help achieve successful, low-risk change through a simple and effective process of continuous learning and adaptation.
This document summarizes the final report from the Forum on Teamworking in Primary Healthcare. The forum was convened by several national healthcare organizations to examine teamworking in primary care. The report found evidence that effective teamwork occurs when roles are clearly defined and rewarding, communication is good, and there are shared goals. It identified barriers like competing demands, status differences, and lack of resources. The report provides recommendations to improve teamworking at both the organizational and team member levels. It also highlights several examples of successful teamworking initiatives in UK primary care settings.
The document discusses strategies for improving patient flow and reducing cycle times in medical practices. It describes how mapping patient flows, measuring cycle times, and identifying interruptions can help practices pinpoint bottlenecks. Practices have found that small tests of change focused on areas like visit planning, co-locating staff, efficient office design, exam room standardization, documentation shortcuts, and streamlined check-in/out processes can uncover hidden capacity and increase revenue. The key is developing a deep understanding of the current process from the patient's perspective before envisioning an ideal flow and implementing changes while monitoring for unintended consequences. Physician leadership and a team effort are essential to successfully redirecting patient flow.
Snap%2 B Framework%2 Bfor%2 B General%2 B Practiceprimary
This document presents the Smoking, Nutrition, Alcohol and Physical Activity (SNAP) Risk Factor Framework for General Practice. The framework was developed to provide integrated approaches for general practitioners to support behavioral risk factor management for smoking, nutrition, alcohol and physical activity.
It identifies these four risk factors as major contributors to disease burden and outlines seven outcomes areas for action: organizational structures, financing, workforce development, information systems, communication, partnerships and referral networks, and research. The framework is intended to streamline support for general practices and encourage collaboration across different organizations and levels of care.
The document is the first annual report from the Health Results Team, which was created by the Minister of Health and Long-Term Care to improve patient access to healthcare in Ontario. The report details progress made in the first year to transform the healthcare system through initiatives like establishing Local Health Integration Networks, reducing wait times, implementing Family Health Teams, and improving information management. The Health Results Team worked across the healthcare community and achieved many milestones to deliver on the vision of creating a more integrated, sustainable, and patient-centered healthcare system.
This document provides updates on chronic disease management initiatives including the Chronic Disease Management Collaborative (CDMC). Key information includes:
1. An explanation of delivery system design which involves defining roles, using planned interactions, providing case management, and ensuring regular follow-up to effectively manage chronic illnesses.
2. Details on upcoming training for the Clinical Practice Redesign program and information sessions on a new diabetes education program using group visits.
3. Announcements of learning workshops and conferences on chronic disease management and diabetes.
The document discusses the role of registered dietitians in primary health care. It begins by explaining that primary health care focuses on wellness promotion rather than just illness treatment. It also notes that nutrition is important for health but access to nutrition services is limited. The document then describes key elements of primary health care, including using a population health approach, comprehensive services, coordination of care, interdisciplinary teams, and cost-effectiveness. It outlines the practice of registered dietitians in primary health care, including their skills in health promotion, education, and working with communities. Examples are provided of how dietitians contribute to quality of life, health outcomes, and cost containment through various strategies and actions.
Rg0035 A Guideto Service Improvement Nhs Scotlandprimary
This document provides a guide to using various tools and techniques for improving health care services. It focuses on using process mapping to analyze patient journeys through the health care system. Process mapping involves capturing each step of a patient's experience in a visual map to identify issues like bottlenecks, unnecessary steps, or handoffs between staff. Preparing for process mapping by defining the scope and goals and involving relevant staff and patients is important. Once complete, process maps can reveal problems and opportunities for improving efficiency and patient experience.
This document discusses the role of dietitians in collaborative primary health care mental health programs. It was developed as part of the Canadian Collaborative Mental Health Initiative to help integrate specialized services like nutrition and mental health expertise into primary care settings. Individuals with mental health issues are often nutritionally at risk due to factors like eating disorders, mood disorders, medication side effects, poverty and more. Dietitians are uniquely qualified to assess nutritional needs in this population and develop interventions as part of mental health care teams. However, more resources and strategies are still needed to fully realize dietitians' potential contributions to mental health care.
When relationships break down in organizations, it is often due to a lack of clear communication and shared understanding. The document outlines five common types of relationship breakdowns - role confusion, conflicting priorities, hidden expectations, communication issues, and resistance to change - and recommends strategies to address each one. These strategies include sharing key information, setting interaction agreements, building communication skills, and individual coaching. Addressing the root causes through open discussion and setting clear expectations is generally more effective than superficial fixes like team-building classes.
The article discusses rethinking the challenge of change management in organizations. It argues that traditional change management focuses too much on changing individual attitudes and behaviors and not enough on changing organizational systems and structures. The article proposes an alternative framework that views organizational change as an ongoing process of adaptation and focuses on aligning organizational components like strategy, culture and structure with each other and the external environment.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
1. Implementing Primary Care
Reform in Canada:
Barriers and Facilitators
By
Cathy Fooks
Director, Health Network
Canadian Policy Research Networks Inc.
Presented at
Implementation of Primary Care Reform
School of Policy Studies
Queen’s University
Kingston, ON
November 2003
Submitted January 2004
2. Implementing Primary Care Reform in Canada: Barriers and Facilitators
Table of Contents
1.0 Introduction ................................................................................................................................3
2.0 Definitions ...................................................................................................................................3
3.0 Analytic Framework ...................................................................................................................4
4.0 Canadian Health Policy Culture ...............................................................................................5
4.1 Barriers .................................................................................................................................5
4.2 Facilitators............................................................................................................................6
5.0 Structure and Design..................................................................................................................6
5.1 Barriers ..................................................................................................................................6
5.2 Facilitators.............................................................................................................................7
6.0 Required Supports ......................................................................................................................7
6.1 Barriers ..................................................................................................................................7
6.2 Facilitators..............................................................................................................................8
7.0 Why Has Been Implementation Been Slow?..........................................................................8
8.0 Conclusions .................................................................................................................................8
9.0 References................................................................................................................................. 10
________________________________________________________________________
2
3. Implementing Primary Care Reform in Canada: Barriers and Facilitators
1.0 Introduction
Governments and health care stakeholders have been talking about reorganizing the way
Canadians receive primary care services for a very long time (1). Yet it is hard to discern real
change at the local level – publicly-funded medical and hospital services are organized largely
the way they were at the inception of Canadian medicare. Despite solid evidence services
could be organized more effectively and achieve better health outcomes for citizens, reform
is slow in coming (2). Why?
This paper briefly describing the current policy directions taken by provinces in reforming
their primary care services and analyzes implementation barriers and facilitators to realizing
those policy directions.
2.0 Definitions
Terms abound: primary care, primary health care, primary care services etc. A recent review
of international models makes a useful distinction between primary care and primary health
care (3). The authors describe primary care as the diagnosis, treatment and management of
health problems with services delivered largely by physicians. Primary health care is
described as including primary care but also including the broader determinants of health
such as sickness prevention and health promotion activities that are provided by physicians
and others in a team-based environment.
It is clear when looking at current provincial reforms that a variety of terms are used
somewhat interchangeably:
Alberta Primary Health Care is based on a holistic definition of health that recognizes the
influence of social, economic and environmental factors on a person’s well-being, is
delivered by a variety of providers and emphasizes the coordination of health services, health
promotion, illness and injury prevention to cover episodic illness and chronic conditions (4).
BC Primary Health Care is defined as the point at which a person enters the health care system
and receives the health care services that meet most of their everyday needs (5).
Manitoba Primary Health Care is defined as first level contact with the health system where
services are mobilized to promote health, prevent illnesses, care for common illnesses and
manage ongoing health problems. It includes all human services that play a part in
addressing the interrelated factors that affect health (6).
Nova Scotia Primary Health Care Renewal focuses on improvements in population health and
allows citizens to select a primary health care provider and access a range of primary health
care services (7).
________________________________________________________________________
3
4. Implementing Primary Care Reform in Canada: Barriers and Facilitators
Ontario Primary Care Reform has created family health networks to deliver primary care.
Groups of physicians, supplemented with a nurse-staffed telephone service 24 hours a day,
emphasize comprehensive care while promoting a stronger doctor-patient relationship (8).
Prince Edward Island focuses on primary health services described as those services that
people access first and most often, such as family physicians, public health nursing, screening
programs, addiction services and community mental health services (9).
Despite the different terminology and varying degrees of scope in provincial plans, there are
a number of common elements consistently referenced in the policy documents. They are:
• Team approach to service delivery: this is loosely defined given that some provinces begin
with the family physician and build other providers around him or her whereas other
provinces start with a nurse or nurse practitioner and use medical resources at the
next stage of contact.
• Roster of patients: there is a general desire to get patients registered with a specific
group practice or team of providers. There appears to be varying degrees of
formality about this aspect of reform with some provinces talking about “sign-up”
periods and others not limiting patient movement amongst difference providers in
any way.
• Twenty-four hour access seven days a week: this commitment appears to be largely after-
hours access to a nurse by telephone.
• Mixed funding formulas for services and programs: there is fairly mild experimentation being
proposed for new funding models such as capitation, salary and combinations of
such in conjunction with fee-for-service payments. A number of provinces are
proposing to move to a population-based funding model linked to specific
demographic and health characteristics of enrolled populations.
• Increased emphasis on health promotion and prevention: all the provinces’ policy materials
emphasize a focus on health promotion and prevention.
If we take these common elements as a loose Canadian “model”, we can examine the
barriers and facilitators to implementation.
3.0 Analytic Framework
Three variables are proposed for the barriers and facilitators analysis:
• The legacy of Canadian health policy culture;
• The structure and design of Canadian health care;
• The supports required for policy implementation.
________________________________________________________________________
4
5. Implementing Primary Care Reform in Canada: Barriers and Facilitators
4.0 Canadian Health Policy Culture
The Canadian health policy culture is not an environment in which rapid change is easily
achieved. Various policy legacies exist which effect the ability of leaders to lead change in
positive and negative ways.
4.1 Barriers
Ten years ago health reform efforts highlighted the need for better integration, coordination
and multidisciplinary care for primary care services. The solutions offered by experts was to
reform physician payment mechanisms with a shift towards capitation and other alternative
payment schemes (10)(11)(12)(13). The focus on physician payment was not surprising as
medical services are publicly funded and are therefore the logical entry point for
governments to lever change.
The language has not changed dramatically over the decade – integration, coordination and
multidisciplinary care are still the policy descriptors for reform. And not surprisingly, the
legacy of a focus on physician payment remains. Current efforts of primary care reform are
organized around services provided by physicians, albeit in conjunction with others, and
funding flows to the physician or group of physicians, not to patients or other health
professionals.
Embedded within the history of physician payment in Canada is another legacy – that of
paying physicians on a fee-for-service basis. Physicians entered Canadian medicare on the
basis of existing fee schedules – a price for each service delivered. Although some
experimentation has occurred over time, and physicians are indicating an increasing
willingness to consider alternative forms of payment (14), fee-for-service is still the primary
way in which primary care services are funded. Alternate payments only account for 11% of
total clinical earnings in Canada (15). Fee-for service payment is predicated on single
services delivered by one professional at a time. It does not facilitate care delivered
holistically or delivered by teams of professionals and it does not compensate for time spent
for administrative, managerial, educational or communication tasks.
Most expert reviews and some of the evaluations from the Health Transition Fund have
identified the need to move away from fee-for-service payment in varying degrees (4)(16).
Yet movement away from fee-for-service payment is not endorsed by provincial medical
associations – the bargaining agents for Canadian physicians. Provincial governments have
not, to date, been prepared to implement new funding models over the objections of the
medical profession. And, because negotiations are bipartite between governments and
medical associations, there is no opportunity for the influence and views of other health
professions to be considered as part of allocation decisions.
A third legacy of the culture of Canadian health policy is the use of pilot projects. Rather
than move to full implementation, provincial governments often attempt policy reforms of
new initiatives through pilot projects. This often gives an impression that a final decision on
________________________________________________________________________
5
6. Implementing Primary Care Reform in Canada: Barriers and Facilitators
a policy direction hasn’t been made, permits time for opposition to build, and leaves open
the possibility of policy reversal when new Ministers or governments take office. Primary
care reform in Canada is being introduced largely through pilot or demonstration projects.
4.2 Facilitators
While Canadian health policy culture has created some legacy problems for primary care
reform, it also contains several positive legacies that could contribute to successful
implementation.
Canadians are open to new models of care and service delivery and have been for some time.
They are aware that a range of providers would benefit their health and are willing to
consider their first point of contact with a primary health care system to be with someone
other than a physician (17)(18). And while Canadians clearly want to maintain a close
connection to a personal family physician, they also use a wide variety of other professionals
and pay for their services directly (19).
Canadians have also expressed a strong interest in health promotion and prevention activities
(20) which supports the thrust of current provincial efforts.
5.0 Structure and Design
The structure and design of Canadian health care provides some difficulties for
implementing new models as well as opportunities.
5.1 Barriers
Although primary care design is being touted as an integrated reform, a closer look at actual
implementation plans indicates that this is not the case; indeed, it could not be the case
under current legislative arangements. Neither funding models or provincial health
professions regulatory frameworks are structurally supportive of primary care reform.
Federal funding covers only portions of the comprehensive services being envisionsed for
primary care. Some services are funded under the Canada Health Act (eg, physician
services), some are funded through specific federal-provincial programmatic arrangements
(eg, pharmacare) and some are covered only by individual provinces (eg, alternative health
professionals). As well, funding at the provincial level is not always in one pot. For
example, Ontario Family Health Networks must work through a different part of the
Ministry of Health with a different funding stream to access nurse practitioner funding.
Because funding is tied to providers rather than patients, it is not integrated. Attempting to
implement new delivery models on the existing hodge-podge of funding arrangements
cannot support integration and team-based care.
On the regulatory side, health professions legislation is based on distinct professions with
their own educational requirements, practice standards and regulatory colleges. There is no
common approach even in areas of overlapping scopes of practice. Professional liability
________________________________________________________________________
6
7. Implementing Primary Care Reform in Canada: Barriers and Facilitators
schemes are focused on individuals rather than teams and are legally based on professional
autonomy rather than shared accountability. As well, increased specialization and calls for
continually higher levels of educational certification as entry qualifications to practice would
appear to be decreasing rather than increasing integration and team-based care.
5.2 Facilitators
One of the most positive facilitators for implementing primary care is the role played by the
Primary Health Care Transition Fund. Initial evaluation reports are now available and make
clear that much was learned about implementation at the local level from the providers’ and
patients’ perspectives. Although many felt more time was required to undertake actual
implementation, they were positive about new models of delivery (4)(16). This evidence
provides a good basis for enlarging the scope of activity and the number of participants
across the country.
Secondly, provincial governments have wisely chosen to offer a number of delivery models
allowing providers to choose the model they feel best suits their individual circumstances
and patients to change care providers if they wish. Although this likely lengthens the time
required for implementation, providers will feel more in control of their practice
arrangements and that the decision to change was theirs and patients will be more likely to
enrol.
6.0 Required Supports for Policy Implementation
Change management literature tells us that that certain supports are required to implement
change. Things such as personnel and skills, appropriate resources and information
technology are needed to support the desired policy change.
6.1 Barriers
Health human resources planning has become an urgent policy issue for the Canadian health
care system in the last five years. In particular, national strategies for physician and nursing
personnel have been recommended. This is difficult to do in the absence of a clear vision
for primary care and some consistency across provincial jurisdictions. Without a stronger
link between national health human resource planning and local primary care delivery,
implementation of primary care may be less than optimal. For example, a greater use of
nurse practitioners is clearly envisioned but to date increased training slots and new funding
models are have not materialized.
Information technology has been recognized as a necessary support to clinical integration
and improved health outcomes and governments are investing in varying degrees. However,
initial projects indicate the costs of real time information technology are more than
anticipated (4)(16). This may deter some governments from province-wide implementation
or slow down the time frame.
________________________________________________________________________
7
8. Implementing Primary Care Reform in Canada: Barriers and Facilitators
Another potential barrier is expressed concerns about the privacy of the health information
that will be shared across practitioners or networks in the new delivery models. Although
there is no evidence that the information will be any less secure than in current primary care
settings, citizens do occasionally raise the issue and privacy legislation specific to health
information is being introduced or implemented in a number of provinces. Primary care
reform efforts will need to ensure compliance with new legislative requirements and take
into account citizens’ sensitivities.
6.2 Facilitators
There are a number of supports in place for primary care reform that will likely facilitate
implementation. New funding is being made available at the federal and provincial levels.
Health information systems are being put in place to support changed delivery. Initial
reports from early adopters of the new models are positive both from the provider and the
patient perspective. And, some provinces have new health professions legislation that
provides a more flexible regulatory scheme to take advantage of the full scope of practice of
non-physician personnel.
7.0 Why Has Implementation Been Slow?
Although we often use the term health care system, Canadians don’t really have a system.
Each province and territory has its own particular set of programs, models, funding rules etc.
Primary care is no different. Whatever the design for primary care in any particular
jurisdiction, it is still viewed as a program on its own. It is still not connected to other parts
of the health care system such as mental health services, long term care facilities, or home
care programs.
Until a systems approach is taken that integrates the constitute elements of health care,
primary care reform will likely be slow. Change is being attempted on a number of levels
with somewhat competing demands for attention, resources and public support. It is
difficult to see where the priority lies at present. This is combined with four year electoral
cycles that negate political will to change the closer the election call becomes. Therefore,
there are actually very short windows of opportunity to undertake reform, particularly when
those affected are not entirely supportive of all aspects of the change.
Given these conditions, it is not surprising that primary care implementation has been slow
and arduous.
8.0 Conclusions – Is it Impossible?
Despite the difficult policy environment, a number of factors have aligned which make the
likelihood of success stronger as we begin 2004 than it has been historically. These factors
include:
________________________________________________________________________
8
9. Implementing Primary Care Reform in Canada: Barriers and Facilitators
- there is an evidence-base for some of the elements of the reform packages;
- citizens are interested in comprehensive and accessible primary care services;
- a growing number of health professionals are expressing interest in new models of
care and are participating in projects;
- the required supports are coming on-line, albeit slowly.
Perhaps the question now is not why has implementation been slow but rather how patient
are we prepared to be?
________________________________________________________________________
9
10. Implementing Primary Care Reform in Canada: Barriers and Facilitators
9.0 References
1. Hutchsion B, Abelson J, Lavis J. Primary care in Canada: so much innovation, so
little change. Health Aff 2001; 20(3):116-31.
2. Lamarche PA, Beaulieu MD, Pineault R, Contandriopoulos AP, Denis JL, Haggerty J
et al. Choices for change: The path for restructuring primary healthcare services in
Canada. Final Report. Ottawa: Canadian Health Services Research Foundation.
November 2003.
3. Marriott J, Mable AL. Opportunities and potential. A review of international
literature on primary health care reform and models. Ottawa: Health Canada. August
2000.
4. Alberta Health and Wellness. Primary health care as a model: lessons learned.
August 2001.
5. BC Health Planning. Primary health care renewal in BC.
www.healthplanning.gov.bc.ca
6. Manitoba Health. Primary health care reform in Manitoba.
www.gov.mb.ca/health/primaryhealth.html
7. Department of Health. Primary health care renewal.
www.gov.ns.ca/health/phcrenewal/vision/htm
8. Ontario Ministry of Health and Long Term Care. Primary care reform in Ontario.
www.health.gov.on.ca/english/public/updates.archives/hu_03/docnurse/pricare
9. Prince Edward Island Department of Health and Social Services. Strategic Plan
2001-2005. www.gov.pe.ca
10. Ontario Health Review Panel. Toward a shared direction for health in Ontario.
Toronto. 1987.
11. British Columbia Royal Commission on Health Care and Costs. Closer to home.
Victoria: Government of British Columbia. 1991.
12. Premier’s Commission on Future Health Care for Albertans. The rainbow report:
our vision for health. Edmonton. 1989.
13. Minister’s Implementation Committee. Health strategy for the nineties: managing
better health. Halifax. 1990.
14. Canadian Medical Association. Physician Resource Questionnaire 2003.
www.cma.ca
________________________________________________________________________
10
11. Implementing Primary Care Reform in Canada: Barriers and Facilitators
15. Canadian Institute for Health Information. Health care in Canada 2003. Ottawa:
CIHI. 2003.
16. Knock M. Primary care demonstration project. Final report to the Health
Transition Fund. Ottawa: BC Primary Care Reform Project. March 31, 2001.
17. Maxwell J et al. A citizens’ dialogue on the future of health care in Canada.
Saskatoon: the Commission on the Future of Health Care in Canada. November
2002.
18. Pollara. Health care in Canada survey 2002. Toronto: Pollara.
19. Pollara. Public input on the future of health care in Canada. Saskatoon: the
Commission on the Future of Health Care in Canada. November 2002.
20. Fooks C and Maslove L. Understanding public views on concepts of population
health and health determinants. Submitted to CPHI. September 2003.
________________________________________________________________________
11