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Physician Compensation, Accountability and Performance in Canada: Changing the Pas de Deux. 加拿大医生报酬、责任和表现:改变双人舞。
Healthcare Papers Pub Date : 2018-04-01 DOI: 10.12927/hcpap.2018.25581
Terrence Sullivan
{"title":"Physician Compensation, Accountability and Performance in Canada: Changing the Pas de Deux.","authors":"Terrence Sullivan","doi":"10.12927/hcpap.2018.25581","DOIUrl":"https://doi.org/10.12927/hcpap.2018.25581","url":null,"abstract":"<p><p>Physician bargaining with provincial governments has been a challenge in the provinces of Canada since the origins of medicare, when this bilateral negotiation first began in Saskatchewan and was eventually codified in the Canada Health Act. In recent years, the emergence of accountability for performance has become a central policy focus in advanced countries to raise the bar on the quality and value of physician services and their effective integration within the broader healthcare system. The challenge has been to create real accountability while balancing growth in physician incomes with fiscal capacity and affordability. This commentary reflects a rich variety of perspectives from our contributing authors. It also lays out a number of challenges and changes that may be required to strengthen the importance of accountability for fair payments within Canadian medicare.</p>","PeriodicalId":35522,"journal":{"name":"Healthcare Papers","volume":"17 4","pages":"4-12"},"PeriodicalIF":0.0,"publicationDate":"2018-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.12927/hcpap.2018.25581","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36562308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Improving Physician Accountability through Primary Care Reform in Alberta. 通过阿尔伯塔省初级保健改革改善医生问责制。
Healthcare Papers Pub Date : 2018-04-01 DOI: 10.12927/hcpap.2018.25576
John Church, Rob Skrypnek, Neale Smith
{"title":"Improving Physician Accountability through Primary Care Reform in Alberta.","authors":"John Church,&nbsp;Rob Skrypnek,&nbsp;Neale Smith","doi":"10.12927/hcpap.2018.25576","DOIUrl":"https://doi.org/10.12927/hcpap.2018.25576","url":null,"abstract":"<p><p>Like other Canadian provinces and territories, Alberta has been attempting to reform primary care since the mid-1990s. Although initially these efforts were focused almost exclusively on the method of payment for physicians, since 2003, the focus of government policy has broadened to include other aspects of practice, including governance and accountability, improved continuity, the use of a team-based approach and the use of electronic information systems. Although significant progress has been made, Alberta continues to face challenges.</p>","PeriodicalId":35522,"journal":{"name":"Healthcare Papers","volume":"17 4","pages":"48-55"},"PeriodicalIF":0.0,"publicationDate":"2018-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36562681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Regional Inequalities in All-Cause and Premature Mortality in Ontario. 安大略省全因死亡率和过早死亡率的区域不平等。
Healthcare Papers Pub Date : 2018-01-01 DOI: 10.12927/hcpap.2018.25504
David Henry, Emmalin Buajitti, Laura Rosella
{"title":"Regional Inequalities in All-Cause and Premature Mortality in Ontario.","authors":"David Henry,&nbsp;Emmalin Buajitti,&nbsp;Laura Rosella","doi":"10.12927/hcpap.2018.25504","DOIUrl":"https://doi.org/10.12927/hcpap.2018.25504","url":null,"abstract":"<p><p>Although all-cause mortality rates have fallen in many countries in the last 40 years, the well-off and city dwellers have experienced the greatest gains. In this paper, we report on socio-economic and regional variations in premature mortality in Ontario. Premature mortality rates were highest in areas with the greatest degrees of social deprivation. While premature mortality continued to fall in the least deprived group, they flattened in the other groups and rose between 2000-2007 and 2008-2015 in the most deprived group. There were substantial variations in premature mortality rates across the Local Health Integration Networks, with the greatest disadvantage being seen in the southeast, northwest and northeast regions of Ontario. These data present a major challenge to policy makers. Health, social and economic policies need to be directed toward narrowing the gaps we have identified here. We have excellent metrics with which to measure their success.</p>","PeriodicalId":35522,"journal":{"name":"Healthcare Papers","volume":"17 3","pages":"28-34"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36349580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Challenges of Capacity and Development for Health System Sustainability. 能力和发展对卫生系统可持续性的挑战。
Healthcare Papers Pub Date : 2018-01-01 DOI: 10.12927/hcpap.2018.25505
Roger Strasser, Don Mitchell, Jessica Logozzo, Paul Preston, Neil Walker
{"title":"Challenges of Capacity and Development for Health System Sustainability.","authors":"Roger Strasser,&nbsp;Don Mitchell,&nbsp;Jessica Logozzo,&nbsp;Paul Preston,&nbsp;Neil Walker","doi":"10.12927/hcpap.2018.25505","DOIUrl":"https://doi.org/10.12927/hcpap.2018.25505","url":null,"abstract":"<p><p>To achieve sustainability, remote and rural communities require health service models that are designed in and for these settings and are responsive to local population health needs. This paper draws on a panel discussion at the Rural and Indigenous Health Symposium held in Toronto, ON, on September 21, 2017. Active community participation is an important contributor to success in rural health system transformation, as well as health workforce recruitment and retention. Increasingly, communication technology is contributing to the quality and effectiveness of healthcare in remote rural community settings, particularly by ensuring that specialist expertise is accessible to and supportive of the local providers of care. Recent medical graduates bring life experiences and work expectations to rural primary care that are different from their senior colleagues. Successful recruitment and retention of the rural primary care workforce depend increasingly on offering a \"turnkey\" clinic work supported by a functioning electronic medical record. Rural health system sustainability occurs most frequently through ongoing collaboration and partnerships, partnerships, partnerships. It is through partnerships with communities, health services and healthcare providers that the Northern Ontario School of Medicine (NOSM) has been successful in producing medical graduates who provide care responsive to population health needs in previously underserved communities of northern Ontario. Sustainable healthcare in remote and rural communities is enhanced by active community participation and clustering these communities in local networks. An important key to success is shifting from hospital-centric to community-centric care.</p>","PeriodicalId":35522,"journal":{"name":"Healthcare Papers","volume":"17 3","pages":"18-27"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36349579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
The Challenge of Rural and Northern Health Systems. 农村和北方卫生系统的挑战。
Healthcare Papers Pub Date : 2018-01-01 DOI: 10.12927/hcpap.2018.25508
Adalsteinn D Brown
{"title":"The Challenge of Rural and Northern Health Systems.","authors":"Adalsteinn D Brown","doi":"10.12927/hcpap.2018.25508","DOIUrl":"https://doi.org/10.12927/hcpap.2018.25508","url":null,"abstract":"Canada’s rural and northern health communities reflect and amplify the greatest challenges facing our health system today. Chief among these challenges is the continuing dramatic inequity in health between Indigenous and non-Indigenous peoples in Canada. Fittingly, this issue on rural and northern health systems features separate pieces on Indigenous health that transcend the rural and northern context. But the challenges facing northern and rural health systems also bring into clear focus the immensity of Canada. Smaller communities, spread broadly across large geographies, do not have the ability to sustain and access the resources of dense urban settings. This means that health inequities are accentuated by access to the resources necessary to ensure the promise of access to care. A recent paper by Young et al. (2016) with contributions from two of the authors in this issue (Chatwood 2018; Marchildon 2018) pointed to both the higher costs of access and lower performance related to access in our north. For many years, the prevailing wisdom of healthcare politics has been more is better. More physicians, more nurses and more access to care. While more is definitely necessary in our rural and northern communities, it is clear that more will not be enough on its own. Real health reform that benefits rural and northern communities will depend on meeting the Calls to Action from the Truth and Reconciliation Commission. It will also depend on articulating new relationships between rural and urban centres, on the spread and scale of new ways of providing care that match the challenges of remote geographies and on educational and The Challenge of Rural and Northern Health Systems","PeriodicalId":35522,"journal":{"name":"Healthcare Papers","volume":"17 3","pages":"3-4"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.12927/hcpap.2018.25508","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36349576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Reconciliation and Health Systems Performance in Northern, Indigenous and Rural Communities. 北部、土著和农村社区的和解与卫生系统绩效。
Healthcare Papers Pub Date : 2018-01-01 DOI: 10.12927/hcpap.2018.25506
Susan Chatwood
{"title":"Reconciliation and Health Systems Performance in Northern, Indigenous and Rural Communities.","authors":"Susan Chatwood","doi":"10.12927/hcpap.2018.25506","DOIUrl":"https://doi.org/10.12927/hcpap.2018.25506","url":null,"abstract":"<p><p>This commentary calls for a broader conceptualization of the healthcare system and proposes a health systems performance framework that will guide reconciliation and health system improvements in northern, Indigenous and rural communities. Reconciliation provides an opportunity to develop more reciprocal approaches to performance framework and indicator development in Indigenous and northern regions. An enhanced performance framework will inform management that is underpinned by policies and actionable strategies that build on evidence and Indigenous knowledge to inform health systems improvements. Performance measurement systems rooted in reconciliation and based on Indigenous values enable us to have a deeper understanding of system drivers and the legislation and policy levers that perpetuate health inequities.</p>","PeriodicalId":35522,"journal":{"name":"Healthcare Papers","volume":"17 3","pages":"11-17"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36349578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
A Policy Research Agenda for Health Systems in Canada's North. 加拿大北部卫生系统政策研究议程。
Healthcare Papers Pub Date : 2018-01-01 DOI: 10.12927/hcpap.2018.25503
Gregory P Marchildon
{"title":"A Policy Research Agenda for Health Systems in Canada's North.","authors":"Gregory P Marchildon","doi":"10.12927/hcpap.2018.25503","DOIUrl":"https://doi.org/10.12927/hcpap.2018.25503","url":null,"abstract":"<p><p>In Canada, remoteness is mainly a northern phenomenon, with Indigenous residents constituting the majority population in the vast majority of northern communities. Despite this reality, there has been a surprising lack of research focus on the interface between remote and Indigenous health. From the perspective of health policy and system reform in Canada's north, there are at least three areas that are worthy of far greater research attention. The first, and perhaps most pressing, field of research would involve comparing various models and approaches for regional and Indigenous governance and administration and delivery of health services. The second concerns a program of research on the inevitable trade-offs in cost, responsiveness and quality between providing a broader range of health services in northern communities or transporting northern residents to southern urban centres for such services. The third research area should explore the ways in which primary care can be made even more effective in remote areas. Properly designed comparative research can take advantage of the past and current policy and system differences in the provinces and territories.</p>","PeriodicalId":35522,"journal":{"name":"Healthcare Papers","volume":"17 3","pages":"35-40"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36348510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Addressing the Duality of Access to Healthcare for Indigenous Communities: Racism and Geographical Barriers to Safe Care. 解决土著社区获得医疗保健的双重问题:种族主义和安全护理的地理障碍。
Healthcare Papers Pub Date : 2018-01-01 DOI: 10.12927/hcpap.2018.25507
Carrie Bourassa
{"title":"Addressing the Duality of Access to Healthcare for Indigenous Communities: Racism and Geographical Barriers to Safe Care.","authors":"Carrie Bourassa","doi":"10.12927/hcpap.2018.25507","DOIUrl":"https://doi.org/10.12927/hcpap.2018.25507","url":null,"abstract":"<p><p>This commentary examines the inequitable access to healthcare services that Indigenous peoples in Canada face on a daily basis. It considers not only geographical or physical access but also culturally safe access to healthcare. Racism is cited as a major deterrent in not accessing mainstream health services. Three recent studies are cited that reveal that racism, discrimination, stigma, sexism and bias prevent Indigenous peoples from accessing mainstream health services. Cultural safety training is recommended, as well as recruitment and retention of Indigenous health professionals. Several recommendations to address physical and geographical access are also recommended, including self-governance and capacity building; enhanced partnerships and collaboration to address jurisdictional issues, particularly for First Nations communities, and a national strategy for access to healthy and affordable food in northern, remote and rural communities.</p>","PeriodicalId":35522,"journal":{"name":"Healthcare Papers","volume":"17 3","pages":"6-10"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36349577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 9
Experience of Care as a Critical Component of Health System Performance Measurement: Recommendations for Moving Forward. 作为卫生系统绩效衡量关键组成部分的护理经验:向前发展的建议。
Healthcare Papers Pub Date : 2017-10-01 DOI: 10.12927/hcpap.2017.25415
Kerry Kuluski, Michelle L A Nelson, C Shawn Tracy, Carole Ann Alloway, Charles Shorrock, Sara Shearkhani, Ross E G Upshur
{"title":"Experience of Care as a Critical Component of Health System Performance Measurement: Recommendations for Moving Forward.","authors":"Kerry Kuluski,&nbsp;Michelle L A Nelson,&nbsp;C Shawn Tracy,&nbsp;Carole Ann Alloway,&nbsp;Charles Shorrock,&nbsp;Sara Shearkhani,&nbsp;Ross E G Upshur","doi":"10.12927/hcpap.2017.25415","DOIUrl":"https://doi.org/10.12927/hcpap.2017.25415","url":null,"abstract":"<p><p>People's experiences can provide critical guidance on how to better meet their quality of life and care needs and deploy resources more appropriately. To maximize the utility of experience data and to advance the current debate, we present four recommendations: (1) measuring experiences outside the healthcare system can provide insight into what needs to change within the healthcare system; (2) focusing on patient experience is necessary but insufficient, (family) caregiver insights and experiences require attention and can provide insight into the needs of the patient; (3) moving from \"one time/single sector\" measurement of experience to iterative, ongoing measurement across sectors better reflects the true lived experience of patients (especially those with complex care needs) and their caregivers; and (4) embedding measurement within engagement-capable environments that adequately resource patients, caregivers, and providers to work together is required to move from collection to meaningful change. Applying these recommendations requires a longer-term vision, shifting from provider-centred to person-centred models of care, and a deep understanding of the structural, cultural, and normative barriers to measuring care experiences.</p>","PeriodicalId":35522,"journal":{"name":"Healthcare Papers","volume":"17 2","pages":"8-20"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.12927/hcpap.2017.25415","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35959425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 14
Rethinking Healthcare Performance Evaluation Systems towards the People-Centredness Approach: Their Pathways, their Experience, their Evaluation. 以人为本的医疗绩效评估体系的反思:他们的路径，他们的经验，他们的评估。
Healthcare Papers Pub Date : 2017-10-01 DOI: 10.12927/hcpap.2017.25408
Sabina Nuti, Sabina De Rosis, Manila Bonciani, Anna Maria Murante
{"title":"Rethinking Healthcare Performance Evaluation Systems towards the People-Centredness Approach: Their Pathways, their Experience, their Evaluation.","authors":"Sabina Nuti,&nbsp;Sabina De Rosis,&nbsp;Manila Bonciani,&nbsp;Anna Maria Murante","doi":"10.12927/hcpap.2017.25408","DOIUrl":"https://doi.org/10.12927/hcpap.2017.25408","url":null,"abstract":"<p><p>Patient experience should be the starting point to achieve a high quality of care. Coherently, healthcare performance evaluation systems, driving the change in line with the main strategic goals, should be designed considering the patient perspective. Instead, they are traditionally defined according to the healthcare service provider's point of view. Consequently, they reproduce a \"silo-vision\" characterized by a clear separation of responsibilities limited to a specific setting of care or to a single organization. This commentary discusses the importance of using patient-reported measures together with indicators based on administrative data to evaluate cross-setting healthcare services within a multidimensional healthcare performance evaluation system. The experience of the Tuscany regional healthcare Performance Measurement System (PMS), implemented more than 10 years ago and in continuous evolution, represents an innovative example of how to measure the quality of the whole care pathway including patient experience. This new approach is based on a systematic, systemic and standardized collection of patient-reported experience measures in several healthcare pathways and evaluating them using a coherent graphical representation. Targets, incentives and other managerial tools are fixed, overcoming organizational boundaries and integrating the patient point of view with the goal of moving the healthcare system towards a patient-centredness approach to care.</p>","PeriodicalId":35522,"journal":{"name":"Healthcare Papers","volume":"17 2","pages":"56-64"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.12927/hcpap.2017.25408","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35959428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 44
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