Home care in Canada: passing the buck.

This paper provides an overview of Canadian home-care utilization, highlights the health-policy assumptions that have resulted in an increasing reliance on in-home services, and assesses the current roles of the private and public sectors in the financing of home care. Significant interprovincial variations in per capita home-care expenditures and potential inequalities in access to home care call for resolution by federal and provincial governments. There is a need for consensus with respect to medically and socially necessary services that are subject to national standards, irrespective of the setting in which services are sought, received, and delivered. The development and enforcement of national home-care standards that complement the principles of the Canada Health Act would be a useful first step in ensuring that the Canadian health-care system is ready to confront the challenges of the new millennium.

[1]  J. Freeman,et al.  ARE HOSPITAL SERVICES RATIONED IN NEW HAVEN OR OVER-UTILISED IN BOSTON? , 1987, The Lancet.

[2]  D. Sackett,et al.  On the need for evidence-based medicine. , 1995, Journal of public health medicine.

[3]  F. Weaver,et al.  Impact of home care on hospital days: a meta analysis. , 1997, Health services research.

[4]  J. Wright,et al.  Demographic variation in the rate of knee replacement: a multi-year analysis. , 1996, Health services research.

[5]  E. Vayda.  The Canadian Health Care System: An Overview , 1986, Journal of public health policy.

[6]  W. Weissert.  Seven reasons why it is so difficult to make community-based long-term care cost-effective. , 1985, Health services research.

[7]  G. Stoddart,et al.  Controlling health expenditures--the Canadian reality. , 1989, The New England journal of medicine.

[8]  D. Sackett,et al.  Evidence based medicine: what it is and what it isn't , 1996, BMJ.

[9]  Frances M. Weaver,et al.  The cost-effectiveness of home care. , 1991, Caring : National Association for Home Care magazine.

[10]  P. Coyte,et al.  Regional variations in the use of home care services in Ontario, 1993/95. , 1999, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[11]  M. Lund,et al.  Home care: the Ontario experience. , 1990, Pride Institute journal of long term home health care.

[12]  J. Rawls,et al.  John Rawls: A Theory of Justice , 1973 .

[13]  N. Weissman,et al.  Patient Outcomes Research Teams and the Agency for Health Care Policy and Research. , 1990, Health services research.

[14]  P. Coyte,et al.  Applied home care research. , 1997, International journal of health care quality assurance incorporating Leadership in health services.

[15]  W. Hsiao.  Medical savings accounts: lessons from Singapore. , 1995, Health affairs.

[16]  A. Maynard.  Evidence-based medicine: an incomplete method for informing treatment choices , 1997, The Lancet.

[17]  S Greenfield,et al.  The state of outcome research: are we on target? , 1989, The New England journal of medicine.

[18]  On the need for evidence-based medicine , 1995, Evidence Based Medicine.

[19]  H. Hricak,et al.  Evidence-based medicine. , 1997, Singapore medical journal.

[20]  C. Cready,et al.  Toward a model for improved targeting of aged at risk of institutionalization. , 1989, Health services research.

[21]  W. Weissert.  A new policy agenda for home care. , 1991, Health affairs.

[22]  T. Wan,et al.  Effects and Costs of Day-Care Services for the Chronically Ill: A Randomized Experiment , 1980, Medical care.

[23]  R H Brook,et al.  Variations in the use of medical and surgical services by the Medicare population. , 1986, The New England journal of medicine.

[24]  A. Linton.  The Canadian health care system. A Canadian physician's perspective. , 1990, New England Journal of Medicine.

[25]  Comparative health systems: the future of national health care systems and economic analysis. , 1990, Advances in health economics and health services research. Supplement.

[26]  A. Detsky,et al.  Evidence-based medicine. A new approach to teaching the practice of medicine. , 1992, JAMA.