Term
| How does financing of acute care hospitals in Canada compare relative to other OECD countries? |
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Definition
| In Canada use a wide variety of approaches are used to fun hospitals including line by line, population based, global budget, and service based. Service based funding is used internationally. Compared to other OECD countries we spend more on our hospitals but they are in worse condition. |
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Term
| How do we compare on bed occupancy rate? What are the implications of this? |
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Definition
| We have a fewer number of acute care beds than the OECD average and they are at full occupancy. We have one of the highest occupancy rates of all the OECD countries. This means that during a bad outbreak of disease our hospital system would not be able to accomodate the extra patients because it is already stressed. |
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Term
| What have been the trends in financing in Canada? |
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Definition
| In Canada the majority of the health budget goes towards funding hospitals, followed by drugs and physicians. |
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Term
| What are the trends with respect to in-patient and out-patient services? What are the implications? |
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Definition
| Visits to out-patient care has increased substantially as well as the average number of in-patient days decreasing. This means that hospitals are putting more money into ambulatory care and less money into nursing inpatient services. |
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Term
| Where is the money 'spent' in hospitals? (Which part of the hospital takes up the most budget?) |
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Definition
| Most money is spent on paying salaries. Withing the hospital nursing inpatient services and diagnostic and therapeutic services get the biggest part of the budget. |
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Term
| What factors affect hospital costs? |
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Definition
| age, # of co-morbidities, flagged interventions (feeding tubes, IV's), other interventions (interventions on top of interventions) |
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Term
| What are the different types of funding formulas/budgets used to fund hospitals? |
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Definition
Line by line: funding per specific line item (ex. nursing salaries) based on what they have done in the past
global budgets: focus on total hospital spending but still based on last years spending
population based: demographic info used to predict demand for services, info based
service based: funding based on volume and type of case treated (weigh average cost of treating a case) |
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Term
| What are the pros/cons of different hospital funding types? |
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Definition
Line by line: links cost to activities (transparent), but it is difficult to re-allocate money. No incentive to improve efficiency, quality or innovate (spend less=less money next year). Lots of administration costs and difficult to link to needs of a community.
Global budget: can move money around based on needs, easy to calculate, encourages efficiency. Money not based on services (hospitals badly managed), inequities between hospitals, no wiggle room for higher demand, and cant accommodate change.
Population base: can be objective, equitable and accommodating to needs. The information is expensive, no incentives for performance, not all hospitals serve demographic around them (sick kids), expensive to run hospitals in isolation
Service based: incentives for efficiency. Patient induced demand,high administration costs? |
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Term
| Which type of hospital funding is used in Ontario? |
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Definition
| In Ontario hospitals are funded on global budgets but would like to change to a service based funding approach. |
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Term
| What are some of the challenges facing the hospital sector? |
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Definition
| Full beds, staffing shortages, hospital infrastructure and age |
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Term
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Definition
| Access to health care can be measured by looking at wait lists, services accessed, # of people with gps, and peoples perceptions. |
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Term
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Definition
| Measured by stats canada, commonwealth fund, fraser institute, and pollsters. |
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Term
| What do the various sources have to say about access to health care services? |
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Definition
Statistics Canada: 11% accessed specialist, 6% non-emergency surgery, 8.5% diagnostic tests, 10% accessed health care in a meaningful way
Commonwealth fund: U.S. healthcare system not working well, but Canada not doing much better, and in some cases worse.
Fraser Institute: looks at wait times which are long in canada. Not much has changed since romanov report but peoples perceptions have changed
Pollsters: confidence in canadian health care has fallen slightly and people are less against private health care than before. |
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Term
| How do we compare with respect to other countries on access? |
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Definition
| We are doing worse than most other OECD countries on wait times. |
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Term
| Are we making progress in access? If so, where? If not, where and why not? |
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Definition
We are making some progress with initiatives for wellness and disease prevention, increased efficiencies, prioritizing, and increasing the number of procedures.
There are also benchmark wait times for radiation oncology, hip replacement, knee replacement, cataract surgery, and cardiac surgery. |
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Term
| Have other countries had success addressing access issues? If so, who and how? |
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Definition
| Australia has had no success. England has had some success by setting aggressive targets, large funding boots, supplying side initiatives and private sector purchasing. New Zealand appeared to have had success but their approach was to kick everyone off wait lists and start over again, so not really a success. |
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Term
| What access concerns were raised in the Ombudsman's report? |
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Definition
newborn screening (only screening for 2, should be screening for at least 29), gotcha attitude
"enmeshed in red tape, blindly following rules without due consideration" |
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Term
| What is performance measurement? |
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Definition
| Performance measurement assesses the effectiveness of the health care system. |
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Term
| Why is performance measurement important? |
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Definition
| It will help us to improve our health care system by showing us where it is flawed. |
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Term
| What are performance indicators? |
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Definition
measurable elements of practice with evidence or consensus that they reflect quality
ex) health status measures: core indicators, health related measures: when direct measures not possible like # of readmissions or adverse incidents, non-health related measures: patient satisfaction |
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Term
| What are the 'core' indicators? |
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Definition
| infant mortality, life expectancy, and vaccine preventable diseases |
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Term
| How is performance measured among western nations? |
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Definition
| set of 40 indicators including: suicide rates, breast & cervical cancer screening, wait times, vaccine rates, smoking rates, patient doctor communication |
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Term
| What are the challenges to measuring performance in international setting? |
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Definition
| no international standards that are agreed upon. |
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Term
| International Working Group on Quality Indicators: What did they do? |
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Definition
| OECD countries working to develop a set of benchmark indicators to compare health system performance across countries. Made set of 40 indicators. |
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Term
| How does Canada compare on the international performance measures relative to other OECD countries? |
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Definition
| Canada has less doctors than most OECD countries, very good breast cancer survival rate. Does worse or slightly above average on most indicators. |
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Term
| Several outcome measures comparing UK & German Health Care systems-how do these systems compare? |
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Definition
Germany spends more on health care as a total expenditure. They also have more doctors and a slightly higher life expectancy. UK has long wait times, while wait times are non existent in Germany.
Both are universal, but Germany is a mandatory health insurance while in England services are paid for through general taxation. Germany is decentralized with mostly private physicians providing ambulatory care while UK has family physicians as gatekeepers. |
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Term
| Can you describe the German health care system and its various components? |
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Definition
Statutory health insurance is mandatory to all and provides a standardized level of care to all through sickness funds. The federal government oversee drugs & medical devices, vaccines, health education, surveillance and research. The state governments own hospitals, supervise health professions. Providers have a regional organizations. Payers:88% use statutory sickness funds, 9% use private health insurance if their income reaches threshold, and other 3% has free government healthcare.
People choose to join a sickness fund and then they pay premium. Contributions are income dependent. |
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Term
| Can you describe the UK health care system and relate the functions of its various components? |
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Definition
National Health services is the closest comparison to the canadian system. It provides health care to all regardless of ability to pay.
Department of Health: sets strategic direction for NHS and social services. Targets and benchmarks, allocates and secures resources, ensure accountability. 3 parts; standards and quality, delivery group, strategy and business.
Strategic Health Authority: sets up local health service framework, oversees local primary care trusts and NHS trusts. No role in purchasing or finance. 10 in england
Primary Care Trusts: determine local needs then commission providers and organizations to deliver services, directly fund physicians, dentists. Funded directly by DH.
NHS trusts: acute hospital, mental health, and ambulance services. Paid through arrangements with PCT's.Employ majority of NHS staff. Must meet national targets and break even financially (few do).
Foundation trusts: independent public benefit corporations. new, free from central gov't control and SHA performance management. accountable to local people,innovate for local community. Only trust able to borrow and retain surpluses.
NICE: national institute for clinical excellence, independent organization that operates like a watchdog. Conducts economic review and prioritizes new and existing technologies.
Healthcare commission: renewal in the systems |
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Term
| what are the major areas of health research? |
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Definition
| The major areas are biomedical (developing drugs), clinical, health services, and population health. |
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Term
| Why engage in health research? |
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Definition
| It leads to increased knowledge, creates knowledge based employment, improves economic health, and enhances international competitiveness. |
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Term
| Who are the major funders of health research? |
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Definition
major funders is the government and industry/NGO
CIHR, SSHRC, NSERC |
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Term
How do we compare internationally on health research?
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Definition
| We do not fare well compared to other OECD countries |
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Term
How much is spent on R & D in Canada?
Where is it spent? |
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Definition
| spending in 2006 was $6.6 billion, 1/4 of that was spent on health care. |
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Term
| What are the various legal challenges that have been or are before the canadian courts? |
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Definition
Chaoulli & Zelliotis: wait times violates charter of freedoms
Shona Holmes & Lindsay McCreith: right to private care |
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Term
| What were the results of the legal challenges? |
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Definition
4 to 3 judges ruled that wait times violated quebec charter of rights and freedoms.
accenting:right to life, liberty, and security of person should not be deprived. current system fails to provide public health care in a reasonable time. Government currently holds monopoly but it is failing to deliver so ban on private care found to be inconsistent with principles of fundamental justice.
dissenting: social policy should not be decided by judges, lack of specificity as to what constitutes reasonable health care within a reasonable time. |
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Term
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Definition
| encompasses a wide range of technology including telemedicine, EHR's, assistive devices. |
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Term
| Why do we want to implement e-health strategies? |
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Definition
| e-health could improve information accuracy, efficiency, track data for health surveillance and track diseases. |
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Term
| what are some barriers to implementation? |
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Definition
| some barriers: social & organizational, privacy, costs, interoperability, technology limitations, and uncertainty. |
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Term
| what happened at e-health ontario? |
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Definition
| 800 million on info superhighway that is unusable by most physicians because it was built for pcs and most physicians used macs. 2.5 million per month spent, and nothing to show for it. totally corrupt, ceo hiring friends. |
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