Health Reform: The Many- Headed Dragon Pols 321 Lecture 6

Government Concerns cost control: concern with how much money is being spent on public services efficacy: concern with how the money is being spent coordination and integration: concern with fragmentation of administration and delivery citizen participation: concern with responsiveness and accountability

“Health as an Ailing System” “corporate rationalizers” (Alford, 1975) “an attractive patient for the ministration of experts in cost-benefit analysis, programme budgeting, and other methodological niceties of the systems approach” (Hoos, 1972)

Why Regionalization ? appears to address the major problems now associated with health care: facilitates coordination and integration provides for greater responsiveness and accountability offers increased points of access for citizen participation allows for the prudent containment of costs

Why Regionalization? “Regionalization…not only will make the administration of health systems easier, but more constructively, will aid in the distribution of services to all regions on a more equitable basis…regionalization can also avoid duplication of services, promote coordination among specialist, and provide numerous points of access for consumer participation.” - Weller, 1977 -linked to the concepts of consumer participation and CHCs

Health Politics: Emerging Trend “health care delivery includes the organization and management of health care as well as the physical provision of services.” - Raisa Deber, 2002 “These components are increasingly linked through the efforts of third party benefits plan sponsors and public health programs to more aggressively manage rapidly rising costs – and equally aggressive counter efforts by product manufacturers, suppliers and private insurers to expand their sales and markets. This makes for a lot of politics, politicking and political pressures.”- Wendy Armstrong

Population Health Recognized need to increase efforts to promote health and wellness So far only major initiative has related to children

Financing How, who, sustainability Privatization De-insure, de-list User fees Contract out Private health insurance Public-private partnerships

Primary Care Reform Payment mechanisms Teams Gatekeeper role Continuity of care Rostering 24/7 (access) Focus on wellness/promotion

Alberta Health and Wellness, 2005.

Pharmaceuticals Discussion of a national pharmacare program

Health Human Resources Supply Reduce barriers by increased use of foreign-trained health providers, realignment of scopes of practice, consolidation of high risk procedures, AND national planning

Quality Assurance Needs for improved patient outcomes, clear performance measures/targets, public reporting and better information systems Agreement to 14 performance indicators

Governance/Accountability Improved federal-provincial-territorial relations Public reporting New structures to support public reporting

Homecare A major theme nationally, but not provincially Sustainable funding

“The first time I started to look at the Massachusetts General Hospital in the spring of 1969 I had the uneasy feeling there was too much flux, too much instability in the system. I felt a little like an interviewer who has come upon his subject at a bad time. Only later did I realize that there would never be a “good” time, and that change is a constant feature of the hospital environment.” - Michael Crichton, 1969