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

2. 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

3. “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)

4. 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

5. 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

6. 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

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

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

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

10. Alberta Health and Wellness, 2005.

11. Pharmaceuticals
Discussion of a national pharmacare program

12. 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

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

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

15. Homecare A major theme nationally, but not provincially
Sustainable funding

16. “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