Healthcare expenditure and community care delivery in Canada

Home Care and Community Care in Canada

The commitment towards reducing, eliminating and reducing inequities aims at extending the prevention timeline and modalities to victims of any disease. Health promotion promotes good health and sanitation to citizens. It also aims at providing and creating conducive environments that enable the society to be self-reliant in forming a robust community that can offer all aspects of a healthy care (Epp, 1986).

Communities are encouraged to participate in forming a health society through creating good health systems. This can be achieved by the active participation of communities in obtaining the desired community health policies and suggestions. There have been many efforts recently to bring the community on board in health participation. This is seen as the only way to create robust health systems sustaining a healthy society (Petersen, & Lupton, 1996).

Canada has had up and down curve of expenditure on healthcare for her citizens. Between the year 1975 and 1991 there was a growing expenditure in the healthcare investment. It was followed by a non-investment period of between 1992 and 1996 which accompanied by pull out of resources and investments. The Canadian government dealt with the logistical issues and prioritized healthcare leading to an annual growth of 4.0% per year through to the year 2011. This was the greatest breakthrough in health care in Canada. Since 2005, there has been a fairly moderated growth to date (Canadian Institute for Health Information 2013)

Canada is one of the high-income nations in the world, populated by 33 million individuals. In spite of the 2008 recession, Canada's economic performance remained strong. General tax proceeds of the territorial, federal, and provincial governments makes up around 70% of overall Canadian health costs. The nation has a highly decentralized system of health service delivery, governance, and organization, with the territories and provinces in charge of health service planning and Medicare administration. In the past decade, no significant pan-Canadian campaign for health reform has been witnessed; individual territories and provinces, however, have concentrated on perfecting or restructuring their respective regional healthcare structures and bettering timeliness, patient experience, and quality of chronic, primary, and acute care. Medicare has proven successful in providing citizens with financial safety against physician and hospital expenses (Marchildon, 2013).

A more inclusive approach to delivering care to communities is the establishment of community facilities. This model aims at providing24/7 health, community, and social services, as needed. Health professionals hailing from different disciplines provide care through an array of interventions. Health promotion, disease prevention, diagnostic care, palliative care, curative care, homecare, early detection, and rehabilitative services can be availed by patients. A core aspect is emphasis on care continuity and cooperation among care providers (College of Licensed Practical Nurses of Alberta, 2005).

Home care denotes care, which enables special needs patients to remain at home. 'Special needs individuals' include the elderly, the chronically sick, the disabled, or those recuperating from surgery. Home care facilities include the following

Personal care (e.g., assistance with washing hair, bathing, dressing, etc.)

Homemaking (e.g., cleaning, laundry, yard work, etc.)

Cooking or meal delivery

Health care (e.g., provision of health aide coming to assist patients at home)

Virtually all kinds of support are available. Some community and care services are donation- based or free, while others require a fee. Patient's health insurance or government programs help cover specific homecare costs, in some cases (Home Care Services: MedlinePlus, 2015).

Lit Review

In the early years of the Second World War, Canada did not have trained medical practitioners and hence it relied heavily on foreign-trained practitioners who were few to satisfy the needs of the country. In early 1970s, there was an upsurge in the number of medical practitioners most being foreign trained. In late 1980s, Canada prioritized the health care system and training of health care specialists. In Early 1990s, the great health care transformation happened that set the base for the great transformation of health care systems in Canada, which in return paved the way for decentralizing the system to effectively reach the locals (Clarke, & Wright, 2013).

Decentralized Administrative Structure

Decentralization of health systems was the major contributor to the successful health care systems in many regions. It was the biggest contributor to free and good health systems that are beneficial to the society. In mid 1990s, most provincial governance systems focused on creating better and improving the existing health care services that created and improved human value to the citizens. The governance systems invested heavily in research on health care systems and their jurisdictions. Much of the research findings on the health care systems emphasized on:

Decentralization of health care systems facility and equipment including and not limited to the health experts and practitioners

Local participation and input to the long-term health care systems.

Efficient communication and response health systems.

Integration of community health care services in the region (Boychuk, 2009).

The decentralized knowledge and practice appears to be declining over the last five years despite it being advocated for and being in use. This is due to lack of knowledge among the community members. The concerned parties (mostly the policy makers and analysts) have not been able to remove ambiguity in understanding decentralization in health care systems to the affected communities. The variables represented in research of how decentralization works and help communities in the health care systems only serve to confuse the benefactors more without the explanations and real representation. In other words, representations of the data in writing and proposals are not well understood by communities that make it an impediment to their acceptance by the communities. When politics is involved it is not possible for the project to be effectively implemented and hence it is better implemented on a non-political environment that is all inclusive (Black, & Fierlbeck, 2006). The current regionalization persists since it is politically useful in two ways:

It sustains concentration of power which existed in the past in formal healthcare decentralization

It restores representation system that existed before deployment of regionalization.

To understand the way regionalization is implemented in any jurisdiction, an individual needs have keen interest on the political setting around which regionalization strategies have been implemented (Black, & Fierlbeck, 2006).

Progress is, in fact, more restrained in the intergovernmental sphere since 2004, when the first 10-Year healthcare-strengthening plan was formulated. After that ministerial meeting, territorial and provincial administrations employed additional cash transfers from the federal government for investing in waiting time reduction in priority fields, boosting reforms in primary care, and offering more homecare coverage, as a substitute to hospital care. Several territorial and provincial governments commenced catastrophic medication coverage of some form for specific populations within their jurisdiction, but made very little progress in developing a pan-Canadian strategy for prescription drug management and coverage (Marchildon, 2005).

All territories and provinces have their own programs and policies concerning informal caregivers, often forming part of homecare benefits and services package provided by their respective governments. The Canadian federal government, since the year 2002, has provided eligible caregivers with tax credits. Following the outcome of one work by the Palliative and End-of-Life Care Unit (conducted between 2001 and 2007), the Canadian government launched Compassionate Care Benefits, offering 6 weeks of paid leave to employees for supporting terminally ill member of their family who have only about half a year to live. This Benefit comes under Employment Insurance and, hence, is not available to self-employed individuals and non- standard workers (Marchildon, 2005).

Societal Needs

Homecare in more extensively integrated territorial and provincial healthcare structures may be regarded as a more economical substitute to hospital care. Furthermore, rise in publicly financed homecare in the nation have brought about reduction in hospital service usage, decreased informal-caregiver dependence, and enhanced self-perceived health status levels. While there is no significant change in the basic profile and proportion of Canadian citizens receiving public-financed homecare services from mid-90s to mid-2000s, proof of growing needs of homecare receivers can be witnessed. For instance, in 1994-95, incontinent patients comprised 8% of receivers of homecare services; by 2003, however, this percentage increased more than twofold, to 17% (Wilkins, 2006).

A traditional health system is acceptable if it meets certain thresholds. The system should be able to influence health status and welfare in a positive way. The system should primarily target individual care effectively for it to be effective to the community. A good health system will be society-centered and is composed and dominated by practitioners ranging from nurses doctors and other physicians. In order to achieve the desired goal in providing quality health care, systems resources have to be adequately allocated (Lalonde, 1974).

Originally, the Canadian health system aimed at dealing with severe medical issues such as injuries, tuberculosis, diphtheria, measles, and scarlet fever. Chronic illnesses and diseases pose a greater challenge and burden. Such illnesses include diabetes, AIDS, cancer, and heart diseases. Most of these chronic diseases are occurring in old ages and in most cases, they cause cognitive issues to victims. Most hospitals in Canada are overpopulated by victims of such chronic illnesses.

70% of the deaths in Canada are caused by chronic illnesses

60% of the health costs in Canada arise from chronic illnesses

A third of yearly mortalities in Canada arise from chronic illnesses (Rachlis, 2004).

Primary care sector

Primary health care is the attention and care accorded to a patient immediately when an incidence occurs right from first aid to hospital care. Primary health care in any country defines the country's ability to manage and maintain good and quality healthcare system that focuses on fairness and fair cost care to all. A case example, Canada has, over the past period of between 10 to 20 years focused on creating good infrastructure and strengthening the already existing health infrastructure that support primary care. Primary care affects each and everybody in need of health care primarily. Every growing economy needs a good health care systems and a community needs a robust and accommodative primary care that is reachable at any time of need (Aggarwal, & Hutchison, 2012).

Initiatives by the Government

Governments agreed to first-dollar insurance coverage extension for targeted facilities in homecare in three fields: (1) a fortnight of acute homecare following discharge from infirmaries; (2) end-of-life homecare; and (3) a fortnight of acute homecare for mental health patients. Apparently, nearly all provinces now cover these limited areas, though there is considerable territorial and provincial variability with regard to other homecare facilities (Marchildon, 2005).

The process of healthcare restructuring now in progress in every territory and province has started heading in the direction of integrated systems. Territorial/Provincial administrations are instituting regional systems of healthcare, which integrate community health, hospitals, and homecare services. Nevertheless, it typically appears that the voice of health promotion and community health is weak; biomedical and hospital perspectives still dominate. Some marked improvements have been made with regard to preventive practice enhancement among professionals in the health sector, led by professional institutions (Bell, & Joly, 1998).

Though a majority of health reform plans by territorial/provincial governments includes statements supporting health promotion, cost cutting remains the overriding concern. The net impact has been major employee layoffs and closures of hospital beds. Whether this has been accompanied by redirection of savings of institutions to community-centered initiatives is unclear (Bell, & Joly, 1998).

Healthcare Professionals

Healthcare has a number of stakeholders that are directly involved with the system. Of importance are the health care professionals that work in the various departments of the healthcare system. They range from administration, patient care providers, equipment operators, equipment suppliers who altogether form the health care system and make it successful (Boychuk, 2009).

The Labor Statistics Bureau (BLS) estimated, in 2006, that homecare services and medical facilities employ 1.85 million workers; this figure does not include directly-appointed caregivers (i.e., hired by patients and their family members) and informal caregivers (Bureau of Labor Statistics, 2006). In this paper, the following categories will be addressed:

Licensed professionals: These include nurse practitioners, doctors, assisted living and nursing home administrators, registered nurses, other community service and home health agency CEOs and executives, and licensed vocational and practical nurses;

The rapidly growing number of nursing assistants in these years was both a response to the inadequate supply of registered nurses and the expansion of hospitals that characterized these years. Nursing assistants were a heterogeneous category of labor that had a long history within hospitals; however, it is readily acknowledged that nursing assistants have been important to nursing practice (Twohig, 2014).

Public financing of individual doctors, usually family physicians has developed Primary health care in Canada. However, there have been other models in the development of primary health care like the public health nurses, community health centers, well-baby clinics as well as the incorporation of non-medical health care providers whose focus is promotion of health have been included. The development of the system witnessed the rise of several concerns:

The absence of providers of primary health care;

the incoherent manner in which several sections of the health care system engaged with each other, usually leaving patients to seek medications from different institutions and providers;

problems in assimilating primary health care providers like nurse practitioners, social workers, pharmacists, or community health workers;

more evidence that practices in Canadian primary health care focus on acute or episodic conditions, while chronic conditions like diabetes, heart disease or even hypertension require more comprehensive care;

Recognition that more utilization of multidisciplinary teams of providers can decrease clinical errors, increase satisfaction in the provider, and improve patient outcomes within chronic and acute care settings (Health Council of Canada, 2005).

The Canadian health committee came up with three major new perspectives to deal with the health care systems. The perspectives agreed upon were:

The creation of the Federal Health Promotion Directorate housed within the Department of National Health and Welfare in 1978

Rapid growth in programs aimed at lifestyle featuring social marketing and health education campaigns

A refinement of health promotion practice in communities and grassroots efforts across the country (Evidence-informed change management in Canadian healthcare organizations. Ottawa, ON: Canadian Health Services Research Foundation, 2012)

The way forward for community health and homecare in Canada

Canada has a policy that no one should be denied medical attention in whatever situation or case he/she has found himself in. This policy helps greatly in achieving a healthy health care system to take care of her citizens (MacKinnon, 2013).

Reorientation

For effective positive change to occur in the healthcare system, there needs to be a mindset change in the key players. Their needs to be a re-organization of the key factors affecting the lives, principles and rules and the way certain regulations work. The factor that needs a lot to be done on is the way money and resources are used in the health care systems. For acceptability and uniformity, there is the need to come up with common definitions and standard measures. This will enable easy evaluation process and measurement of progress and effect of healthcare to communities (Starfield, Shi, & Macinko, 2005).

Community Participation

There is the need to come up with and build community-sharing forums that enable people to share and build on experiences. This plays a greater part in building and coming up with lasting solutions to support healthcare in the community. It is further reasonable and advisable that the governance systems facilitate efficient delivery models to the community. This is important in providing real time information and response to the community. With good systems, it means that there is easy information transfer, quick feedback and help reaches the victim in time. This will also foster the acceptance of the system by the community and the practitioners in general. Attention needs to be given to known impediments and barriers.

Remuneration Issues

Previously, there existed barriers to effective coordination between the stakeholders and that slowed down the pace and effectiveness of service delivery. These issues are the different interests of different key players. The different interests play out on different levels of the system. Many logistical issues are involved right from planning through training and implementation. The biggest difference creator is the remuneration issue that affects everyone across board. Different key players across board always seem to agitate for higher pay on different levels. This is a big concern.

Information and Communication

The need also to have better information system is another issue that all the stakeholders hold at high esteem. If unchecked, it may lead to failure in the service delivery. The training models needs to reflect future of collaborative practice between all disciplines of humanity. To achieve this, there is the need to have a continuous professional training program to the staff. Information technology is important today and so it has become another basic necessity to every aspect of life and it needs to be incorporated in the healthcare system as a management and reference tool. This facilitates the availability of information and patient's history whenever needed. To achieve the desired goals by the health system there needs to be a decision making support system that outline the steps and the accepted measures to the needs and evaluation of the people when needed (Nolte, & Tremblay, 2005).

Access to healthcare

Infrastructure shortage

Recent studies show that Canadians suffer in waiting for medical attention as compared to other countries. It is in this realization, that there is a need to come up with more swift and fluent course of actions to iron out these hitches in the medical healthcare systems. To realize these, goals have to be set and actualized (Health Care in Canada, 2012; Samson, 2003). Akin to other western democratic countries, Canada faces significant changes within its health care system. Undeniably, many writers as well as decision makers illustrate the extent of change the Canadian health care system needs as a large-scale transformation. The notion of the desire for noteworthy change in the Canadian system is extensive. In addition, the backdrop of change confronting the health care systems is wide. It entails issues that tend to challenge health care systems for a number of years; for instance, addressing needs of the aging population, executing effective primary care reform, enhancing management of chronic situations as well as end of life care, addressing patient safety problems, creating more inclusive care models and delivery, and handling increasing costs associated with health care. As well, as Canadian health care systems increase both in size and complexity, the amount of technical and people factors, which must be considered in carrying out change, grow considerably. Hence, the ground for change in the Canadian system is large and different (Dickson, Lindstrom, Black & Van der Gucht, 2012).

Services and Information delivery through Technology

Also, there are upcoming challenges that entail other areas like the change to service delivery models which promote patient centered and deploying effective health technology and information systems. There is a need to create an "innovation and transformation" web of organizations devoted to creating system-wide change. Considering the provinces' core role in change, federal government role and other national agencies supporting and expediting change should be re-evaluated and dealt with in the prevailing dialogue that is taking place in Canada with regard to the Premiers' latest obligation to cooperate and lead an innovation agenda. The aim is be to promote and allow national and provincial health organizations looking for quality improvements, primary care, safety, public health, information systems, drug and technology use, among others, all of which necessitate change in processes in order to work together in guaranteeing that there are adequate resources to support programs and knowledge support mainly for decision makers in learning and practicing change skills. The Canadian healthcare system is among the most de-centralized in the western world where its provincial governments are constitutionally authorized to offer health services in their jurisdictions. Therefore, the federal context in Canada is diffused with decision making duties operationalized at four levels: national, provincial, regional, and local as well as one "where central targets appear relatively absent in comparison with England ... allowing leadership to be more collective in Canada" (Dickson, Lindstrom, Black & Van der Gucht, 2012)

Social causes as well as consequences associated with health, illness, and healthcare arise from social forces such as social class, race, ethnicity, and gender that affect:

Illness and health possibility.

Experience in illness.

Behaviors in health care providers.

Procedures and results of an health care system (Weitz, 2009)

Welfare Reforms

Evaluation of Canada Health Act (CHA) illustrates the experience of welfare reforms in mid-1990s that provides a commanding lesson on the best way to make reforms within the Canadian health care. Federal budget in 1995 reformed the transfer of social programs to provinces. Moreover, the federal government eliminated many of the federal standards in trying to free provinces so that they can innovate and experiment in regulation, delivery, and funding social assistance as well as related programs. Many observers agree that in total, the changes were considerably successful with regard to the way it reduced dependency by focusing on assistance aimed at solving problems, creating individual programs targeting individual problems (Clemens & Esmail, 2012).