HealthcarePapers
-
Academic health sciences centres in both the United States and Canada, once major "brokers" of medical and biomedical knowledge and other scare resources, are frequently depicted as "victims" of the environments in which they exist. While the national and local environments in which these organizations exist differ substantially, the integrity of AHSCs in both nations is threatened by a variety of emergent and continuing externalities. It is important that AHSCs develop a sufficient vision and market to be self-determining and successful in countering pressures that challenge their teaching, research and service activities. Leadership in both Canada and the United States must become much more skilled in strategic management to achieve this goal.
-
To the extent possible, drug policy should be based upon good quality evidence. This must extend beyond the traditional focus on efficacy and safety in carefully selected patients, to evidence about real-world effectiveness, cost-effectiveness and safety of drugs. This paper will consider methods of improving the quality of the evidence currently available, and the implications of requiring that evidence. ⋯ This program would build on the existing passive reporting of adverse events by adding a proactive system that would systematically describe the use and impact of drugs. The notion of drug safety would be extended to include not only adverse events, but also inappropriate use of drugs that results inpatients receiving drugs that do not benefit them. Inappropriate use wastes resources and can put patients and populations at risk.
-
Comment Review
Managing healthcare costs within an integrated framework.
Laupacis, Anderson and O'Brien's comprehensive diagnosis of the illness affecting the Canadian healthcare system is very insightful. In addition, their call for improving the quality of drug evidence and outcomes is a laudable goal. However, their prognosis of the negative impact on healthcare due to escalating drug costs appears to be rather pessimistic, as they fail to view drugs within an integrated framework. ⋯ The authors' goal-oriented concept of creating a clinical milieu that encourages cost-effective prescribing via "optimum" drug use is very attractive. One such approach is Disease Management, which relies on evidence-based, outcome-oriented performance indicators. It is highly regarded for promoting effective treatment options, improving patient care and optimizing healthcare resource utilization--hence deserving serious consideration for reducing overall costs while achieving improved outcomes.
-
The Mazankowski committee considered all too familiar problems with the Alberta healthcare system, in particular expenditure inflation and public "affordability," and the efficiency of the provision of care to the population. The remedies if offers are incomplete and unconvincing because of the failure to use rigorously the evidence base. ⋯ Investment in these areas together with global budgets and equitable financial allocations offers better health for the Alberta population. Many of the Council's proposals are not consistent with the goals of expenditure control, equity and efficiency.