HealthcarePapers
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Significant early positive cultural changes have been made in the Ontario healthcare system to address the province's Wait Time Strategy. Improving efficiency in parallel with the introduction of accountability agreements will provide early successes. ⋯ Innovative approaches such as gain-sharing should be considered. Though resources are scarce, there is a need for significant early additional investments to achieve long-term success.
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Physician reimbursement in Canada has been dominated by pay-for-volume which leads to high utilization. The concern is that this does not promote attention to quality issues that are known to affect health services. However, the evidence that pay-for-quality works is weak, despite the logic of the approach. ⋯ Canada offers opportunities to assess the effect of pay-for-performance in several areas. Developing primary care networks are attractive locations to study the effect of pay-for-quality, perhaps even in a randomized trial. Specialized high-volume surgical programs, such as the Alberta arthroplasty pilot project, might be study of pay-for-participation, in a partnership of providers and sponsors.
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After a late start, Ontario is well on its way to implementing an ambitious Wait Time Strategy that has already begun to show some tangible improvements in access to the five priority areas. This commentary argues that in addition to the supporting tools identified in the lead essay, a sustainable wait time strategy must encompass prevention and demand management, address shortages in health human resources, provide patients with recourse to a safety valve and promote interprovincial standards and cooperation. Care will also be needed to ensure ongoing support and engagement of organized medicine, realigning incentives to support patient care and extending the reach of health information systems into the community.
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The Australian Council for Safety and Quality in Health Care (the Council) has made considerable advances in gaining acceptance of and commitment to the healthcare safety improvement agenda by all involved in healthcare in Australia. It has provided a focus for national efforts in safety and quality improvement, by raising awareness, building consensus and clarifying areas for priority action. While the Council has set the agenda for change and provides advice in relation to problems, initiatives and actions, it has limited operational capacity and lacks the statutory authority to embed a culture of safety at all levels of the healthcare system. ⋯ Progress depends on coordinating the activities of Departments of Health and Human Services of nine sovereign governments. The "levers for change" available to the Council were leadership, persuasion, advice and example, with the ability to develop strategies, frameworks, standards, tools and guidelines. With the end of the Council's term approaching, a recent review recommended the establishment of an Australian Commission on Safety & Quality in Health Care (the Commission).
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Cancer Care Ontario (CCO) is the largest provincial cancer agency in Canada, with a long and rich history as a specialized service entity within a generic delivery system in Ontario. CCO's evolution has been well characterized by Hayter (1998), and described by us previously (Sullivan et al. 2003, 2004). Once criticized as a very inward-looking body with a mixed record in solving a series of radiation waiting-time crises, CCO has reinvented itself over the past three years in ways that are very similar to the transformation of the Veterans Health Administration.