HealthcarePapers
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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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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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Public health systems in other countries have been experimenting with pay mechanisms that specifically target improvements in productivity and quality. The potential gains are huge, but actual results are less certain, since they rely on a detailed and strategic understanding of local incentives. ⋯ As the international community sets new standards for both quality and productivity in healthcare, Canadians will find it increasingly difficult to stay with their existing pay mechanisms, safe as they may seem to us at the moment. The transition, which will not be easy, will force us to take a hard look at some of the values we take for granted.
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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.