HealthcarePapers
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Comment
The public/private debate in the funding, administration and delivery of healthcare in Canada.
To help clarify the confusing debate concerning the public-private divide in Canada and the respective positions of the Romanow and Kirby reports, a new approach is proposed. The funding, administration and delivery of the healthcare "system" is split into distinct analytical categories and then applied to three major coverage groupings: universal public (Canada Health Act) coverage for medically necessary/required services; mixed coverage for drug care, home and long-term care; and private health goods and services. ⋯ In particular, the Romanow report recommended that home mental healthcare services become universally covered under the Canada Health Act as well as fundamental changes to the regulation and administration of prescription drug care. The reports also differed in terms of framing the private delivery question, with the Romanow report questioning whether the evidence justified private-for-profit delivery replacing current private not-for-profit or public arm's length delivery modes.
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Complementary and alternative medicine (CAM) use is increasing rapidly in Canada. This use is mostly driven by consumer demand. ⋯ This commentary highlights three areas of increasing maturation: the emergence of integrative healthcare; the development and application of new approaches to investigating CAM and integrative healthcare; and the development of a research infrastructure to support these developments. It is encouraging, the authors note, that organizations, networks and federal agencies such as the Canadian Institutes of Health Research and Health Canada are collectively and collaboratively identifying barriers to these developments and are developing strategies to overcome them.
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This paper addresses the problem of the implementation of both clinical and managerial evidence-based decision-making in healthcare. The lack of implementation of research findings in clinical and management practice has been identified as a key failure in healthcare. Many await the development of better methods of research transfer led by academics and clinicians. ⋯ The second way in which healthcare managers can act as catalysts for promoting evidence-based practice is through cataloguing and reporting, using documented stories, the unique barriers to evidence-based approaches that are peculiar to their specific healthcare environments. It is hypothesized that local contextual circumstances, which can be expressed only through stories, are the most powerful barriers to research transfer within specific organizations. This has implications for what we count as useful knowledge as we try to better understand how rigorous research on the one hand and research and stories on the other contribute to strategies for research transfer at the organizational level.
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Comment
Hospitals and academic health sciences centres: leaders or followers in health globalization?
The overall impact of globalization on health outcomes is contentious, but there is no doubt that knowledge transfer and the extension of specific health interventions to developing countries promise extraordinary benefits. It has been suggested that improved information/communications technology and the creation of distributed hospital systems leading a virtual healthcare web will permit realization of the promise of globalization. ⋯ The leading vision is most likely to come from academic institutions, researchers, health professionals and governments. The "super-hospital" of the future should be expected to play a key role as service provider and partner.
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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.