Health Reform: The Many Headed Dragon

1
Health Reform The Many- Headed Dragon

• Pols 321
• Lecture 6

2
Government Concerns

• cost control concern with how much money is
  being spent on public services
• efficacy concern with how the money is being
  spent
• coordination and integration concern with
  fragmentation of administration and delivery
• citizen participation concern with
  responsiveness and accountability

3
Health as an Ailing System

• corporate rationalizers (Alford, 1975)
• an attractive patient for the ministration of
  experts in cost-benefit analysis, programme
  budgeting, and other methodological niceties of
  the systems approach (Hoos, 1972)

4
Why Regionalization ?

• appears to address the major problems now
  associated with health care
• facilitates coordination and integration
• provides for greater responsiveness and
  accountability
• offers increased points of access for citizen
  participation
• allows for the prudent containment of costs

5
Why Regionalization?
Regionalizationnot only will make the
administration of health systems easier, but more
constructively, will aid in the distribution of
services to all regions on a more equitable
basisregionalization can also avoid duplication
of services, promote coordination among
specialist, and provide numerous points of access
for consumer participation. - Weller,
1977 -linked to the concepts of consumer
participation and CHCs
6
Health Politics Emerging Trend
health care delivery includes the organization
and management of health care as well as the
physical provision of services. - Raisa Deber,
2002 These components are increasingly linked
through the efforts of third party benefits plan
sponsors and public health programs to more
aggressively manage rapidly rising costs and
equally aggressive counter efforts by product
manufacturers, suppliers and private insurers to
expand their sales and markets. This makes for a
lot of politics, politicking and political
pressures.- Wendy Armstrong
7
Population Health

• Recognized need to increase efforts to promote
  health and wellness
• So far only major initiative has related to
  children

8
Financing

• How, who, sustainability
• Privatization
• De-insure, de-list
• User fees
• Contract out
• Private health insurance
• Public-private partnerships

9
Primary Care Reform

• Payment mechanisms
• Teams
• Gatekeeper role
• Continuity of care
• Rostering
• 24/7 (access)
• Focus on wellness/promotion

10
Alberta Health and Wellness, 2005.
11
Pharmaceuticals

• Discussion of a national pharmacare program

12
Health Human Resources

• Supply
• Reduce barriers by increased use of
  foreign-trained health providers, realignment of
  scopes of practice, consolidation of high risk
  procedures, AND national planning

13
Quality Assurance

• Needs for improved patient outcomes, clear
  performance measures/targets, public reporting
  and better information systems
• Agreement to 14 performance indicators

14
Governance/Accountability

• Improved federal-provincial-territorial relations
• Public reporting
• New structures to support public reporting

15
Homecare

• A major theme nationally, but not provincially
• Sustainable funding

16
The first time I started to look at the
Massachusetts General Hospital in the spring of
1969 I had the uneasy feeling there was too much
flux, too much instability in the system. I felt
a little like an interviewer who has come upon
his subject at a bad time. Only later did I
realize that there would never be a good time,
and that change is a constant feature of the
hospital environment. - Michael Crichton, 1969