Tuesday, September 13, 2011

Solutions Within Medicare

Nurses for Medicare

There are better solutions for a sustainable Canadian health system that reflects Canadian needs.

Improvements are needed in the health system to make it more sustainable, but these improvements need to be made within the public funding framework.

Health system reform requires greater accountability with respect to the health-care budget – in other words, stronger business cases to justify spending and greater emphasis on outcomes.

  • New models of care that use a multidisciplinary, team-based approach can improve access to care and better utilize existing human resources. The Capital District Health Authority in Halifax has started a new program using a collaborative team of nurses and fee-for-service physicians. After six months, the teams estimated a 52 per cent increase in the number of patients scheduled for appointments each hour and a reduction in wait times for the next appointment from 1-2 weeks to the next day (Smith, 2007). The Alberta Bone and Joint Health Institute’s “new approach to hip and knee replacements” has reduced the average wait time between consultation and surgery from 290 working days to 37 days, all within the publicly funded system (Canadian Health Services Research Foundation, 2008).
  • A wider adaptation of the queuing theory in the health system would increase through-put and reduce wait times. Around the globe, the queuing theory has been used in in-patient facilities, outpatient clinics, physician offices, public health units, facility and resource planning, emergency preparedness planning, mental health care, long-term care, pharmacy services and inventory control (Singh, 2006). The Saskatoon Community Clinic is using the “Improved Access” queuing model, which has reduced wait times from 36 days for a complete physical or eight days for a regular appointment to two days for most kinds of appointments (Larson, 2006). Recent survey results have shown that almost 90 per cent of respondents received an appointment at the clinic within their requested timeframe (private communication, Ingrid Larson, 2008). The Saskatchewan Surgical Care Network is using a province-wide surgical patient registry as part of an initiative to reduce wait times. Both of these models are being used within the publicly funded system.
  • A greater emphasis on strategies that promote healthy living and prevent chronic disease will reduce the demand for health services. In Canada, chronic disease accounted for approximately 89 per cent of all deaths in 2005 and at least 67 per cent of all direct health-care costs (World Health Organization [WHO], n.d.; Conference Board of Canada, 2004). According to WHO (n.d.), at least 80 per cent of cases of premature heart disease, stroke and type 2 diabetes and 40 per cent of cancer cases in Canada “could be prevented through a healthy diet, regular physical activity and avoidance of tobacco products.” Investment in a best practice approach to chronic disease prevention management that is population-based, patient-centred and focused on health promotion, disease prevention and disease management “has the potential to realize annual benefits of $1.6 billion in avoided health-care costs” (Morgan et al., 2007).

Expanding the use of innovative technologies will improve health care and enhance the productivity of the health-care workforce. River Valley Health in New Brunswick has incorporated telehealth into its home care program, resulting in improved clinical responsiveness through daily monitoring: a study showed 85 per cent fewer hospital admissions and 55 percent fewer visits to the emergency department among people enrolled in the program (Canadian Home Care Association, 2006). Telehomecare, as it commonly referred to, reduces the frequency of home care visits that nurses need to make, thereby improving their productivity (Canadian Home Care Association, 2008).


Canadian Health Services Research Foundation. (2008). Evidence boost: Manage waits centrally for better efficiency. Ottawa: Author. Retrieved September 23, 2008, from www.chsrf.ca/mythbusters/html/boost13_e.php

Canadian Home Care Association. (2006). High impact practices. Ottawa: Author. Retrieved September 11, 2008, from www.cdnhomecare.ca/media.php?mid=1744

Canadian Home Care Association. (2008). Integration through information communication technology for home care in Canada: Final report. Ottawa: Author. Retrieved September 10, 2008, from www.cdnhomecare.ca/media.php?mid=1840.

Conference Board of Canada. (2004). Understanding health care cost drivers and escalators. Ottawa: Author.

Larson, I. (2006). Improved access at the community clinic. Focus: Saskatoon Community Clinic, 42(2), 2. Retrieved September 9, 2008, from www.saskatooncommunityclinic.ca/pdf/2006-summer-focus.pdf

Morgan, M.W., Zamora, N.E., & Hindmarsh, M.F. (2007). An inconvenient truth: A sustainable healthcare system requires chronic disease prevention and management transformation. Health Papers, 7(4), 6-23.

Singh, V. (2006). Use of queuing models in health care. [Unpublished paper.] Available at http://works.bepress.com/vikas_singh/4

Smith, Patsy. (2007). Nursing in your family practice: A program for physicians. Preliminary qualitative findings. Halifax: Capital Health Primary Care.

World Health Organization. (n.d.). Facing the facts: The impact of chronic disease in Canada. Retrieved September 9, 2008, from www.who.int/chp/chronic_disease_report/media/impact/en/index.html

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