Grant: Partnerships for Health System Improvement (PHSI)

Alberta Health (Edmonton); Statistics Canada (Ottawa, ON); Canadian Association of Retired Persons (Toronto Ontario); Alberta Health Services; Health Canada (Ottawa); Institute of Health Economics (Edmonton); Fonds de recherche du Québec - Santé (FRQS); Nova Scotia Health Research Foundation; Ministère de la Santé et des Services sociaux (Québec); Nova Scotia Department of Health and Wellness (Halifax); Ontario Health - Health Quality Ontario (Toronto); Ontario Ministry of Health and Long Term Care

<html> <body> <p>Canada&rsquo;s aging population is putting pressure on our out-dated health care system. The realities of population aging mean our system must evolve to <em>be</em> a long-term care (LTC) system. It needs to shift its focus from hospitals and physicians towards a far greater reliance on community care, home care and nursing homes. Strains are already evident: long wait times for nursing homes and home care; increasing complexity of care needs for the lucky who have secured public LTC beds; persistently high numbers of patients in acute care hospitals who need LTC (&lsquo;bed-blockers&rsquo;) (CIHI, 2009); and spill-over to private retirement homes for increasingly complex care. Canadians are rightly anxious about access to and the quality of care they will receive later in life.<br> <br> Challenges to reforming our LTC system include the fact that provincial health budgets are stretched and that the <em>Canada Health Act</em> does not establish a federal role for LTC. The provinces need stable and sufficient funding for LTC&mdash;ensuring that all patients have equitable access to essential care, when they need it, from an appropriate provider. Experts are pessimistic as to the prospects of meeting this challenge under the existing mix of tax-based and private financing. There is an urgent need for both deeper research and policy-maker engagement into alternative finance models capable of achieving sustainable, universal LTC coverage in Canada. Definitions of 'long-term care' vary. &nbsp;Our main focus will be on individuals who qualify for costly institutionalized care, though we are interested in how alternative funding models might support home and community care.<br> <br> Our proposed in-depth <strong>case studies</strong> of the Netherlands and Germany present a valuable opportunity to re-examine other key components of provincial LTC systems, such as methods of needs assessment, payment, and delivery. Our team of policy-makers have expressed particular interest in learning from international experiences with &lsquo;personal care budgets&rsquo; (PCBs). Under this approach, LTC users are given the option of receiving cash or vouchers reflecting their assessed needs, with the aim of providing greater choice in the care and support they receive and allowing them to remain for longer periods of time at home and in their communities. From a finance perspective, properly designed PCBs hold the promise of averting or postponing more expensive institutional care.<br> <br> Armed with new research generated by our <strong>Systematic Review</strong> and <strong>Case Studies</strong> we will stage round-tables with decision-makers, to generate a range of policy options for Canada. On the basis of this, we will subsequently use <strong>computer simulations to project future utilization of LTC</strong> for different policy scenarios. Our policy-making partners will in concert with us determine other key criteria to be modelled, but we anticipate that we will model the following: 1) future utilization of LTC; 2) future costs and how they are distributed; 3) intergenerational equity issues and (where possible) 4) impact on labour markets, especially participation by woman.<br> <br> Our Systematic Review, Case Studies and Modelling will provide important new evidence to better inform LTC policy choices now and in the future. Together our team will fill a critical knowledge deficit, and help Canada move past a stagnant debate of public vs. private financing into a more sophisticated and nuanced understanding of alternative finance models, including their interplay with regulation and modes of delivery.</p> </body> </html>