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Gregory P Marchildon, Michael Sherar
The respondents all raised valuable, informative points in response to our Invited Essay. There was convergence around the need to alter governance structures at the same time as payment arrangements for physicians to achieve higher-performing health systems within Canada. At the same time, there were different views on how best to address the disconnect between levels of physician remuneration and accountability for healthcare performance and delivery. In addition to ongoing efforts to improve governance, such as the recent amendments to the government-physician agreement in Alberta, individual provincial governments can and should take the lead in initiating and evaluating further payment and governance experiments...
April 2018: HealthcarePapers
Lars Nielsen, Arthur Sweetman
Understanding physician remuneration and its growth is extremely complex, much more so than for a typical worker. Highlighting one narrow aspect of this issue, this paper focuses on governments' increased incentives for physicians to incorporate and the ensuing physician response in the period 1996-2011. Nationally, incorporation rates increased for both general practitioners and specialists between 1996 and 2011. We observe that the largest changes in provincial regulation were in Ontario, and incorporation increased from 18% in 2001 to 54% five years later...
April 2018: HealthcarePapers
Susan Chatwood
This commentary responds to Marchildon and Sherar's (2018) paper, "Doctors and Canadian Medicare: Improving Accountability and Performance," in which they explore questions around governance and physician accountability in Canada. This response situates the issues raised in a northern context by sharing experiences with primary care reform in the Northwest Territories and exploring the implications these changes have had for physician accountability and reported system improvements. Physician leadership and accountability are further explored in the northern context, where health systems for Indigenous communities include multiple jurisdictions and transitions in governance advance the self-government, land claims and treaty rights of Indigenous peoples...
April 2018: HealthcarePapers
Jack M Mintz
The Marchildon and Sherar (2018) paper provides some useful insights: the role of primary care, improved approaches to physician compensation and the importance of accountability and governance. But their approach of focusing on doctors, including their compensation, misses the boat. Canada's healthcare system needs a major overhaul to improve integration and reward good performance for patient care going beyond medical practitioner compensation.
April 2018: HealthcarePapers
Tom McIntosh
Marchildon and Sherar's (2018) "Doctors and Canadian Medicare" presents a specific dilemma for healthcare reform: the ability of physicians to negotiate ever-increasing incomes without reference to the consequences to healthcare costs or provincial budgeting. This commentary situates that discussion in the broader debate of the challenges to healthcare reform as exemplified by studies such as Paradigm Freeze (Lazar et al. 2013) and the ability of provincial medical associations to act as both system insiders (gatekeepers) and outsiders (with no responsibility for system finances)...
April 2018: HealthcarePapers
John Church, Rob Skrypnek, Neale Smith
Like other Canadian provinces and territories, Alberta has been attempting to reform primary care since the mid-1990s. Although initially these efforts were focused almost exclusively on the method of payment for physicians, since 2003, the focus of government policy has broadened to include other aspects of practice, including governance and accountability, improved continuity, the use of a team-based approach and the use of electronic information systems. Although significant progress has been made, Alberta continues to face challenges...
April 2018: HealthcarePapers
Richard H Glazier, Tara Kiran
Many of the issues raised and insights provided by Marchildon and Sherar (2018) in their essay on doctors and Canadian medicare are on target. The inadequacy of available data on physician payment, however, calls into question the robustness of some interprovincial comparisons, and when it comes to compensation, comparisons to US physicians would be most relevant. In contrast to their assertion of a steadily increasing growth rate in physician expenditure, a more recent and longer view shows historically low growth in the past few years...
April 2018: HealthcarePapers
Lawrence Rosenberg
In hindsight, there have been unintended systemic consequences stemming from the traditional roles physicians have assumed and the structures within which they have been permitted to organize themselves. It is critical that the national discussion take account of this because we must reconcile ourselves to the current reality in which all other allied healthcare professionals are practising at "the top of their licence." Furthermore, the pace of technological change, especially the deciphering of the genome and the digitalization of virtually everything, has engendered a revolution characterized by the democratization of knowledge and technology, so that the point of care will be wherever the patient is...
April 2018: HealthcarePapers
Audrey Laporte
The rising portion of national income devoted to healthcare in general and the portion allocated to physician services have been a focus of the health policy literature for some time. Greater recognition should be given to the fact that the observed trends in physician service expenditures are the product of the interaction between physicians and provincial governments. Improving the productivity of healthcare systems in the delivery of high-quality primary care will require moving beyond simple oversight to deeper engagement with physicians as partners in system improvement...
April 2018: HealthcarePapers
Gregory P Marchildon, Michael Sherar
Physician compensation has been a rapidly growing segment of healthcare costs in Canada since the late 1990s. In comparative terms, Canadian physicians are now well compensated compared to physicians in other high-income countries. This has caused provincial governments to begin constraining physician remuneration. However, physician payment should be examined in a larger governance context, including the potentially changing role of physicians, as provincial governments try to improve quality, increase coordination and improve overall health system performance...
April 2018: HealthcarePapers
Terrence Sullivan
Physician bargaining with provincial governments has been a challenge in the provinces of Canada since the origins of medicare, when this bilateral negotiation first began in Saskatchewan and was eventually codified in the Canada Health Act. In recent years, the emergence of accountability for performance has become a central policy focus in advanced countries to raise the bar on the quality and value of physician services and their effective integration within the broader healthcare system. The challenge has been to create real accountability while balancing growth in physician incomes with fiscal capacity and affordability...
April 2018: HealthcarePapers
Gregory P Marchildon
In Canada, remoteness is mainly a northern phenomenon, with Indigenous residents constituting the majority population in the vast majority of northern communities. Despite this reality, there has been a surprising lack of research focus on the interface between remote and Indigenous health. From the perspective of health policy and system reform in Canada's north, there are at least three areas that are worthy of far greater research attention. The first, and perhaps most pressing, field of research would involve comparing various models and approaches for regional and Indigenous governance and administration and delivery of health services...
January 2018: HealthcarePapers
David Henry, Emmalin Buajitti, Laura Rosella
Although all-cause mortality rates have fallen in many countries in the last 40 years, the well-off and city dwellers have experienced the greatest gains. In this paper, we report on socio-economic and regional variations in premature mortality in Ontario. Premature mortality rates were highest in areas with the greatest degrees of social deprivation. While premature mortality continued to fall in the least deprived group, they flattened in the other groups and rose between 2000-2007 and 2008-2015 in the most deprived group...
January 2018: HealthcarePapers
Roger Strasser, Don Mitchell, Jessica Logozzo, Paul Preston, Neil Walker
To achieve sustainability, remote and rural communities require health service models that are designed in and for these settings and are responsive to local population health needs. This paper draws on a panel discussion at the Rural and Indigenous Health Symposium held in Toronto, ON, on September 21, 2017. Active community participation is an important contributor to success in rural health system transformation, as well as health workforce recruitment and retention. Increasingly, communication technology is contributing to the quality and effectiveness of healthcare in remote rural community settings, particularly by ensuring that specialist expertise is accessible to and supportive of the local providers of care...
January 2018: HealthcarePapers
Susan Chatwood
This commentary calls for a broader conceptualization of the healthcare system and proposes a health systems performance framework that will guide reconciliation and health system improvements in northern, Indigenous and rural communities. Reconciliation provides an opportunity to develop more reciprocal approaches to performance framework and indicator development in Indigenous and northern regions. An enhanced performance framework will inform management that is underpinned by policies and actionable strategies that build on evidence and Indigenous knowledge to inform health systems improvements...
January 2018: HealthcarePapers
Carrie Bourassa
This commentary examines the inequitable access to healthcare services that Indigenous peoples in Canada face on a daily basis. It considers not only geographical or physical access but also culturally safe access to healthcare. Racism is cited as a major deterrent in not accessing mainstream health services. Three recent studies are cited that reveal that racism, discrimination, stigma, sexism and bias prevent Indigenous peoples from accessing mainstream health services. Cultural safety training is recommended, as well as recruitment and retention of Indigenous health professionals...
January 2018: HealthcarePapers
Adalsteinn D Brown
No abstract text is available yet for this article.
January 2018: HealthcarePapers
Kerry Kuluski, Michelle L A Nelson, C Shawn Tracy, Carole Ann Alloway, Charles Shorrock, Sara Shearkhani, Ross E G Upshur
We are grateful for the thoughtful discussion and ideas put forth in this issue on the measurement of healthcare experiences. Our colleagues, who span multiple jurisdictions across Canada and internationally, agree that we need to do a better job at engaging patients and families in their care and measuring their experiences across health services and sectors. In this response paper, we reflect on three core content areas that were identified across the eight papers in this issue: the role of context and engagement-capable environments; approaches to improve the measurement of experience and acting on results; and challenges that must be attended to in our quest to make our healthcare systems work better...
October 2017: HealthcarePapers
Rose McCloskey, Pamela Jarrett, Linda Yetman
Improving performance measurement within the Canadian healthcare system is proving to be challenging despite advances in evidence-informed care and best practices for healthcare delivery. Perhaps what is most challenging is the need to meet requirements to measure what most Canadians hold dear - being seen as a person during a healthcare encounter. Measures of healthcare delivery have typically been developed to capture patient satisfaction during isolated healthcare encounters. Such measures simply do not get to the essence of what matters to patients and their families...
October 2017: HealthcarePapers
Sabina Nuti, Sabina De Rosis, Manila Bonciani, Anna Maria Murante
Patient experience should be the starting point to achieve a high quality of care. Coherently, healthcare performance evaluation systems, driving the change in line with the main strategic goals, should be designed considering the patient perspective. Instead, they are traditionally defined according to the healthcare service provider's point of view. Consequently, they reproduce a "silo-vision" characterized by a clear separation of responsibilities limited to a specific setting of care or to a single organization...
October 2017: HealthcarePapers
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