Canada - World Health Organization Regional Office for Europe

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110 Health systems in transition Canada • enhance analysis of cost drivers and cost-effectiveness, including best practices, in public drug plan policies. Although the ministerial committee made incremental progress, work on the nine reform items had largely come to a halt by the end of the decade. This was due in part to changes in federal and provincial government administrations in the intervening years, and it leaves a large policy vacuum that remains to be addressed in the future (HCC, 2009). 5.7 Rehabilitation/intermediate care Inpatient rehabilitation services provided in hospitals and specialized rehabilitation facilities are deemed medically necessary services and are available without charge to Canadians. Inpatient rehabilitation tends to focus on orthopaedics (immediately following hip and knee replacement surgery), stroke, brain dysfunction, limb amputation and spinal cord injury, with almost two-thirds (63%) involving orthopaedic and post-stroke rehabilitation (CIHI, 2008a). Public coverage, including workers’ compensation for outpatient rehabilitation services, varies by province and territory, and PHI coverage and OOP payments are common (Landry et al., 2008; Landry, Raman & Al-Hamdan, 2010). These outpatient services are generally provided in clinics or workplaces directed by physiotherapists or occupational therapists. 5.8 Long-term care This section focuses on long-term care provision for older adults as well as individuals of any age with physical disabilities, chronic diseases or learning disabilities. LTC can be provided in facility-based institutions or in the community through home care and other support services. Care for acute and chronic mental health disorders are discussed in section 5.11. Since long-term care is not considered an insured service under the Canada Health Act, public policies, subsidies, programmes and regulatory regimes for long-term care vary among the provinces and territories (Chan & Kenny, 2002; Berta et al., 2006; Hirdes, 2002). There is a variety of facility-based long-term care in Canada, ranging from residential care with some assisted living services to chronic care facilities – which used to be called nursing homes – with 24-hour a day nursing supervision.
Health systems in transition Canada 111 Most residential care is privately funded whereas most high-acuity long-term care providing 24-hour a day nursing supervision is publicly funded by the provincial and territorial governments. long-term care facilities face different provincial and territorial regimes in terms of licensing and quality control as well as accreditation requirements. Ownership also varies considerably across the country (Berta et al., 2006). In some provinces, a majority of publicly funded long-term care beds are in profit-making facilities: for example, in Ontario, 60% of publicly-funded beds are in profit-making facilities (Berta, Laporte & Valdamanis, 2005). In other provinces, a majority of publicly funded long-term care beds are in not-for-profit facilities, owned either by the provincial government and regional health authorities or by community-based or faithbased organizations; for example, in British Columbia, 70% of publicly-funded long-term care beds are in non-profit-making facilities (McGrail et al., 2007). In all cases, the non-profit-making facilities tend to be larger with higher direct care staffing levels because their residents’ needs tend to be more complex, requiring higher levels of care (Berta et al., 2006). While there is some evidence that better patient outcomes are associated with non-profit-making long-term care facilities compared with profit-making homes, more research is needed to test this association (McGrail et al., 2007). In the more highly integrated provincial and territorial health systems, home-based care can be a cost-effective alternative to facility-based care. Moreover, increases in publicly funded home care in Canada have been shown to reduce the use of hospital services, reduce reliance on informal caregivers and increase self-perceived levels of health status (Stabile, Laporte & Coyte, 2006; Hollander et al., 2009). Although the percentage, and basic profile, of Canadians receiving publicly subsidized home care changed little between the mid-1990s and the mid-2000s (Table 5.2), there is evidence that the needs of those receiving home care have grown in acuity. For example, while 8% of home-care recipients were incontinent in 1994–1995, the proportion more than doubled to 17% by 2003 (Wilkins, 2006).
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Contents Preface . . . . . . . . .
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Preface The Health Systems in Trans
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Acknowledgements The HiT on Canada
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Abstract Canada is a high-income co
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The European Observatory on Health
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Canada - World Health Organization Regional Office for Europe

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