加拿大留学生作业：High Cost Low Quality Healthcare in Canada

加拿大留学生作业-加拿大的高成本低质量医疗。本文主要内容是讲述加拿大的医疗保健费用正在增长；然而，护理质量似乎在下降。解释为什么会发生这种情况，提出了哪些解决方案来解决这些问题？本篇加拿大作业利用阅读资料、课堂讨论四大循证解决方案，以解决加拿大高成本低质量的医疗保健问题。是小编精选的一篇优秀的加拿大留学作业范文，供参考。

加拿大留学生作业

The costs of healthcare in Canada are growing; however, the quality of care seems to be declining. a) Why this is happening, and what solutions have been proposed to fix these issues? b) Utilizing the readings, class discussions and your own research, discuss your top 4 evidence-informed solutions to address the high-cost low-quality health care in Canada.
医疗费用在加拿大是一个突出的问题，因为它是每个省最大的预算项目。虽然加拿大的医疗保健费用在增长，但医疗保健质量似乎在下降。
The cost of healthcare is a prominent issue in Canada, for it is the single largest budget item for every province. Although the costs of healthcare in Canada are growing, but the quality of care is seen to be declining.
a） 目前加拿大的医疗保险制度建立于20世纪60年代，当时人们的需求大不相同。重点是急症护理，以满足民众的需求。现在，需求大不相同，但系统没有能力处理它。质量下降的可能原因是缺乏问责制和公民参与、服务提供和整合的混乱和不协调，以及缺乏对社区护理的重视。缺乏责任感在很大程度上是因为那些提供金融服务的人在资金流向上几乎没有发言权。此外，没有简单的问责制模式可供参考。目前存在的各种模型不明确且不一致，并且它们没有提供应该实现的目标。当患者参与医疗系统时，患者会觉得他们对适当医疗系统的需求和要求没有得到适当的解决；然而，许多人觉得，关于医疗保健的决定应该由“专家”而不是他们来决定。即使公民向官员表达了他们的担忧，他们也会觉得自己没有被真正听到或认真对待。这是建立区域卫生机构的最初原因，但许多公民不知道这些机构或其成功利用这些机构的目的。服务提供和整合的无序和不协调导致资源被不适当地利用不足或过度利用，以及服务提供和可用性之间的不一致。这通常会导致等待时间增加等模式。由于缺乏特别是在各省授予RHA的权限，加拿大没有明确的整合。对融合的关注往往受到以下事实的阻碍：融合是一个需要长期投资和资金以提供长期利益的目标，这是在考虑改变政党及其政策和竞选连任战略时的一个问题。缺乏对社区护理的关注可能是由于关注机构护理（如医院）。尽管有人试图增加社区护理支出，但这些努力收效甚微。此外，医疗保健的成本仍在增加，但这一支出的增加并未导致医疗质量的相应提高。
a) The current Canadian system, Medicare, was founded in the 1960s when the needs of the population were vastly different. The focus was on acute care, to match the needs of the population. Now, the needs are vastly different, but the system is not equipped to handle it. The likely reasons for this decline in quality are lack of accountability and citizen participation, disorganization and un-coordination of service delivery and integration, and lack of attention paid to community-based care. The lack of accountability is in large part due to the fact that those that finance care have little say in where that money goes. Furthermore, there is no simple accountability model to reference. The various models present are unclear and inconsistent, and they do not provide goals for what should be accomplished. When patients engaged with the healthcare system, the would feel as if their needs and requirements of a proper healthcare system were not being properly addressed; however, many people feel as if the decisions regarding healthcare should be made by ‘the experts’ instead of them. Even if citizens raised their concerns to officials, they would feel like they were not actually being heard or being taken seriously. This is the original reason Regional Health Authorities were created in response to this, but many citizens do not know about them or their purpose to successfully utilize them. The disorganization and un-coordination of service delivery and integration leads to resources being inappropriately being under or over utilized, as well as inconsistencies within the delivery and availability of services. This often leads to patterns such as increasing wait times. Because of the lack of authority given to RHAs in provinces especially, there is no clear integration across Canada. Attention to integration is often hindered by the fact that it is a goal that needs long-term investment and funding to provide long-term benefits, which is an issue when considering the changing of political parties and their policies and strategies for re-election. The lack of attention paid to community-based care is likely due to the focus on institutional care (e.g., hospitals). Although there have been attempts to increase spending on community-based care, these efforts have had a minimal effect. Furthermore, the cost of healthcare remains increasing, but this rise in spending has not seen proportional advances in quality of care.
b） 解决加拿大高成本低质量医疗问题的解决方案包括：合理分配资源、家庭护理的eShift模式等举措、负责任的护理组织，以及提高对RHA的授权。
b) Solutions to the address the high-cost low-quality healthcare in Canada include: proper allocation of resources, initiatives such as the eShift model of homecare, Accountable Care Organizations, and increased authority given to RHAs.
加拿大国内的一个重大问题是资源分配不当，主要与过度使用医院有关。在加拿大，医院消耗了相当一部分医疗支出。这主要是由于初级保健的使用不足和/或不可用。许多人不使用它们，或者是因为他们不知道它们的存在，或者他们不知道他们应该使用这些资源而不是急诊室（例如，去急诊室治疗手臂骨折而不是急诊中心）。此外，与其他经合组织国家相比，加拿大获得这种初级保健的机会要低得多。这种缺乏机会的情况不仅导致更多可预防的住院治疗，而且还导致生活质量下降和医疗部门投资回报率下降。因此，增加初级保健的机会和知识将有助于适当和有效地利用资源。
A huge issue seen within Canada is the misallocation of resources primarily associated with the overuse of hospitals. Hospitals use up a substantial portion of the healthcare expenditure within Canada. This is largely due to the underuse and/or unavailability of primary care. Many people do not use them either because they don’t know they exist, or they don’t know that they should be using these resources instead of the emergency room (e.g., going to the ER for a broken arm instead of an urgent care center). Moreover, the access to this primary care in Canada fares much lower compared to other OECD countries. This lack of access not only leads to more preventable hospital admissions, but also poorer quality of life and bad returns on investment within the healthcare sector. Therefore, increasing access and knowledge about primary care would help use resources appropriately and efficiently.
eShift模式包括临床护理护士、感官技术、西南LHIN和西南社区护理访问中心之间的协作。这一模式的建立是为了回应人们对西南社区护理准入中心缺乏护士的日益关注，特别是在夜班和姑息治疗单位。这主要是因为在姑息治疗领域缺乏训练有素和知识渊博的护士。护士的需求太多，但供应太少，给家庭带来了更大的负担。eShift模型作为一个跨学科的解决方案应运而生。护士不必站在患者床边帮助治疗和协助他们进行护理，而是可以通过eShift系统远程管理护理。这使得护士可以在更短的时间内甚至同时治疗多个患者，从而利用具有适当知识的护士，使更多的人受益。此外，eShift减少了寻求临终治疗的人以及那些与症状处理不当有关的人的可预防急诊就诊次数。它还增加了那些以前没有家庭护理资源的人的出院人数。
The eShift model consists of collaboration between clinical care nurses, Sensory Technologies, Southwest LHIN, and Southwest Community Care Access Centre. The model was created in response to a growing concern about the lack of nurses in the Southwest Community Care Access Centre, especially during night shifts and in palliative care units. This was largely because of a lack of trained and knowledgeable nurses in the palliative care field. There was too much demand, but too little supply existed of nurses, putting more burden on the families. The eShift model emerged as an interdisciplinary answer to this problem. Nurses would not have to be at the patient’s bedside to help treat and assist them with their care, but rather they could help manage that care remotely via the eShift system. This makes it so that a nurse can treat multiple patients in a shorter amount of time and even simultaneously, thereby utilizing that nurse with the appropriate knowledge so that more people may benefit. Furthermore, eShift decreased the amount of preventable emergency room visits by those seeking end-of-life treatment, as well as those related to inadequately handled symptoms. It also increased the number of hospital discharges for those that did not previously have the resources for care at home.
该系统基本上不向公众负责，但引入责任关怀组织（ACO）是一个例外。这些医院和医疗集团通过与公共或私人保险公司签订具有法律约束力的协议，通过资本化预算，承认并承担特定人群的医疗成本和质量责任。在这个综合医疗服务提供系统中，可以提供更多的服务。医生群体更小，更专业，此外，由医院、医生和健康中心组成的混合、跨学科群体提供服务。该系统已在美国实施。这些组织有效地提高了系统中的问责制和患者满意度。
The system is largely unaccountable to the public, but an exception is the introduction of Accountable Care Organizations (ACOs). These are hospitals and medical groups that have recognized and absorbed the responsibility for both cost and quality of care for specific groups of people by means of a capitated budget between them and a public or private insurer via a legally binding agreement. In this integrated system of healthcare delivery, more services are able to be provided. The groups of physicians are smaller and more specialized, and additionally a hybrid, interdisciplinary group consisting of hospitals, physicians, and health centers offer services. This system has already been implemented in the U.S. These organizations are effectively increasing the accountability in the system and patient satisfaction within it.
RHA未得到充分利用和重视。没有多少公民知道它们以及如何使用它们，而且RHA本身也没有足够的权力来正确发起变革。他们的作用和权威需要得到更明确的界定。此外，需要给他们发挥作用的空间。这一变化将有助于保持护理的连续性和标准，并验证RHA在其领域的权威性。此外，许多人不知道RHA或他们做什么。如果公众知情，那么他们更倾向于利用这一资源，同时也更经常、更有效地表达他们的担忧。公民参与的增加将有助于确保医疗体系更加以患者为中心，包括公众参与其形成和修订，有效提高医疗质量。
The RHAs are underused and underappreciated. Not many citizens know about them and how to use them, and the RHAs themselves are not given enough authority to properly initiate change. Their role and authority need to be more clearly defined. Furthermore, they need to be given the room to act upon their role. This change would help to maintain the continuity and standards of care, as well as validate the RHAs as authorities in their field. Moreover, many people do not know about the RHA or what they do. If the public is informed, then they are more inclined to utilize this resource while also voicing their concerns more often and effectively. This increase in citizen participation will help to make sure that healthcare systems are more patient-centered by including the public in their formation and revisions, effectively progressing quality of care.
获得优质健康是加拿大健康差距的主要决定因素之一；目前的《加拿大卫生法》（CHA）和全民医保似乎无法解决这一问题。不幸的是，健康差距对少数群体的影响最大，包括妇女、儿童、老年人、新来者、LGBTQ、有心理健康问题的人和农村地区的人。请讨论上述各少数群体所面临的一个主要问题，并提供一种有效和高效的方式来解决这些问题。
Access to quality health is one of the main determinant factors of health disparities in Canada; it seems the current Canada Health Act (CHA) and the universal coverage is unable to address this issue. Unfortunately, health disparities are affecting the minority groups the most, including women, children, seniors, newcomers, LGBTQ, the people living with mental health issues and those living in the rural areas. Please discuss 1 main issue faced by each of the above minority groups, and provide an effective and efficient way to address each of those issues.
加拿大妇女面临的主要问题是暴力，特别是亲密伴侣之间的暴力。暴力对健康的影响更关注心理健康；这些症状包括：抑郁、依赖（如酗酒）、焦虑以及性传播感染。必须指出，暴力是可以预防的。因此，解决这一问题的一种方法是为妇女提供更多的社区支持，特别是那些私人和离散的妇女，以便她们能够报告暴力事件。同样重要的是，他们对向某人倾诉感到舒适，因此受过培训的人必须知道如何处理这样一个敏感的话题。也许只要有一条广为宣传的求助热线，就可以在这种关系变得太严重之前，对其进行干预。
The main issue women face in Canada is violence, especially among intimate partners. The health implications that result from violence concern more with mental health; these include: depression, dependencies (e.g., alcoholism), anxiety, as well as sexually transmitted infections. It is important to note that violence can be prevented. So, a way to address this issue is to provide more community supports for women, especially those that are private and discrete, so that they may report the violence. It is also important that they feel comfortable confiding in someone, so the person trained must know how to handle such a sensitive topic. Perhaps just having a widely advertised helpline can help to intervene in these relationships before it becomes too serious.
加拿大遭受虐待的儿童随后表现出更差的心理健康结果，特别是在妇女中。这种虐待为日后更糟糕的健康结果铺平了道路（例如，肺部问题、背部问题和慢性疲劳）。因此，减少儿童期虐待的发生应该可以减少日后不良健康后果的发生。因此，解决这一问题的一种方法是为儿童提供更多的支持，以便他们在感到舒服的情况下可以大声说话，并培训从业者和社区（例如，教牙医在检查儿童时应该注意什么），以便更好地识别虐待的迹象，以便尽早进行干预。
Children in Canada that have been abused have been shown to subsequently show worse mental health outcomes, especially among women. The abuse paves the way for worse health outcomes later in life (e.g., lung problems, back problems, and chronic fatigue). So reducing the instance of childhood abuse should lower the amount of bad health outcomes later in life. Therefore, a way to address this issue is to provide more supports for children so they may speak up if they are comfortable, as well as training practitioners and communities (e.g., teaching dentists what to look for when examining children) to better recognize the signs of abuse so an intervention can happen sooner than later.
老年人的主要问题是多发病，即两种或两种以上疾病同时发生。它与许多不良健康结果有关，包括：预期寿命缩短、日常功能和能力下降以及预期寿命缩短。随着加拿大人年龄的增长，他们的生活满意度会下降。解决这一问题的一种可能的有效方法是使用一种更加协调和综合的健康模式，以便老年人更容易获得医疗保健，同时更好地管理他们的慢性病。
The primary concern with seniors is multi-morbidity, which is when two or more illnesses are occurring at the same time. It is associated with numerous bad health outcomes, including: decreased life expectancy, decrease in daily function and ability, and lower life expectancy. As Canadians age, it is found that their life satisfaction decreases. A possible effective and efficient way to address this is by using a more coordinated and integrated health model so that seniors’ times attaining healthcare is easier, as well as their chronic illnesses are better managed.
加拿大的新移民（如移民和难民）在试图获得医疗保健时经常面临歧视。这种歧视会导致有价值的健康结果，包括：更差的身心健康和更危险的健康行为。新来者在试图获得与其文化和宗教信仰相一致的护理时，往往会感到羞耻，这反过来会对他们的健康产生负面影响。医疗从业者需要敏感性培训，以了解如何以一种不“其他”患者的方式治疗患者。此外，雇用具有这些背景的工作人员也很有用，这样患者就能感觉到他们之间的联系，并乐于分享他们的健康信息和经验。
Newcomers (e.g., immigrants and refugees) to Canada often face discrimination when trying to attain healthcare. This discrimination results in worth health outcomes, including: worse physical and mental health and more risky health behavior. Newcomers are often made to feel ashamed when trying to attain care that is consistent with their cultural and religious beliefs—which in turn negatively affects their health. Healthcare practitioners need sensitivity training regarding how to treat patients in a way that does not ‘other’ them. Further, it would also be useful to hire staff that are from these backgrounds so that patients feel a connection and are comfortable sharing their health information and experiences.
加拿大LGBTQ青年人口在试图获得护理时面临许多耻辱。这些结果包括害怕受到严厉的评判，在被问及他们最认同的性别时感到不安，以及只在非规范环境中接受教育。学校董事会为这些青少年提供了支持服务，为他们提供性健康信息和社区支持，否则他们可能得不到这些支持。很多时候，医疗从业者发现难以与LGBTQ青少年建立联系，因此他们不确定如何为他们呈现和定制信息，从而导致这些青少年进一步迷失和困惑。加拿大的LGBTQ青年没有接受与他们有关的问题的适当教育，但没有接受被视为“正常”的问题（即独联体性别、异性恋等），特别是在性健康教育方面。因此，解决这一问题的最佳方法也许是雇佣更多的医疗专业人员进入LGBTQ领域，或者深入了解他们的需求，以便干预和教育包括他们的需求，并确保他们感到舒适。
The Canadian LGBTQ youth population faces a lot of stigma when trying to attain care. These results of fear of being judged harshly, uneasiness when asked about what sex they most identify with, and only being educated in a heteronormative context. School boards have implemented support services for these youth to provide them with the sexual health information as well as community support that they may not receive otherwise. Many times healthcare practitioners find difficulty in relating to LGBTQ youths, so they are unsure how to present and tailor information for them—which then leads these youths further lost and confused.  LGBTQ youth in Canada are not properly educated about issues that relate to them but not those considered “normal” (i.e., cis-gender, heterosexual, etc.), especially in regards to sexual health education. Therefore, the best way to address this issue is perhaps to employ more healthcare professionals into the field that are either LGBTQ or have a deep understanding of their needs so that interventions and education include their needs and ensures that they are comfortable.
患有心理健康问题的人面临着复杂的健康需求，解决方案往往不容易或不明确。在这些人中发现的最常见的障碍是阻碍他们获得护理的个人环境。解决这一问题的一种方法是给予心理健康与其他慢性病同等的重要性，从而改变人们对心理健康的偏见。一旦被当作其他慢性病一样对待，心理健康将是一种公认的手段，可以让你错过工作去接受治疗，并在保险范围内，被视为一个不履行义务的适当理由。
People living with mental health issues face complex health needs where the solution is not often easy or clear. The most common barrier found among these people was personal circumstances that hinder their access to care. A way to address this issue would be to give mental health the same level of importance as other chronic conditions, and thus change the stigma against mental. Once treated like any other chronic condition, mental health will be an accepted means to miss work to get treatment for, covered by insurance, and deemed an appropriate reason for having to be absent from obligations for.
生活在农村地区的人通常比生活在城市地区的人得到医疗护理的时间晚，频率低，这主要是因为他们没有适当的机会（特别是获得初级保健的机会），这与城市居民相比是不公平的。解决这一问题的一种方法是通过激励措施将医疗从业者招募到农村地区，然后通过能够为这些新员工开设更多的初级保健设施来增加初级保健的机会。
Those living in rural areas often get medical attention later and less frequently than those living in urban areas (Silver, 1994), which is largely due to the fact that they do not have the appropriate amount of access (especially to primary care) that is inequitable in comparison to their urban counterparts. A way to address this issue is by recruiting healthcare practitioners into rural areas through incentive measures, which would then subsequently increase access to primary care through being able to open more primary care facilities with this new staff.
根据阅读材料和课堂讨论，加拿大似乎需要扩大其全民医疗覆盖范围，包括医药保健、家庭/社区保健和联合医疗保健提供者提供的医疗保健服务，以确保改善所有人的医疗保健服务体系。考虑到医疗服务的成本目前还不可持续，请讨论您对P4 医学2.0和数字健康/虚拟医疗如何帮助应对这些挑战（如上所述扩大全民医疗覆盖，改善医疗服务交付和控制医疗成本）。
As per the readings and class discussions, it appears that Canada requires to expand its universal health coverage to include the pharma care, home/community care and the healthcare services provided by allied healthcare providers to ensure improving the healthcare delivery system for all. Considering the costs of healthcare delivery is not even currently sustainable, please discuss your evidence-informed opinions on how P4 Medicine, Medicine/Health 2.0, and the digital health/virtual healthcare could assist with these challenges (expanding universal health coverage as above, improving healthcare delivery & containing healthcare cost).
加拿大需要扩大其全民医疗覆盖范围，包括医药保健、家庭/社区保健以及联合医疗保健提供商提供的医疗保健服务，以确保改善所有人的医疗保健服务体系。由于目前医疗服务的成本是不可持续的，P4 医学2.0以及数字和虚拟医疗服务可以帮助应对上述挑战，从而改善医疗服务，而无需在没有足够结果的情况下向系统投入更多资金。换言之，这些方法有助于促进更可持续的医疗服务体系，既经济高效又高效。
Canada needs to expand its universal health coverage to include pharma care, home/community care, and the healthcare services provide by allied healthcare providers to ensure improving the healthcare delivery system for all. Since the cost of healthcare delivery now is not sustainable, the P4 Medicine, Medicine 2.0, and digital and virtual healthcare can assist with the above challenges in order to improve healthcare without also investing more money into the system without adequate results. In other words, these methods can help promote a more sustainable healthcare delivery system that is both cost-efficient and effective.
P4医学是具有预测性、个性化、预防性和参与性的医学。预测性是指如何使用该模型预测人群的需求，以及他们对健康和疾病的主观看法，其方式类似于预防性护理。该药物是个性化的，因为它将在个人数据云中保存有关个人健康和身体的所有信息。这将使人们能够以更容易和更容易访问的方式拥有和访问他们的信息。预防医学的目的是分析疾病的根源，以便在疾病开始存在之前与之斗争。预防医学不会在卫生设施之外结束，因为它需要延伸到日常生活中，因此需要人口参与。参与式医学是指人们的日常生活以及他们在这一过程中的行动和行为对他们的健康是如何重要的。人口必须参与自身的健康。这种思想导致人们更加积极地提供更适合他们和当前人口需求的医疗服务。通过这种方式，它确保投资流向更有效地促进健康和积极变革的激励和设施。
P4 Medicine is that which is predictive, personalized, preventative, and participatory. Predictive refers to how this model can be used to predict the needs and wants of a population, as well as their subjective view of health and disease in a manner similar to preventative care. The medicine is personalized in that it will hold all information concerning an individual’s health and body in a personal data cloud. This will allow people to have and access their information in an easier and more accessible manner. Preventative medicine aims to analyze the root of a disease to combat it before it even begins to exist. Preventative medicine does not end once outside health facilities, for it needs to extend into everyday life, thus requiring population engagement. Participatory medicine refers to how the population’s everyday life and their actions and behaviors during it is important to their health. Populations must participate in their own health. This ideology leads to people becoming more active health delivery that is more tailored to them and current population needs. In this way, it ensures that investment goes to incentives and facilities that are more effective in promoting good health and positive change.
医学2.0是指在非中介、非中介和中介过程中使用社交网络、参与、协作、开放和电子中介。非中介化指的是取消一个步骤，以使民众更容易、更快地接收信息（例如，WebMD等网站）。Apomediation指的是医学2.0如何为您工作，而是通过您自己的研究引导您找到答案。中介是指患者和医生之间的传统关系，在这种关系中，中介机构向患者提供信息。对于那些不具备必要的健康知识水平的患者来说，这更适合于参与调解；考虑到患者评估信息的能力是准确和可信的，这一点也很重要。通过这些不同的渠道，可以更有效地利用信息传播，这样，如果患者有能力的话，就不必总是要求他们去医生那里接受他们需要的健康信息。这减少了对诊所，尤其是医院的大量投资，因为它让患者在家里更容易、更快地接收信息，而不需要政府承担任何费用。
Medicine 2.0 refers to the use of social networking, participation, collaboration, openness, and epomediation in the processes of disintermediation, apomediation, and intermediation. Disintermediation refers to eliminating a step to make the population’s efforts to receive information easier and faster (e.g., websites such as WebMD). Apomediation refers to how Medicine 2.0 do the work for you but rather lead you to the answer through your own research. Intermediation refers to the traditional relationship between patient and physician in which a mediating agent curates the information to the patient. This is better for those patients that do not possess the necessary level of health literacy to engage in apomediation; this also relevant when considering patients’ capacities to evaluate information as accurate and credible. Through these different channels, information dissemination can be more efficiently used so that patients are not always required to go to the doctor to receive the health information they need, if they are capable. This decreases the amount of heavy investment in clinics and especially hospitals, for it allows patients to receive information at home easier and faster at no cost to the government.
加拿大在获取和分发虚拟医疗服务方面没有与其他国家保持联系，这主要是因为缺乏适当的基础设施和支付模式。已经在安大略省试行的虚拟诊所（正变得越来越流行，并预计将成为未来的标准。虚拟医疗环境可以类似于空中交通控制中心。这将是一个充满了包含患者信息的计算机的房间。一名医疗从业者将根据患者的当前状况在这些计算机上监控两名患者。这所需要的监视量可能不可行。相反，“家中医院”将充满监控设备和家庭检查点，传感器嵌入日常物品中，可以提供分析，以告知和可能改变某人的健康行为。这种将健康融入患者日常生活的方式使他们能够更好地控制自己，但同时也给他们带来了更多的负担来监控自己的健康。患者被动提供的信息使医疗专业人员能够监控患者，绕过在办公室进行更多测试，等待结果。这种类型的医疗服务提供系统减少了患者入院和等待时间。然而，由于初始投资可能很高，这种类型的信息收集可能会导致访问方面的差异。这可以通过政府补贴来缓解。这一制度的实施还可能导致更具成本效益的国家医疗体系。它还促进了公众参与，目前加拿大医疗体系及其治理中缺乏公众参与。
Canada has not kept other with other countries in their access to and distribution of virtual care, which is largely because of a lack of appropriate infrastructure and payment models (Reid, 2017). Virtual visits to the clinic, as already being piloted in Ontario (Reid, 2017), are becoming more popular and are predicted to become the standard in the future (Topol, 2015). The virtual healthcare environment can be analogized to an air-traffic control center. It would be a room full of computers that contain patient information. A healthcare practitioner would monitor a couple patients on these computers dependent on their current condition. The amount of surveillance this entails may not be feasible. Rather, the ‘hospital at home’ would be full of monitoring devices and home checkpoints, with sensors being embedded into everyday items that can provide analytics to inform and possible change someone’s health behavior. This integration of health into the patient’s everyday life allows them to have more control but also put more of the burden on them to monitor their own health. The information the patient passively supplies allows healthcare professionals to monitor patients and bypass performing more tests in-office and wait for results. This type of healthcare delivery system reduces patient admissions and decreases wait times. However, this type of information-gathering can cause a disparity in access, as the initial investment can be high. This can be alleviated by government subsidies. The implementation of this system could also result in a more cost effective national healthcare system. It promotes public participation as well, which is currently shown to be lacking within the Canadian healthcare system and its governance.
The principal way these models would benefit the healthcare system is by alleviating the current financial burden many practices hold (e.g., patients going to the doctor for potentially simple questions they could’ve found online). Therefore, this change to the primary care practices of patients and healthcare practitioners could lead to cost savings, which in turn could then be used to fund expanding universal health coverage to things such as pharma care. Further, these methods also enhanced the healthcare delivery system by allowing patients faster access to answers, allows doctors faster access to patient information and test results, and easier access for patients to see their own health information. Integrating these would lead to more seamless care and effective preventative medicine to respond to chronic conditions (e.g., through tracking measures and physicians instant feedback on patient behavior and vitals) as well, which are currently costing the Canadian healthcare a large portion of spending.
The health and wellbeing of every individual in the society are among the core governments’ responsibility. Utilizing the ‘Triple Aim’, ‘Health in All Policies’ and ‘The Whole of Government Approach’, please research, develop and explain a new Canadian (health) governance structure (with one, two or three-tier structure of your choice) to address the future health and wellbeing of individual.
The Canada Health Act has performed well in maintaining funding for services through taxes, but this vary feature is what is likely holding Canada back in innovation. The restriction it places blocks further advancement through its rigid criteria. In the last 40 years, there have not been essential changes to the healthcare system. It is argued that nothing will happen most likely until a catastrophic event or paradigm shift occurs. This results in restricted focus on hospitals and doctors, as well as Canada falling behind relative to other OECD countries. There has been limited attempts at changing health policy in Canada, and many of these attempts were just to procrastinate making meaningful changes and innovations to the system. Therefore, without reviewing and updating Medicare, change is unlikely to occur in the Canadian healthcare system (Adams, 2015). For these reasons, it is clear that the structure of the Canadian health governance structure must be transformed to a three-tier structure through examining the ‘Triple Aim’ approach, ‘Health in All Policies’ approach, the ‘Whole of Governance’ approach, hybridization, and the role of Canadian federal government.
The Triple Aim approach to health in Canada “is the simultaneous pursuit of improved population health, care experience and per capita cost of care” (830). This approach incorporates the organization of populations, thus providing improved services that have been scaled to the whole country while also engaging in a system that advances and adjusts to challenges appropriately. The triple aim approaches require a high degree of integration among the healthcare sector as well as those that fall outside of it, which is often accomplished through means such as the “integrator” role. This role is aimed to improve and maintain the healthcare sector while simultaneously connecting and communicating with other sectors, both on a micro and macro level. The micro-level ensures that the system itself is operating efficiently and correctly while also maintaining that the intended population is reached. The macro-level integrator ensures that the confines in which the system operates is learned and kept up-to-date with recent advances, as well as help to standardize the process. The Triple Aim approach will thus also lead healthcare within Canada to steer more towards a value-based approach (Farmanova et al., 2016). Because this approach happens in such an integrated and multi-level manner, evaluation is difficult. This is already a problem that plagues Canada’s system, and so having a method that further complexes it may not be the best solution at this moment. However, as will be elaborated on later, a larger role of the federal government may aid this.
The Triple Aim approach was shown to be beneficial in increasing performance and use of primary care methods, predict those patients that may need preventative care, learning from previous mistakes to improve future performance, integrating with the community, decreasing unnecessary use of emergency rooms, and integrating the approach within other frameworks and reforms. However, with all of these advances, there have been some areas of improvement that have arose. There is a larger need for team-based models of primary care, customization of healthcare plans for patients (i.e., more patient-centered care), more support for population health, more emphasis on public health, approaching privacy issues in a way that ensures patients’ privacy while also allowing collaboration among teams, more evaluation measures, a move away from volume-based to value-based care, and scaling of improvements (Farmanova et al., 2016). However, in order to adopt the Triple Aim approach, Canada must first alleviate existing problems (e.g., weak evaluation measures, misallocation of resources, underuse of primary care, and lack of population level interventions) in order to implement new interventions and approaches. With this in mind, I do think that the Triple Aim approach will make a significant impact, as it aims to fix many of the problems that plague Canada’s healthcare sector as well as set Canada up to be more prepared in the future and have a more sustainable and meaningful healthcare framework.
The ‘Health in all Policies’ approach ensures that health implications are incorporated in all policy implementations from every sector, for many factors that determine health are not directly controlled by the healthcare sector. Success in reforming healthcare can seldom be accomplished without collaboration between all sectors. Gase, Pennotti, and Smith (2013) found seven “interrelated strategies for incorporating health considerations into decisions and systems: (1) developing and structuring cross-sector relationships; (2) incorporating health into decision-making processes; (3) enhancing workforce capacity; (4) coordinating funding and investments; (5) integrating research, evaluation and data systems; (6) synchronizing communications and messaging; and (7) implementing accountability structures” (p. 529). This approach allows a form of integration and communication between healthcare practitioners and other sectors that may have not be possible before. Health in all policies entails an influence not only on the policy aspect, but also in every aspect of development, implementation, evaluation, and communication. It also allows the burden to not only be placed on those operating within the healthcare sector to maintain a healthy population, for now it is the responsibility of all sectors equally and shared. Moreover, more attention must be placed on the social determinants of health and equity. According to the Health in all Policies approach, all of these concerns will be addressed and have intersectoral actors. Because it involves all sectors of government and beyond, it better coordinates activities in a way that is cost-effective and decreases duplicates of similar policies (Gase et al., 2013).
Whole of governance occurs when different professionals from different sectors work towards the same goal(s). When applying this in a healthcare setting, it streamlines care in a way that is more integrated, organized, and efficient. Interprofessional teams aim to provide a multitude of services while ensuring they are backed by up-to-date technology and protocols in a way that is sufficient to connect the public to their environment and healthcare practitioners in a meaningful manner. This intersectoral collaboration also entails that the financial burden is not placed on only the healthcare sector. Most physicians are capable and ready to help innovate the current healthcare system in Canada, and their participation is crucial to implementing and designing change. However, with all of these sectors coming together to collaborate, it is important to maintain transparency while also establishing clear objective and roles for each member (Naylor et al, 2015). The Conference Board of Canada (2017) found that individual-level barriers (e.g., confusion which function should be performed by whom and who, if anyone, has more power or voice in decisions), practice-level barriers (e.g., difficulties in establishing a governance model in which everyone has comparable contributions and tools), and system-level barriers (e.g., inadequate accountability measures) can all thwart the progress of interprofessional teams that aim to use a whole of governance approach.
Hybridization occurs when governing bodies and professional communities come together to collaborate towards their best solution. In the United Kingdom hybridization between public and private delivery of services was used in an attempt to introduce competition as a means to improve the whole sector (Turner, Lourenço, & Allen, 2016). An assigned reading outlined “communities of practice” in which states that change occurs through interactions. This entails that the result of hybridization is unique to the situation and stake holders present. Every player becomes a resource for information and change. These communities of practice become experts and tools of change through their “knowledge use, social interaction, organizational structure, and innovation” (Turner, Lourenço, & Allen, 2016, p. 703). The shift within the NHS in the early 1990s led to increased autonomy that led to greater competition and a more ‘business-like’ mentality. The addition of competition was seen as a way to increase performance, effectiveness, and change. This shift also prompted professional communities to engage with and learn new forms of necessary knowledge (e.g., market tendencies). The effect of competition stretched to how providers interacted with each other. They were less likely to share ideas to maintain a competitive advantage; however, this also led to a hindrance of wide-spread innovation and decrease in cooperation. Within the NHS there was resistance to change via the private sector entering the public. Professional communities are most likely to accept and participate in gradual rather than sudden changes. The collaboration between different communities can lead to novel and more effective interventions (Turner, Lourenço, & Allen, 2016). Therefore, it is clear that hybridization is essential to advancing the healthcare system within Canada. The benefits seen in the U.K. could also be seen in Canada. However, the single-payer model and its bilateral monopoly act as a barrier to this type of hybridization from occurring. In other words, the one-tier system is hindering the progression of the healthcare system. Canada does not have a good holding on the regulation of private services; it is limited to basic functions. It is argued that the Canadian government has too much control over the healthcare system and its proponents for meaningful change to occur (e.g., that in the U.K.) (Touhy, 2012). Thus, Canada must enable entrepreneurs to have the opportunity to implement innovation in the private sector to influence and accommodate the public sector (Banting & Myles, 2013). The recommended incremental implementation by the articles would help Canadians accept a new norm within healthcare.
In the Adams (2015) article, the author argues that, in order to change healthcare policy within Canada, three things must be accomplished: a way of “policy governance,” stopping “policy inertia,” and long-term planning. It is important for healthcare to stop being thought of as reactive (e.g., focused on acute care in primarily in hospitals by health practitioners) but rather as proactive (e.g., focused on prevention and chronic diseases in settings including hospitals as well as outside of them). This is especially true when considering the rising concern and prevalence of chronic and complex conditions within Canada that cannot be properly treated and monitored through the traditional measures that worked for acute conditions. Now, the main role of the federal government in healthcare is essentially funding it through the provisions set in the Canada Health Act and Canada Health Transfer. The Federal government having more control and accountability in the healthcare system will also lead to more consistency across Canada in terms of access, quality, collaboration, coordination, and ability to scale noteworthy interventions on a national scale. This increase in federal control would also likely decrease the amount of fragmentation that now plagues the Canadian healthcare system, thus aiding the lack of appropriate coordination and evaluation measures.
One proposed solution to the lack of innovation within the Canadian healthcare system is the Healthcare Innovation Fund, which aims to “enhance the quality and value of healthcare provided to Canadians, while improving the performance of Canada’s healthcare systems as measured against their international peers” (Naylor et al., 2015, p. 39). This would aim to provide long-term funding for interdisciplinary initiatives from actors from multiple sectors. The Fund aims to both address and alleviate fragmentation, as well as aid in scaling up of noteworthy interventions in an effort to promote innovation and prevent many of the limitations seen today in the health system as detailed above. Furthermore, the funding would only be given to those who clearly state their intentions. Those who receive funding must also report when they meet goals to the Healthcare Innovation Agency of Canada, and this information will be made public (Naylor et al., 2015). This would effectively increase the accountability of the healthcare system as well. The federal government must establish and guarantee that the health infrastructure and health human resources teams are appropriately equipped to handle these new changes within the community.
In a three tier system, tier 1 consists of items that are medically necessary and thus covered by the government; tier 2 items are those that are not required to live but enhance quality of life; and, tier 3 refers to items that are used for cosmetic reasons or for comfort (Montgomery, 2017). Through this system tier 2 procedures and items would be covered by private insurance, while those that lie in the tier 3 would be completely out-of-pocket. This structure of organization of different procedures based on necessity helps to alleviate the financial burden on the healthcare system by allowing others to access procedures on a private basis. This would also help to decrease wait times for those that want to access procedures faster and have the means to do so. In conclusion, it is clear that more integration and collaboration is needed in the Canadian health governance structure, and, given the current state, it needs to implement initiatives and structures that promote sustainability by decreasing the financial responsibility of the government while also increasing the control and oversight of the federal government.
The introduction of health information technologies (HIT) in recent years has provided the health care systems in Canada and around the globe with a great hope and potential to address many of the challenges they face with, including providing better health, better care, better value and empowering patient/public to actively engage in their health. With examples, please discuss your evidence-informed critical analysis on how HIT could assist with each of the above (better health, better care, better value and patient/public empowerment).
Before elaborating on how Health information technologies (HIT) can assist better health, care, value and patient/public empowerment through its ability to provide more seamless integration of care, as well as provide quicker, more efficient access to patient information, it is important to understand the state of it right now in Canada. Firstly, the primary mode of HIT is electronic health records (EHR): health information that is compiled and saved in electronic mediums. Development and innovations are occurring very slowly in Canada compared to other OECD countries, and most Canadian doctors do not use it. However, the use of it is increasing (Canadian Foundation for Healthcare Improvement, 2014). Many of the EHR methods used today are outdated and incapable of providing the functions that healthcare practitioners need. Like the Internet used today, EHR needs to be able to quickly adapt to changes and incorporate new information and methods. This is largely attributed to the leaders in EHR development that insist on having full private control of all the data contained in their respective programs (Mandl & Kohane, 2012). The advances that have prompted the existence evolution of EHR were in response to needs of healthcare practitioners, so now a change is happening where, although it is still suggested to change to accommodate healthcare practitioners better (Mandl & Kohane, 2012), it is also beginning to conform to the requests and needs of the public as well. However, it is difficult to modify a system that was never made with the intention of being able to support rapid innovations. The inability of the multiple EHR systems to communicate and integrate with one another, as well as other systems, does not foster the integrated care that is being promoted, but rather limits its own advancement (Mandl & Kohane, 2012).
HIT can give patients access to their own records, which allows them to become more informed players in their own healthcare process. EHR can allow markers for strengths and weaknesses within each system so that evaluation measures are more easily attained, as well as determination of what needs improvement versus what needs to be scaled-up is more easily identified. By making the system more public to advancement and incorporating more of patient needs into the software, the Triple Aim approach can be used, which calls for more integration of key players to improve health, care, and value in an effort to increase patient empowerment. It effectively breaks a barrier to care that was previously decreasing the quality and amount of care the public has.
Optional Question: Please also answer one of the following questions as per your choice.
In recent years there has been significant discussion about aboriginal health in Canada. Please discuss how HIT, interprofessional collaborative practice and healthcare governance could assist with improving the aboriginal health in Canada.
Health human resources (HHR) is a major component in Canada’s health care. As per the readings, class discussions and your own research please discuss: a) whether or not Canada is suffering from a shortage in HHR (i.e., physicians), b) the ‘ups’ and ‘downs’ of the current status of the HHR utilization in Canada’s health care, and c) ways to improve the HHR utilization in Canada’s health care.
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加拿大作业对近年来加拿大对土著居民健康问题进行了重要讨论。讨论HIT、跨专业合作实践和医疗保健治理如何有助于改善加拿大土著居民的健康状况。加拿大作业根据阅读材料、课堂讨论和自己的研究，讨论了加拿大是否存在HHR短缺以及加拿大医疗保健中HHR利用现状的“起伏”，包括改善加拿大医疗保健中HHR利用的方法。本站提供各国各专业留学生作业写作指导服务，如有需要可咨询本平台。