Healthcare Policy最新文献

For adolescents seeking abortion care in Canada, clear information about age and parental consent requirements is not always available. This article details the state of age of consent law and policy across Canada, focusing on access to abortion care. It identifies three key concerns, namely, challenges with unclear or contradictory information, obstacles presented by having additional requirements for minors' consent and difficulties posed by restrictions that require parents and/or guardians to be involved in decision making. The article concludes with recommendations to reduce these barriers to care.

Abortion access in Canada has improved in the past 37 years. However, as healthcare delivery is primarily a provincial/territorial responsibility, there are divergences in the administration and operation of abortion care, including coverage in rural areas, access to telemedicine for medication abortion and the laws and policies governing medical consent for minors. In addition, the access and experience of care are often conditioned by raced, classed and gendered inequalities. When considering abortion care in Canada, it is vital to consider the complexities of federalism, the realities of rural and semi-rural life and intersecting forms of marginalization impacting service users, especially adolescents.

No standardized cost-based homecare-specific indicators are used provincially or nationally in Canada. We trended and portrayed Alberta's homecare costs and health system usage between 2015-16 and 2019-20. In addition, we conducted a cost-effectiveness ratio analysis. Total avoided acute care utilization was estimated at 346.2 thousand in-patient days. With $240.3 million in homecare investments above general growth, our cost-effectiveness ratio is 694:1. Application of these cost-based indicators reveals that homecare programs improve system cost-effectiveness. These indicators can assist health-system policy makers in understanding how systems are structured, specifically in achieving the goal of sustaining the publicly funded health system.

A Canadian list of essential medicines to be publicly funded is crucial for implementing national universal pharmacare. The federal government maintains multiple medicine lists of publicly funded medicines for specific populations in Canada. Despite significant overlap across these lists, Canada does not yet have a single list that defines a minimum set of publicly funded medicines for everyone in Canada. Instead of creating a list from scratch, extant federal lists could form the basis for a harmonized list for all Canadians. We examined seven federal lists of publicly funded medicines and made recommendations for a potential future Canadian essential medicines list.

An advance request for medical assistance in dying (MAiD) (ARM) is a document that allows individuals to request euthanasia if they lose their decision-making capacity. Currently, it is available in all countries where MAiD is permitted for individuals suffering from a serious and incurable illness whose natural death is not reasonably foreseeable, except in Canada. In this country, various citizen and parliamentary initiatives are considering the inclusion of this document in national legislation. This article presents for the first time a compilation of all ARM regulations worldwide. Analysis of the international framework suggests that the requirements for drafting an ARM could influence the effective implementation of patients' wishes.

Privatization - either of funding or provision - is not a solution to Canada's health system woes. However, access issues abound, and part - but only part - of the solution should be to look to improve efficiency of service delivery so that better access can be achieved with the same money.

There is no doubt that healthcare systems in Canada's provinces and territories are under duress - staffing problems, costly technology adoptions and barriers to accessing care are endemic. Among those who are already ill, the systems' problems create frustration, anxiety and even unchecked disease progression for some people. The worst instances are seen in the media almost daily; the result is an erosion of trust among the Canadian public who had been assured that high-quality medically necessary services would be accessible when needed.

We seek to highlight key ethical considerations that arise as Canada considers an expansion of medical assistance in dying (MAiD) to include advance requests. To do so, we will first highlight the ethical and practical concerns that arise with advance care planning and advance directives in general and then draw attention to the unique considerations that arise with advance requests for MAiD. Finally, we will take a closer look at the concerns that will arise with an expansion to include the population with dementia. We will argue that the stakeholder concerns for a vulnerable population such as dementia patients are significant. Legislative frameworks will need to address these concerns to ensure the safety of individual patients and support the role of surrogates and healthcare providers in this process.

Since the passage of the Canada Health Act (1985), there have been many advisory bodies established by successive federal governments, each tasked with providing advice and making recommendations about where and how to improve the health system. Our analysis of interviews with advisory board members and implementers (e.g., ministry of health leaders, staff and consultants) addresses why participants perceived their advice and recommendations were generally not implemented and informal strategy groups used to facilitate implementation. We recommend that future health system advisory bodies focus on coalition building during policy development, integrate implementation plans into policy recommendations and evaluate the impact of policy recommendations.

Since the passage of the Canada Health Act (CHA) in the mid 1980s, advocates for private finance in Canada have challenged the CHA and its underlying access and equity principles. Such challenges have grown in recent years to encompass, among other things, facility fees, membership fees, private virtual care, private interprovincial surgery clinics and private practice nurse practitioners. The continued technological and organizational evolution of healthcare will expand and complicate this further over time. A multipronged approach is needed that includes expanded data to support research on the impacts of such activity, new regulatory frameworks and coordinated action across levels of government.