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Policy, Payment, and Participation: Long-Term Care Reform in Ontario

Published online by Cambridge University Press:  29 November 2010

Raisa B. Deber  and
A. Paul Williams
Raisa B. Deber
Affiliation:
University of Toronto
A. Paul Williams
Affiliation:
University of Toronto
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Abstract

Although Canadian Medicare gives the population “reasonable” access” to all “medically necessary” physician and hospital services, long-term care is not formally subject to those conditions. In Ontario, long-term care involves a “patchwork quilt” of government, charitable, for-profit, and personally-provided services; an ongoing consultation has been under way in an attempt to rationalize service financing and provision. This paper reviews the series of policy proposals and the accompanying public consultation processes. It concludes that the emphasis on “community involvement” without a clear definition of “community” or the goals of participation has paradoxically increased the “scope of conflict,” increased frustration among stakeholders, and made policy action more difficult.

Résumé

Bien que le programme d'assurance-maladie canadien assure à la population un «accès raisonnable» à des services médicaux et hospitaliers «nécessaires au point de vue médical,» les soins de longue durée ne font pas officiellement partie de ces modalités. En Ontario, les soins de longue durée consistent en un amalgame de services offerts par le gouvernement, des organismes de charité, des organismes à but lucratif et des particuliers. Une consultation continue a été entreprise afin de rationaliser le financement et la prestation des services. Cet article passe en revue la série de propositions de politiques présentées et le processus de consultation auprès du public s'y rattachant. Les auteurs concluent que l'accent mis sur la «participation communautaire» sans une définition claire du concept «communautaire» ou des objectifs de la participation a contribué paradoxalement à élargir «l'ampleur du conflit,» à frustrer davantage les intervenants et à faire obstacle à la mise en oeuvre de politiques.

Keywords

Long-term CareHealth ServicesHealth PolicyFinancingConsumer Participation.Soins de longue duréeservices de santépolitique de santéfinancementparticipation.
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 14 , Issue 2 , Été/Summer 1995 , pp. 294 - 318
Copyright
Copyright © Canadian Association on Gerontology 1995

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References

1.Government of Canada. The Constitution Act, 1982. Ottawa: Government of Canada, 1982. (Formerly the British North America Act, 1867.)Google Scholar
2.Government of Canada. Hospital Insurance and Diagnostic Services Act, c. 28, S.l. Statutes of Canada, 1957.Google Scholar
3.Government of Canada. Medical Care Act. Statutes of Canada, c. 64, s. 1, 1966–67.Google Scholar
4.Taylor, MG.Health Insurance and Canadian Public Policy: The Seven Decisions That Created the Canadian Health Insurance System and Their Outcomes. Kingston, ON: McGill-Queen's University Press, 1987.Google Scholar
5.Government of Canada. Federal-Provincial Fiscal Arrangements and Federal Post-Secondary Education and Health Contributions Act. Revised Statutes of Canada, chapter F-8, 1985.Google Scholar
6.Canada. Parliamentary Task Force on Federal-Provincial Fiscal Arrangements. Fiscal Federalism in Canada. Report of the Parliamentary Task Force on Federal-Provincial Fiscal Arrangements, August, 1981.Google Scholar
7.Health and Welfare Canada. Canada Health Act, R.S.C. Revised Statutes of Canada, c. C-6, 1989.Google Scholar
8.Barker, P. The development of the major shared-cost programs in Canada. In: Oilling, RD, Westmacott, MW, eds. Perspectives on Canadian Federalism. Toronto: Prentice Hall, 1988; 195–219.Google Scholar
9.Courchene, TJ, Conklin, DW, Cook, GCA, eds. Ottawa and the Provinces: The Distribution of Money and Power, v. 1–2. Toronto: University of Toronto Press, 1985.Google Scholar
10.Milne, D.Tug of War. Toronto: James Lorimer & Company Publishers, 1986.Google Scholar
11.Evans, RG, Stoddart, GL. Producing health, consuming care. Soc Sci Med 1990; 31(12): 1347–63.Google Scholar
12.Mhatre, SL, Deber, RB. From equal access to health care to equitable access to health: a review of Canadian provincial health commissions and reports. Int J Health Serv 1992; 22(4): 645–68.Google Scholar
13.Blendon, RJ, Taylor, H. Views on health care: public opinion in three nations. Health Affairs 1989; 8(2): 149–57.Google Scholar
14.Blendon, RJ, Leitman, R, Morrison, I, Donelan, K. Satisfaction with health systems in ten nations. Health Affairs 1990; 9(2): 185–92.Google Scholar
15.Cairns, AC, Constitutional change and the three equalities. In: Watts, RL, Brown, DM, eds. Options for a New Canada. Toronto: University of Toronto Press, 1991; 77–100.Google Scholar
16.Simpson, J. Faultlines: Struggling for a Canadian Vision. Toronto: Harper Collins Publishers Ltd., 1993.Google Scholar
17.Angus, DE. Review of significant health care commissions and task forces in Canada since 1983–84. Prepared for the Canadian Medical Association, Canadian Nurses Association and Canadian Hospital Association Ottawa, December, 1989.Google Scholar
18.Deber, RB, Baker, GR, Mhatre, SL. Review of provincial systems. In: Davis, SM, ed, Health Care. Innovation, Impact and Challenge. Queen's University, Kingston: School of Policy Studies/School of Public Administration, 1992: 9–23.Google Scholar
19.Deber, RB, Mhatre, SL, Baker, GR. A review of provincial initiatives. In: Blomqvist, A, Brown, DM, eds, Limits to Care: Reforming Canada's Health System in an Age of Restraint. Toronto: C.D. Howe Institute, 1994: 91–124.Google Scholar
20.Schieber, GJ, Poullier, J-P, Greenwald, LM. U.S. health expenditure performance: an international comparison and update. Health Care Financing Review 1992; 13(4): 1–14.Google Scholar
21.Evans, RG. Health care reform: “The issue from hell”. Policy Options 1993; 14(6): 35–41.Google Scholar
22.World Health Organization. Health Promotion: A Discussion Document on the Concept and Principles. Copenhagen: WHO Regional Office for Europe, 1984.Google Scholar
23.Adams, O, Curry, L, Deber, RB. Public and Private Health Care Financing: Literature Review and Description: Volumes 1 & 2. Ottawa: Curry Adams & Associates, 1992.Google Scholar
24.Canadian Medical Association Working Group on Health System Financing in Canada. Toward a New Consensus on Health Care Financing in Canada. Discussion paper prepared by the Working Group on Health System Financing in Canada, Canadian Medical Association, July, 1993.Google Scholar
25.Schattschneider, EE. The Semisovereign People: A Realist's View of Democracy in America. New York: Holt, Rinehart and Winston, 1964.Google Scholar
26.Stone, DA. Policy Paradox and Political Reason. Glenview, IL: Harper Collins Publishers Ltd., 1988.Google Scholar
27.Kellow, AJ. Promoting elegance in policy theory: simplifying Lowi's arenas of power. Pol Stud J 1988; 16(4): 713–24.CrossRefGoogle Scholar
28.Stanbury, WT. A sceptic's guide to the claims of so-called public interest groups. Can Pub Admin 1993; 36(4): 580–605.Google Scholar
29.Shapiro, E. Community and long-term health care in Canada. In: Blomqvist, A, Brown, DM, eds, Limits to Care: Reforming Canada's Health System in an Age of Restraint. Toronto: C.D. Howe Institute, 1994: 327–62.Google Scholar
30.Tarman, VI. Privatization and Health Care: The Case of Ontario Nursing Homes. Toronto: Garamond Press, 1990.Google Scholar
31.Metro Toronto District Health Council. Charting the Landscape: an MSA Network for Metro. Discussion paper prepared by the Long-Term Care Steering Committee, Metro Toronto District Health Council, for use at a conference on MSA Design, Toronto, December 1–62, 1993.Google Scholar
32.Deber, RB, ed. Case Studies in Canadian Health Policy and Management, v. 1. Ottawa: Canadian Hospital Association Press, 1992.Google Scholar
33.Nickoloff, B, Quinn, B, Zulys, H, Deber, RB. To Be or Not To Be: Coordinating and Integrating Services for the Elderly. Case Study Series in Canadian Health Policy, Department of Health Administration, University of Toronto, 1991.Google Scholar
34.Rachlis, M, Kushner, C. Second Opinion: What's Wrong With Canada's Health Care System and How to Fix It. Toronto: Collins Publishing, 1989.Google Scholar
35.Weissert, WG. Cost-effectiveness of home care. In: Deber, RB, Thompson, GG, eds, Restructuring Canada's Health Services System: How Do We Get There From Here? Toronto: University of Toronto Press, 1992; 89–98.Google Scholar
36.Shapiro, E. There's no place like home. In: Deber, RB, Thompson, GG, eds. Restructuring Canada's Health Services System: How Do We Get There From Here? Toronto: University of Toronto Press, 1992; 99–104.Google Scholar
37.Price Waterhouse Management Consultants. Summary of the Pilot Project Evaluation of the Alberta Assessment and Placement Model for Long-Term Care Services. Prepared for the Assessment and Placement Pilot Project Committee, Alberta Health, by Price Waterhouse Management Consultants, September, 1988.Google Scholar
38.Ontario Minister for Senior Citizens' Affairs. A New Agenda: Health and Social Service Strategies for Ontario's Seniors. Toronto: Ontario Minister for Senior Citizens' Affairs, 1986.Google Scholar
39.Ontario Ministry of Community and Social Services, Ontario Ministry of Health, et al. Strategies for Change: Comprehensive Reform of Ontario's Long-Term Care Services. Toronto: Queen's Printer for Ontario, 1990.Google Scholar
40.Lamb, M, Deber, RB. Managed care: what is it and can it be applied to Canada? In: Deber, RB, Thompson, GG, eds, Restructuring Canada's Health Care System: How Do We Get There From Here? Toronto: University of Toronto Press, 1992; 159–64.Google Scholar
41.Deber, RB, Masnyk, K, Gordon, L. Summary of Stakeholder Responses to Comprehensive Health System Planning Commission (Orser Report). Document prepared for the Ontario Ministry of Health, November 30,1992.Google Scholar
42.Ontario Ministry of Community and Social Services, Ontario Ministry of Health, Ontario Ministry of Citizenship. Redirection of Long-Term Care and Support Services in Ontario: A Public Consultation Paper. Toronto: Queen's Printer for Ontario, 1991.Google Scholar
43.Aronson, J. Giving consumers a say in policy development: influencing policy or just being heard? Can Pub Policy 1993; 19(4): 367–78.Google Scholar
44.Ontario Ministry of Health, Ontario Ministry of Community and Social Services, Ontario Ministry of Citizenship. Partnerships in Long-Term Care: A New Way to Plan, Manage and Deliver Services and Community Support: A Policy Framework. Toronto: Queen's Printer for Ontario, 1993.Google Scholar
45.Charles, C, DeMaio, S. Lay Participation in Health Care Decision Making: A Conceptual Framework. Centre for Health Economics and Policy Analysis. Journal of Health Politics, Policy and Law, 1993; 18(4): 881–904.Google Scholar
46.Senior Citizens' Consumer Alliance for Long-Term Care Reform. Public Hearings into the Government of Ontario's Proposals for the Redirection of Long-Term Care. Report sponsored by The Consumer's Association of Canada (Ontario), The Ontario Coalition of Senior Citizens' Organizations, and United Senior Citizens of Ontario, November, 1991.Google Scholar
47.Senior Citizens' Consumer Alliance for Long-Term Care Reform. Consumer Report on Long-Term Care Reform. Report prepared for the Policy Conference on Long-Term Care Reform, The Old Mill, Toronto, July 6, 1992.Google Scholar
48.Ontario Community Support Association. Response to Redirection of Long-Term Care and Support Services in Ontario. Long-Term Care Consultation Project Report Part 1, prepared by the Ontario Community Support Association, April 3, 1992.Google Scholar
49.Osborne, DE, Gaebler, T. Reinventing Government: How the Entrepreneurial Spirit is Transforming the Public Sector. Reading, MA: Addison-Wesley Publications, 1992.Google Scholar
50.Saltman, RB, von Otter, C. Planned Markets and Public Competition: Strategic Reform in Northern European Health Systems. Philadelphia: Open University Press, 1992.Google Scholar
51.Ontario Ministry of Health, Ontario Ministry of Community and Social Services, Ontario Ministry of Citizenship. Building Partnerships in Long-Term Care: A New Way to Plan, Manage and Deliver Services and Community Support: A Local Planning Framework. Toronto: Queen's Printer for Ontario, 1993.Google Scholar
52.Ontario Ministry of Health, Ontario Ministry of Community and Social Services, Ontario Ministry of Citizenship. Partnerships in Long-Term Care: A New Way to Plan, Manage and Deliver Services and Community Support: An Implementation Framework. Toronto: Queen's Printer for Ontario, 1993.Google Scholar
53.Ontario Ministry of Health, Ontario Ministry of Community and Social Services, Ontario Ministry of Citizenship. Partnerships in Long-Term Care: A New Way to Plan, Manage and Deliver Services and Community Support: Guidelines for the Establishment of Multi-Service Agencies. Toronto: Queen's Printer for Ontario, 1993.Google Scholar
54.Metropolitan Toronto Commissioner of Community Services. Memo to the Metropolitan Toronto Community Services and Housing Committee from the Commissioner of Community Services. Memo re: Government of Ontario's Bill 173, An Act Respecting Long-Term Care and the Metropolitan Toronto District Health Council's Report Entitled “An MSA Framework for Metropolitan Toronto”, July 21, 1994.Google Scholar
55.Khanlou, N. Citizen Participation in Local Health Care Planning. Master of Science Thesis, Graduate Department of Community Health, University of Toronto, 1993.Google Scholar