Day One
10:00-10:10
Welcome and Introduction
Continuity between home and hospital has been impacted by restructuring in both Canada and Japan. Policy makers have had to create frameworks that acknowledge changing demography and the transfer of care from hospital to home. This workshop will provide a comprehensive overview of critical issues that need to be addressed in order to create health system that provides high quality, seamless care between the hospital and home setting.
10:10-10:40
Overview of Changes in Health Care System
This lecture provides a brief overview of Canada's health system and the impact of economic restructuring and health care expenditures. It reviews the health hunan resources available to serve health needs. Both Canada (9.3%) and Japan (7.3%) share relatively low health care expenditures (Gross National Product) relative to the United States (14%). Over the past 20 years, health care expenditures in hospitals have been reduced by approximately 10%. Physician services decreased by 1% in contrast to pharmaceutical costs which increased approximately 7%. Other health care expenditures increased by 6% which is reflected in privatization costs. In the past 7 years, the number of public hospitals decreased by 14%. There has been a reduction in acute care beds, and the number of outpatient visits increased due to early discharge. Canada reorganized the community services and in some provinces, privatized the services. In Japan, the trend toward privatization have companies with little or no health care drawn into the sector by newly available government funds (Matushita Electric works, Shimiazu Construction and Seven-Eleven). The new national insurance program provides seniors 65 and older new access to services ranging from household help to nursing care. Saphir (2000) reports that 2 million out of a potential 18 million have applied for these benefits. In Canada this move towards privatization has lead to a reduced number of nursing personnel and a disruption in the continuity of care. In the community sector contracts for nursing care are individually negotiated depending on a competitive price. These companies, in order to be competitive cut costs by using fewer services and non-regulated personnel. This reorganization has not been seen as particularly successful. It is interesting to note that public opinion on Canada's health care system has declined. In 1991 in a national survey 61% rated the health care system as excellent and in 1998 only 29% rated the system as excellent. In conclusion, there was a consistent decline in hospital expenditures and as a result a decline in total days spent in hospital.
