Aging in atlantic Canada: service-rich and service-poor communities.

The delivery of services for seniors in Canada is increasingly complex and challenging. Communities across Canada age at different rates, and the forces underlying the differences, such as "aging in place" and migration, vary from community to community. We have identified two types of aging communities: service-rich communities, in which seniors have good health status and better amenities, and service-poor communities, in which seniors have poor health status and limited amenities.

Does It Matter? Decision-maker Perceptions on the Impact of the Regional Training Centres.

A key feature of the Regional Training Centres (RTCs) is the scope and nature of their engagement with decision-makers. While the RTCs may believe that they have an excellent association with decision-makers, is that belief shared? The authors of this paper draw on the results of a survey of decision-makers undertaken by the Canadian Health Services Research Foundation (CHSRF) as part of the preparation for the fourth-year assessment and evaluation of the RTCs. The discussion encompasses three substantive issues: (1) decision-makers' assessment of the added value of the RTCs, (2) the RTCs' ability to effect cultural change in decision-maker organizations and (3) the experience and value of the internship/placement to the decision-maker organization.

Deciding whether to engage the public on health care issues.

Health care decision-makers often face calls for greater public participation or see increasing public engagement as part of their organizational mandate. This article identifies six questions decision-makers must consider when deciding whether to formally engage the public or other stakeholders around a particular health care issue. These questions focus on (1) the clarity of the issue for public engagement, (2) the appropriateness of the issue for public engagement, (3) the extent to which there are viable options, (4) the role for the public, (5) whether the public likely want to be involved and (6) consideration of the expected advantages and disadvantages of public engagement.

Services for seniors in small-town Canada: the paradox of community.

There is a prevailing argument that what small towns lack in formal services they make up for in close ties among rural people and a shared understanding of the notion of community. Drawing on research undertaken in 9 small towns across Canada, the authors examine how the concept of community operates with respect to the provision ofin-home and community care for seniors. The analysis is based on interviews with 55 key informants from local governments, health and social care agencies, voluntary sector organizations, and community groups.

A framework for involving the public in health care coverage and resource allocation decisions.

Coverage and resource allocation decisions are a very important area for public engagement because of their direct impact on the public's access to care and because the affected services are publicly funded. We present a framework that guides decision-makers through key questions they must address when deciding on, structuring, evaluating and disseminating the results of public engagement exercises, particularly as they relate to coverage and resource allocation decisions. The framework will enable decision-makers to better conduct viable and meaningful citizen engagement around these issues.

Medical savings accounts and the Canada Health Act: complimentary or contradictory.

The publicly funded health system in Canada, almost since inception, has been the focus of numerous critiques, matched only by the solutions offered, and the secondary problems generated. One of the proposed solutions is the use of medical savings accounts (MSAs). It is reasoned that MSAs will make Canadians more accountable for the health services they utilize, yield cost containment, and potential savings.

Running to stand still: change and management in Canadian healthcare.

There is a pervasive belief among health system reformers that new public management techniques such as decentralization and market-based approaches will provide the answers to what ails healthcare systems. In this first installment of a two-part discussion, the assumptions and empirical evidence underpinning these techniques are scrutinized, and the effect of their implementation on those who manage the healthcare system is assessed. Other paradigms for delivering healthcare will be considered and described in the second article of this series.

Looking over the horizon: an Internet-based international course in healthcare management.

The International Course in Healthcare Management is predicated on the belief that comparative benefits can most effectively be 'taught' by enabling students to work directly with colleagues in other countries, sharing views, discussing differences, and checking understandings on how healthcare is structured and managed in different countries. The course focuses on four countries--Canada, Germany, Finland and Ireland--which offer an interesting range and mix of approaches to healthcare, and yet are sufficiently similar to ensure relative ease of understanding. The course, which is delivered and taught jointly by faculty from five participating institutions in the four countries using the Internet as the distance delivery medium, is an integral component of each institution's participating department's graduate program.

Health care reforms in Bulgaria: an initial appraisal.

Bulgaria is in the process of re-structuring its health care system from one based on command and control to one founded on pluralism. This paper explores the way this transformation is taking place from the comparative perspective of the health care reforms being implemented in Britain and elsewhere. It draws out the lessons that there may be for Bulgaria based on western European experience and concludes with an assessment of the applicability and desirability of relying on the experience of other countries as a precursor for policy development and formulation in another.

Health care in Canada: a system in turmoil.

Canada, in common with most countries, is re-examining its health care system. The main reasons for the reappraisal are the rising cost of health care and the growing unease that the cost is fast outstripping the capacity of the tax base to support it. This paper examines the way in which Canada's provinces are attempting to meet this health care challenge.

Stochastic simulation and sensitivity analysis: estimating future demand for health resources in China.

A simulation model has been built to estimate the demand for hospital beds and doctors in China between 1990 and 2010. The model was used to compare deterministic sensitivity analysis and stochastic simulation in assessing inherent uncertainty in health projections. The stochastic simulation method uses information more efficiently, and produces a more reasonable average estimate and a more meaningful range of projections than deterministic sensitivity analysis.

An analytical framework of physician productivity and variation in utilization.

The utilization of medical services by patients is an important determinant of doctor productivity, but this factor does not appear to have been given much attention in previous studies. In order to answer the question of why is there a wide variation in doctor output at low level medical facilities in China, an analytical framework of doctor productivity and utilization is developed. The simulation model is used to produce data that can be analyzed by such a framework.

Realities of Health For All by the year 2000.

The European Region of the World Health Organisation (WHO) took the global lead on Health For All when the Regional Committee in 1980 approved a European Health For All Strategy. This was an important breakthrough for WHO as it was the first time Member States in a Region endorsed a common health policy and agreed to be monitored on their progress towards attainment of the strategy. The paper reviews the progress of Member States to date towards the Regional Health For All goal.

Pursuing health for all in Britain--an assessment.

In 1977 the World Health Organisation adopted the strategic goal "Health For All by the Year 2000". The Regional Office for Europe of the World Health Organisation has taken important steps toward the attainment of the goal, with the formulation in 1980 of a common health policy and the adoption by the Regional Committee in 1984 of 38 wide-ranging targets. The targets represent a common view of what could be Health For All in Europe and constitute a major challenge which the 33 member states in the European Region have set for themselves.

The effect of health services on mortality: amenable and non-amenable causes in Spain.

Recent work has demonstrated the usefulness of employing 'avoidable' deaths as an outcome measure for assessing and comparing the effectiveness and quality of health care systems. This paper considers the relevance of 'avoidable' deaths as an outcome measure for the Spanish health system. Mortality data for 1960 to 1984, were examined and the results, with the exception of cancer of the cervix, show a marked decline in 'avoidable' deaths, consistent with studies elsewhere.

General practice, ethnicity and health services delivery.

This paper explores the inter-relationships between the conventional model of general medical practice, a society undergoing the transition from one essentially homogeneous to one that is heterogeneous in composition, and the effects that these changes may have on the mechanisms for the determination and delivery of health care. It is argued that the changing circumstances highlight the inappropriateness of the conventional medical model to primary health care and that an alternative approach for providing care is required.