This is an evaluation of the health system changes in Montreal, Quebec, in the late 1990s. We hav... more This is an evaluation of the health system changes in Montreal, Quebec, in the late 1990s. We have estimated their effects for surgical patients with conditions amenable to day surgery. We contrasted the experiences of a cohort of such patients seen in 1996, at the beginning of the changes, with those of a second cohort seen in 1999, after adaptation
Background: There is much interest in reducing hospital stays by providing some health care servi... more Background: There is much interest in reducing hospital stays by providing some health care services in patients' homes. The authors review the evidence regard- ing the effects of this acute care at home (acute home care) on the health of pa- tients and caregivers and on the social costs (public and private costs) of manag- ing the patients' health conditions.
I am thankful to all my colleagues for their commentaries. I believe that Human Ecology offers th... more I am thankful to all my colleagues for their commentaries. I believe that Human Ecology offers the theoretical and practical structure for reframing the larger context of finance, delivery, and population health aspects of health care systems be them primary or otherwise. It also specifies what seems to me to be the best unit for complexity analysis: the communal (and yes complex) adaptive system, the ecosystem of illness and illness management---a complex of systems so intricately interconnected that no intervention can ...
This paper argues that jurisdictions in Canada need a common Primary Health Care (PHC) framework ... more This paper argues that jurisdictions in Canada need a common Primary Health Care (PHC) framework that is operational and ‘evaluatable’ to ensure accountability to Canadians. The 2000 Health Accord20 stated that improvements in the Primary Health Care system were crucial to providing Canadians with sustainable health care. While the individual first-contact PC level of services is a deeply embedded strategy for PHC, a broader PHC orientation is required to address health inequities and care distribution, to support capacity building for individuals, families and their local communities and to develop the social and community dimensions of health care. The paper argues that there is unfinished business in the conceptualisation and evaluation of PHC which needs to be addressed in ongoing PHC transition activities. It proposes a framework in order to guide future development. The ‘new orientations’ contained in the Pan American Health Organisation/World Health Organisation regional Declaration of Montevideo, 2005 to which Canada is already a signatory provide values and an agreed upon vision for such a framework. Currently, reforms in PHC are driven by goals of standardisation of structure, process and agency according to the ‘best’ PHC model of delivery. Such competition and attempts at standardisation do not seem appropriate for attaining the goals of PHC, as there does not presently seem to be an agreed upon single PHC model that is ‘best’ for all populations under all conditions in Canada. In contrast, a complex systems approach looks for the combination of models with providers networking in a local participatory system that will produce the best health outcomes for the population of a particular community. A complex systems approach while valuing high level principles and values promotes local governance, allowing for flexibility to adapt operations in different local settings.
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 15, 1997
Budget constraints, technological advances and a growing elderly population have resulted in majo... more Budget constraints, technological advances and a growing elderly population have resulted in major reforms in health care systems across Canada. This has led to fewer and smaller acute care hospitals and increasing pressure on the primary care and continuing care networks. The present system of care for the frail elderly, who are particularly vulnerable, is characterized by fragmentation of services, negative incentives and the absence of accountability. This is turn leads to the inappropriate and costly use of health and social services, particularly in acute care hospitals and long-term care institutions. Canada needs to develop a publicly managed community-based system of primary care to provide integrated care for the frail elderly. The authors describe such a model, which would have clinical and financial responsibility for the full range of health and social services required by this population. This model would represent a major challenge and change for the existing system. D...
This is an evaluation of the health system changes in Montreal, Quebec, in the late 1990s. We hav... more This is an evaluation of the health system changes in Montreal, Quebec, in the late 1990s. We have estimated their effects for surgical patients with conditions amenable to day surgery. We contrasted the experiences of a cohort of such patients seen in 1996, at the beginning of the changes, with those of a second cohort seen in 1999, after adaptation
Background: There is much interest in reducing hospital stays by providing some health care servi... more Background: There is much interest in reducing hospital stays by providing some health care services in patients' homes. The authors review the evidence regard- ing the effects of this acute care at home (acute home care) on the health of pa- tients and caregivers and on the social costs (public and private costs) of manag- ing the patients' health conditions.
I am thankful to all my colleagues for their commentaries. I believe that Human Ecology offers th... more I am thankful to all my colleagues for their commentaries. I believe that Human Ecology offers the theoretical and practical structure for reframing the larger context of finance, delivery, and population health aspects of health care systems be them primary or otherwise. It also specifies what seems to me to be the best unit for complexity analysis: the communal (and yes complex) adaptive system, the ecosystem of illness and illness management---a complex of systems so intricately interconnected that no intervention can ...
This paper argues that jurisdictions in Canada need a common Primary Health Care (PHC) framework ... more This paper argues that jurisdictions in Canada need a common Primary Health Care (PHC) framework that is operational and ‘evaluatable’ to ensure accountability to Canadians. The 2000 Health Accord20 stated that improvements in the Primary Health Care system were crucial to providing Canadians with sustainable health care. While the individual first-contact PC level of services is a deeply embedded strategy for PHC, a broader PHC orientation is required to address health inequities and care distribution, to support capacity building for individuals, families and their local communities and to develop the social and community dimensions of health care. The paper argues that there is unfinished business in the conceptualisation and evaluation of PHC which needs to be addressed in ongoing PHC transition activities. It proposes a framework in order to guide future development. The ‘new orientations’ contained in the Pan American Health Organisation/World Health Organisation regional Declaration of Montevideo, 2005 to which Canada is already a signatory provide values and an agreed upon vision for such a framework. Currently, reforms in PHC are driven by goals of standardisation of structure, process and agency according to the ‘best’ PHC model of delivery. Such competition and attempts at standardisation do not seem appropriate for attaining the goals of PHC, as there does not presently seem to be an agreed upon single PHC model that is ‘best’ for all populations under all conditions in Canada. In contrast, a complex systems approach looks for the combination of models with providers networking in a local participatory system that will produce the best health outcomes for the population of a particular community. A complex systems approach while valuing high level principles and values promotes local governance, allowing for flexibility to adapt operations in different local settings.
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 15, 1997
Budget constraints, technological advances and a growing elderly population have resulted in majo... more Budget constraints, technological advances and a growing elderly population have resulted in major reforms in health care systems across Canada. This has led to fewer and smaller acute care hospitals and increasing pressure on the primary care and continuing care networks. The present system of care for the frail elderly, who are particularly vulnerable, is characterized by fragmentation of services, negative incentives and the absence of accountability. This is turn leads to the inappropriate and costly use of health and social services, particularly in acute care hospitals and long-term care institutions. Canada needs to develop a publicly managed community-based system of primary care to provide integrated care for the frail elderly. The authors describe such a model, which would have clinical and financial responsibility for the full range of health and social services required by this population. This model would represent a major challenge and change for the existing system. D...
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Papers by Terry Kaufman
The 2000 Health Accord20 stated that improvements in the Primary Health Care system were crucial to providing Canadians with sustainable health care. While the individual first-contact PC level of services is a deeply embedded strategy for PHC, a broader PHC orientation is required to address health inequities and care distribution, to support capacity building for individuals, families and their local communities and to develop the social and community dimensions of health care.
The paper argues that there is unfinished business in the conceptualisation and evaluation of PHC which needs to be addressed in ongoing PHC transition activities. It proposes a framework in order to guide future development. The ‘new orientations’ contained in the Pan American Health Organisation/World Health Organisation regional Declaration of Montevideo, 2005 to which Canada is already a signatory provide values and an agreed upon vision for such a framework.
Currently, reforms in PHC are driven by goals of standardisation of structure, process and agency according to the ‘best’ PHC model of delivery. Such competition and attempts at standardisation do not seem appropriate for attaining the goals of PHC, as there does not presently seem to be an agreed upon single PHC model that is ‘best’ for all populations under all conditions in Canada. In contrast, a complex systems approach looks for the combination of models with providers networking in a local participatory system that will produce the best health outcomes for the population of a particular community. A complex systems approach while valuing high level principles and values promotes local governance, allowing for flexibility to adapt operations in different local settings.
The 2000 Health Accord20 stated that improvements in the Primary Health Care system were crucial to providing Canadians with sustainable health care. While the individual first-contact PC level of services is a deeply embedded strategy for PHC, a broader PHC orientation is required to address health inequities and care distribution, to support capacity building for individuals, families and their local communities and to develop the social and community dimensions of health care.
The paper argues that there is unfinished business in the conceptualisation and evaluation of PHC which needs to be addressed in ongoing PHC transition activities. It proposes a framework in order to guide future development. The ‘new orientations’ contained in the Pan American Health Organisation/World Health Organisation regional Declaration of Montevideo, 2005 to which Canada is already a signatory provide values and an agreed upon vision for such a framework.
Currently, reforms in PHC are driven by goals of standardisation of structure, process and agency according to the ‘best’ PHC model of delivery. Such competition and attempts at standardisation do not seem appropriate for attaining the goals of PHC, as there does not presently seem to be an agreed upon single PHC model that is ‘best’ for all populations under all conditions in Canada. In contrast, a complex systems approach looks for the combination of models with providers networking in a local participatory system that will produce the best health outcomes for the population of a particular community. A complex systems approach while valuing high level principles and values promotes local governance, allowing for flexibility to adapt operations in different local settings.