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. We also report on results for Atlantic Canada from a national study of service provisions. Three issues stand out: (a) the impact on communities of migration and aging in place, (b) the factors that distinguish service-rich and service-poor communities and (c) the conditions necessary to create a service-rich community. All levels of government in Atlantic Canada must work together to develop policies and programs that create and sustain service-rich communities.

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. The findings reveal the paradox of the conventional belief that rural communities can compensate for lack of services for seniors while failing to take into account the uncertain coping ability of the local informal sectors. The authors challenge rural health policy decision-makers, researchers, and providers to debunk assumptions about services for seniors in rural Canada.

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.

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. However, before a nation-wide, public MSA can be considered further, there is need to reconcile the following: (a) empirical evidence in support of MSAs that is not as compelling as some of its proponents argue; (b) the scale and complexity of a MSA if integrated into a publicly funded, nation-wide health system in a country the size of Canada; (c) whether the cost to formulate, implement, and operate a nation-wide Canadian MSA would yield the net gains to warrant such an expenditure; (d) the fact that implementation of a nation-wide MSA potentially may contravene the Canada Health Act.

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. Healthcare systems around the world have been buffeted by rising costs, perceived inefficient use of resources, and consumer and provider dissatisfaction with the delivery and outcomes of care.