Journal articles on the topic 'Child care services – Government policy – Canada'
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Prentice, Susan, and Linda A. White. "Childcare deserts and distributional disadvantages: the legacies of split childcare policies and programmes in Canada." Journal of International and Comparative Social Policy 35, no. 1 (February 2019): 59–74. http://dx.doi.org/10.1080/21699763.2018.1526700.
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AbstractEarly childhood education and care (ECEC) policies and services in Canada exhibit marked gaps in access, creating ‘childcare deserts’ and distributional disadvantages. Cognate family policies that support children and families, such as parental leave and child benefits, are also underdeveloped. This article examines the current state of ECEC services in Canada and the reasons behind the uncoordinated array of services and policy, namely, a liberal welfare state tradition that historically has encouraged private and market-based care, a comparatively decentralised federal system that militates against coordinated policy-making, and a welfare state built on gendered assumptions about care work. The article assesses recent government initiatives, including the federal 2017 Multilateral Framework on Early Learning and Child Care, concluding that existing federal and provincial initiatives have limited potential to bring about paradigmatic third-order change.
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Teghtsoonian, Katherine. "Neo-Conservative Ideology and Opposition to Federal Regulation of Child Care Services in the United States and Canada." Canadian Journal of Political Science 26, no. 1 (March 1993): 97–121. http://dx.doi.org/10.1017/s000842390000247x.
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AbstractThis article explores neo-conservative ideology in the industrialized West through a comparative analysis of the arguments advanced against a strong role for the federal government in regulating child care services in the United States and Canada. Existing analyses of neo-conservatism suggest that it is composed of many different elements which may lead to contradictory policy prescriptions; this literature also downplays the presence of a “pro-family” component in the Canadian context. The article illustrates the presence of an “anti-statist,” a “pro-market” and a “pro-family” strand of neo-conservatism in each country, and shows that they converge in opposing federal regulation of child care services. It also suggests that, while there appears to be a shared neo-conservative vision of the appropriate relationship between families and the state across national contexts, discussions of the state and its relationship to the market take on a distinctive tone in each country.
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Milner, Kate M., Raquel Bernal Salazar, Sunil Bhopal, Alexandra Brentani, Pia Rebello Britto, Tarun Dua, Melissa Gladstone, et al. "Contextual design choices and partnerships for scaling early child development programmes." Archives of Disease in Childhood 104, Suppl 1 (March 18, 2019): S3—S12. http://dx.doi.org/10.1136/archdischild-2018-315433.
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Translating the Nurturing Care Framework and unprecedented global policy support for early child development (ECD) into action requires evidence-informed guidance about how to implement ECD programmes at national and regional scale. We completed a literature review and participatory mixed-method evaluation of projects in Saving Brains®, Grand Challenges Canada® funded ECD portfolio across 23 low- and middle-income countries (LMIC). Using an adapted programme cycle, findings from evaluation related to partnerships and leadership, situational analyses, and design for scaling ECD were considered. 39 projects (5 ‘Transition to Scale’ and 34 ‘Seed’) were evaluated. 63% were delivered through health and 84% focused on Responsive Caregiving and Early Learning (RCEL). Multilevel partnerships, leadership and targeted situational analysis were crucial to design and adaptation. A theory of change approach to consider pathways to impact was useful for design, but practical situational analysis tools and local data to guide these processes were lacking. Several RCEL programmes, implemented within government services, had positive impacts on ECD outcomes and created more enabling caregiving environments. Engagement of informal and private sectors provided an alternative approach for reaching children where government services were sparse. Cost-effectiveness was infrequently measured. At small-scale RCEL interventions can be successfully adapted and implemented across diverse settings through processes which are responsive to situational analysis within a partnership model. Accelerating progress will require longitudinal evaluation of ECD interventions at much larger scale, including programmes targeting children with disabilities and humanitarian settings with further exploration of cost-effectiveness, critical content and human resources.
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Norris, Shane A., Catherine E. Draper, Alessandra Prioreschi, CM Smuts, Lisa Jayne Ware, CindyLee Dennis, Philip Awadalla, et al. "Building knowledge, optimising physical and mental health and setting up healthier life trajectories in South African women (Bukhali): a preconception randomised control trial part of the Healthy Life Trajectories Initiative (HeLTI)." BMJ Open 12, no. 4 (April 2022): e059914. http://dx.doi.org/10.1136/bmjopen-2021-059914.
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IntroductionSouth Africa’s evolving burden of disease is challenging due to a persistent infectious disease, burgeoning obesity, most notably among women and rising rates of non-communicable diseases (NCDs). With two thirds of women presenting at their first antenatal visit either overweight or obese in urban South Africa (SA), the preconception period is an opportunity to optimise health and offset transgenerational risk of both obesity and NCDs.Methods and analysisBukhali is the first individual randomised controlled trial in Africa to test the efficacy of a complex continuum of care intervention and forms part of the Healthy Life Trajectories Initiative (HeLTI) consortium implementing harmonised trials in Canada, China, India and SA. Starting preconception and continuing through pregnancy, infancy and childhood, the intervention is designed to improve nutrition, physical and mental health and health behaviours of South African women to offset obesity-risk (adiposity) in their offspring. Women aged 18–28 years (n=6800) will be recruited from Soweto, an urban-poor area of Johannesburg. The primary outcome is dual-energy X-ray absorptiometry derived fat mass index (fat mass divided by height2) in the offspring at age 5 years. Community health workers will deliver the intervention randomly to half the cohort by providing health literacy material, dispensing a multimicronutrient supplement, providing health services and feedback, and facilitating behaviour change support sessions to optimise: (1) nutrition, (2) physical and mental health and (3) lay the foundations for healthier pregnancies and early child development.Ethics and disseminationEthical approval has been obtained from the Human Ethics Research Committee University of the Witwatersrand, Johannesburg, South Africa (M1811111), the University of Toronto, Canada (19-0066-E) and the WHO Ethics Committee (ERC.0003328). Data and biological sample sharing policies are consistent with the governance policy of the HeLTI Consortium (https://helti.org) and South African government legislation (POPIA). The recruitment and research team will obtain informed consent.Trial registrationThis trial is registered with the Pan African Clinical Trials Registry (https://pactr.samrc.ac.za) on 25 March 2019 (identifier: PACTR201903750173871).Protocol version20 March 2022 (version #4). Any protocol amendments will be communicated to investigators, Institutional Review Board (IRB)s, trial participants and trial registries.
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Fried, Bruce J., Raisa B. Deber, and Peggy Leatt. "Corporatization and Deprivatization of Health Services in Canada." International Journal of Health Services 17, no. 4 (October 1987): 567–84. http://dx.doi.org/10.2190/0aul-3h8t-8lwt-rf4g.
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Canada's system of health services has been shaped by the forces and values in the Canadian political, cultural, social, and economic environment; these forces continue to place constraints on future changes. We distinguish between “corporatization” and “privatization,” and the implications of each for improved efficiency of the system. Although the organization of health services is, in certain provinces, undergoing significant structural changes, there is evidence that rather than privatizing, the system may actually be continuing to experience what we have termed deprivatization, as the scope of government involvement expands to include a more comprehensive definition of health care. Trends in Canada differ considerably from those in the United States; universal health insurance has curbed the ability and desire of institutions to exclude members of some socioeconomic groups from receiving care. U.S.-based models, if applied to Canada, could lead to both higher costs and lower quality of care. Considerable efficiencies can be realized within Canada's current system.
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Church, John, and Paul Barker. "Regionalization of Health Services in Canada: A Critical Perspective." International Journal of Health Services 28, no. 3 (July 1998): 467–86. http://dx.doi.org/10.2190/ufpt-7xpw-794c-vj52.
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Since the introduction of universal health insurance in Canada in the late 1960s, the federal and provincial governments have been concerned with cost savings, efficiency of service delivery, equity in service provision, enhanced citizen participation, and increased accountability of decision-makers. A plethora of government royal commissions and task forces have recommended a similar range of options for addressing these concerns. Central to the reforms has been a proposed regionalized health system with an intermediary body responsible for functions previously assigned to local or central structures. For its supporters, regionalization offers a means of better coordinating and integrating health care delivery and controlling expenditures, and promises a more effective provision of services and an avenue for citizen participation in health care decision-making. All provincial governments except Ontario have introduced regional structures for health care, with the hope that these changes will increase efficiency, equity, and responsiveness. However, despite the alleged benefits, regionalization presents significant challenges. It faces obstacles to integrating and coordinating services in a manner that produces economies of scale; it requires an enhanced level of information that may be difficult to achieve; it is unlikely to involve citizens in health care decision-making; and it may actually lead to increased costs.
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Ostry, Aleck S. "International Trade Regulation and Publicly Funded Health Care in Canada." International Journal of Health Services 31, no. 3 (July 2001): 475–80. http://dx.doi.org/10.2190/mt8d-h4ec-jkme-3kd3.
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The World Trade Organization (WTO) creates new challenges for the Canadian health care system, arguably one of the most “socialized” systems in the world today. In particular, the WTO's enhanced trade dispute resolution powers, enforceable with sanctions, may make Canadian health care vulnerable to corporate penetration, particularly in the pharmaceutical and private health services delivery sectors. The Free Trade Agreement and its extension, the North American Free Trade Agreement, gave multinational pharmaceutical companies greater freedom in Canada at the expense of the Canadian generic drug industry. Recent challenges by the WTO have continued this process, which will limit the health care system's ability to control drug costs. And pressure is growing, through WTO's General Agreement on Trade in Services and moves by the Alberta provincial government to privatize health care delivery, to open up the Canadian system to corporate penetration. New WTO agreements will bring increasing pressure to privatize Canada's public health care system and limit government's ability to control pharmaceutical costs.
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Moroz, Nicholas, Isabella Moroz, and Monika Slovinec D’Angelo. "Mental health services in Canada: Barriers and cost-effective solutions to increase access." Healthcare Management Forum 33, no. 6 (July 2, 2020): 282–87. http://dx.doi.org/10.1177/0840470420933911.
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In this article, an overview of the barriers to accessing mental health services in Canada is provided and the recent federal funding commitments toward increasing the availability of evidence-based and cost-effective solutions to improve access to mental health services are highlighted. Barriers pertain mainly to costs, not knowing where to get help, excessive wait times, and insufficient funding. Through the Common Statement of Principles on Shared Health Priorities agreement, action is being taken by all jurisdictions in Canada to increase community-based mental health promotion programs and early interventions, especially those targeting children and youth. A growing body of evidence is demonstrating how specific community and primary care-based interventions are both effective and cost-effective. These integrated community solutions, shown to be effective for increasing access to appropriate services for patients while saving costs to the healthcare system, would benefit from the recent funding investments put in place by the federal government.
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Skamnakis, Christoforos. "Local child care policies: A reformulation of the structural deficiencies of social protection." Social Cohesion and Development 11, no. 2 (June 23, 2017): 139. http://dx.doi.org/10.12681/scad.14132.
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For years, care has been at the fore of social policy among local government authorities in Greece. In a context of budgetary constraints and protracted austerity policy, both of which lead to a retrenchment in social protection, the contribution of local government authorities has become essential. Our study engages with the present-day context, and with the features, objectives and prospects for the dynamic role of local government authorities in preschool care. We highlight those features that shape the new environment, while accounting for the demand and supply of the relevant services, the funding of the facilities, and finally, their contribution to social protection, as the latter proliferates at the local level.
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Di Matteo, Livio. "Finances of the Nation: The Evolution of Health Expenditures in Canada, 1926-2019." Canadian Tax Journal/Revue fiscale canadienne 69, no. 3 (November 2021): 889–920. http://dx.doi.org/10.32721/ctj.2021.69.3.fon.
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In this article, Livio Di Matteo provides an overview of expenditures on health care in Canada over the long term. He examines changes in the size, relative importance, growth, and composition of health expenditures, with an additional focus on provincial-territorial government spending since the 1970s. Di Matteo links the evolution of health-care spending to factors affecting the demand for and supply of health services, including income, demographic changes, technological development, cost, policy, and public finances.
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Rochefort, David A. "Making Single-Payer Reform Work for Behavioral Health Care: Lessons From Canada and the United States." International Journal of Health Services 50, no. 3 (February 23, 2020): 334–49. http://dx.doi.org/10.1177/0020731420906746.
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The claim is often made that the adoption of single-payer health care in the United States would result in dramatic improvement of services for people with mental health and substance use disorders. Evidence from this sector in countries with such frameworks is mixed, however, presenting both positive and negative lessons for an American audience. Focusing on Canada as an example, this article sheds light on this topic by drawing on sources in the professional and academic literature, government reports, news stories and features, and research on-site by the author. A concluding section highlights key policy issues that American single-payer advocates will need to address for meaningful reform of the behavioral health care sector.
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R. Grant, Karen. "Women's Health in a Changing Society: Changing Women's Health." Australian Journal of Primary Health 4, no. 3 (1998): 20. http://dx.doi.org/10.1071/py98028.
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Women's health and health care for women have been undergoing significant changes in Canada in recent years. In part, change has occurred as a result of health care restructuring (or health reform), brought on by reduced funding by the federal government. Whereas in 1971 (when Canadian Medicare was established), the federal government contributed 50% of the costs of all insured services, today its contribution is a mere 15% and declining. Demands for greater economic efficiencies in the health sector, coupled with concerns about the ageing of the population have also led many provincial governments to restructure health services. There has been a growing shift toward community-based health care, as well as changes to how health care in institutions is delivered. In all of this restructuring, relatively little attention has been focused on the impact of these changes on women.
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Jones, Ray. "The marketisation and privatisation of children’s social work and child protection." Journal of Integrated Care 23, no. 6 (December 21, 2015): 364–75. http://dx.doi.org/10.1108/jica-10-2015-0040.
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Purpose – Whilst the government makes progress on opening up children’s social work, including child protection, to the market place and to private and commercial businesses, there has been little comment on the strengths and weaknesses, and the opportunities and threats, of the political policy direction being pursued. In particular, what are the implications for the integration and consolidation of services, which had been the “joined-up” services policy ambition of previous governments and, for health and social care services, remain the declared ambition of the current government? The paper aims to discuss these issues. Design/methodology/approach – This paper considers the potential impact on children’s social work services and child protection from the government’s policy and regulatory changes which open up all children’s social work to the market place. Findings – Particular concerns are noted that the changes now being allowed and promoted will lead to greater fragmentation rather than integration. Originality/value – This is the first paper to reflect on the government’s push and preference for the unregulated market place it created in 2014 for children’s social work, including child protection.
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Lavoie, Josée G., and Judith Dwyer. "Implementing Indigenous community control in health care: lessons from Canada." Australian Health Review 40, no. 4 (2016): 453. http://dx.doi.org/10.1071/ah14101.
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Objective Over past decades, Australian and Canadian Indigenous primary healthcare policies have focused on supporting community controlled Indigenous health organisations. After more than 20 years of sustained effort, over 89% of eligible communities in Canada are currently engaged in the planning, management and provision of community controlled health services. In Australia, policy commitment to community control has also been in place for more than 25 years, but implementation has been complicated by unrealistic timelines, underdeveloped change management processes, inflexible funding agreements and distrust. This paper discusses the lessons from the Canadian experience to inform the continuing efforts to achieve the implementation of community control in Australia. Methods We reviewed Canadian policy and evaluation grey literature documents, and assessed lessons and recommendations for relevance to the Australian context. Results Our analysis yielded three broad lessons. First, implementing community control takes time. It took Canada 20 years to achieve 89% implementation. To succeed, Australia will need to make a firm long term commitment to this objective. Second, implementing community control is complex. Communities require adequate resources to support change management. And third, accountability frameworks must be tailored to the Indigenous primary health care context to be meaningful. Conclusions We conclude that although the Canadian experience is based on a different context, the processes and tools created to implement community control in Canada can help inform the Australian context. What is known about the topic? Although Australia has promoted Indigenous control over primary healthcare (PHC) services, implementation remains incomplete. Enduring barriers to the transfer of PHC services to community control have not been addressed in the largely sporadic attention to this challenge to date, despite significant recent efforts in some jurisdictions. What does this paper add? The Canadian experience indicates that transferring PHC from government to community ownership requires sustained commitment, adequate resourcing of the change process and the development of a meaningful accountability framework tailored to the sector. What are the implications for practitioners? Policy makers in Australia will need to attend to reform in contractual arrangements (towards pooled or bundled funding), adopt a long-term vision for transfer and find ways to harmonise the roles of federal and state governments. The arrangements achieved in some communities in the Australian Coordinated Care Trials (and still in place) provide a model.
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Corrado, Ray, Lauren Freedman, and Catherine Blatier. "THE OVER-REPRESENTATION OF CHILDREN IN CARE IN THE YOUTH CRIMINAL JUSTICE SYSTEM IN BRITISH COLUMBIA: THEORY AND POLICY ISSUES." International Journal of Child, Youth and Family Studies 2, no. 1/2 (January 31, 2011): 99. http://dx.doi.org/10.18357/ijcyfs21/220115429.
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<span style="font-size: small; font-family: Times New Roman;">Placement in child protection services, or becoming a child in care, is associated with a disproportionate involvement in youth and adult criminal justice systems. While there is not extensive research on this relationship, there is evidence that many children in care have risk profiles consistent with criminal justice involvement. This article provides an overview of the prevalence of exposure to risk factors related to mental health, education, and antisocial behaviour among children in care, in addition to risk factors that are distinctive to those placed in child protection services. A recent large cohort dataset from British Columbia, Canada, is utilized to examine these risk profiles. Recommendations to identify those involved in child protection services most at risk for criminal justice involvement, with the use of risk management instruments such as the Cracow Instrument, are discussed. In addition, several other important policy themes regarding diagnostic and case management challenges are explored.</span>
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Charles, Cathy, Corinne Schalm, and Joyce Semradek. "Involving Stakeholders in Health Services Research: Developing Alberta's Resident Classification System for Long-Term Care Facilities." International Journal of Health Services 24, no. 4 (October 1994): 749–61. http://dx.doi.org/10.2190/63jt-f754-er7f-7g4a.
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Little attention has been directed in Canada to identifying stakeholders at the administrative policy level to whom relevant health services research information can be targeted. This article describes a case study in which key stakeholders (long-term care facility owners, operators, and care providers) were explicitly defined not only as targets of original research information to inform administrative public policy but also as collaborators in the research process and dissemination of results. The research involved development of a classification system to measure resident care requirements in the province's nursing homes and auxiliary hospitals. The classification system formed the basis of a new government administrative policy for allocating public funds to these facilities based on levels of care. The authors describe the rationale for involving stakeholders in the research process, the role of stakeholders as collaborators, and lessons learned from the Alberta experience. Examples are presented of how stakeholders can contribute to the health services research process and outcome: by providing experiential knowledge related to the research outcome, anticipating and overcoming potential problems with policy implementation, facilitating policy-oriented learning across stakeholder groups, assisting in the transfer of research information to wider stakeholder audiences, and promoting acceptance for policy change.
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Shatkin, Jess P., Neaka Balloge, and Myron L. Belfer. "Child and adolescent mental health policy worldwide: an update." International Psychiatry 5, no. 4 (October 2008): 81–84. http://dx.doi.org/10.1192/s174936760000223x.
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Few countries worldwide maintain policies specifically designed to address the mental health needs of children and adolescents. Yet policies are essential to guide the development of systems of care, training programmes for practitioners, and research endeavours. Without policy, there is no clear pathway for programme development, no specific commitment from government, no expression of governance, no guide to support funding, and no clarification of who exactly is responsible for providing services to children and adolescents. In 2004, we published a report aimed at identifying child and adolescent mental health policies worldwide (Shatkin & Belfer, 2004). The present review expands upon that report and provides an up-to-date assessment of these policies.
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Telford, Nicole. "Can Canadian Women Have it All? How Limited Access to Affordable Child Care Restricts Freedom and Choice." Canadian Journal of Family and Youth / Le Journal Canadien de Famille et de la Jeunesse 8, no. 1 (January 27, 2016): 153–72. http://dx.doi.org/10.29173/cjfy27146.
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The objective of this essay is to provide an historical account of the attempts made to implement a universal child care policy in Canada. Since World War II, we have been seeing large numbers of women entering the workforce and have had no centralized child care policy in place. This contributes to role strain on women as there appears to be little choice in work and family life. This paper explores the effort made by the feminist movement and women’s advocates to establish a universal child care system. I hope to achieve a clear understanding that the need for child care remains an equality issue. Throughout this paper, I will shed light on the effects child care has on women, their families, and society. I will also address the current policies in place and what is to come under the new Liberal government.
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P Marchildon, Gregory. "Canadian health system reforms: lessons for Australia?" Australian Health Review 29, no. 1 (2005): 105. http://dx.doi.org/10.1071/ah050105.
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This paper analyses recent health reform agenda in Canada. From 1988 until 1997, the first phase of reforms focused on service integration through regionalisation and a rebalancing of services from illness care to prevention and wellness. The second phase, which has been layered onto the ongoing first phase, is concerned with fiscal sustainability from a provincial perspective, and the fundamental nature of the system from a national perspective. Despite numerous commissions and studies, some questions remain concerning the future direction of the public system. The Canadian reform experience is compared with recent Australian health reform initiatives in terms of service integration through regionalisation, primary care reform, Aboriginal health, the public?private debate, intergovernmental relations and the role of the federal government.
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WHITE, LINDA A. "Ideas and the Welfare State." Comparative Political Studies 35, no. 6 (August 2002): 713–43. http://dx.doi.org/10.1177/0010414002035006004.
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This article examines the legacy of American and Canadian welfare state development to explain surprisingly comparable levels of child care provision. It highlights the ironies of policy history while demonstrating the importance of ideas as independent causal factors in the development of public policies and the effect of their institutionalization on future policy development. Maternalist, nativist, and eugencist imperatives led U.S. governments to intrude in areas normally considered part of the private sphere and led to the adoption of policies to respond to a perceived decline primarily of the White population. These policies provided a normative and institutional basis for future government involvement in child care funding and programs, even after the conditions that led to the original policies changed. In Canada, the lack of large-scale entrenchment of similar ideas constrained an otherwise more interventionist government and made it more difficult for child care policies to find governmental and societal acceptance.
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Struthers, Ashley, Colleen Metge, Catherine Charette, Jennifer E. Enns, Nathan C. Nickel, Dan Chateau, Mariette Chartier, Elaine Burland, Alan Katz, and Marni Brownell. "Understanding the Particularities of an Unconditional Prenatal Cash Benefit for Low-Income Women: A Case Study Approach." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 56 (January 2019): 004695801987096. http://dx.doi.org/10.1177/0046958019870967.
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We explored the particularities of the Healthy Baby Prenatal Benefit (HBPB), an unconditional cash transfer program for low-income pregnant women in Manitoba, Canada, which aims to connect recipients with prenatal care and community support programs, and help them access healthy foods during pregnancy. While previous studies have shown associations between HBPB and improved birth outcomes, here we focus on how the intervention contributed to positive outcomes. Using a case study design, we collected data from government and program documents and interviews with policy makers, academics, program staff, and recipients of HBPB. Key informants identified using evidence and aligning with government priorities as key facilitators to the implementation of HBPB. Program recipients described how HBPB helped them improve their nutrition, prepare for baby, and engage in self-care to moderate the effect of stressful life events. This study provides important contextualized evidence to support government decision making on healthy child development policies.
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Marceau, Raelene, Kathleen Hunter, Stephanie Montesanti, and Tammy O’ Rourke. "Sustaining Primary Health Care Programs and Services: A Scoping Review Informing the Nurse Practitioner Role in Canada." Policy, Politics, & Nursing Practice 21, no. 2 (May 2020): 105–19. http://dx.doi.org/10.1177/1527154420923738.
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Sustainability is a key concept in the politics and local policy of health care delivery, particularly during discussions on the principles of primary health care (PHC) and health care reform. In Canada, previous reforms in PHC were implemented with the goal of achieving long-term sustainable change in health systems across the country. However, insufficient resources and a changing environment have impeded the sustainability of many PHC programs and services. An example is the nurse practitioner (NP) role, which was introduced in Canada in 1967 but failed to be sustained. In the mid-1990s, in response to a call for PHC reform, the role was reimplemented with the support of government legislation, regulation, and remuneration mechanisms. However, despite evidentiary success of NP role effectiveness and efficiency in Canada’s health system, many barriers toward full implementation of the role continue to exist and sustainability remains at risk. This scoping review was undertaken to inform a research project exploring the closure of an NP clinic in a western Canadian province. The review searched relevant peer-reviewed and gray literature from Canada, United Kingdom, and Australia, to better understand and describe the factors influencing sustainability of the NP role and other PHC programs and services.
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Shapiro, Gilla K., Eryn Tong, Rinat Nissim, Camilla Zimmermann, Sara Allin, Jennifer Gibson, Madeline Li, and Gary Rodin. "Exploring key stakeholders’ attitudes and opinions on medical assistance in dying and palliative care in Canada: a qualitative study protocol." BMJ Open 11, no. 12 (December 2021): e055789. http://dx.doi.org/10.1136/bmjopen-2021-055789.
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IntroductionCanadians have had legal access to medical assistance in dying (MAiD) since 2016. However, despite substantial overlap in populations who request MAiD and who require palliative care (PC) services, policies and recommended practices regarding the optimal relationship between MAiD and PC services are not well developed. Multiple models are possible, including autonomous delivery of these services and formal or informal coordination, collaboration or integration. However, it is not clear which of these approaches are most appropriate, feasible or acceptable in different Canadian health settings in the context of the COVID-19 pandemic and in the post-pandemic period. The aim of this qualitative study is to understand the attitudes and opinions of key stakeholders from the government, health system, patient groups and academia in Canada regarding the optimal relationship between MAiD and PC services.Methods and analysisA qualitative, purposeful sampling approach will elicit stakeholder feedback of 25–30 participants using semistructured interviews. Stakeholders with expertise and engagement in MAiD or PC who hold leadership positions in their respective organisations across Canada will be invited to provide their perspectives on the relationship between MAiD and PC; capacity-building needs; policy development opportunities; and the impact of the COVID-19 pandemic on the relationship between MAiD and PC services. Transcripts will be analysed using content analysis. A framework for integrated health services will be used to assess the impact of integrating services on multiple levels.Ethics and disseminationThis study has received ethical approval from the University Health Network Research Ethics Board (No 19-5518; Toronto, Canada). All participants will be required to provide informed electronic consent before a qualitative interview is scheduled, and to provide verbal consent prior to the start of the qualitative interview. Findings from this study could inform healthcare policy, the delivery of MAiD and PC, and enhance the understanding of the multilevel factors relevant for the delivery of these services. Findings will be disseminated in conferences and peer-reviewed publications.
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Putri, Dina Eka, Estie Kruger, and Marc Tennant. "Retrospective analysis of utilisation of the Australian Child Dental Benefit Scheme." Australian Health Review 44, no. 2 (2020): 304. http://dx.doi.org/10.1071/ah19011.
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Objective The Child Dental Benefit Scheme (CDBS), which provides dental services for targeted children in Australia, was implemented in 2014. Currently there is no information available on the cost and utilisation patterns of this publicly funded scheme. This study aimed to analyse the pattern of dental visits under the CDBS, as well as the cost of the CDBS over the first 2 years of operation. Methods This study was a retrospective descriptive analysis, using data from Medicare Statistics (an Australian Government website) from two calendar years (2014 and 2015). Results Nationally, the number of CDBS patients declined by 16.3% after the first year, and patients were predominantly aged 5–14 years. Preventive services were the most used service, and contributed to approximately 30% of total expenditure. Conclusion The utilisation of CDBS is considered to be low. What is known about the topic? Previous government dental schemes in Australia resulted in inequalities in utilisation of the scheme by targeted groups. The CDBS was implemented with an extension of eligibility criteria and services offered as a means to improve access to dental care. What does this paper add? There is no information available on the utilisation and cost patterns of the CDBS; hence, this study analysed the pattern of utilisation and the cost of the CDBS over the first 2 years of operation. What are the implications for practitioners? It is important that practitioners promote the scheme among those eligible to enable targeted populations access to the scheme and to ultimately improve child oral health.
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Wardani, Yuniar, and Ichtiarini Nurullita Santri. "REFORM OF MATERNAL AND CHILD HEALTH SERVICES DURING THE COVID-19 PANDEMIC: IS IT NECESSARY?" Epidemiology and Society Health Review (ESHR) 3, no. 2 (July 31, 2021): 31–35. http://dx.doi.org/10.26555/eshr.v3i2.3865.
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The COVID-19 pandemic has impacted the health crisis and led to significant government policy changes with the maternal and child health care system. Long-term termination of essential services affects the risk of losing trust in the health system, decreasing services use. Health service reform is carried out to maintain the sustainability of health services. Priority services aim to ensure access to sexual and reproductive health, growth monitoring, screening for acute malnutrition in children, mothers, and pregnant women. Furthermore, implement a health information system to support maternal and child health and a robust system to monitor and respond to real-time data during COVID-19.
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Aubrecht, Katie, Rosanne Burke, Jacqueline Gahagan, Laura Dowling, Christine Kelly Mary Jean Hande, Susan Hardie, and Janice Keefe. "Health equity impacts of COVID-19 policies on dementia-relevant community services: A SGBA+ policy scan." Innovation in Aging 4, Supplement_1 (December 1, 2020): 966. http://dx.doi.org/10.1093/geroni/igaa057.3529.
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Abstract This presentation shares the methodology and early findings from a policy scan conducted to understand and assess the impact of COVID-19 policies on dementia care in the community for diverse populations in the province of Nova Scotia, Canada. The scan provided baseline information on: 1) Provincial legislative and regulatory policies related to dementia care in the community; 2) Orders and legislation enacted in response to COVID-19 that potentially impact those policies. Information was obtained from publicly accessible databases and government websites. Searches were also conducted using Google. 135 Acts were collected and reviewed. A specific aim of the scan was to generate knowledge about the impact of these layered policies in the context of a public health crisis from the perspective of local socially and geographically marginalized communities. A Sex and Gender Based Analysis Plus analytical approach was used to assess potential health equity impacts of COVID-19 policies on dementia care in the community. Information was organized using an adapted Health Equity Impact Assessment tool and Systems Health Equity Lens. Strengths and limitations of the approach and tools are discussed.
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Fraser, Sarah, Rémy Rouillard, Lucie Nadeau, Léna D’Ostie Racine, and Raymond Mickpegak. "Collaborating to improve child and youth mental health in Nunavik." Études/Inuit/Studies 40, no. 1 (June 14, 2017): 23–41. http://dx.doi.org/10.7202/1040143ar.
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Following various reports highlighting the lack of mental health services for children and youth in Nunavik (Quebec, Canada), high rates of child placements under youth protection, and gaps in the coordination of services, the Regional Partnership Committee of Nunavik decided to prioritize collaborative, community-based approaches to the health and wellbeing of children, youth, and their families. It is in this context that the regional project Ilagiinut (‘For families’) was initiated and is being piloted in Kuujjuaraapik. In mental health care, collaborative practices are highly valued, and various models are flourishing. However, collaborative care models are not necessarily easy to implement and involve a variety of ingredients, including trust, strong partnerships, clarity of roles, and power dynamics, all of which are influenced by culture and context. In this study, we conducted a total of 54 interviews with administrators, clinicians, and Inuit family members to explore their everyday expectations for and experiences with child and youth mental health services and collaboration between people involved in care. In our analysis we explore how context influences expectations, beliefs, and experiences, and ultimately how these factors impact the nature of services offered to children, youth, and families. The aim is to shed light on obstacles to and facilitators of collaboration in child and youth mental health in order to inform individuals, communities, and organizations that are trying to change policy and practice.
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Hanlon, N. T., and M. W. Rosenberg. "Not-So-New Public Management and the Denial of Geography: Ontario Health-Care Reform in the 1990s." Environment and Planning C: Government and Policy 16, no. 5 (October 1998): 559–72. http://dx.doi.org/10.1068/c160559.
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New public management (NPM) has become the mantra for public sector restructuring in OECD nations. We critically examine NPM in the context of recent public sector restructuring initiatives in the province of Ontario, Canada. Two NPM-inspired reform mechanisms employed by the Ontario government—the benchmarking of hospital-utilization indicators and the offloading of a greater share of patient-care responsibilities to the private sector—are examined as they impact on the economically disadvantaged city of Thunder Bay in the province's remote Northwestern region. We argue that the health reforms pursued by the Ontario government are focused on a one-dimensional notion of efficiency which denies important socioeconomic and health-service-environment dimensions that account for local differences in health-services utilization. Although this type of reform approach achieves short-term cost savings, we question whether the longer term effects on health and social services are efficient and equitable from a systemwide perspective. Ultimately, we question whether NPM will solve the problems inherent in publicly supported health and social services or will generate a new set of problems linked to the belief in the primacy of market mechanisms.
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Serohina, T. V. "The system of protection of the rights of children as a object of government policy." Public administration aspects 6, no. 11-12 (February 20, 2019): 64–71. http://dx.doi.org/10.15421/151875.
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There is no doubt that the evaluation system should be an integral part of the management of any sphere. However, in the context of this study, the actuality is exacerbated by the fact that children are one of the most vulnerable strata of Ukrainian society. Insufficient attention to problematic issues in this area entails consequences for each child as well as for society as a whole. evidence of the priority of this direction of state policy is the participation of the state in a number of international documents in this area, which include the UN Convention on the Rights of the Child, the agreements within the framework of the Council of Europe and the Hague Conference on Private International Law, the Convention on Civil Aspects of International Child Abduction, European Convention on the Exercise of Children’s Rights, Convention on contact with children, etc. Despite the declared principles and high level of financing, there are no noticeable changes. Consequently, it is considered necessary to introduce into the management the evaluation system, which will answer a number of questions: Have the planned results been achieved? How positive were the assumptions about the results of the policy / program / project? How effective, productive and sustainable are the changes? Evaluating the results of the policy / program / project gives feedback on the achievement of the policy / program / project objectives and objectives. In the context of the research it is impossible not to take into account the features of the service sphere, which include the following: the object of evaluation is the activities of the organization providing the service; the complexity of the numerical expression of the quality of services; the consumer of the service itself acts as a participant in the process of rendering the service; therefore, the quality must meet its expectations; services are not stored, they are realized in the process of contact with the consumer.On the other hand, the peculiarities of the sphere of children’s rights protection should also be taken into account, as it is impossible to assess the degree of satisfaction of needs, which is one of the important indicators in assessing the effectiveness of public services. This is due to the fact that children do not represent real consumers, that is, those who decide for themselves, need help or not, should be arranged in the residential institution or not, what requirements for the services provided to them and t. The National Strategy for the Reform of the Institutional Care and the Rearing of Children for 2017-2026 is intended to promote the development of a system for protecting children’s rights under the new principles. Among other things, the document provides the basis for applying evaluation as one of the key points in achieving the goals set in the Strategy. First, the Strategy contains elements of the preliminary assessment, which is carried out before the implementation of the program documents, and creates the preconditions for conducting qualitative evaluation at subsequent stages. In particular, the document discloses existing problems, describes the institutional structure, identifies the indicators, including the number of children in institutions of institutional care and upbringing of children, the percentage of children who have orphan status or a child deprived of parental care, the number of children, who have a disability, etc.Secondly, the Strategy contains a basis for evaluating the effectiveness. In particular, the Action Plan for the implementation of Stage I of the Strategy defines the measures responsible for implementation, terms of implementation and indicators. Indicators include: the number of children covered by inclusive education; the number of orphans provided with housing, children deprived of parental care; the number of children who are raised in institutions of institutional care and upbringing of children, etc.Thirdly, the Strategy contains data on the expected results, which include: the suspension of placement by the year 2020 of children up to three years of age prior to institutional care and upbringing; the termination by 2026 of activity of all types of institutional care institutions and the upbringing of children in which more than 15 pupils live; providing children and families with children with access to services according to their needs in each territorial community, etc.To date, the establishment of a regional Register of children of institutional care and education institutions (electronic database) has been started, which will provide an opportunity to receive updated data on the number of pupils in institutions and their needs in terms of settlements and to plan content and volume support services for children returning from institutional institutions to the community and their families.
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Nguyen, Anne Xuan-Lan, Alexander Kevorkov, Patricia Li, and Rislaine Benkelfat. "93 Mapping Mobile Health Clinics in Canada: Delivering Equitable Primary Care to Children and Vulnerable Populations." Paediatrics & Child Health 27, Supplement_3 (October 1, 2022): e43-e44. http://dx.doi.org/10.1093/pch/pxac100.092.
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Abstract Background Low-income and racially diverse populations often have multiple barriers in accessing healthcare and are at increased risk of poor health outcomes. COVID-19 exacerbated these health inequities: decreased in-person appointments, difficult access to virtual care and deprioritization of elective clinical activity led to delays in well-child visits and vaccination. This public health emergency highlighted a need to develop alternative models to enable access to primary care for vulnerable children. While mobile clinics are well-established in the United States, little is known about them in Canada. Objectives This study aims to characterize Canadian mobile clinics providing primary care health services to vulnerable populations, including children, and seeks to inform the implementation of a pediatric mobile clinic under development. Design/Methods This environmental scan screened scientific databases and the grey literature using a combination of terms designating mobile health clinics and Canadian locations. Relevant Canadian primary care mobile clinic initiatives were subsequently included. We defined primary care mobile clinics as movable health care units providing primary healthcare services delivered by general medical practitioners (pediatricians and family physicians). Examples of excluded initiatives were mobile clinics focused on education/literacy, dental care, vision care, endocrinology, cancer screening, safe injection sites, vaccination, physical rehabilitation and urgent care. Descriptive statistics and qualitative analysis were performed. Results 29 clinics were identified, of which 26 are still active. Most clinics were located in Ontario (n=11), followed by British Columbia (n=8), Alberta (n=5), Quebec (n=2) and the Maritimes (n=2). The first mobile clinic in Canada was launched in 1996, with an increasing number of new clinics in 2021. While all clinics served vulnerable populations, some targeted specific groups, such as children, people experiencing homelessness, immigrants, LGBTQ+ individuals and Indigenous peoples. We identified three pediatric mobile clinics, two of which targeted teenagers. Onboard the clinics, physicians often worked with nurses, outreach workers and social workers. These professionals provided primary care services, as well as healthcare navigation, sexual education, mental health care, harm reduction supplies, vaccination and emergency care. All mobile clinics partnered with their local government, charities or businesses to fund their initiative. Conclusion Mobile health clinics are a growing model of primary care in Canada. They are the result of a multidisciplinary collaboration between healthcare providers, social workers and outreach workers. To this date, Canadian pediatric mobile clinics remain a handful and represent an interesting avenue to address health inequities in children, during the pandemic and beyond.
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Tuohy, Carolyn Hughes. "Icon and taboo: single-payer politics in Canada and the US." Journal of International and Comparative Social Policy 35, no. 1 (February 2019): 5–24. http://dx.doi.org/10.1080/21699763.2018.1550010.
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AbstractIn 1965 and 1966, the United States and Canada adopted single-payer models of government insurance for physician and hospital services – universal in Canada, but restricted to certain population groups in the US. At the time, the American and Canadian political economies of health care and landscapes of public opinion were remarkably similar, and the different policy designs must be understood as products of the distinctive macro-level politics of the day. Subsequently, however, the different scopes of single-payer coverage would drive the two systems in different directions. In Canada, the single-payer system became entrenched in popular support and in the nexus of interest it created between the medical profession and the state. In the US, Medicare became similarly entrenched in popular support, but did so as part of the larger multi-payer private insurance system. In the process universal single-payer coverage became politically iconic in Canada and taboo in the US.
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Allin, Sara, and Mark Stabile. "Socioeconomic status and child health: what is the role of health care, health conditions, injuries and maternal health?" Health Economics, Policy and Law 7, no. 2 (January 26, 2012): 227–42. http://dx.doi.org/10.1017/s174413311100034x.
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AbstractThere is a persistent relationship between socioeconomic status and health that appears to have its roots in childhood. Not only do children in families with lower income and with mothers with lower levels of education have worse health on average than those with greater socioeconomic advantage, but also the gradient appears to steepen with age. This study contributes to the literature on the relationship between socioeconomic status and child health by testing the hypothesis that the increasing effect of family income on children's health with age relates to the children's use of health care services. It also investigates the role of specific health conditions, injuries or maternal health in explaining the steepening gradient. Drawing on a nationally representative survey from Canada, the National Longitudinal Survey of Children and Youth from the period 1994/95–2008/09, this study provides further evidence of a steepening socioeconomic gradient in child health with age. It finds that accounting for health care use does not explain the steepening gradient and that the protective effect of income appears to be greater for those who had contact with the health system, in particular with regard to physician care and prescription drug use.
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Buttivant, Helen, and Cécile Knai. "Improving food provision in child care in England: a stakeholder analysis." Public Health Nutrition 15, no. 3 (August 23, 2011): 554–60. http://dx.doi.org/10.1017/s1368980011001704.
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AbstractObjectiveTo review national policy governing nutrition in child-care settings and explore policy translation at a regional and local level in the South East of England.DesignSemi-structured interviews with regional experts.SettingChild-care settings in Southampton, England, registered by OFSTED (Office for Standards in Education Children's Services and Skills).SubjectsThirteen subjects including child-care professionals in Southampton and policy advisors from the Government Office of the South East.ResultsPolicy regarding early years food provision varies across the country. Although there appears to be consensus between local stakeholders on the importance of improving early years nutrition in Southampton, intentions have yet to be translated into cohesive action, with differences in food and nutrition practice in child-care settings across the city. There are also areas of incoherence, inequalities in access to training and development, and duplication in local and regional support mechanisms.ConclusionsThe importance of proper early nutrition to provide the building blocks for life-long health and well-being is grounded in a substantial evidence base. Outside the home, early years child-care settings are an ideal place for providing a strong foundation in nutritional health and dietary habits for young children. The long-term benefits of achieving optimum nutrition in the early years should be secured through the coherent efforts of national, regional and local policy makers, child-care practitioners and parents. Existing commitment and capacity to achieve this objective at a local and regional level must be supported and matched at a national level with the acceleration of policy development, including quality control and support mechanisms.
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Tarren-Sweeney, Michael. "It’s time to re-think mental health services for children in care, and those adopted from care." Clinical Child Psychology and Psychiatry 15, no. 4 (October 2010): 613–26. http://dx.doi.org/10.1177/1359104510377702.
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Much of what is written in this special issue points to the need for a clinical workforce that has much greater knowledge and skills for working with children with a history of alternate care, including those who are subsequently adopted. Standard child clinical conceptualization, assessment methods, and formulations miss the mark for these vulnerable populations in a number of critical ways. The present paper proposes 10 principles to guide the design of mental health services for children in care, and those adopted from care. Effective specialization in child welfare work by clinical child psychologists, psychotherapists and psychiatrists, requires: (i) specialized knowledge and skills; (ii) a shift from traditional clinical practice to a clinical psychosocial-developmental scope of practice; and (iii) a strong advocacy role. To support such specialized practice, service design should be guided by: (iv) a primary—specialist care nexus, that includes universal, comprehensive assessments; (v) a shift from acute care to preventative, long-term engagement and monitoring; (vi) integration within the social care milieu; (vii) a shift from exclusion to active ownership of these client groups; (viii) normalization strategies; and (ix) alignment of services for these client groups. Finally, it is argued that mental health service provision for these children is strengthened by policy that promotes (x) “whole of government” accountability for their mental health needs.
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Ganguly, Enakshi, Rahul Gupta, Alik Widge, R. Purushotham Reddy, K. Balasubramanian, and P. S. Reddy. "Increasing Full Child Immunization Rates by Government Using an Innovative Computerized Immunization Due List in Rural India." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 55 (January 1, 2018): 004695801775129. http://dx.doi.org/10.1177/0046958017751292.
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Increasing child vaccination coverage to 85% or more in rural India from the current level of 50% holds great promise for reducing infant and child mortality and improving health of children. We have tested a novel strategy called Rural Effective Affordable Comprehensive Health Care (REACH) in a rural population of more than 300 000 in Rajasthan and succeeded in achieving full immunization coverage of 88.7% among children aged 12 to 23 months in a short span of less than 2 years. The REACH strategy was first developed and successfully implemented in a demonstration project by SHARE INDIA in Medchal region of Andhra Pradesh, and was then replicated in Rajgarh block of Rajasthan in cooperation with Bhoruka Charitable Trust (private partners of Integrated Child Development Services and National Rural Health Mission health workers in Rajgarh). The success of the REACH strategy in both Andhra Pradesh and Rajasthan suggests that it could be successfully adopted as a model to enhance vaccination coverage dramatically in other areas of rural India.
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Nyazema, Norman Z. "The Zimbabwe Crisis and the Provision of Social Services." Journal of Developing Societies 26, no. 2 (June 2010): 233–61. http://dx.doi.org/10.1177/0169796x1002600204.
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Historically, health care in Zimbabwe was provided primarily to cater to colonial administrators and the expatriate, with separate care or second-provision made for Africans. There was no need for legislation to guarantee its provision to the settler community. To address the inequities in health that had existed prior to 1980, at independence, Zimbabwe adopted the concept of Equity in Health and Primary Health Care. Initially, this resulted in the narrowing of the gap between health provision in rural areas and urban areas. Over the years, however, there have been clear indications of growing inequities in health provision and health care as a result of mainly Economic Structural Adjustment Policies (ESAP), 1991–1995, and health policy changes. Infant and child mortality have been worsened by the impact of HIV/AIDS and reduced access to affordable essential health care. For example, life expectancy at birth was 56 in the 1980s, increased to 60 in 1990 and is now about 43. Morbidity (diseases) and mortality (death rates) trends in Zimbabwe show that the population is still affected by the traditional preventable diseases and conditions that include nutritional deficiencies, communicable diseases, pregnancy and childbirth conditions and the conditions of the new born. The deterioration of the Zimbabwean health services sector has also partially been due to increasing shortages of qualified personnel. The public sector has been operating with only 19 per cent staff since 2000. Many qualified and competent health workers left the country because of the unfavourable political environment. The health system in Zimbabwe has been operating under a legal and policy framework that in essence does not recognize the right to health. Neither the pre-independence constitution nor the Lancaster House constitution, which is the current Constitution of Zimbabwe, made specific provisions for the right to health. Progress made in the 1980s characterized by adequate financing of the health system and decentralized health management and equity of health services between urban and rural areas, which saw dramatic increases in child survival rates and life expectancy, was, unfortunately, not consolidated. As of 2000 per capita health financing stood at USD 8.55 as compared to USD 23.6, which had been recommended by the Commission of Review into the Health Sector in 1997. At the beginning of 2008 it had been dramatically further eroded and stood at only USD 0.19 leading to the collapse of the health system. Similarly, education in Zimbabwe, in addition to the changes it has undergone during the different periods since attainment of independence, also went through many phases during the colonial period. From 1962 up until 1980, the Rhodesia Front government catered more for the European child. Luckily, some mission schools that had been established earlier kept on expanding taking in African children who could proceed with secondary education (high school education). Inequity in education existed when the ZANU-PF government came into power in 1980. It took aggressive and positive steps to redress the inequalities that existed in the past. Unfortunately, the government did not come up with an education policy or philosophy in spite of massive expansion and investment. The government had cut its expenditure on education because of economic and political instability. This has happened particularly in rural areas, where teachers have left the teaching profession.
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Newbold, Bruce, and Marie McKeary. "Investigating the diversity of Canada’s refugee population and its health implications: does one size fit all?" International Journal of Migration, Health and Social Care 13, no. 2 (June 12, 2017): 145–56. http://dx.doi.org/10.1108/ijmhsc-02-2015-0007.
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Purpose Based on a case study in Hamilton, Ontario, Canada, the purpose of this paper is to explore the difficulties faced by local health care providers in the face of constantly evolving refugee policies, programs, and arrivals. In doing so, it illustrates the complications faced by service providers in providing care to refugee arrivals and how the diversity of arrivals challenges health care provision and ultimately the health and well-being of refugees. Design/methodology/approach A series of semi-structured, in-depth interviews with key service professionals in both the social service and health fields in Hamilton, Ontario, Canada, examined both health and health care issues. Findings Beyond challenges for service providers that have been previously flagged in the literature, including language barriers and the limited time that they have with their clients, analysis revealed that health care providers faced other challenges in providing care, with one challenge reflecting the difficulty of providing care and services to a diverse refugee population. A second challenge reflected the lack of knowledge associated with constantly evolving policies and programs. Both challenges potentially limit the abilities of care providers. Research limitations/implications On-going changes to refugee and health care policy, along with the diversity of refugee arrivals, will continue to challenge providers. The challenge, therefore, for health care providers and policy makers alike is how to ensure adequate service provision for new arrivals. Practical implications The Federal government should do a better job in disseminating the impact of policy changes and should streamline programs. This is particularly relevant given limited budgets and resources, tri-partite government funding, short time-frames to prepare for new arrivals, inadequate background information, barriers/challenges or inequitable criteria for access to health and social services, while addressing an increasingly diverse and complex population. Social implications The research reinforces the complexity of the needs and challenges faced by refugees when health is considered, and the difficulty in providing care to this group. Originality/value While there is a large refugee health literature, there is relatively little attention to the challenges and difficulties faced by service providers in addressing the health needs of the diverse refugee population, a topic that is particularly important given limited funding envelopes, shifting policies and programs, and a focus on clients (refugees). It is this latter piece – the challenges faced by providers in providing care to refugees – which this paper explores.
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Herawati, Lindia, and Haerawati Idris. "DETERMINANTS OF THE UTILIZATION OF OUTPATIENT AMONG CHILD IN INDONESIA." Jurnal Ilmu Kesehatan Masyarakat 10, no. 1 (April 8, 2019): 67–73. http://dx.doi.org/10.26553/jikm.2019.10.1.67-73.
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Background: Child’s health becomes the government concern in developing countries. Improving child’s health is a challenge for developing countries due to poor health care. Children tend to need more health services as they are more susceptible to various diseases. This study was aimed to determine the determinants influencing outpatient services utilization on children in Indonesia.
Method: This research was a descriptive with cross-sectional design research using quantitative approach. The data were obtained from secondary data of the Indonesian Family Life Survey (IFLS) 2014. The dependent variable was the number of health service visits on children. In this study, the samples were 2,472 0-14 years old individuals selected according to inclusion and exclusion criteria. The data were analyzed using binomial negative regression.
Result: The study found out that child using health services at least one outpatient visit in the last 4 weeks was 75.77%. Woman, perception of ill, parental formal employment, parental education (high), economic status were statistically related to utilization of health service for outpatient
Conclusion: The perception of ill greatly affects the children in outpatient health service utilization, it is expected that government gives policy by family approach as the effort of family member caring, health protection and improvement especially for child.
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Hebdon, Robert P., and Robert N. Stern. "Tradeoffs among Expressions of Industrial Conflict: Public Sector Strike Bans and Grievance Arbitrations." ILR Review 51, no. 2 (January 1998): 204–21. http://dx.doi.org/10.1177/001979399805100203.
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This examination of industrial conflict in over 9,000 bargaining units in Ontario, Canada, in 1988 yields robust cross-sectional evidence of a trade-off between legal strike bans and forms of industrial conflict other than strikes. Within Ontario's health care and provincial government services sectors, the incidence of grievance arbitrations, especially those concerning economic issues, was significantly higher where striking was prohibited than where it was permitted. The authors argue that researchers and policy makers should be aware that there may be unanticipated changes in expressions of industrial conflict when legal changes restrict specific actions such as strikes. In particular, research and policy models of industrial conflict should be specified to include more than one form of conflict expression at a time.
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Johnston, Campbell Stuart, Erika Belanger, Krystal Wong, and David Snadden. "How can rural community-engaged health services planning achieve sustainable healthcare system changes?" BMJ Open 11, no. 10 (October 2021): e047165. http://dx.doi.org/10.1136/bmjopen-2020-047165.
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ObjectivesThe objectives of the Rural Site Visit Project (SV Project) were to develop a successful model for engaging all 201 communities in rural British Columbia, Canada, build relationships and gather data about community healthcare issues to help modify existing rural healthcare programs and inform government rural healthcare policy.DesignAn adapted version of Boelen’s health partnership model was used to identify each community’s Health Care Partners: health providers, academics, policy makers, health managers, community representatives and linked sectors. Qualitative data were gathered using a semistructured interview guide. Major themes were identified through content analysis, and this information was fed back to government and interviewees in reports every 6 months.SettingThe 107 communities visited thus far have healthcare services that range from hospitals with surgical programs to remote communities with no medical services at all. The majority have access to local primary care.ParticipantsParticipants were recruited from the Health Care Partner groups identified above using purposeful and snowball sampling.Primary and secondary outcome measuresA successful process was developed to engage rural communities in identifying their healthcare priorities, while simultaneously building and strengthening relationships. The qualitative data were analysed from 185 meetings in 80 communities and shared with policy makers at governmental and community levels.Results36 themes have been identified and three overarching themes that interconnect all the interviews, namely Relationships, Autonomy and Change Over Time, are discussed.ConclusionThe SV Project appears to be unique in that it is physician led, prioritises relationships, engages all of the healthcare partners singly and jointly in each community, is ongoing, provides feedback to both the policy makers and all interviewees on a 6-monthly basis and, by virtue of its large scope, has the ability to produce interim reports that have helped inform system change.
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Imershein, Allen W., Carolyn Turner, Janice G. Wells, and Allen Pearman. "Covering the Costs of Care in Neonatal Intensive Care Units." Pediatrics 89, no. 1 (January 1, 1992): 56–61. http://dx.doi.org/10.1542/peds.89.1.56.
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The continued rise of health care costs, despite private and governmental control efforts, has sustained cost containment as a central issue for health care researchers and policy makers. In keeping with these concerns, the Florida Health Care Cost Containment Board conducted a study of neonatal intensive care units (NICUs) in Florida to ascertain the costs, charges, and net revenues associated with NICU services in individual hospitals, to document cost shifting and cross-subsidization as a means of financing NICU care for indigent populations, and to assess the fiscal impact of NICUs in state-sponsored vs non-state-sponsored Regional Perinatal Intensive Care Center hospitals providing NICU care. Hospitals in the state-sponsored program reported a loss of approximately $16.5 million in contrast to the non-state-sponsored hospitals, which reported a gain of $1 million. Payment being generated by privatepay patients amounted to almost 60% of total revenues but constituted less than one third of the costs in statesponsored hospitals, indicating a high level of cost shifting. Government support of state-sponsored NICUs, while substantial, has been insufficient; increasing constraints on this funding source would likely worsen the deficit and increase the necessity of cost shifting.
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Manitowabi, Joshua. "Wii Niiganabying (Looking Ahead):." Turtle Island Journal of Indigenous Health 1, no. 1 (October 12, 2020): 59–71. http://dx.doi.org/10.33137/tijih.v1i1.34017.
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Fifty years ago, Indigenous elders and leaders drafted their response to the Statement of the Government of Canada on Indian Policy (White Paper of 1969). Their formal rebuttal, Citizens Plus (Red Paper), published in 1970, was a turning point in Indigenous education policy. It marked the beginning of the shift away from government-controlled, assimilationist educational policies to greater Indigenous control over funding and pedagogical methods. The Red Paper refuted the White Paper’s main conclusions and stated that Indigenous peoples are “citizens plus” because the federal government is legally bound to provide Indigenous peoples with services in exchange for the use of the land they occupy. The most important Indigenous rights to be upheld included education, health care, Aboriginal status, and Aboriginal title. These unique rights recognized that Indigenous peoples are the original owners of all the natural resources on their traditional treaty lands. The Red Paper became a political turning point for Indigenous peoples in Canada by presenting an Indigenous vision for a new political and legal relationship between Canada and Indigenous peoples based on Aboriginal and treaty rights. Since the 1970s, Indigenous leaders have struggled to maintain control of educational funding while having to abide by provincial standards of educational curricula. Indigenous communities want to provide more positive learning experiences and positive identity through reconceptualizing educational curricula. They are exploring ways to indigenize the educational experience by igniting cultural resurgence through the integration of Indigenous languages, knowledge, culture, and history by reconnecting students to their elders, land, and communities.
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Grose, Elysia, Sarah Chiodo, Marc Levin, Antoine Eskander, Vincent Lin, Brad Hubbard, and Albino Chiodo. "Patient Perspectives on Removing Adult Tonsillectomy and Septoplasty from the Government Health Insurance Plan in a Publicly Funded Health Care System." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 58 (January 2021): 004695802110051. http://dx.doi.org/10.1177/00469580211005193.
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In several publicly funded health care systems, including Ontario, Canada, adult tonsillectomies and septoplasties have been suggested to be removed or “delisted” from the government health insurance plan. Thus, the objective of this study was to explore patient perspectives regarding out of pocket (OOP) payment for these procedures. An anonymous survey was administered to patients consented to undergo a tonsillectomy or septoplasty at a community otolaryngology—head and neck surgery (OHNS) practice. The survey asked patients if they would pay the projected cost for their surgery OOP and the maximum amount of time they would wait for their surgery. The survey also contained questions on socioeconomic status and disease severity. Seventy-one patients were included. Overall, 21% of patients were willing to pay OOP for their surgery. Forty-nine percent of patients reported that the maximum amount of time they would be willing to wait for their surgery was 2 to 6 months. There was no significant correlation found between any of the demographic variables or disease severity and willingness to pay OOP for these surgeries. In this study, a small percentage of patients who met the clinical indications for a tonsillectomy or a septoplasty would pay for their surgery in the event that it was not covered by the government health insurance plan. These surgeries are common operations and delisting them could potentially decrease the provision of these services and have a significant impact on Canadian OHNS practices.
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Evans, Andrea, and Savithiri Ratnapalan. "EMERGENCY DEPARTMENT VISITS BY CHILD REFUGEE CLAIMANTS AT A PEDIATRIC TERTIARY CARE CENTER." Paediatrics & Child Health 23, suppl_1 (May 18, 2018): e7-e7. http://dx.doi.org/10.1093/pch/pxy054.018.
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Abstract BACKGROUND The Canadian government has announced the resettlement of 50 000 refugees from the Middle East by 2018. The proportion of refugees that are below 18 years of age have increased from 20% to almost 40% from 2005 to 2014 and is expected to increase further with new refugee influxes. Barriers to timely health care can worsen clinical presentations and outcomes, especially in vulnerable children such as refugees. This study aims to provide an overview of the epidemiology, clinical presentations, hospital stay metrics, and non-clinical support needs for child refugee claimants presenting to the emergency department at a large tertiary care hospital in Canada. OBJECTIVES To describe the emergency department visits by refugee claimants with IFH, including demographics, primary care access, immunization status, acuity of presentation, repeat visits, and admission rates. DESIGN/METHODS A retrospective chart review of all refugee children presenting to the emergency department at this tertiary care hospital from April 1 2014 to March 31st 2017. A case was defined as a child who presented to the hospital with Interim Federal Health (IFH) which is the federal health insurance program covers newly arrived refugee claimants in Canada. Descriptive statistics and chi square test for categorical data was used. Data was analyzed using SPSS v21 IBM 2012. Ethics was approved by the Ethics Review Board of the hospital. RESULTS In total, there were 646 visits to the emergency department by 388 patients with IFH. The average age was 6.4 years (IQR 2.9–9.3), of which 58% were females. Travel history was documented in 65% of cases. The majority of patients arrived from Southeast Asia and the Middle East. The average time spent in Canada was 217 days (IQR 78–205). Sixty percent of patients did not have an identified primary care provider. Those with an identified primary care provider had more non-acute (CTAS 4–5) visits than those without an identified primary care provider (p<0.05). Immunizations were not up-to-date per Canadian standard in 25% of those who had an immunization history documented. Translation services was used in 11% of visits. Admission rate was 12%, with average length of stay 3.4 days (std 4). Top three reasons for admission were febrile neutropenia, respiratory distress, and blood per rectum. One fifth (20%) of admissions occurred on the same day as the arrival of the patient to Canada. CONCLUSION A significant number of refugee children are needing emergency care and admission to hospital on the day they arrive to Canada. Most child refugees presenting to the emergency department did not have an identified primary care provider, and a quarter did not have up-to-date immunizations. Association with primary care provider suggests that linkage to primary care in this population should be a priority.
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Segal, Hugh, Keith Banting, and Evelyn Forget. "The need for a federal Basic Income feature within any coherent post-COVID-19 economic recovery plan." FACETS 6, no. 1 (January 1, 2021): 394–402. http://dx.doi.org/10.1139/facets-2021-0015.
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COVID-19 has shone a harsh light on the extent of poverty in Canada. When normal economic activity was interrupted by the exigencies of public health driven lockdowns, the shutdown disproportionately affected people who, before the pandemic, were living on incomes beneath the poverty line or dependent upon low-paying hourly remunerated jobs, usually part time and without appropriate benefits. Those living beneath the poverty line in Canada, three million of welfare poor and working poor, include a disproportionately large population of Black and Indigenous people and people of colour. This paper addresses the challenge of inclusive economic recovery. In particular, we propose that the federal government introduce a Basic Income guarantee for all residents of Canada as part of a comprehensive social safety net that includes access to housing, child care, mental and physical health care, disability supports, education, and the many other public services essential to life in a high-income country. Residents with no other income would receive the full benefit that would be sufficient to ensure that no one lives in poverty, while those with low incomes would receive a reduced amount.
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Malkki, Rita M., Jianhua Chen, Danielle Honegger, Catharine Simonnet, Talma Kushnir, and Julio Soto. "A Comparison of Child Day-Care Settings in Four Countries." Pediatrics 94, no. 6 (December 1, 1994): 1100–1101. http://dx.doi.org/10.1542/peds.94.6.1100.
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A surprisingly wide variety of child day-care systems exist throughout the world, and each system has its own particular purposes, benefits, and drawbacks. In some countries, child day care is viewed as an integral part of the public education process; in others it serves primarily to provide working parents a safe haven for their children during work hours. The issue of health and health care in the day-care setting is also viewed in a number of ways, from the Chinese view that health care should be built into the daily routine of child day care to the American approach of placing that responsibility primarily on the parent. This paper explores the day-care settings found in four countries. Both child care and health services are determined by a number of different influences in the cultural, social, and historical background of a given country. The economic situation and overall societal values combine to produce a child day-care system that at least attempts to respond to the needs of the majority of that society. Furthermore, the economic trends of the last two decades have had an even greater impact on day care than could have been imagined at the outset. Even in countries where the extended family is still a strong force in the care and rearing of children, the need for additional assistance has increased. A look at the systems in China, Israel, France, and Canada will identify a range of approaches to dealing with this issue. Child day care is largely a public undertaking in most countries, often with a smaller, private system operating independently under government regulations.
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Minihan, Paula M., Sarah N. Fitch, and Aviva Must. "What Does the Epidemic of Childhood Obesity Mean for Children with Special Health Care Needs?" Journal of Law, Medicine & Ethics 35, no. 1 (2007): 61–77. http://dx.doi.org/10.1111/j.1748-720x.2007.00113.x.
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Although the obesity epidemic appears to have affected all segments of the U.S. population, its impact on children with special health care needs (SHCN) has received little attention. Children with special health care needs is a term used in the U.S. to describe children who come to the attention of health care providers and policy makers because they need different services and supports than other children. Government, at both the federal and state levels, has long felt a particular responsibility for safeguarding the health of children with special needs. The definition children with special health care needs, in fact, was developed by a work group established by the U.S. Maternal and Child Health Bureau (MCHB) to assist states in their efforts to develop community systems of services for children with complex medical and behavioral conditions.
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Penney, Christine, and Effie Henry. "Improving Performance Management for Delivering Appropriate Care for Patients No Longer Needing Acute Hospital Care." Journal of Health Services Research & Policy 13, no. 1_suppl (January 2008): 30–34. http://dx.doi.org/10.1258/jhsrp.2007.007025.
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Objective The public, providers and policy-makers are interested in a service continuum where care is provided in the appropriate place. Alternate level of care is used to define patients who no longer need acute care but remain in an acute care bed. Our aims were to determine how subacute care and convalescent care should be defined in British Columbia (BC); how these care levels should be aligned with existing legislation to provide more consistent service standards to patients and what reporting requirements were needed for system planning and performance management. Method A literature review was conducted to understand the international trends in performance management, care delivery models and change management. A Canada-wide survey was carried out to determine the directions of other provinces on the defined issues and a BC survey provided a current state analysis of programming within the five regional health authorities (HAs). Results A provincial policy framework for subacute and convalescent care has been developed to begin to address the concerns raised and provide a base for performance measurement. The policy has been approved and disseminated to BC HAs for implementation. An implementation plan has been developed and implementation activities have been integrated into the work of existing provincial committees. Evaluation will occur through performance measurement. The benefits anticipated include: clear policy guidance for programme development; improved comparability of performance information for system monitoring, planning and integrity of the national acute care Discharge Abstracting Database; improved efficiency in acute care bed use; and improved equity of access, insurability and quality for patients requiring subacute and convalescent care. While a national reporting system exists for acute care in Canada, this project raises questions about the implications for this system, given the shifting definition of acute care as other care levels emerge. Questions are also raised by the finding in Australia that the current case-mix system is inadequate to describe these patients. Further, given the inadequacy of our understanding of health system capacity and output, consideration of a more comprehensive national reporting system along the care continuum may be warranted. Conclusions This project is an example of effective collaboration between the provincial government, a national organization and HAs, and suggests that provincial governments can participate in a meaningful way to accomplish research-informed health services policy.
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Skinner, Mark W., and Mark W. Rosenberg. "Co-Opting Voluntarism? Exploring the Implications of Long-Term Care Reform for the Nonprofit Sector in Ontario." Environment and Planning C: Government and Policy 23, no. 1 (February 2005): 101–21. http://dx.doi.org/10.1068/c0434.
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Within public policy discourse on health care restructuring and voluntarism, the nonprofit sector is now expected to play an active and direct role in the provision of health care services. The viability of the nonprofit sector to take up this role, however, remains unclear. This paper explores the changing role of nonprofit organisations with respect to the provision of long-term care in Ontario, Canada, where extensive restructuring of public services occurred during the 1990s. Drawing on a critical review of legislation, government policies and documents, and stakeholder reports, the authors present a comparative study of two distinct long-term care reform models, featuring public and private provision, respectively, which were developed by ideologically opposed provincial governments. The results indicate that despite unanimous promotion of voluntarism (and the attendant ascendancy of the nonprofit sector) as a central feature of health care restructuring, the divergent reform models actually trap nonprofit organisations between direct incorporation within public provision on the one hand, and direct free-market competition on the other. The findings suggest that underscoring long-term care reform in Ontario, and elsewhere, is the co-option of the nonprofit sector, which resonates with concern for its ability to replace effectively the public provision of health care services. The results also point to the need to conceptualise the consequent actions taken by nonprofit organisations in order to inform current debates surrounding health care restructuring and voluntarism.
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Nagpal, Somil, Emiko Masaki, Eko Setyo Pambudi, and Bart Jacobs. "Financial protection and equity of access to health services with the free maternal and child health initiative in Lao PDR." Health Policy and Planning 34, Supplement_1 (October 1, 2019): i14—i25. http://dx.doi.org/10.1093/heapol/czz077.
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Abstract Though Lao People’s Democratic Republic (Lao PDR) has made considerable progress in improving maternal and child health (MCH), significant disparities exist nationwide, with the poor and geographically isolated ethnic groups having limited access to services. In its pursuit of universal health coverage, the government introduced a Free MCH initiative in 2011, which has recently been subsumed within the new National Health Insurance (NHI) programme. Although this was a major national health financing reform, there have been few evaluations of the extent to which it improved equitable access to MCH services. We analyse surveys that provide information on demand-side and supply-side factors influencing access and utilization of free MCH services, especially for vulnerable groups. This includes two rounds of household surveys (2010 and 2013) in southern Lao PDR involving, respectively 2766 and 2911 women who delivered within 24 months prior to each survey. These data have been analysed according to the socio-economic status, geographic location and ethnicity of women using the MCH services as well as any associated out-of-pocket expenses and structural quality of these services. Two other surveys analysed here focused on human resources for health and structural quality of health facilities. Together, these data point to persistent large inequities in access and financial protection that need to be addressed. Significant differences were found in the utilization of health services by both economic status and ethnicity. Relatively large costs for institutional births were incurred by the poor and did not decline between 2010 and 2013 whereby there was no significant impact on financial protection. The overall benefit incidence of the universal programme was not pro-poor. The inequity was accentuated by issues related to distribution and nature of human resources, supply-side readiness and thus quality of care provided across different geographical areas.