Abstract

Why is home care excluded from the Canada Health Act? In the 1960s, the Hall Commission suggested that home care be covered through medicare. History decided otherwise - only "medically" necessary care was insured. Today, home-care services are provided in conjunction with episodes of hospital care, or are delivered to frail individuals as part of their social and healthcare needs. However, healthcare can no longer be defined simply as a state of absence of disease. Health also includes individuals' physical and mental functional abilities. Coverage for health services should include those services aimed at preserving and maintaining functional abilities. Moreover, access to home care is inequitable in Canada. Financing mechanisms should improve integration of care, not increase barriers between medical, hospital and social care. As home-care services are provided to persons with different needs, financing and organizational mechanisms have to guarantee that resources are distributed most effectively to meet these needs. Finally, home-care delivery should adapt to local, regional and provincial realities. There is no such thing as "one" Canadian home-care model. Already, a number of experiments with home care are being implemented in Canada. It is in the search for innovative service delivery modalities that Canadians will best be served.