To maximize the effectiveness of home care in improving or maintaining the health of Canadians, home-care programs must have clear goals, be founded firmly on evidence of effectiveness, form part of an integrated healthcare system and be grounded in constitutional and political reality. Goals should be client-centred and distinguish between curative, supportive and preventive care. Curative and supportive home care can be cost-effective if substitution for more costly institutional services can be achieved, but the cost-effectiveness of preventive home care and comprehensive care for the elderly has not been clearly demonstrated. Integrated delivery systems are a prerequisite for effective substitution of care at home for institutional care. Federal financing dedicated to a homecare program is unnecessary and is a political and constitutional non-starter. Federal leadership for a national home-care approach would be welcome. Canada Health Act protection for access to medically necessary home care is attractive, but such protection for pharmaceuticals is a higher need. Federal support for research and demonstration of new models of care is valuable.

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