Abstract

The Romanow Report recommends revisions to the Canada Health Act to include home care as an entitlement. The Report calls for annual federal contributions of almost $1 Billion to support 4 categories of home care. However, the Report's cost estimates may be too low to provide appropriate care to patients in these four categories. Background: In April 2001, the Prime Minister of Canada established the Commission on the Future of Health Care in Canada. The Commission, headed by Roy Romanow, was assigned a mandate to make recommendations that enhance the quality and sustainability of health care. In its review of Canadian health care, the Commission did not have an easy task. It confronted: pressure to constrain the growth of health expenditures; difficulties in accessing health care services; shortages of key health professionals; the need for clarity with respect to the role of the private sector in both the financing and delivery of health care; and an aging population. Despite these challenges the Commission delivered its report in November 2002. Only the home care recommendations are addressed herein.

Method: The Commission engaged in an extensive process of consultation with Canadians and commissioned a series of reports that formed the basis of its home care recommendations. Financing recommendations for 4 areas of home care were based on Canadian and international data.

Findings: The Commission argued that health care has evolved since the period when medicare was introduced. Health care today is associated with more than one privileged setting (hospitals) and one set of providers (physicians). Many health care services are now available to Canadians at home. Consequently, the Commission recommended revisions to the Canada Health Act to include home care as an entitlement.

The Commission recommended annual funding of almost $1 Billion for 4 home care areas:
Home mental health: Based on a caseload of 57,137 and annual case costs of almost $10,000, yielding expenditures of $568.1 million pa;
Post-acute rehabilitation: Based on a caseload of seniors over 75 years of age (167,471) who are serviced for 28 days at the daily cost of $43.63, yielding $204.6 million pa;
Post-acute medical care: Based on a caseload of seniors over 65 years of age (267,953) who are serviced for 14 days at the daily cost of $31.39, yielding $117.8 million pa; and
Palliative care: Based on a caseload of 50,974 patients who are serviced for 30 days at a daily cost of $58.40, yielding $89.3 million pa. This caseload is derived from all cancer deaths, inflated by 20% to account for other eligible care recipients, and discounted by 33.3% to account for those who may not use such care.

Conclusions: Home care entitlement helps to modernize the Canada Health Act. However, if federal transfers for home care are insufficient, this entitlement will present a significant unfunded liability for provinces. The Romanow funding recommendations warrant further inquiry because: the caseloads appear to be underestimated; the servicing periods may be too short; and the estimated daily cost of appropriate care may be insufficient.

Reference:Building on Values: The Future of Health Care in Canada, 2002. (The Romanow Report.)