Home and Community Care Digest

Home and Community Care Digest December 2002 : 0-0

Post-acute home care should be the first step in creating a national home care program and should be fully integrated with hospitals

Abstract

This report offers a blueprint for the financing, delivery, and organization of a publicly funded national Post-Acute Home Care (PAHC) program. Efficiencies are best achieved when home care is integrated with other necessary health care services; hence, this report specifically rejects the creation of separate funding envelopes and distinct organizational structures for PAHC. Instead, it recommends financing PAHC through hospitals.
Background: Although necessary health care is delivered today in wide range of settings, the Canada Health Act recognizes only one health care setting for medically necessary care: the hospital. This report outlines steps the federal government could take to ensure that necessary health care is funded irrespective of the setting where it is delivered or received. It calls for phased reform, beginning with post-acute home care (PAHC), and emphasizes service integration and mechanisms to limit liability exposure for governments. This report was summarized in "The Health of Canadians, The Federal Role" (The Kirby Report).

Method: Derived entirely from Canadian data, this report offers a blueprint for the financing, delivery, and organization of a national Post-Acute Home Care (PAHC) program. Post-acute care services that were once provided exclusively in hospitals are now available - sometimes exclusively - at home. A PAHC episode is defined as all home care services and products received within 1 year of the first home care visit, if that visit occurred within 30 days of hospital discharge. This definition applies only to services that were not used prior to hospitalization. Cost estimates are based on the product of 4 factors: (1) total Canadian public home care expenditures in 2000; (2) the proportion of expenditures attributable to PAHC; (3) a mark-up to reflect home care expenditure growth to 2002; and (4) a mark-up to reflect the cost of ancillary services, drugs, and assistive devices.

Findings: Cost estimates are reflected in fiscal year 2002 dollars. Two PAHC cost estimates were derived. The first is based on the proportion of home care clients that receive PAHC, while the second depends on the proportion of costs attributable to PAHC services. These estimates suggest that the total cost of a national PAHC program ranges from a low of $1,021.1 million to a high of $1,511.8 million. If the federal government were to cost-share these expenditures on an equal basis with the provinces, the federal share would range from $510.6 million to $755.9 million.

Conclusions: Compared to other types of home care, PAHC provides the best test case for incorporating home care under the Canada Health Act because the care was originally insured qua necessary hospital care. Efficiencies are best achieved where PAHC is fully integrated with hospital care; hence this report specifically rejects the creation of separate funding envelopes and distinct organizational structures for PAHC. Key recommendations are: (1) to finance PAHC through hospitals, which will encourage innovation and service integration; (2) to allow hospitals to outsource PAHC, under quality monitored conditions; and (3) to pay for PAHC services on a per patient basis, in conjunction with similar payment arrangements for hospital care.

Reference: Coyte, P.C. Expanding the Principle of Comprehensiveness from Hospital to Home: Submission to the Senate Standing Committee on Social Affairs, Science and Technology, 2002.

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