Improving access to health services in Canada

2018 ◽  
Vol 31 (6) ◽  
pp. 256-260 ◽  
Author(s):  
David R. Urbach
Keyword(s):  
Surgical Procedures ◽  
Public Awareness ◽  
Surgical Care ◽  
Wait Times ◽  
Access To Health Services ◽  
Elective Surgical Procedures ◽  
Entry Models ◽  
Physician Leaders ◽  
Single Entry ◽  
The Cost

The Commonwealth Fund 2017 report ranked Canada’s healthcare system low in access to care and last among all 11 counties studied in terms of timeliness of care. While long wait times for certain elective surgical procedures appear to be emblematic of Canadian Medicare, they are not inevitable. Wait times could be improved by focusing on public awareness and measurement of wait times and improving the appropriateness, efficiency (eg, with implementation of single-entry models for surgical referrals and greater use of ambulatory surgery), and productivity of surgical care (eg, by activity-based funding for surgical procedures and by reducing the cost of perioperative care). Ideas on how physician leaders can build on recent accomplishments are provided.

scholarly journals What is the influence of single-entry models on access to elective surgical procedures? A systematic review

BMJ Open ◽  
2017 ◽  
Vol 7 (2) ◽  
pp. e012225 ◽  
Author(s):  
Zaheed Damani ◽  
Barbara Conner-Spady ◽  
Tina Nash ◽  
Henry Tom Stelfox ◽  
Tom W Noseworthy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Procedures ◽  
Elective Surgical Procedures ◽  
Entry Models ◽  
Single Entry

scholarly journals A surgeon’s perspective on resuming elective surgeries during COVID-19 pandemic: the new normal

2020 ◽  
Vol 7 (12) ◽  
pp. 4157
Author(s):  
Jesme A. Paul ◽  
Dhinesh Kumar N. ◽  
Boopathi Subbarayan ◽  
Tirouaroul Tirougnanassmbandamourty
Keyword(s):  
Health Care ◽  
Surgical Procedures ◽  
Virus Disease ◽  
Case Series ◽  
Surgical Care ◽  
World Health ◽  
Clinical Algorithm ◽  
Elective Surgical Procedures ◽  
Health Organization ◽  
Deep Crisis

Novel corona virus disease 2019 (COVID-19) outbreak was declared a pandemic on 10th March by World Health Organization (WHO) putting the entire health care system including medical and surgical care in deep crisis. All the resources and manpower are being diverted to tackle this rampant spread of COVID-19. The result of which, all elective surgical procedures are rescheduled to an extent of cancellation. This case series present 3 cases operated during the pandemic in a mannered clinical algorithm. In the light of underlying uncertainty, it is essential to resume elective surgeries with caution to prevent backlog and worsening of the disease. 

scholarly journals Survey of Patient Knowledge and Expectations about a Free-Standing Emergency Department

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Christopher Bucciarelli ◽  
Thomas Payton ◽  
Emily Weeks ◽  
Michael Falgiani
Keyword(s):  
Emergency Department ◽  
Emergency Care ◽  
General Public ◽  
Public Awareness ◽  
Wait Times ◽  
Patient Knowledge ◽  
Free Standing ◽  
Convenience Sample ◽  
Adequate Knowledge ◽  
The Cost

Objectives. A free-standing emergency department (FSED) is defined as a facility that is structurally separate and distinct from a hospital and provides emergency care. Nationally, the number of FSEDs continues to grow, but the general public may have limited knowledge about the costs and services associated with FSEDs. The purpose of this paper is to survey patient knowledge and expectations about FSEDs. Methods. A convenience sample of patients presenting to a FSED was given a 19-item survey to complete. Results. 187 surveys were collected; 126 were included for analysis. 40% of respondents thought they could be seen by a specialist at the FSED, and 55% of patients did not know they had to be transferred for hospitalization if required. Most patients did not know that the cost of services at the FSED would be the same as that at the traditional ED. Convenience and perceived shorter wait times were the primary reasons patients selected the FSED for care. Conclusion. In general, patients do not have adequate knowledge about the costs and services associated with FSEDs. Education through marketing and advertising may be helpful in creating more public awareness about FSEDs.

scholarly journals Changes in the activity levels and financing sources of Israel’s private for-profit hospitals in the wake of reforms to the public-private divide

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Royi Barnea ◽  
Adi Niv-Yagoda ◽  
Yossi Weiss
Keyword(s):  
Health Insurance ◽  
Surgical Procedures ◽  
Health Expenditure ◽  
Medical Center ◽  
Waiting Times ◽  
Publicly Funded ◽  
Private Hospitals ◽  
The Public ◽  
For Profit ◽  
Elective Surgical Procedures

Abstract Background The Israeli National Health Insurance Law provides permanent residents with a basket of healthcare services through non-profit public health insurance plans, independently of the individual’s ability to pay. Since 2015, several reforms and programs have been initiated that were aimed at reinforcing public healthcare and redressing negative aspects of the health system, and specifically the constant rise in private health expenditure. These include the “From Reimbursement-to-Networks Arrangement”, the “Cooling-off Period” program and the program to shorten waiting times. The objectives of this study were to identify, describe, and analyze changes in private hospitals in 1) the volume of publicly and privately funded elective surgical procedures; and 2) private health expenditure on surgical procedures. Methods Data on the volume and funding of surgical procedures during 2013–2018 were obtained from Assuta Medical Center, Hertzelia Medical Center, the Israeli Ministry of Health and the Central Bureau of Statistics. The changes in the volume and financing sources of surgical activities in private hospitals, in the wake of the reforms were analyzed using aggregate descriptive statistics. Results Between 2013 and 2018 the volume of surgical activities in private for-profit hospitals increased by 7%. Between 2013 and 2017, the distribution of financing sources of surgical procedures in private hospitals remained stable, with most surgical procedures (75–77%) financed by the voluntary health insurance programs of the health plans (HP-VHI). In 2018, following the regulatory reforms, a significant change in the distribution of financing sources was observed: there was a sharp decline in the volume of HP-VHI-funded surgical procedures to 26%. Concurrently, the share of publicly-funded surgical procedures performed in private hospitals increased to 56% in 2018.,. During the study period, private spending on elective surgical procedures in private hospitals declined by 53% while public funding for them increased by 51%. Conclusions and policy implications In the wake of the reforms, there was a substantial shift from private to public financing of elective surgical activity in private hospitals. Private for-profit hospitals have become important providers of publicly-funded procedures. It is likely that the reforms affected the public-private mix in the financing of elective surgical procedures in those hospitals, but due to the absence of a control group, causality cannot be proven. It is also unclear whether waiting times were shortened. Health reforms must be accompanied by a clear and comprehensive set of indicators for measuring their success.

A Guideline for Anticipated Blood Usage during Elective Surgical Procedures

1979 ◽  
Vol 71 (6) ◽  
pp. 680-684 ◽  
Author(s):  
Leonard I. Boral ◽  
Francis J. Dannemiller ◽  
William Stanford ◽  
Sherwood S. Hill ◽  
Terry A. Cornell
Keyword(s):  
Surgical Procedures ◽  
Elective Surgical Procedures ◽  
Blood Usage

The Clinical Neuromuscular Pharmacology of 51W89 in Patients Receiving Nitrous Oxide/Opioid/Barbiturate Anesthesia 

1995 ◽  
Vol 82 (5) ◽  
pp. 1139-1145 ◽  
Author(s):  
Matthew R. Belmont ◽  
Cynthia A. Lien ◽  
Steve Quessy ◽  
Martha M. Abou-Donia ◽  
Amy Abalos ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Surgical Procedures ◽  
Blocking Agent ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agent ◽  
Blocking Effect ◽  
Preclinical Studies ◽  
Physical Status ◽  
Elective Surgical Procedures ◽  
Recovery Index

Background Atracurium is a mixture of ten stereoisomers. 51W89, one of these isomers, is a potent nondepolarizing intermediate-duration neuromuscular blocking agent. Preclinical studies have shown 51W89 to be significantly more potent than atracurium but with a similar neuromuscular blocking profile. This study was undertaken to establish the neuromuscular blocking potency and pharmacodynamics of 51W89 in patients undergoing elective surgical procedures. Methods Ninety-nine ASA physical status 1 or 2 patients undergoing elective surgical procedures under nitrous oxide/opioid/barbiturate anesthesia were studied. The neuromuscular blocking effect of 51W89 was assessed after administration of bolus doses from 0.015 to 0.4 mg/kg, as well as during and after continuous infusions from 11 to 249 min in length. Results The calculated ED95 for inhibition of adductor pollicis twitch evoked at 0.15 Hz was 0.048 mg/kg. At 0.10 mg/kg, maximum block developed within 5.2 +/- 0.3 min, and recovery to 95% twitch height occurred 64.4 +/- 3.9 min after injection. At 0.4 mg/kg, onset was 1.9 +/- 0.1 min, and 95% recovery developed within 121.0 +/- 5.9 min. Comparative recovery indexes from 5% to 95% or from 25% to 75% twitch heights did not differ significantly among all dosage groups from 0.1 to 0.4 mg/kg (means ranged from 29.6 to 32.3 min and from 12.6 to 14.3 min, respectively). The average infusion rate necessary to maintain approximately 95% twitch suppression was 1.35 micrograms/kg/min. Recovery indexes from infusions were 5-95% 33.2 +/- 1.8 min and 25-75% 15.0 +/- 0.6 min, not differing significantly from recovery indexes from single bolus doses. Twenty-five patients received neostigmine (0.06 mg/kg) with atropine (0.03 mg/kg) at twitch height recovery of between 6% and 21%. Antagonism to 95% control twitch height developed within 6.8 +/- 0.3 min, and the neostigmine-accelerated 25-75% recovery index was 2.8 +/- 0.2 min. Conclusions 51W89 is a potent nondepolarizing neuromuscular blocking agent that shows noncumulative intermediate-duration neuromuscular blocking pharmacodynamics.

scholarly journals EFEKTIFITASPELAYANANPUBLIK DIKECAMATAN SAMARINDA KOTA DI SAMARINDA

2019 ◽  
Vol 4 (2) ◽  
Author(s):  
Ahmad Jubaidi
Keyword(s):  
Data Collection ◽  
Service Delivery ◽  
Public Service ◽  
Research Method ◽  
Public Awareness ◽  
Field Research ◽  
Civil Registration ◽  
A Value ◽  
Factors Influencing ◽  
The Cost

The purpose of this study is to determine the effectiveness of KK, KTP, and AK services in Samarinda Kota sub district and its factors influencing the effectiveness of KK, KTP, AKservices.The research used field research method which gives an overview on the effectiveness of KK, KTP, and AK services in Samarinda Kota sub district. Data collection techniques use observation techniques, interviews, and media questionnaires by selecting informants who play a role and are involved technically and functionally in service delivery to the community. The data obtained are then analyzed qualitatively and supported by quantitative data.The results showed that service implementation in Samarinda Kota sub-district, especially in the field of population administration and civil registration is done in accordance with existing mechanism and regulation which have been determined by seeing some service indicator such as simplicity is in very safe category with 6.67% and certainty of service procedure and tariff cost are in accordance with the value of 88.33% and 70% respectively, the security and convenience of facilities and infrastructure are in safe and comfortable category with 65% and 73.33% respectively, openness about the ease of obtaining information and provisions services in the categories easy and explained if requested with the value of 71.67% and 63.33% respectively, economical about the cost of KK rates, ID cards, AK category Rp 10,000 - Rp 15,000, equitable fairness with a value of 60%, the timeliness is in category 1 - 2 days, and the efficiency is an exact category with a value of 80%.  And the factors that affect the service is the resources apparatus, facilities and infrastructure, and public awareness. Keywords: Effectiveness, Public Service

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