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Almost home : [publication] : reforming home and community care in Ontario /

by Baranek, Patricia M; Deber, Raisa B; Williams, Alan Paul.
Material type: materialTypeLabelBookPublisher: Toronto : University of Toronto Press, 2004, cop. 2004Description: XVI, 340 p. ; 23 cm.ISBN: 080208639X.SAPHIR theme(s): Soins infirmiers - Soins à domicileMeSH subject(s): Home Care Services | Long-Term Care | Public Policy | Health Care Reform | OntarioPUBLICATION TYPE SAPHIR: MonographSummary: The shift from hospital to home and community is fundamentally reshaping Canadian health care policy and politics - both the way in which health care services are funded and delivered and the dynamics of health care policy making. This is because the move out of hospitals does more than simply change the site of care; it results in an increasing proportion of care moving beyond the collective 'logic' and institutionalized boundaries of the 'Medicare mainstream', which consists of publicly funded, 'medically necessary' services delivered in hospital or by physicians. Within this mainstream the costs of illness are shared across society and access to services is based on need. Outside, the more individualistic 'logic' of private competitive markets, where care is not an entitlement and where access to services is more likely to be a function of the ability to pay, places the costs of illness on the ill. Within the mainstream of Canadian Medicare there is sustained public and political support for the principles of universal access to medically necessary care, buttressed by the concentrated power of the organized medical profession. Outside, even in proximate fields like home- and community-based care, there is a relative legislative vacuum at the national level, there is little agreement on principles, and policy communities are highly fragmented. [Ed.]
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The shift from hospital to home and community is fundamentally reshaping Canadian health care policy and politics - both the way in which health care services are funded and delivered and the dynamics of health care policy making. This is because the move out of hospitals does more than simply change the site of care; it results in an increasing proportion of care moving beyond the collective 'logic' and institutionalized boundaries of the 'Medicare mainstream', which consists of publicly funded, 'medically necessary' services delivered in hospital or by physicians. Within this mainstream the costs of illness are shared across society and access to services is based on need. Outside, the more individualistic 'logic' of private competitive markets, where care is not an entitlement and where access to services is more likely to be a function of the ability to pay, places the costs of illness on the ill. Within the mainstream of Canadian Medicare there is sustained public and political support for the principles of universal access to medically necessary care, buttressed by the concentrated power of the organized medical profession. Outside, even in proximate fields like home- and community-based care, there is a relative legislative vacuum at the national level, there is little agreement on principles, and policy communities are highly fragmented. [Ed.]