Hospitals are moving to outsource an array of services outside the "basic clinical care" required by patients. Everything from nutritional and security services to information systems and patient records are now provided to many hospital patients by multinationals like Marriott, Versa, ServiceMaster, Data General, Johnson Controls, MDS and U.
In , The Toronto Hospital TTH , a leading outsourcer in Canada, embarked on a plan to move what it called "non-core" services to the corporate sector. Although concerns were expressed that the private sector would lower quality of care and levels of service, they explained that the hospital would apply its own resources more effectively and at less cost to its "end product".
Many of the same companies claim that outsourcing will provide Canadian hospitals with significant cost-savings, greater efficiency, and improved quality. These arguments hold great appeal for administrators facing cuts in public funding, as well as for politicians wielding the knife, but outsourcing has not been shown to be better, more efficient, or less costly.
Studies show higher costs among American hospitals relate primarily to the use of more expensive non-patient care services. Hospital support services in the U. Overall, hospitals in Canada were Yet, Canadian hospitals are following the failed path of their U.
While outsourcing is attractive, the opportunity to generate alternative sources of revenue to offset funding reductions by provincial governments is growing in popularity among hospitals. This shift from saving money to generating revenues is a significant one that threatens the principles of non-profit delivery of services in Canada's hospital sector.
The search for revenue is drawing many hospitals into joint ventures and partnerships with global corporations. Nevertheless, it would be incorrect to characterize hospitals as being completely private in nature, as provincial governments have considerable authority over their operation.
Provincial governments also have the power to set the scope of the services offered by a hospital and even close facilities they deem unnecessary. In examining this idea of provincial government control of health care, it is useful to examine the administrative structure of hospitals in a particular jurisdiction.
Ontario has hospitals, most of which are private, non-profit entities Government of Ontario, While each hospital is free to establish its own internal governance structure, most have a board of directors and are incorporated under the provincial Corporations Act. These boards have legal and management responsibility for the hospital and administer its day-to-day activities, such as finance, planning, in-patient and outpatient care, imaging and laboratory services, and administration services. The Government of Ontario, however, exerts considerable authority over these hospitals and their boards.
Funding for hospital services is provided by the provincial government through annual budget allotments. This funding is based on a number of different factors, such as past financial needs. However, the provincial government has complete discretion to raise or lower hospital funding. The Ministry of Health and Long-Term Care also develops and enforces operational policies for hospitals regarding the services they provide and their financial decision-making.
Hospital boards must further submit annual operating plans to the government and must gain ministry approval before making any changes to the services they offer. While most hospitals in Canada operate in this semi-private manner, some hospitals are completely private, operating on either a non-profit or for-profit basis. These are private hospitals that existed prior to the shift by the provincial governments to the role of health care stewards.
As such, these private facilities have been allowed to continue providing medical services. Ontario, for example, has eight such private hospitals that are regulated by the provincial Private Hospitals Act and funded by the provincial government through annual budget allotments.
Under the P3 model, a private company constructs and owns the physical hospital building and then leases to space to a hospital board. This is different from most other hospitals in Canada, where provincial governments pay for the construction of the hospital building. It is important to note, however, that the hospital board still controls the provision of medical services. Under the P3 model, the private company simply owns the physical building and is responsible for its maintenance.
Private participation in the health care system also occurs outside the hospital realm. For example, residential care for seniors is often delivered by private, for-profit entities.
Additionally, many provinces have allowed the development of private, for-profit specialized medical facilities. These facilities do not operate as standalone hospitals, but offer specific services to complement those offered by traditional hospitals.
Patients may gain quicker access to MRI scans by paying for these private services through private health insurance or paying for them directly. Like health care delivery, health care financing in Canada is a mix of public and private participation. The mix associated with financing, however, differs significantly.
Health care delivery is characterized by private individuals and organizations providing medical services, albeit with considerable government regulation and control. Health care financing, by contrast, is characterized by direct government participation through funding for health care facilities i. Health care costs in Canada are predominantly financed by the public sector.
Compared to other western developed nations, this places Canada towards the upper end of public sector financing of health care, though Canada sits somewhat lower than nations such as the Czech Republic, Denmark and Norway, where public expenditures account for approximately 85 percent of total health care spending. At the other end of the spectrum, in countries such as the United States and Mexico, public spending accounts for only 45 percent — less than one-half of total expenditures.
Source: OECD, Public and private sector financing can be further broken down by specific financial sources. At discussed above, the public sector accounts for the large majority of spending on health care in Canada. While all levels of government contribute to health care financing, the largest source of public spending are provincial and territorial governments. This is because the delivery and financing of health care falls under provincial jurisdiction. The next largest public contributor is the federal government, which provides annual fiscal transfers to the provinces and territories in support of their health care spending in addition to direct contributions for health programs and initiatives falling under its jurisdiction i.
Lastly, local and municipal governments provide small levels of financing for local health initiatives. While the provinces and territories carry the largest portion of health care financing, customarily there is disagreement on the precise federal-provincial split. Much of this is due to the complex fiscal relationship between the two levels of government and the lack of clear transparency in the flow of health care funding.
Each year, the federal government transfers billions of dollars to the provinces. In some cases, these fiscal transfers are dedicated to health care spending, such as the Canada Health Transfer.
In other cases, fiscal transfers simply go into general provincial revenues, which may or may not be spent on health care programs such as the Equalization Program. Some estimates have placed the provincial and territorial share of health care financing as high as 85 percent of all public sector expenditures, with the federal share being less than 15 percent Provincial and Territorial Ministers of Health, Other estimates suggest that provincial and territorial spending has typically accounted for only 60 percent of total expenditures, with the federal government accounting for approximately 40 percent Department of Finance Canada, Public health insurance plans also represent a significant avenue of public sector financing.
Other statistics on the topic. Profit from additional features with an Employee Account. Please create an employee account to be able to mark statistics as favorites. Then you can access your favorite statistics via the star in the header. Profit from additional features by authenticating your Admin account.
Then you will be able to mark statistics as favourites and use personal statistics alerts. Please log in to access our additional functions. Yes, let me download! Exclusive Corporate feature. Corporate Account. Statista Accounts: Access All Statistics. Basic Account. You only have access to basic statistics.
Single Account. By December , all ten provincial psychiatric hospitals were absorbed into the public hospital system and are now governed under the Public Hospitals Act. For insured persons under the Health Insurance Act , insured hospital services are paid, including all physician services, nursing care and diagnostic services such as laboratory tests and X-rays. Medications provided to hospital in-patients and out-patients are covered and certain limited medications are provided to out-patients for use at home.
Once an in-patient is discharged, however, the costs of prescribed medications are not covered. Hospital visits solely for the administration of drugs or vaccines are also not covered. Accommodation, including meals, for hospital in-patients is covered at the public ward level.
However, individuals or private insurance would have to pay some or all of the fees the hospital charges for private or semi-private rooms. Hospitals are required to have a patient relations process that reflects the hospital's Patient Declaration of Values, which outlines what patients and their families can expect when they visit the hospital.
For any complaint or concern about the care provided, patients or families may contact the Patient Advocate or Patient Relations Office of the hospital directly.
0コメント