Authors:Divine-Favour Ofili Abstract: The Interim Federal Health Program (IFHP) has provided temporary healthcare coverage to eligible refugees since 1957, but significant amendments reported to be cost-saving were made to the program by the Conservative-led government in 2012. As a result of the reforms, refugees’ eligibility for publicly-funded health services differed by their country of origin and immigration status. This meant that some refugees faced great financial barriers in accessing healthcare. In 2014, however, the Federal Court of Canada ruled the reform as unconstitutional and requested its repeal. After securing a majority government in 2015, the Liberals reinstated the IFHP to its pre-2012 state in 2016. The IFHP service offerings and funding were fully restored in a bid to protect the health of refugees and public health safety while refugees await either provincial coverage or a decision on their residency application. The 2016 reform was made possible by the active pushback by human rights activists, healthcare providers and refugee service providers. This reform offers a unique opportunity to eliminate structural barriers to accessing healthcare faced by refugees and to reduce existing health disparities. Le Programme fédéral de santé intérimaire (PFSI) offre une couverture de soins de santé temporaire aux réfugiés admissibles depuis 1957. En 2012, le gouvernement conservateur fédéral a instauré des modifications importantes au PFSI afin de réduire certains dépenses. Suite à la réforme, l’admissibilité des réfugiés aux services de santé financés par l'État différait selon le pays d'origine et le statut d'immigration. Cela signifiait que certains réfugiés étaient confrontés à de grands obstacles financiers pour accéder aux soins de santé. Cependant, en 2014, la Cour fédérale du Canada a jugé la réforme inconstitutionnelle et a commandé son abrogation. Après avoir obtenu un gouvernement majoritaire en 2015, les libéraux ont rétabli le PFSI dans son état d'avant 2012 en 2016. Les offres de services et le financement du PFSI ont été entièrement rétablis dans le but de protéger la santé des réfugiés et la sécurité de la santé publique pendant que les réfugiés attendent une couverture provinciale ou une décision sur leur demande de résidence. La réforme de 2016 a été rendue possible grâce aux efforts de militants des droits humains, des prestataires de soins de santé et des prestataires de services aux réfugiés. Cette réforme offre une occasion unique pour éliminer les obstacles structurels à l'accès aux soins de santé auxquels sont confrontés les réfugiés et pour réduire les disparités existantes en matière de santé.
Authors:Catherine Donnelly; Simone Parniak, Nelly Oelke, Ashmita Rai, Sharon Johnston Abstract: The improvement of integration of health services for patients with complex needs has been identified as a priority across Canada. To improve patient experience and reduce costs, provinces and territories have implemented diverse team-based primary health care (PHC) models. In Ontario, a boom in both organizational and funding reforms in the early 2000s resulted in the addition of diverse primary care models, including Family Health Teams which serve approximately 25% of Ontarians. The goals of these reforms were to improve quality of care, care coordination and the comprehensiveness of services. These goals were reflected at both the provincial and regional (Local Health Integration Networks) levels through strategic guidance documents, and through the establishment of primary care evaluation frameworks by key provincial leaders. However, analysis of Ontario provincial and regional-level policies released between 2009-2019 reveals that in the last decade focus has shifted away from highlighting PHC teams as a strategy for integration, instead focusing on broader systems-level integration. Further, primary care evaluation frameworks were not implemented at the local level. Ontario Health Teams show great promise to reduce silos and improve integration, but the role of primary care and PHC teams in this reform remains unclear. À travers le pays, l'amélioration de l'intégration des services pour les patients ayant des besoins complexes a été identifiée comme une priorité. Pour améliorer l'expérience des patients et réduire les coûts, les provinces et les territoires ont mis en place divers modèles de première ligne. En Ontario, au début des années 2000, plusieurs réformes organisationnelles et financières ont proposé des modèles de première ligne, dont les « Family Health Team » qui desservent environ 25 % des Ontariens. Les objectifs de ces réformes étaient d'améliorer la qualité, la coordination des soins et la globalité des services. Ces objectifs ont été identifiés dans des documents d’orientation stratégique et des cadres d’évaluation des services de première ligne. Toutefois, l'analyse des politiques provinciales et régionales de l'Ontario publiées entre les années 2009 et 2019 révèle qu'au cours de la dernière décennie, l'accent n'a plus été mis sur la mise en évidence des équipes de première ligne en tant que stratégie d'intégration, mais plutôt sur une intégration plus large au niveau du système de santé. En outre, les cadres d'évaluation des services de première ligne n'ont pas été mis en œuvre au niveau local. Les équipes interdisciplinaires de première ligne de l'Ontario sont très prometteuses pour réduire les cloisonnements et améliorer l'intégration, mais le rôle des équipes de première ligne de ces réformes reste flou.
Authors:Alexandra Lukey; Karin Maiwald, Paul Wankah Nji, Mylaine Breton, Peter Hirschkorn, Nelly D. Oelke Abstract: Improving health services integration for patients with complex needs is a national priority in Canada. Health systems in all Canadian provinces grapple with the rising complexity of patients and the services they need. Team-based primary health care models have been implemented in diverse ways across the country to improve patients’ experiences, and better coordinate care to improve population health and reduce per capita costs. While some provinces now have more than a decade of experience with primary healthcare (PHC) teams, others are newly innovating in this area. British Columbia has been integrating team-based care through overarching policy support and funding. The creation of a new primary care model, Primary Care Networks (PCNs), was established in the province in 2018 with a phased approach to implementation across the province within regional health authorities. PCNs were designed to address the quadruple aim through integrated primary care. Policies have addressed topics such as vision and goals of team-based care, but discussion of processes that support teams such as a strategy for capitation-based funding and team composition were non-specific. Finally, there is a significant need for a provincial strategy for continuous quality improvement and evaluation of reforms.
Authors:Paul Wankah; Mylaine Breton, Alexandra Luckey, Isabelle Gaboury, Mélanie Ann Smithman, Nelly Oelke Abstract: Primary Health Care (PHC) teams are essential to integrating care for vulnerable patients living with complex health and social needs. PHC teams have been implemented in different forms across Canadian provinces/territories. This paper aims to explore healthcare policies that shaped the form and operations of PHC team-based care in Québec over the past 20 years. In Québec, the main model of multidisciplinary PHC teams – the Family Medicine Groups (FMG) – were created in 2002. Subsequently, the 2004 structural reforms led to the creation of Local Health Networks (LHN). LHNs promoted coordinated and collaborative activities between health and social services providers working in public, private (FMGs) and community-based organisations in concerted efforts to improve patients’ experiences and the efficiency of the health system. This was followed by another structural reform of the health system in 2015 leading to the creation of Territorial Health Networks. Various policy shifts such as the introduction of nurse practitioners, pharmacists, and social workers with extended scopes of practice shaped the configuration of FMGs, while enhancing inter-professional collaborative practices. Evaluations of PHC team-based practices revealed promising results. This article highlights important insights that could contribute to advancing the understanding and creation of future PHC policy initiatives.
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