Marchildon Gregory P, Beck Caroline A, Katapally Tarun R, Abonyi Sylvia, Dosman James A, Episkenew Jo-Ann
Professor and Ontario Research Chair in Health Policy and System Design, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON.
Johnson-Shoyama Graduate School of Public Policy, University of Regina, Regina, SK.
Healthc Policy. 2017 May;12(4):69-85. doi: 10.12927/hcpol.2017.25097.
A complex, poorly understood bifurcated health policy regime exists for Canada's First Nations people for extended health benefits coverage. This research adds to a small body of literature on the regime's impact on access and quality of care and its role in perpetuating health inequities in First Nations populations.
Using a case study of sleep apnea care in Saskatchewan, we identified issues of health service access and coverage through a literature review of extended benefits programs, legislation and policies and through 10 key informant interviews with federal and provincial extended benefit program administrators and sleep medicine physicians.
Important access and coverage differences were found for First Nations populations, many of which were recognized by federal and provincial policy makers. Despite these, government respondents recommended few policy ameliorations, perhaps due to system complexities, constitutional constraints or political sensitivities.
We suggest three policy options to ameliorate current hardships wrought by this policy bifurcation.
加拿大第一民族人民在延长健康福利覆盖范围方面存在一个复杂且鲜为人知的分叉式健康政策体系。这项研究为关于该体系对医疗服务可及性和质量的影响以及其在延续第一民族人口健康不平等方面作用的少量文献增添了内容。
通过对萨斯喀彻温省睡眠呼吸暂停护理的案例研究，我们通过对延长福利项目、立法和政策的文献综述以及对联邦和省级延长福利项目管理人员及睡眠医学医生进行的10次关键信息人访谈，确定了医疗服务可及性和覆盖范围的问题。
发现第一民族人口在医疗服务可及性和覆盖范围方面存在重要差异，其中许多差异已得到联邦和省级政策制定者的认可。尽管如此，政府受访者提出的政策改善建议很少，这可能是由于体系复杂性、宪法限制或政治敏感性所致。
我们提出了三种政策选择，以缓解当前这种政策分歧造成的困难。
