Bergman H, Béland F, Lebel P, Contandriopoulos A P, Tousignant P, Brunelle Y, Kaufman T, Leibovich E, Rodriguez R, Clarfield M
Division of Geriatric Medicine, McGill University, Montreal.
CMAJ. 1997 Oct 15;157(8):1116-21.
Budget constraints, technological advances and a growing elderly population have resulted in major reforms in health care systems across Canada. This has led to fewer and smaller acute care hospitals and increasing pressure on the primary care and continuing care networks. The present system of care for the frail elderly, who are particularly vulnerable, is characterized by fragmentation of services, negative incentives and the absence of accountability. This is turn leads to the inappropriate and costly use of health and social services, particularly in acute care hospitals and long-term care institutions. Canada needs to develop a publicly managed community-based system of primary care to provide integrated care for the frail elderly. The authors describe such a model, which would have clinical and financial responsibility for the full range of health and social services required by this population. This model would represent a major challenge and change for the existing system. Demonstration projects are needed to evaluate its cost-effectiveness and address issues raised by its introduction.
预算限制、技术进步以及老年人口的不断增加，已促使加拿大各地的医疗保健系统进行重大改革。这导致急症护理医院数量减少且规模变小，同时给初级保健和持续护理网络带来了越来越大的压力。目前针对特别脆弱的体弱老年人的护理体系，其特点是服务分散、存在负面激励措施且缺乏问责制。这进而导致健康和社会服务的使用不当且成本高昂，尤其是在急症护理医院和长期护理机构中。加拿大需要建立一个由公共管理的社区初级保健系统，为体弱老年人提供综合护理。作者描述了这样一种模式，该模式将对这一人群所需的全方位健康和社会服务承担临床和财务责任。这种模式对现有系统而言将是一项重大挑战和变革。需要开展示范项目来评估其成本效益，并解决引入该模式所引发的问题。
