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Substudy 8 Fact Sheet
Eligibility for Community, Hospital and Institutional Services in
Canada: A Preliminary Study of Case Managers in Seven Provinces (NA101-08)
University of Waterloo
This project is one of fifteen sub-studies of the National Evaluation
of the Cost-Effectiveness of Home Care Project (NA101). The dearth of
valid and reliable standardized health care data in Canada has made it
difficult to compare responses to health care needs in different parts
of the country. Substudy 8 sought to provide information on resource allocation
patterns across Canada, and to identify similarities and differences in
the manner in which clients are eligible for various types of care services.
Sixty case managers from seven provinces (British Columbia, Alberta, Saskatchewan,
Manitoba, Ontario, Nova Scotia and Prince Edward Island) were asked to
rate 16 client vignettes and indicate the level and type of care they
would recommend in regard to home care, residential care, and hospital
care. The vignettes described older persons in the community with different
social, psychological, medical and environmental characteristics. For
each vignette the case managers indicated the level of care the person
would be eligible for in that jurisdiction. They also reported on waiting
times, duration of services, types of professionals involved, co-payments,
and availability of services. Data from the responses were analysed at
the case-manager level and at the provincial level
The project leaders identified the following outcomes:
- Significant differences existed across jurisdictions in regard to
eligibility for and access to services.
- Manitoba had a somewhat greater emphasis on community care. British
Columbia, Alberta, and Ontario tended to have a higher level of resource
- British Columbia and Ontario were more likely to have admissions
to institutions recommended.
- Clients in Nova Scotia were less likely to have rehabilitation services
- Staff assigned to the clients also differed; for example, the expected
involvement of registered nurses ranged from 93.8 per cent to 54.4 per
cent across jurisdictions.
- Placement results also differed when case managers were blinded and
then not blinded to information regarding informal support.
The project leaders note that vignettes were hypothetical situations leading
to hypothetical responses and suggest further research should use data
from actual home care clients in different provinces to determine what
services are indeed provided across Canada. The authors suggest that the
understanding of "who is eligible for what" be standardized
based on comprehensive assessment data (such as the MDS-Home Care) so
that client needs are met in an effective and equitable manner. While
the project researchers suggest a need for standardized equity, they also
acknowledged the value-based nature at the heart of decisions about eligibility.
As this project was analytic/evaluative in nature, please see the "Activities"
HTF Contribution to the Project:
$1,505,000 (divided among the 15 sub-studies)
Language of Report: