Substudy 8 Fact Sheet

Eligibility for Community, Hospital and Institutional Services in Canada: A Preliminary Study of Case Managers in Seven Provinces (NA101-08)

Sponsor Organization:
University of Waterloo

Rationale/Goals:
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.

Activities:
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

Key Findings:
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 intensity.
• British Columbia and Ontario were more likely to have admissions to institutions recommended.
  
• Clients in Nova Scotia were less likely to have rehabilitation services recommended.
  
• 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.

Implications:
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.

Evaluation Methodology:
As this project was analytic/evaluative in nature, please see the "Activities" section.

HTF Contribution to the Project:
$1,505,000 (divided among the 15 sub-studies)

Language of Report:
English

• Executive summary
• Full report