Care for Canada's frail elderly population: fragmentation or integration?

TLDR

Canada’s aging population, budget constraints, and technological advances have driven health‑care reforms that have reduced hospital size, increased pressure on primary and continuing care, and created a fragmented, incentive‑poor system for frail elders that leads to costly, inappropriate service use. The study argues that Canada must establish a publicly managed, community‑based primary‑care system to deliver integrated care for frail elders. The authors outline a model that assigns clinical and financial responsibility for the full spectrum of health and social services to such a community‑based system.

Abstract

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.