The Canadian health care system has undergone several reforms in the last decade. In 2001 the Prime Minister instituted “The commission on the future of healthcare in Canada”, commonly known as the Romanow Commission. The Romanow report recommended improvements in primary care, home care, catastrophic drug coverage, Aboriginal health among others. Expansion of home-based care services such as palliative care, post-acute patient management and mental healthcare featured prominently among the proposed home care reforms. Accords by ministers have also backed home care services and increased funding to this sector. This paper presents the Home Care reforms at the national level and the progress of Home Care in the province of Ontario.
Home Care Reforms
In April 2001, the Canadian Prime minister established “The Commission on the Future of Healthcare in Canada” led by Roy Romanow to engage Canadians in a national dialogue on healthcare. Over an 18-month period, the Commission obtained thousands of views from ordinary citizens, health ministers, healthcare experts and researchers (Romanow, 2002). The final report comprised of 47 detailed recommendations and implementation time frames.
Home Care was a huge beneficially of the Romanow Commission. The commission noted that all Canadian Provinces and territories have funded Home care programs since the 1970s. The coverage of home care has varied greatly from province to province. While some provinces provide extensive coverage, others limit home nursing care to a monthly dollar amount. For instance, New Brunswick spent about 10% of its total health care budget in 2000/01 on home care while Nunavut spent less than 2%. On average most territories spend between 4 and 5% of their total health budget on home care. Ontario spent 5% of its total expenditure on health care on home care. Provincial governments funded 76% of home care in 2000/01, the private sector funded 23% and the federal government funded the remaining 1% (Romanow, 2002). Increased funding to home care services and the need to offer therapeutic care such as caring for post-acute patients and mental health have led to more people to opt for home-based care (Tuohy, 2002).
The Romanow Commission proposed new health care transfer to include home mental health management, home care management for post-acute patients and palliative home care. The report proposed the inclusion of these services in the Canada Health Act. Home care was one among five target funds proposed to address renewal priorities. The report recommended creation of a Home care Transfer of $2Billion over 2 years to support the expansion of the Canada health Act and provide a foundation for a national home care strategy (Romanow, 2002).
The First ministers Accord emphasized the government’s support for home care by committing themselves to ensuring that Canadians access quality and community care services (First Minister’s Accord on Healthcare Renewal, 2003). Improving home care would affirm the government’s commitment to the 5 Canadian principles on healthcare: Accessibility, Universality, Comprehensiveness, portability and public administration (Rode & Rushton, 2002). The ministers agreed that by 2006 Canadians would access nursing/professional services, pharmaceuticals and medical supplies under home-based health care (First Ministers’ Meeting, 2004).
Ontario Province has had several healthcare reforms recently. In June 2008, the Ontario Government tasked Health Quality Ontario (HQO) with the responsibility of monitoring the quality of long term care and resident satisfaction. In December 2008, the Ontario government again mandated HQO to monitor the quality of home care service (Ontario Health Quality Council (OHQC), 2009. In June 2010, the legislature passed the Excellent Care for All Act which expanded HQO’s roles and mandate regarding home care. The 14 regions in Ontario now have Community Care Access Centres (CCACs) to coordinate home-based care. Case managers access the needs of patients and work with health service providers. All the regions in Ontario now use a new data collection tool called RAI-HC (Resident Assessment Instrument- Health Care). 46% of home care beneficiaries in Ontario require long term care. Health Quality Ontario reports on the developments of improving health care, home care inclusive.
Over the past decade, the Canadian government made great reforms in the provision of quality healthcare to its citizens. In 2001, the government instituted the Commission on the Future of Healthcare in Canada led by Roy Romanow. I health care the commission made three key expansion areas: Home mental health management, home care services for post-acute patients and palliative home care services. The report also recommended the creation of a home care fund of $ 2 billion for 2-years periods. The First Minister’s accord lived up to the Romanow recommendations on home care by increasing funding. Ontario province has had numerous reforms in home care such as creation of Community Care Access Centres (CCACs) to coordinate home – based care through the Ontario Health Quality Council OHQC. The OHQC also monitors home and long term care and reports to the public since 2008. To date, the federal and other provincial governments continue to formulate and implement strategies aimed at improving accessibility and quality of health care.
First Minister’s Accord on Health Care Renewal (2003) Retrieved from:
First Ministers’ Meeting on the Future of Health in Canada (2004) Retrieved from
Ontario Health Quality Council (2009) Long-Term Care Measurement & Reporting Scientific
Panel. Full report and indicators selected based on an environmental scan and a
series of consultation process meetings from November 2008 to March 2009. Retrieved
Romanow Commission Report (2002) retrieved from:
Rode, M. & Rushton, M. (2002). Options for Raising Revenue for Health Care. Discussion Paper
prepared for the Commission on the Future of Health Care in Canada.
Tuohy, C. (2002). The Costs of Constraint and Prospects for Health Care Reform in Canada,