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      加拿大留學生作業:High Cost Low Quality Healthcare in Canada

      時間:2021-09-16 09:42來源:www.nguoikontum.com 作者:cinq 點擊:
      加拿大留學生作業-加拿大的高成本低質量醫療。本文主要內容是講述加拿大的醫療保健費用正在增長;然而,護理質量似乎在下降。解釋為什么會發生這種情況,提出了哪些解決方案來解決這些問題?本篇加拿大作業利用閱讀資料、課堂討論四大循證解決方案,以解決加拿大高成本低質量的醫療保健問題。是小編精選的一篇優秀的加拿大留學作業范文,供參考。
      加拿大留學生作業
      加拿大留學生作業
      The costs of healthcare in Canada are growing; however, the quality of care seems to be declining. a) Why this is happening, and what solutions have been proposed to fix these issues? b) Utilizing the readings, class discussions and your own research, discuss your top 4 evidence-informed solutions to address the high-cost low-quality health care in Canada.
      醫療費用在加拿大是一個突出的問題,因為它是每個省最大的預算項目。雖然加拿大的醫療保健費用在增長,但醫療保健質量似乎在下降。
      The cost of healthcare is a prominent issue in Canada, for it is the single largest budget item for every province. Although the costs of healthcare in Canada are growing, but the quality of care is seen to be declining.
      a) 目前加拿大的醫療保險制度建立于20世紀60年代,當時人們的需求大不相同。重點是急癥護理,以滿足民眾的需求?,F在,需求大不相同,但系統沒有能力處理它。質量下降的可能原因是缺乏問責制和公民參與、服務提供和整合的混亂和不協調,以及缺乏對社區護理的重視。缺乏責任感在很大程度上是因為那些提供金融服務的人在資金流向上幾乎沒有發言權。此外,沒有簡單的問責制模式可供參考。目前存在的各種模型不明確且不一致,并且它們沒有提供應該實現的目標。當患者參與醫療系統時,患者會覺得他們對適當醫療系統的需求和要求沒有得到適當的解決;然而,許多人覺得,關于醫療保健的決定應該由“專家”而不是他們來決定。即使公民向官員表達了他們的擔憂,他們也會覺得自己沒有被真正聽到或認真對待。這是建立區域衛生機構的最初原因,但許多公民不知道這些機構或其成功利用這些機構的目的。服務提供和整合的無序和不協調導致資源被不適當地利用不足或過度利用,以及服務提供和可用性之間的不一致。這通常會導致等待時間增加等模式。由于缺乏特別是在各省授予RHA的權限,加拿大沒有明確的整合。對融合的關注往往受到以下事實的阻礙:融合是一個需要長期投資和資金以提供長期利益的目標,這是在考慮改變政黨及其政策和競選連任戰略時的一個問題。缺乏對社區護理的關注可能是由于關注機構護理(如醫院)。盡管有人試圖增加社區護理支出,但這些努力收效甚微。此外,醫療保健的成本仍在增加,但這一支出的增加并未導致醫療質量的相應提高。
      a) The current Canadian system, Medicare, was founded in the 1960s when the needs of the population were vastly different. The focus was on acute care, to match the needs of the population. Now, the needs are vastly different, but the system is not equipped to handle it. The likely reasons for this decline in quality are lack of accountability and citizen participation, disorganization and un-coordination of service delivery and integration, and lack of attention paid to community-based care. The lack of accountability is in large part due to the fact that those that finance care have little say in where that money goes. Furthermore, there is no simple accountability model to reference. The various models present are unclear and inconsistent, and they do not provide goals for what should be accomplished. When patients engaged with the healthcare system, the would feel as if their needs and requirements of a proper healthcare system were not being properly addressed; however, many people feel as if the decisions regarding healthcare should be made by ‘the experts’ instead of them. Even if citizens raised their concerns to officials, they would feel like they were not actually being heard or being taken seriously. This is the original reason Regional Health Authorities were created in response to this, but many citizens do not know about them or their purpose to successfully utilize them. The disorganization and un-coordination of service delivery and integration leads to resources being inappropriately being under or over utilized, as well as inconsistencies within the delivery and availability of services. This often leads to patterns such as increasing wait times. Because of the lack of authority given to RHAs in provinces especially, there is no clear integration across Canada. Attention to integration is often hindered by the fact that it is a goal that needs long-term investment and funding to provide long-term benefits, which is an issue when considering the changing of political parties and their policies and strategies for re-election. The lack of attention paid to community-based care is likely due to the focus on institutional care (e.g., hospitals). Although there have been attempts to increase spending on community-based care, these efforts have had a minimal effect. Furthermore, the cost of healthcare remains increasing, but this rise in spending has not seen proportional advances in quality of care.
      b) 解決加拿大高成本低質量醫療問題的解決方案包括:合理分配資源、家庭護理的eShift模式等舉措、負責任的護理組織,以及提高對RHA的授權。
      b) Solutions to the address the high-cost low-quality healthcare in Canada include: proper allocation of resources, initiatives such as the eShift model of homecare, Accountable Care Organizations, and increased authority given to RHAs.
      加拿大國內的一個重大問題是資源分配不當,主要與過度使用醫院有關。在加拿大,醫院消耗了相當一部分醫療支出。這主要是由于初級保健的使用不足和/或不可用。許多人不使用它們,或者是因為他們不知道它們的存在,或者他們不知道他們應該使用這些資源而不是急診室(例如,去急診室治療手臂骨折而不是急診中心)。此外,與其他經合組織國家相比,加拿大獲得這種初級保健的機會要低得多。這種缺乏機會的情況不僅導致更多可預防的住院治療,而且還導致生活質量下降和醫療部門投資回報率下降。因此,增加初級保健的機會和知識將有助于適當和有效地利用資源。
      A huge issue seen within Canada is the misallocation of resources primarily associated with the overuse of hospitals. Hospitals use up a substantial portion of the healthcare expenditure within Canada. This is largely due to the underuse and/or unavailability of primary care. Many people do not use them either because they don’t know they exist, or they don’t know that they should be using these resources instead of the emergency room (e.g., going to the ER for a broken arm instead of an urgent care center). Moreover, the access to this primary care in Canada fares much lower compared to other OECD countries. This lack of access not only leads to more preventable hospital admissions, but also poorer quality of life and bad returns on investment within the healthcare sector. Therefore, increasing access and knowledge about primary care would help use resources appropriately and efficiently.
      eShift模式包括臨床護理護士、感官技術、西南LHIN和西南社區護理訪問中心之間的協作。這一模式的建立是為了回應人們對西南社區護理準入中心缺乏護士的日益關注,特別是在夜班和姑息治療單位。這主要是因為在姑息治療領域缺乏訓練有素和知識淵博的護士。護士的需求太多,但供應太少,給家庭帶來了更大的負擔。eShift模型作為一個跨學科的解決方案應運而生。護士不必站在患者床邊幫助治療和協助他們進行護理,而是可以通過eShift系統遠程管理護理。這使得護士可以在更短的時間內甚至同時治療多個患者,從而利用具有適當知識的護士,使更多的人受益。此外,eShift減少了尋求臨終治療的人以及那些與癥狀處理不當有關的人的可預防急診就診次數。它還增加了那些以前沒有家庭護理資源的人的出院人數。
      The eShift model consists of collaboration between clinical care nurses, Sensory Technologies, Southwest LHIN, and Southwest Community Care Access Centre. The model was created in response to a growing concern about the lack of nurses in the Southwest Community Care Access Centre, especially during night shifts and in palliative care units. This was largely because of a lack of trained and knowledgeable nurses in the palliative care field. There was too much demand, but too little supply existed of nurses, putting more burden on the families. The eShift model emerged as an interdisciplinary answer to this problem. Nurses would not have to be at the patient’s bedside to help treat and assist them with their care, but rather they could help manage that care remotely via the eShift system. This makes it so that a nurse can treat multiple patients in a shorter amount of time and even simultaneously, thereby utilizing that nurse with the appropriate knowledge so that more people may benefit. Furthermore, eShift decreased the amount of preventable emergency room visits by those seeking end-of-life treatment, as well as those related to inadequately handled symptoms. It also increased the number of hospital discharges for those that did not previously have the resources for care at home.
      該系統基本上不向公眾負責,但引入責任關懷組織(ACO)是一個例外。這些醫院和醫療集團通過與公共或私人保險公司簽訂具有法律約束力的協議,通過資本化預算,承認并承擔特定人群的醫療成本和質量責任。在這個綜合醫療服務提供系統中,可以提供更多的服務。醫生群體更小,更專業,此外,由醫院、醫生和健康中心組成的混合、跨學科群體提供服務。該系統已在美國實施。這些組織有效地提高了系統中的問責制和患者滿意度。
      The system is largely unaccountable to the public, but an exception is the introduction of Accountable Care Organizations (ACOs). These are hospitals and medical groups that have recognized and absorbed the responsibility for both cost and quality of care for specific groups of people by means of a capitated budget between them and a public or private insurer via a legally binding agreement. In this integrated system of healthcare delivery, more services are able to be provided. The groups of physicians are smaller and more specialized, and additionally a hybrid, interdisciplinary group consisting of hospitals, physicians, and health centers offer services. This system has already been implemented in the U.S. These organizations are effectively increasing the accountability in the system and patient satisfaction within it.
      RHA未得到充分利用和重視。沒有多少公民知道它們以及如何使用它們,而且RHA本身也沒有足夠的權力來正確發起變革。他們的作用和權威需要得到更明確的界定。此外,需要給他們發揮作用的空間。這一變化將有助于保持護理的連續性和標準,并驗證RHA在其領域的權威性。此外,許多人不知道RHA或他們做什么。如果公眾知情,那么他們更傾向于利用這一資源,同時也更經常、更有效地表達他們的擔憂。公民參與的增加將有助于確保醫療體系更加以患者為中心,包括公眾參與其形成和修訂,有效提高醫療質量。
      The RHAs are underused and underappreciated. Not many citizens know about them and how to use them, and the RHAs themselves are not given enough authority to properly initiate change. Their role and authority need to be more clearly defined. Furthermore, they need to be given the room to act upon their role. This change would help to maintain the continuity and standards of care, as well as validate the RHAs as authorities in their field. Moreover, many people do not know about the RHA or what they do. If the public is informed, then they are more inclined to utilize this resource while also voicing their concerns more often and effectively. This increase in citizen participation will help to make sure that healthcare systems are more patient-centered by including the public in their formation and revisions, effectively progressing quality of care.
      獲得優質健康是加拿大健康差距的主要決定因素之一;目前的《加拿大衛生法》(CHA)和全民醫保似乎無法解決這一問題。不幸的是,健康差距對少數群體的影響最大,包括婦女、兒童、老年人、新來者、LGBTQ、有心理健康問題的人和農村地區的人。請討論上述各少數群體所面臨的一個主要問題,并提供一種有效和高效的方式來解決這些問題。
      Access to quality health is one of the main determinant factors of health disparities in Canada; it seems the current Canada Health Act (CHA) and the universal coverage is unable to address this issue. Unfortunately, health disparities are affecting the minority groups the most, including women, children, seniors, newcomers, LGBTQ, the people living with mental health issues and those living in the rural areas. Please discuss 1 main issue faced by each of the above minority groups, and provide an effective and efficient way to address each of those issues.
      加拿大婦女面臨的主要問題是暴力,特別是親密伴侶之間的暴力。暴力對健康的影響更關注心理健康;這些癥狀包括:抑郁、依賴(如酗酒)、焦慮以及性傳播感染。必須指出,暴力是可以預防的。因此,解決這一問題的一種方法是為婦女提供更多的社區支持,特別是那些私人和離散的婦女,以便她們能夠報告暴力事件。同樣重要的是,他們對向某人傾訴感到舒適,因此受過培訓的人必須知道如何處理這樣一個敏感的話題。也許只要有一條廣為宣傳的求助熱線,就可以在這種關系變得太嚴重之前,對其進行干預。
      The main issue women face in Canada is violence, especially among intimate partners. The health implications that result from violence concern more with mental health; these include: depression, dependencies (e.g., alcoholism), anxiety, as well as sexually transmitted infections. It is important to note that violence can be prevented. So, a way to address this issue is to provide more community supports for women, especially those that are private and discrete, so that they may report the violence. It is also important that they feel comfortable confiding in someone, so the person trained must know how to handle such a sensitive topic. Perhaps just having a widely advertised helpline can help to intervene in these relationships before it becomes too serious.
      加拿大遭受虐待的兒童隨后表現出更差的心理健康結果,特別是在婦女中。這種虐待為日后更糟糕的健康結果鋪平了道路(例如,肺部問題、背部問題和慢性疲勞)。因此,減少兒童期虐待的發生應該可以減少日后不良健康后果的發生。因此,解決這一問題的一種方法是為兒童提供更多的支持,以便他們在感到舒服的情況下可以大聲說話,并培訓從業者和社區(例如,教牙醫在檢查兒童時應該注意什么),以便更好地識別虐待的跡象,以便盡早進行干預。
      Children in Canada that have been abused have been shown to subsequently show worse mental health outcomes, especially among women. The abuse paves the way for worse health outcomes later in life (e.g., lung problems, back problems, and chronic fatigue). So reducing the instance of childhood abuse should lower the amount of bad health outcomes later in life. Therefore, a way to address this issue is to provide more supports for children so they may speak up if they are comfortable, as well as training practitioners and communities (e.g., teaching dentists what to look for when examining children) to better recognize the signs of abuse so an intervention can happen sooner than later.
      老年人的主要問題是多發病,即兩種或兩種以上疾病同時發生。它與許多不良健康結果有關,包括:預期壽命縮短、日常功能和能力下降以及預期壽命縮短。隨著加拿大人年齡的增長,他們的生活滿意度會下降。解決這一問題的一種可能的有效方法是使用一種更加協調和綜合的健康模式,以便老年人更容易獲得醫療保健,同時更好地管理他們的慢性病。
      The primary concern with seniors is multi-morbidity, which is when two or more illnesses are occurring at the same time. It is associated with numerous bad health outcomes, including: decreased life expectancy, decrease in daily function and ability, and lower life expectancy. As Canadians age, it is found that their life satisfaction decreases. A possible effective and efficient way to address this is by using a more coordinated and integrated health model so that seniors’ times attaining healthcare is easier, as well as their chronic illnesses are better managed.
      加拿大的新移民(如移民和難民)在試圖獲得醫療保健時經常面臨歧視。這種歧視會導致有價值的健康結果,包括:更差的身心健康和更危險的健康行為。新來者在試圖獲得與其文化和宗教信仰相一致的護理時,往往會感到羞恥,這反過來會對他們的健康產生負面影響。醫療從業者需要敏感性培訓,以了解如何以一種不“其他”患者的方式治療患者。此外,雇用具有這些背景的工作人員也很有用,這樣患者就能感覺到他們之間的聯系,并樂于分享他們的健康信息和經驗。
      Newcomers (e.g., immigrants and refugees) to Canada often face discrimination when trying to attain healthcare. This discrimination results in worth health outcomes, including: worse physical and mental health and more risky health behavior. Newcomers are often made to feel ashamed when trying to attain care that is consistent with their cultural and religious beliefs—which in turn negatively affects their health. Healthcare practitioners need sensitivity training regarding how to treat patients in a way that does not ‘other’ them. Further, it would also be useful to hire staff that are from these backgrounds so that patients feel a connection and are comfortable sharing their health information and experiences.
      加拿大LGBTQ青年人口在試圖獲得護理時面臨許多恥辱。這些結果包括害怕受到嚴厲的評判,在被問及他們最認同的性別時感到不安,以及只在非規范環境中接受教育。學校董事會為這些青少年提供了支持服務,為他們提供性健康信息和社區支持,否則他們可能得不到這些支持。很多時候,醫療從業者發現難以與LGBTQ青少年建立聯系,因此他們不確定如何為他們呈現和定制信息,從而導致這些青少年進一步迷失和困惑。加拿大的LGBTQ青年沒有接受與他們有關的問題的適當教育,但沒有接受被視為“正常”的問題(即獨聯體性別、異性戀等),特別是在性健康教育方面。因此,解決這一問題的最佳方法也許是雇傭更多的醫療專業人員進入LGBTQ領域,或者深入了解他們的需求,以便干預和教育包括他們的需求,并確保他們感到舒適。
      The Canadian LGBTQ youth population faces a lot of stigma when trying to attain care. These results of fear of being judged harshly, uneasiness when asked about what sex they most identify with, and only being educated in a heteronormative context. School boards have implemented support services for these youth to provide them with the sexual health information as well as community support that they may not receive otherwise. Many times healthcare practitioners find difficulty in relating to LGBTQ youths, so they are unsure how to present and tailor information for them—which then leads these youths further lost and confused.  LGBTQ youth in Canada are not properly educated about issues that relate to them but not those considered “normal” (i.e., cis-gender, heterosexual, etc.), especially in regards to sexual health education. Therefore, the best way to address this issue is perhaps to employ more healthcare professionals into the field that are either LGBTQ or have a deep understanding of their needs so that interventions and education include their needs and ensures that they are comfortable.
      患有心理健康問題的人面臨著復雜的健康需求,解決方案往往不容易或不明確。在這些人中發現的最常見的障礙是阻礙他們獲得護理的個人環境。解決這一問題的一種方法是給予心理健康與其他慢性病同等的重要性,從而改變人們對心理健康的偏見。一旦被當作其他慢性病一樣對待,心理健康將是一種公認的手段,可以讓你錯過工作去接受治療,并在保險范圍內,被視為一個不履行義務的適當理由。
      People living with mental health issues face complex health needs where the solution is not often easy or clear. The most common barrier found among these people was personal circumstances that hinder their access to care. A way to address this issue would be to give mental health the same level of importance as other chronic conditions, and thus change the stigma against mental. Once treated like any other chronic condition, mental health will be an accepted means to miss work to get treatment for, covered by insurance, and deemed an appropriate reason for having to be absent from obligations for.
      生活在農村地區的人通常比生活在城市地區的人得到醫療護理的時間晚,頻率低,這主要是因為他們沒有適當的機會(特別是獲得初級保健的機會),這與城市居民相比是不公平的。解決這一問題的一種方法是通過激勵措施將醫療從業者招募到農村地區,然后通過能夠為這些新員工開設更多的初級保健設施來增加初級保健的機會。
      Those living in rural areas often get medical attention later and less frequently than those living in urban areas (Silver, 1994), which is largely due to the fact that they do not have the appropriate amount of access (especially to primary care) that is inequitable in comparison to their urban counterparts. A way to address this issue is by recruiting healthcare practitioners into rural areas through incentive measures, which would then subsequently increase access to primary care through being able to open more primary care facilities with this new staff.
      根據閱讀材料和課堂討論,加拿大似乎需要擴大其全民醫療覆蓋范圍,包括醫藥保健、家庭/社區保健和聯合醫療保健提供者提供的醫療保健服務,以確保改善所有人的醫療保健服務體系??紤]到醫療服務的成本目前還不可持續,請討論您對P4 醫學2.0和數字健康/虛擬醫療如何幫助應對這些挑戰(如上所述擴大全民醫療覆蓋,改善醫療服務交付和控制醫療成本)。
      As per the readings and class discussions, it appears that Canada requires to expand its universal health coverage to include the pharma care, home/community care and the healthcare services provided by allied healthcare providers to ensure improving the healthcare delivery system for all. Considering the costs of healthcare delivery is not even currently sustainable, please discuss your evidence-informed opinions on how P4 Medicine, Medicine/Health 2.0, and the digital health/virtual healthcare could assist with these challenges (expanding universal health coverage as above, improving healthcare delivery & containing healthcare cost).
      加拿大需要擴大其全民醫療覆蓋范圍,包括醫藥保健、家庭/社區保健以及聯合醫療保健提供商提供的醫療保健服務,以確保改善所有人的醫療保健服務體系。由于目前醫療服務的成本是不可持續的,P4 醫學2.0以及數字和虛擬醫療服務可以幫助應對上述挑戰,從而改善醫療服務,而無需在沒有足夠結果的情況下向系統投入更多資金。換言之,這些方法有助于促進更可持續的醫療服務體系,既經濟高效又高效。
      Canada needs to expand its universal health coverage to include pharma care, home/community care, and the healthcare services provide by allied healthcare providers to ensure improving the healthcare delivery system for all. Since the cost of healthcare delivery now is not sustainable, the P4 Medicine, Medicine 2.0, and digital and virtual healthcare can assist with the above challenges in order to improve healthcare without also investing more money into the system without adequate results. In other words, these methods can help promote a more sustainable healthcare delivery system that is both cost-efficient and effective.
      P4醫學是具有預測性、個性化、預防性和參與性的醫學。預測性是指如何使用該模型預測人群的需求,以及他們對健康和疾病的主觀看法,其方式類似于預防性護理。該藥物是個性化的,因為它將在個人數據云中保存有關個人健康和身體的所有信息。這將使人們能夠以更容易和更容易訪問的方式擁有和訪問他們的信息。預防醫學的目的是分析疾病的根源,以便在疾病開始存在之前與之斗爭。預防醫學不會在衛生設施之外結束,因為它需要延伸到日常生活中,因此需要人口參與。參與式醫學是指人們的日常生活以及他們在這一過程中的行動和行為對他們的健康是如何重要的。人口必須參與自身的健康。這種思想導致人們更加積極地提供更適合他們和當前人口需求的醫療服務。通過這種方式,它確保投資流向更有效地促進健康和積極變革的激勵和設施。
      P4 Medicine is that which is predictive, personalized, preventative, and participatory. Predictive refers to how this model can be used to predict the needs and wants of a population, as well as their subjective view of health and disease in a manner similar to preventative care. The medicine is personalized in that it will hold all information concerning an individual’s health and body in a personal data cloud. This will allow people to have and access their information in an easier and more accessible manner. Preventative medicine aims to analyze the root of a disease to combat it before it even begins to exist. Preventative medicine does not end once outside health facilities, for it needs to extend into everyday life, thus requiring population engagement. Participatory medicine refers to how the population’s everyday life and their actions and behaviors during it is important to their health. Populations must participate in their own health. This ideology leads to people becoming more active health delivery that is more tailored to them and current population needs. In this way, it ensures that investment goes to incentives and facilities that are more effective in promoting good health and positive change.
      醫學2.0是指在非中介、非中介和中介過程中使用社交網絡、參與、協作、開放和電子中介。非中介化指的是取消一個步驟,以使民眾更容易、更快地接收信息(例如,WebMD等網站)。Apomediation指的是醫學2.0如何為您工作,而是通過您自己的研究引導您找到答案。中介是指患者和醫生之間的傳統關系,在這種關系中,中介機構向患者提供信息。對于那些不具備必要的健康知識水平的患者來說,這更適合于參與調解;考慮到患者評估信息的能力是準確和可信的,這一點也很重要。通過這些不同的渠道,可以更有效地利用信息傳播,這樣,如果患者有能力的話,就不必總是要求他們去醫生那里接受他們需要的健康信息。這減少了對診所,尤其是醫院的大量投資,因為它讓患者在家里更容易、更快地接收信息,而不需要政府承擔任何費用。
      Medicine 2.0 refers to the use of social networking, participation, collaboration, openness, and epomediation in the processes of disintermediation, apomediation, and intermediation. Disintermediation refers to eliminating a step to make the population’s efforts to receive information easier and faster (e.g., websites such as WebMD). Apomediation refers to how Medicine 2.0 do the work for you but rather lead you to the answer through your own research. Intermediation refers to the traditional relationship between patient and physician in which a mediating agent curates the information to the patient. This is better for those patients that do not possess the necessary level of health literacy to engage in apomediation; this also relevant when considering patients’ capacities to evaluate information as accurate and credible. Through these different channels, information dissemination can be more efficiently used so that patients are not always required to go to the doctor to receive the health information they need, if they are capable. This decreases the amount of heavy investment in clinics and especially hospitals, for it allows patients to receive information at home easier and faster at no cost to the government.
      加拿大在獲取和分發虛擬醫療服務方面沒有與其他國家保持聯系,這主要是因為缺乏適當的基礎設施和支付模式。已經在安大略省試行的虛擬診所(正變得越來越流行,并預計將成為未來的標準。虛擬醫療環境可以類似于空中交通控制中心。這將是一個充滿了包含患者信息的計算機的房間。一名醫療從業者將根據患者的當前狀況在這些計算機上監控兩名患者。這所需要的監視量可能不可行。相反,“家中醫院”將充滿監控設備和家庭檢查點,傳感器嵌入日常物品中,可以提供分析,以告知和可能改變某人的健康行為。這種將健康融入患者日常生活的方式使他們能夠更好地控制自己,但同時也給他們帶來了更多的負擔來監控自己的健康?;颊弑粍犹峁┑男畔⑹贯t療專業人員能夠監控患者,繞過在辦公室進行更多測試,等待結果。這種類型的醫療服務提供系統減少了患者入院和等待時間。然而,由于初始投資可能很高,這種類型的信息收集可能會導致訪問方面的差異。這可以通過政府補貼來緩解。這一制度的實施還可能導致更具成本效益的國家醫療體系。它還促進了公眾參與,目前加拿大醫療體系及其治理中缺乏公眾參與。
      Canada has not kept other with other countries in their access to and distribution of virtual care, which is largely because of a lack of appropriate infrastructure and payment models (Reid, 2017). Virtual visits to the clinic, as already being piloted in Ontario (Reid, 2017), are becoming more popular and are predicted to become the standard in the future (Topol, 2015). The virtual healthcare environment can be analogized to an air-traffic control center. It would be a room full of computers that contain patient information. A healthcare practitioner would monitor a couple patients on these computers dependent on their current condition. The amount of surveillance this entails may not be feasible. Rather, the ‘hospital at home’ would be full of monitoring devices and home checkpoints, with sensors being embedded into everyday items that can provide analytics to inform and possible change someone’s health behavior. This integration of health into the patient’s everyday life allows them to have more control but also put more of the burden on them to monitor their own health. The information the patient passively supplies allows healthcare professionals to monitor patients and bypass performing more tests in-office and wait for results. This type of healthcare delivery system reduces patient admissions and decreases wait times. However, this type of information-gathering can cause a disparity in access, as the initial investment can be high. This can be alleviated by government subsidies. The implementation of this system could also result in a more cost effective national healthcare system. It promotes public participation as well, which is currently shown to be lacking within the Canadian healthcare system and its governance.
      The principal way these models would benefit the healthcare system is by alleviating the current financial burden many practices hold (e.g., patients going to the doctor for potentially simple questions they could’ve found online). Therefore, this change to the primary care practices of patients and healthcare practitioners could lead to cost savings, which in turn could then be used to fund expanding universal health coverage to things such as pharma care. Further, these methods also enhanced the healthcare delivery system by allowing patients faster access to answers, allows doctors faster access to patient information and test results, and easier access for patients to see their own health information. Integrating these would lead to more seamless care and effective preventative medicine to respond to chronic conditions (e.g., through tracking measures and physicians instant feedback on patient behavior and vitals) as well, which are currently costing the Canadian healthcare a large portion of spending.
      The health and wellbeing of every individual in the society are among the core governments’ responsibility. Utilizing the ‘Triple Aim’, ‘Health in All Policies’ and ‘The Whole of Government Approach’, please research, develop and explain a new Canadian (health) governance structure (with one, two or three-tier structure of your choice) to address the future health and wellbeing of individual.
      The Canada Health Act has performed well in maintaining funding for services through taxes, but this vary feature is what is likely holding Canada back in innovation. The restriction it places blocks further advancement through its rigid criteria. In the last 40 years, there have not been essential changes to the healthcare system. It is argued that nothing will happen most likely until a catastrophic event or paradigm shift occurs. This results in restricted focus on hospitals and doctors, as well as Canada falling behind relative to other OECD countries. There has been limited attempts at changing health policy in Canada, and many of these attempts were just to procrastinate making meaningful changes and innovations to the system. Therefore, without reviewing and updating Medicare, change is unlikely to occur in the Canadian healthcare system (Adams, 2015). For these reasons, it is clear that the structure of the Canadian health governance structure must be transformed to a three-tier structure through examining the ‘Triple Aim’ approach, ‘Health in All Policies’ approach, the ‘Whole of Governance’ approach, hybridization, and the role of Canadian federal government.
      The Triple Aim approach to health in Canada “is the simultaneous pursuit of improved population health, care experience and per capita cost of care” (830). This approach incorporates the organization of populations, thus providing improved services that have been scaled to the whole country while also engaging in a system that advances and adjusts to challenges appropriately. The triple aim approaches require a high degree of integration among the healthcare sector as well as those that fall outside of it, which is often accomplished through means such as the “integrator” role. This role is aimed to improve and maintain the healthcare sector while simultaneously connecting and communicating with other sectors, both on a micro and macro level. The micro-level ensures that the system itself is operating efficiently and correctly while also maintaining that the intended population is reached. The macro-level integrator ensures that the confines in which the system operates is learned and kept up-to-date with recent advances, as well as help to standardize the process. The Triple Aim approach will thus also lead healthcare within Canada to steer more towards a value-based approach (Farmanova et al., 2016). Because this approach happens in such an integrated and multi-level manner, evaluation is difficult. This is already a problem that plagues Canada’s system, and so having a method that further complexes it may not be the best solution at this moment. However, as will be elaborated on later, a larger role of the federal government may aid this.
      The Triple Aim approach was shown to be beneficial in increasing performance and use of primary care methods, predict those patients that may need preventative care, learning from previous mistakes to improve future performance, integrating with the community, decreasing unnecessary use of emergency rooms, and integrating the approach within other frameworks and reforms. However, with all of these advances, there have been some areas of improvement that have arose. There is a larger need for team-based models of primary care, customization of healthcare plans for patients (i.e., more patient-centered care), more support for population health, more emphasis on public health, approaching privacy issues in a way that ensures patients’ privacy while also allowing collaboration among teams, more evaluation measures, a move away from volume-based to value-based care, and scaling of improvements (Farmanova et al., 2016). However, in order to adopt the Triple Aim approach, Canada must first alleviate existing problems (e.g., weak evaluation measures, misallocation of resources, underuse of primary care, and lack of population level interventions) in order to implement new interventions and approaches. With this in mind, I do think that the Triple Aim approach will make a significant impact, as it aims to fix many of the problems that plague Canada’s healthcare sector as well as set Canada up to be more prepared in the future and have a more sustainable and meaningful healthcare framework.
      The ‘Health in all Policies’ approach ensures that health implications are incorporated in all policy implementations from every sector, for many factors that determine health are not directly controlled by the healthcare sector. Success in reforming healthcare can seldom be accomplished without collaboration between all sectors. Gase, Pennotti, and Smith (2013) found seven “interrelated strategies for incorporating health considerations into decisions and systems: (1) developing and structuring cross-sector relationships; (2) incorporating health into decision-making processes; (3) enhancing workforce capacity; (4) coordinating funding and investments; (5) integrating research, evaluation and data systems; (6) synchronizing communications and messaging; and (7) implementing accountability structures” (p. 529). This approach allows a form of integration and communication between healthcare practitioners and other sectors that may have not be possible before. Health in all policies entails an influence not only on the policy aspect, but also in every aspect of development, implementation, evaluation, and communication. It also allows the burden to not only be placed on those operating within the healthcare sector to maintain a healthy population, for now it is the responsibility of all sectors equally and shared. Moreover, more attention must be placed on the social determinants of health and equity. According to the Health in all Policies approach, all of these concerns will be addressed and have intersectoral actors. Because it involves all sectors of government and beyond, it better coordinates activities in a way that is cost-effective and decreases duplicates of similar policies (Gase et al., 2013).
      Whole of governance occurs when different professionals from different sectors work towards the same goal(s). When applying this in a healthcare setting, it streamlines care in a way that is more integrated, organized, and efficient. Interprofessional teams aim to provide a multitude of services while ensuring they are backed by up-to-date technology and protocols in a way that is sufficient to connect the public to their environment and healthcare practitioners in a meaningful manner. This intersectoral collaboration also entails that the financial burden is not placed on only the healthcare sector. Most physicians are capable and ready to help innovate the current healthcare system in Canada, and their participation is crucial to implementing and designing change. However, with all of these sectors coming together to collaborate, it is important to maintain transparency while also establishing clear objective and roles for each member (Naylor et al, 2015). The Conference Board of Canada (2017) found that individual-level barriers (e.g., confusion which function should be performed by whom and who, if anyone, has more power or voice in decisions), practice-level barriers (e.g., difficulties in establishing a governance model in which everyone has comparable contributions and tools), and system-level barriers (e.g., inadequate accountability measures) can all thwart the progress of interprofessional teams that aim to use a whole of governance approach.
      Hybridization occurs when governing bodies and professional communities come together to collaborate towards their best solution. In the United Kingdom hybridization between public and private delivery of services was used in an attempt to introduce competition as a means to improve the whole sector (Turner, Lourenço, & Allen, 2016). An assigned reading outlined “communities of practice” in which states that change occurs through interactions. This entails that the result of hybridization is unique to the situation and stake holders present. Every player becomes a resource for information and change. These communities of practice become experts and tools of change through their “knowledge use, social interaction, organizational structure, and innovation” (Turner, Lourenço, & Allen, 2016, p. 703). The shift within the NHS in the early 1990s led to increased autonomy that led to greater competition and a more ‘business-like’ mentality. The addition of competition was seen as a way to increase performance, effectiveness, and change. This shift also prompted professional communities to engage with and learn new forms of necessary knowledge (e.g., market tendencies). The effect of competition stretched to how providers interacted with each other. They were less likely to share ideas to maintain a competitive advantage; however, this also led to a hindrance of wide-spread innovation and decrease in cooperation. Within the NHS there was resistance to change via the private sector entering the public. Professional communities are most likely to accept and participate in gradual rather than sudden changes. The collaboration between different communities can lead to novel and more effective interventions (Turner, Lourenço, & Allen, 2016). Therefore, it is clear that hybridization is essential to advancing the healthcare system within Canada. The benefits seen in the U.K. could also be seen in Canada. However, the single-payer model and its bilateral monopoly act as a barrier to this type of hybridization from occurring. In other words, the one-tier system is hindering the progression of the healthcare system. Canada does not have a good holding on the regulation of private services; it is limited to basic functions. It is argued that the Canadian government has too much control over the healthcare system and its proponents for meaningful change to occur (e.g., that in the U.K.) (Touhy, 2012). Thus, Canada must enable entrepreneurs to have the opportunity to implement innovation in the private sector to influence and accommodate the public sector (Banting & Myles, 2013). The recommended incremental implementation by the articles would help Canadians accept a new norm within healthcare.
      In the Adams (2015) article, the author argues that, in order to change healthcare policy within Canada, three things must be accomplished: a way of “policy governance,” stopping “policy inertia,” and long-term planning. It is important for healthcare to stop being thought of as reactive (e.g., focused on acute care in primarily in hospitals by health practitioners) but rather as proactive (e.g., focused on prevention and chronic diseases in settings including hospitals as well as outside of them). This is especially true when considering the rising concern and prevalence of chronic and complex conditions within Canada that cannot be properly treated and monitored through the traditional measures that worked for acute conditions. Now, the main role of the federal government in healthcare is essentially funding it through the provisions set in the Canada Health Act and Canada Health Transfer. The Federal government having more control and accountability in the healthcare system will also lead to more consistency across Canada in terms of access, quality, collaboration, coordination, and ability to scale noteworthy interventions on a national scale. This increase in federal control would also likely decrease the amount of fragmentation that now plagues the Canadian healthcare system, thus aiding the lack of appropriate coordination and evaluation measures.
      One proposed solution to the lack of innovation within the Canadian healthcare system is the Healthcare Innovation Fund, which aims to “enhance the quality and value of healthcare provided to Canadians, while improving the performance of Canada’s healthcare systems as measured against their international peers” (Naylor et al., 2015, p. 39). This would aim to provide long-term funding for interdisciplinary initiatives from actors from multiple sectors. The Fund aims to both address and alleviate fragmentation, as well as aid in scaling up of noteworthy interventions in an effort to promote innovation and prevent many of the limitations seen today in the health system as detailed above. Furthermore, the funding would only be given to those who clearly state their intentions. Those who receive funding must also report when they meet goals to the Healthcare Innovation Agency of Canada, and this information will be made public (Naylor et al., 2015). This would effectively increase the accountability of the healthcare system as well. The federal government must establish and guarantee that the health infrastructure and health human resources teams are appropriately equipped to handle these new changes within the community.
      In a three tier system, tier 1 consists of items that are medically necessary and thus covered by the government; tier 2 items are those that are not required to live but enhance quality of life; and, tier 3 refers to items that are used for cosmetic reasons or for comfort (Montgomery, 2017). Through this system tier 2 procedures and items would be covered by private insurance, while those that lie in the tier 3 would be completely out-of-pocket. This structure of organization of different procedures based on necessity helps to alleviate the financial burden on the healthcare system by allowing others to access procedures on a private basis. This would also help to decrease wait times for those that want to access procedures faster and have the means to do so. In conclusion, it is clear that more integration and collaboration is needed in the Canadian health governance structure, and, given the current state, it needs to implement initiatives and structures that promote sustainability by decreasing the financial responsibility of the government while also increasing the control and oversight of the federal government.
      The introduction of health information technologies (HIT) in recent years has provided the health care systems in Canada and around the globe with a great hope and potential to address many of the challenges they face with, including providing better health, better care, better value and empowering patient/public to actively engage in their health. With examples, please discuss your evidence-informed critical analysis on how HIT could assist with each of the above (better health, better care, better value and patient/public empowerment).
      Before elaborating on how Health information technologies (HIT) can assist better health, care, value and patient/public empowerment through its ability to provide more seamless integration of care, as well as provide quicker, more efficient access to patient information, it is important to understand the state of it right now in Canada. Firstly, the primary mode of HIT is electronic health records (EHR): health information that is compiled and saved in electronic mediums. Development and innovations are occurring very slowly in Canada compared to other OECD countries, and most Canadian doctors do not use it. However, the use of it is increasing (Canadian Foundation for Healthcare Improvement, 2014). Many of the EHR methods used today are outdated and incapable of providing the functions that healthcare practitioners need. Like the Internet used today, EHR needs to be able to quickly adapt to changes and incorporate new information and methods. This is largely attributed to the leaders in EHR development that insist on having full private control of all the data contained in their respective programs (Mandl & Kohane, 2012). The advances that have prompted the existence evolution of EHR were in response to needs of healthcare practitioners, so now a change is happening where, although it is still suggested to change to accommodate healthcare practitioners better (Mandl & Kohane, 2012), it is also beginning to conform to the requests and needs of the public as well. However, it is difficult to modify a system that was never made with the intention of being able to support rapid innovations. The inability of the multiple EHR systems to communicate and integrate with one another, as well as other systems, does not foster the integrated care that is being promoted, but rather limits its own advancement (Mandl & Kohane, 2012).
      HIT can give patients access to their own records, which allows them to become more informed players in their own healthcare process. EHR can allow markers for strengths and weaknesses within each system so that evaluation measures are more easily attained, as well as determination of what needs improvement versus what needs to be scaled-up is more easily identified. By making the system more public to advancement and incorporating more of patient needs into the software, the Triple Aim approach can be used, which calls for more integration of key players to improve health, care, and value in an effort to increase patient empowerment. It effectively breaks a barrier to care that was previously decreasing the quality and amount of care the public has.
      Optional Question: Please also answer one of the following questions as per your choice.
      In recent years there has been significant discussion about aboriginal health in Canada. Please discuss how HIT, interprofessional collaborative practice and healthcare governance could assist with improving the aboriginal health in Canada.
      Health human resources (HHR) is a major component in Canada’s health care. As per the readings, class discussions and your own research please discuss: a) whether or not Canada is suffering from a shortage in HHR (i.e., physicians), b) the ‘ups’ and ‘downs’ of the current status of the HHR utilization in Canada’s health care, and c) ways to improve the HHR utilization in Canada’s health care.
      References 參考文獻
      Adams, O. (2016). Policy Capacity for Health Reform: Necessary but Insufficient: Comment on”
      Health Reform Requires Policy Capacity”. International journal of health policy and management, 5(1), 51.
      Banting, K. & Myles, J. (2013). Inequality and the Fading of Redistributive Politics. UBC Press.
      Canadian Foundation for Healthcare Improvement (2014). Healthcare Priorities In Canada: A
      Backgrounder.
      Conference Board of Canada (2017). Improving Primary Health Care Through Collaboration
      Briefing 2— Barriers to Successful Interprofessional Teams.
      Farmanova, E., Kirvan, C., Verma, J., Mukerji, G., Akunov, N., Phillips, K., & Samis, S. (2016).
      Triple Aim in Canada: developing capacity to lead to better health, care and cost. International Journal for Quality in Health Care. 
      Gase, L. N., Pennotti, R., & Smith, K. D. (2013). “Health in All Policies”: taking stock of
      emerging practices to incorporate health in decision making in the United States. Journal of Public Health Management and Practice, 19(6), 529- 540.
      Mandl, K. D., & Kohane, I. S. (2012). Escaping the EHR trap—the future of health IT. New
      England Journal of Medicine, 366(24), 2240-2242.
      Montgomery, C. (2017). Publicly Funded Healthcare: Comprehensive Reference Guide &
      Citation Source.
      Naylor, D., Girard, F., Mintz, J., Fraser, N., Jenkins, T., & Power, C. (2015). Unleashing
      Innovation: Excellent Healthcare for Canada. Report of the Advisory Panel on Healthcare Innovation.
      Reid, S. (2017, May 24). What the Uber of health care means for Ontario patients. TVO.
      Touhy, C. H. (2012). Reform and the politics of hybridization in mature health care states.
      Journal of Health Politics, Policy and Law, 37(4):611-32. doi: 10.1215/03616878-1597448.
      Topol, E. (2015, Jan 9). The future of medicine is in your smartphone: new tools are tilting
      health-care control from doctors to patients. The New York Times.
      Turner, S., Lourenço, A. N. A., & Allen, P. (2016). Hybrids and Professional Communities:
      Comparing UK Reforms in Healthcare, Broadcasting and Postal Services. Public Administration, 94(3), 700-716.

      加拿大作業對近年來加拿大對土著居民健康問題進行了重要討論。討論HIT、跨專業合作實踐和醫療保健治理如何有助于改善加拿大土著居民的健康狀況。加拿大作業根據閱讀材料、課堂討論和自己的研究,討論了加拿大是否存在HHR短缺以及加拿大醫療保健中HHR利用現狀的“起伏”,包括改善加拿大醫療保健中HHR利用的方法。本站提供各國各專業留學生作業寫作指導服務,如有需要可咨詢本平臺。


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