Healthcare Management Forum

Hospitals typically absorb the costs of unremunerated health care services; however, budget cuts make this no longer feasible. This article identifies important ethical and legal dimensions of a hospital's duty regarding unremunerated services in a climate of scarce resources. While, except in certain emergency situations, a hospital has no obligation to provide services to those who cannot pay, some guidelines are offered to help hospitals respond to requests for unremunerated services.

D'ordinaire, les hôpitaux assument les coûts de services de santé non rémunérés, cependant, il n'est plus possible de le faire en raison des compressions budgétaires. Le présent article définit des aspects éthiques et juridiques importants de l'obligation d'un hôpital à l'égard des services non rémunérés dans un contexte de ressources limitées. Sauf dans certaines situations d'urgence, même si un hôpital n'a pas l'obligation d'assurer la prestation de services aux personnes qui ne sont pas en mesure d'en acquitter les frais, certaines lignes directrices sont proposées afin d'aider les hôpitaux à répondre aux demandes de services non rémunérés.

The South Calgary Health Centre, a new venture for the Calgary Health Region, was mandated to be an accessible, integrated, community-based health services facility. A comprehensive evaluation provided details on planning and implementation. Functional integration was a large focus of the planning and was operationalized as central admitting, shared charts, shared space and co-location of clinical services with no history of integration. Challenges are discussed and recommendations for future health centres developed.

The discourse of health reform has emphasized the need to increase public participation in decision-making as a way to enhance accountability. Despite recent gains in public participation in health care — primarily through citizen governance of regional health authorities — a clearly articulated accountability framework remains elusive in the Canadian context. If citizen participation is to be effective and meaningful, governing boards and politicians need to adopt an accountability framework that clearly delineates roles and responsibilities.

There are particular knowledge translation (KT) challenges in communicating evidence on low awareness topics. Often considered peripheral to the main focus of health care provision, these issues may fail to “get on the agenda” of decision-makers, even when supported by strong evidence. This article describes the successful application of KT strategies to a specific low awareness issue (the importance of using trained health interpreters) within a large Canadian Regional Health Authority.

Given the increased call for accountability and quality of care in long-term care, it is important that government and long-term care provider organizations contemplate resident and family satisfaction with long-term care. This article highlights important considerations and provides practical recommendations for conducting satisfaction surveys in long-term care homes in terms of content, method of implementation and analysis, and use of findings. We conclude by recommending three surveys worthy of consideration by the government and long-term care provider organizations in Canada.