5.5 Physical and rehabilitation medicine in health-care systems: Long-term care and community-based rehabilitation

Author(s):  
Marta Imamura ◽  
Zaliha Omar ◽  
Mario Giraldo-Prieto ◽  
Luz-Helena Lugo-Agudelo
2021 ◽  
pp. 097206342199499
Author(s):  
Sangay Thinley

Population ageing is both an achievement and challenge, an achievement as longevity is the result of successful prevention and control of diseases, decreasing fertility rates and overall socio-economic development. It is at the same time a challenge as the increasing number of older people and the resultant demographic shift are accompanied by the need to adjust and scale up the social and health care systems. The challenges are of particular relevance to the developing world where the demographic shift is occurring much faster. Comprehensive efforts based on country contexts are required in the following areas: (a) older persons and development, (b) health and well-being and (c) enabling and supportive environments to address population ageing needs. This article, however, focuses only on three most crucial issues, that is, livelihood, health care systems and care of the older dependent people. Measures to sustain the livelihood of older people, to align the health systems to provide care and to develop long-term care systems are highlighted. Person-centred care, integration and functional capacity are advocated. Further, ageing in place or living in one’s own home, community or a place with the closest fit with the person’s needs and preferences is considered very important for healthy ageing. In terms of enhancing livelihood, major policy changes and reforms to improve the social security systems and expanding coverage as well as increasing the amounts to minimum subsistence levels are highlighted. Another area which needs to be strengthened is the tradition of existing family support systems. The health systems alignment required are reflected for each health system building block, and focuses mainly on (a) developing and ensuring access to services that provide older-person-centred care; (b) shifting the clinical focus from disease to intrinsic capacity; and (c) developing or reorienting the health workforce to provide care as per alignment. Long-term care systems would best meet the needs of dependent older people if families, communities, civil society organisations and private sector are equally involved while governments play leadership roles in setting up and monitoring quality.


2021 ◽  
Vol 1 (5) ◽  
Author(s):  
Sinwan Basharat ◽  
Karen Born

Low-value tests, treatments, and procedures are an important health care quality problem in Canada and across the world because they provide little clinical benefit, may be harmful for patients, and waste limited resources. Due to the COVID-19 pandemic, health care systems face increased challenges of limited resources, reduced capacity, and a growing backlog of surgeries and other procedures. The pandemic has compelled health care professionals to make challenging decisions to prioritize health care services while coping with increased demand. As Canada emerges from the pandemic and health care systems rebuild and begin to address the backlog of delayed or cancelled services, there is an imperative to introduce lasting changes to reduce low-value care and ensure high-quality care is available to everyone. To help inform efforts for using health care resources wisely and to support decision-making, CADTH and Choosing Wisely Canada convened a 10-member multi-disciplinary panel of clinicians, patient representatives, and health policy experts to review areas of low-value care that can be reduced or limited. This panel reviewed, deliberated, and prioritized 19 recommendations of the more than 400 Choosing Wisely Canada recommendations, the implementation of which can help ensure high-value care after the pandemic. Examples of the 19 recommendations include: Avoiding unnecessary transfers for patients in long-term care to hospitals unless there is an urgent medical need. Limiting blood tests and imaging unless required to answer a specific clinical question or guide treatment. Not transfusing red blood cells for hemodynamically stable patients in the intensive care unit. Not delaying palliative care for patients with serious illness because they are pursuing disease-directed treatment. Moreover, the panel’s discussion highlighted how the selected recommendations can advance key priorities, including improving health equity and access to care, appropriately using limited resources, emphasizing patient-focused care, and addressing challenges the pandemic has presented for long-term care.


Author(s):  
Wing Tung Ho ◽  
Ben Yuk Fai Fong

An exponential growth in elderly population reflects a proportional increase in recourses that are unaffordable and unsustainable to the economy. This rapid demand for health services and long-term care not only leads to non-financial implication like shortage of manpower and long waiting time, but this also creates a large burden on health and related services in the public sector. Involving the private sector to provide better and more efficient facilities and services and to encourage innovation will enhance productivity, speed up project and service delivery, and increase opportunities for investment in health. This chapter examines existing problems within health care systems in aging populations such as Hong Kong, explores the advantages and challenges of Public Private Partnership (PPP), identifies successful factors in establishing PPPs models, reviews the PPP projects in Hong Kong and elsewhere and recommends methods in promoting PPP in health and long-term care as sustainable solutions.


2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S159-S159
Author(s):  
Ya-Mei Chen ◽  
Hsiao-Wei Yu ◽  
Ying-Chieh Wang

Abstract Ideally, continuum of care involves wide-ranging health and long-term care (LTC) services. Taiwan’s National Health Insurance scheme and 10-Year Long-term Care Plan attempts to provide universal and fundamental services of continuum care. However, the accessibility of these services for care recipients remains unclear. This study aims to examine the effectiveness of continuum care in decreasing the healthcare expenditure of LTC recipients using home- and community-based services (HCBS). Data collated from the 2010–2013 Long-Term Care Service Management System (N = 77,251) were subjected to latent class analysis to identify subgroups of recipients using HCBS. Subsequently, the 1-year primary care expenditure after receiving HCBS was compared through generalized linear modeling. Three discrete HCBS subgroups were found: home-based personal care (HP), home-based health care (HH), and community-based care (CC). No difference in the number of visits to doctors and the average primary care expenses was observed between the HP and HH subgroups. However, considering physical and psychosocial confounders, care recipients in the CC subgroup recorded a higher number of visits to doctors (β = 3.05, SD = 0.25, p < 0.05) and lower primary care expenditure (β = -98.15, SD = 43.17, p = 0.02) than the other two subgroups. These findings suggest that LTC recipients in Taiwan may obtain better continuum care only for CC service recipients. Additionally, community-based LTC services may lower the cost of health expenditure after 1 year.


2001 ◽  
Vol 58 (1) ◽  
pp. 100-119 ◽  
Author(s):  
Nancy A. Miller ◽  
Sarah Ramsland ◽  
Elizabeth Goldstein ◽  
Charlene Harrington

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