Incentivizing Full-time Employment for New Graduate Nurses in Ontario: Impact of Policy on Care

There is consensus that a professional full-time nursing workforce leads to better patient outcomes and a safer health care environment. In 2007, the Ontario Ministry of Health and Long-Term Care introduced the Nursing Graduate Guarantee (NGG), a policy mechanism designed to strengthen the nursing workforce by increasing full-time (FT) employment for newly graduated nurses. Several factors have affected the supply and employment status of nurses in the province over the past two decades, including the introduction of unregulated health care workers and crises such as SARS and COVID-19. A secondary analysis of the College of Nurses of Ontario registration database was conducted to identify and evaluate trends in the supply and employment of nurses in Ontario prior to and following introduction of the NGG. The results demonstrate that full-time employment of new registered nurses and new registered practical nurses initially increased but has since fallen to below pre-policy levels. Part-time work among newly graduated nurses is increasing across all sectors, signaling a diminishing effect of the NGG investments over time. Investments in health human resources have a stabilizing effect on the nursing workforce. Ensuring an adequate number of nurses is necessary for crisis preparation, management and recovery, particularly in sectors with low surge capacity such as long-term care. However, sustained financial, political, public, and professional support is required.

Introducing an Organ Donor Registry is Saskatchewan

On 3 September 2020, Saskatchewan launched an organ donor registry that allows participants 16 years and older to register their intent to be an organ donor either online or using a paper form. Saskatchewan has historically performed poorly at a national level with low rates of organ donations. Saskatchewan's new registry is intended to increase the numbers of organ donors in the province, while also helping to modernize its organ donation system and ease donation conversations with families. Saskatchewan's introduction of this registry brought the province in line with other provinces and territories across Canada that use similar systems, and provided a response to the surge in public interest around organ donation that followed the Humboldt Bronco bus crash tragedy and related ``Logan Boulet Effect.'' The 2019-2020 and 2020-2021 provincial budgets included dedicated funding for the development and launch of the registry, which was accompanied by a media campaign to increase public awareness. Though it is too early to evaluate the success of the registry, early indications suggest donation rates will be a key evaluation metric. Registries are commonly thought to help increase public awareness of, and support for, organ donation, but improving Saskatchewan's organ donation rates will likely also require companion measures to strengthen the culture and practice of donation in the province.

Introducing an Organ Donor Registry is Saskatchewan

On 3 September 2020, Saskatchewan launched an organ donor registry that allows participants 16 years and older to register their intent to be an organ donor either online or using a paper form. Saskatchewan has historically performed poorly at a national level with low rates of organ donations. Saskatchewan's new registry is intended to increase the numbers of organ donors in the province, while also helping to modernize its organ donation system and ease donation conversations with families. Saskatchewan's introduction of this registry brought the province in line with other provinces and territories across Canada that use similar systems, and provided a response to the surge in public interest around organ donation that followed the Humboldt Bronco bus crash tragedy and related ``Logan Boulet Effect.'' The 2019-2020 and 2020-2021 provincial budgets included dedicated funding for the development and launch of the registry, which was accompanied by a media campaign to increase public awareness. Though it is too early to evaluate the success of the registry, early indications suggest donation rates will be a key evaluation metric. Registries are commonly thought to help increase public awareness of, and support for, organ donation, but improving Saskatchewan's organ donation rates will likely also require companion measures to strengthen the culture and practice of donation in the province.

Increasing Access Through Privatization? Bill 33 and the Introduction of Private Clinics and Duplicative Insurance in Québec

On 15 June 2006, Bill 33: Act to amend the Act respecting health services and social services and other legislative provisions, was tabled at the Québec Legislature. It served as the government's response to the Supreme Court of Canada's 2005 ruling in Chaoulli vs. Québec (Attorney General), which had ruled that Québec's ban on duplicative health insurance was not consistent with the Québec Charter of Human Rights and Freedoms. Bill 33 implemented centralized waiting lists, specialized private medical centres and introduced duplicative private health insurance. The stated objectives were to reduce wait times and abide by the SCC ruling. However, the scope of the reform was strictly limited to three services: hip and knee replacement, cataract extraction, and intraocular lens implantation. It also placed regulations on the ability of physicians to practice in the private sector, suggesting that the government sought to achieve these reforms while attempting to maintain the integrity of the public system and change as little as possible. Minimal evaluations of Bill 33 have been conducted by the government, with no further evaluations planned. However, analysis of the current Québec health care landscape indicates that despite the stated aspirations of Bill 33, it has not made a substantial impact on reducing wait times. At the same time, it has not contributed to the growth of a private insurance market in Québec, as many of its detractors feared. The implications of the Chaoulli decision and Québec's response provide key lessons for government and stakeholders in responding to legal challenges on health equity and parallel health system.

Implementing the Caregiver Benefit Program in Nova Scotia: Supporting Unpaid Caregivers at Home

Nova Scotia is the only province in Canada to implement the Caregiver Benefit Program, an allowance of $400 a month to eligible caregivers if both the caregiver and care receiver qualify for the program. In response to Nova Scotia's aging population -- a population with increasingly complex chronic conditions -- more attention was given to home care and unpaid caregivers through the Continuing Care Strategy, which set the stage for implementation of more caregiver supports. The goals of the Caregiver Benefit are to acknowledge the contributions of eligible caregivers in providing assistance to a family member or friend, help sustain the support these caregivers provide, and keep people in their homes and out of long-term care. A policy window was created in 2009 for the New Democratic Party (NDP) to implement the Caregiver Benefit quickly after their election win by building on a previous Progressive Conservative initiative, thus fulfilling the NDP's promise to support seniors and caregivers. While no official evaluation has been conducted, it is the role of the Executive Director, Risk Mitigation of the Continuing Care Branch to provide accountability and monitoring of the policy. The Caregiver Benefit helps caregivers feel recognized and supported, however it potentially excludes a vulnerable population of caregivers and does not provide enough support to cover lost wages.

Improving Access to Home and Community Care: An Analysis of the 2017 Health Accord

In 2017, the federal Liberal government confirmed the new Canadian Health Accord, which included a targeted transfer of $6B over ten years to the provinces and territories to improve access to home and community care services. Although there were previous federal initiatives aimed at enhancing home and community care services, challenges remain. Many Canadians cannot access home care, and a high burden of care is placed on formal and informal caregivers. These challenges partly stem from an unregulated home care sector and a societal undervaluing of the caregiving role. In 2016, federal, provincial, and territorial governments met and established home and community care as a Canadian health priority. Funding was agreed to in principle from 2016 to 2017 and finalized from 2017 to 2019 through a series of bilateral agreements. The targeted transfer appears to be boosting investments in the home care sector and fostering collaboration across jurisdictions. However, it is unclear whether there have been improvements in access to home and community care.

Integrating Health Services in Ontario Through Mergers and Centralization

On 18 April 2019, the Legislative Assembly of Ontario passed Bill 74, The People’s Health Care Act, which provided new authorities to the Ministry of Health and a newly createdOntario Health super agency to facilitate the integration of health care services across Ontario. This reform represents a shift away from the previous regionalized system of Local Health Integration Networks (LHINs). While centralization is intended to improve efficiency within the system and create a patient-centred model of care, it also equips the Ministry and Ontario Health with greater authority over health agencies. Ontario’s reform represents another move towards centralization in a wave of regionalization reversal that has swept across the country. Implementation of this reform will take several years to roll out. An analysis of centralization reforms in other jurisdictions can provide insight into Ontario’s decision to reform. Though this bill was presented as a modernization of Ontario’s health system to meet people’s needs, a common theme in stakeholders’ opinions is the lack of consultation with the public.