Public Management and Regulation of Contracted Health Services

Rapid Review 23

Allin S., Sherar M., Church Carson M., Jamieson M., McKay R., Quesnel-Vallee A., & Marchildon G.

English – [PDF]

Much debate surrounding the delivery of healthcare services in private, non-hospital settings centres around efficiency. For their parts, provincial governments must hold facilities accountable for costs and quality, ensure adherence to Medicare rules (i.e., medically necessary services based on need not ability to pay), and maintain adequate personnel to meet rising demands within provincial health insurance programs. This rapid review compares the experience of five provinces as they strive to enforce accountability between non-hospital facilities and provincial health insurance programs for the delivery of advanced diagnostic and surgical services. We identify the challenges and point to possible approaches and mechanisms open to provincial governments to ensure that the rules of Medicare are applied.