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necessary health services no longer rationed on ability to pay
intended to make access to insured hospital and physician services reasonably equal across the country reduced federal cost-sharing, rising expenditures, recession, mismanagement by government the province was virtually bankrupt, huge public deficit (around $15 billion)
cuts to services, incl. healthcare health system revamp, with focus on broader determinants of health Wellness Model: cost containment, maintenance of standards, improving population health, integration, continuity of care
social determinants lens (SES, education, housing, sewer and water quality, etc.) focus was on deficit reduction, not necessarily health reform (e.g. changes to drug plan, cuts to chiropractic services) hospital conversions became negative symbol of health reform
Importance of community development building awareness of health reform a powerful way to bring public along with change population health approach required buy-in from many partners: district boards, governments (local and provincial), educational programs, health care professionals, individuals, communities and families
-reform needs a champion - the individual minister needs to be interested and motivated; -the stage needs to be set so that there is a readiness amongst the general public and stakeholders to accept change (fiscal situation - set the stage); -reform needs to be launched early in a government’s mandate; -there needs to be a body of research that supports the change (many commissions had discussed the need for reform); -a vision and the goals must be clearly defined, and compelling; -the vision needs to offer hope in order to make the tough measures that will be required more palatable; -stakeholders (including unions) should be involved in the development of the vision and goals, and in the development of the strategic plan for implementation; -once defined, the vision needs to be communicated to a larger audience - the public; -steps for implementation need to be set out with clear deadlines for accomplishing the various steps. It was also helpful to have materials advising and guiding the implementers through the various steps of implementation; -if significant change is required the strategic implementation must be bold and go beyond small steps of no real significance in themselves; -public opinion leaders need to be part of the process - they should be encouraged to hop on the bus; -the plan needs to be flexible - if changed is required - it is a two-way process. The government needs to be open to advice and willing to nurture non-threatening dialogue to explore options with those who would be affected by change and to implement their suggestions where appropriate; -there needs to be critical management of issues as they arise or preferably issues should be anticipated and dealt with before they become an issue; -the consistency of the message needs to be maintained.
Numbers of general practitioners/family physicians and specialists increased in SK between 1996 and 2000 Supply of GPs/FPs in SK is under the Canadian rate (91 per 100,000 population compared to 94). SK has significantly fewer specialists (62 versus 93 per 100,000 population)