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1 Online-Ressource
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Introduction: In Ontario, Canada, Community Care Access Centres (CCACs) are the organizations that manage access to publicly funded home care services. CCACs employ case managers who assess individuals' needs and then develop plans for service provision. Provider agencies are then contracted to supply the services as proscribed in the service plan. Although legislation and provincial policies place some constraints on priority setting decisions, it is not clear how CCACs satisfy the competing goals of delivering effective, efficient, and equitable services within a defined budget. The overall objective of this research study is to describe the criteria, constraints, and values associated with priority setting within CCACs, focusing on decisions around nursing, personal support, and homemaking services. The objective of this presentation is to explore the role that values play in case manager's decisions, highlighting the relative importance of efficiency. Methods: Case studies of priority setting processes were conducted with two Ontario CCACs. Qualitative data were collected through semi-structured interviews with 25 employees of an urban area CCAC and 14 employees of a rural area CCAC. In addition, CCAC policies and other relevant documents were reviewed. A modified thematic analysis was used to identify themes related to values, criteria and constraints that are important to resource allocation. Results: Priority setting decisions occurred at both the 'meso', or institutional level, and the 'micro' or home care case manager level. We found that most priority setting occurs at this micro level. This presentation will focus, therefore, on the daily decisions made by home care case managers regarding which individuals to accept as clients and how much service to provide to these clients. In assessing the eligibility and need of potential clients, case managers consider a range of factors that reflect the values of safety, client-focused care, independence, and compassion. In developing service plans to address these needs, case managers do value efficiency and effectiveness but appear to be more concerned with equity. They define equity as consistent decisions marked by allocation of equal amounts of service to those in equal need. 'Equitable' decisions are often considered to be 'fair' decisions. Conclusions: The analysis demonstrates that resource allocation decisions are not simply driven by the desire to maximize health benefits. Need for service is often defined by a client's level of risk rather than by their capacity to benefit from service. At the micro level, case managers do not simply conceptualize their decisions as a trade-off between equity and efficiency but there appears to be a more complex hierarchy of values that drives resource allocation
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Language:
English
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