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  1. Cost-effective provision of cardiac services in a fixed-dollar environment.

    Article, Communication - En anglais

    Risk Management in CABG : A Continuing Perspective. Symposium. Orlando, Florida (USA), 1996/01/27.

    In the Canadian single-payer system, all hospital payments, including payments for cardiac operations, are negotiated with the government annually.

    Each hospital is required to remain within 50 cases of its negotiated surgical target.

    Physicians are paid on a capitated basis and are subject to penalties if negotiated targets are exceeded.

    There is a computerized waiting list for cardiac operation, with patients classified by an urgency rating scale and objectives set for the maximum period for any given urgency category.

    Experience has shown that many patients are delayed in the queue, waiting longer than expected for surgical procedures.

    Waiting times are not influenced by age, sex, or reoperative status, but are influenced by factors such as the presence of multiple risk factors, the number of diseased vessels, stability or unstability of angina, left main coronary artery disease, and recent angioplasty.

    Waiting time has not been shown to affect operative mortality, the incidence of postoperative low-output syndrome, or length of hospital stay.

    Canada's 30-year experience with the provision of cardiac services under managed care may provide useful information to hospitals and physicians in the United States currently confronting capitation.

    The following overview focuses on two critical issues : negotiation of costs and management of patient waiting lists.

    Mots-clés Pascal : Chirurgie, Coeur, Service hospitalier, Economie santé, Coût, Système santé, Rémunération, Homme, Canada, Amérique du Nord, Amérique, Appareil circulatoire

    Mots-clés Pascal anglais : Surgery, Heart, Hospital ward, Health economy, Costs, Health system, Remuneration, Human, Canada, North America, America, Circulatory system

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 97-0016855

    Code Inist : 002B30A01B. Création : 21/05/1997.