Meet Growing Demand for Elderly Care With "Cash" Voucher and Self-Directed Funding - C.D. Howe Institute

TORONTO, Jan.19, 2016 /CNW/ - Canadians would benefit from a new funding model for elder care, finds a new report from the C.D. Howe Institute. In "Shifting Towards Autonomy: A Continuing Care Model for Canada," authors Åke Blomqvist and Colin Busby argue that Canadian provinces can learn important lessons from the debates and reforms in other developed countries, specifically when it comes to offering individuals the option to receive a payment, or a cash voucher, allowing them to choose from a menu of services that are delivered where they want them.

"Given how poorly our health system is coping with the demand for continuing-care services today, Canadians should be seriously concerned – and most polls confirm that they are," states Blomqvist. He adds, "it has been estimated that more than 15 percent of all acute-care hospital beds in Canada are filled every day with patients waiting for care in a location outside a hospital, costing provincial governments slightly under $3 billion per year." Additionally, there is increasing strain being placed on Canadian families; more than one in four Canadians provide care to family or friends, and among this group one in 10 provides more than 30 hours weekly, often with significant disruption to their paid work.

"Our provincial approaches are beginning to look not only inefficient and unresponsive to individual preferences but also, in some dimensions, inequitable," notes Busby.

To help face these challenges, the authors find that provinces can learn important lessons from the reforms in other developed countries. According to the Busby, "the experience abroad shows several countries, such as France, Germany and recently Australia, have implemented self-directed models of care delivery, boosting patient satisfaction by giving individuals and families a greater say in their care packages." Two of the biggest challenges for governments contemplating more cash-based, self-directed benefits for continuing-care services are impact on government budgets and quality assurance. "All countries we studied have managed to overcome these challenges, at least to some degree, through restrictions on the size of the subsidy to those with financial means and by establishing oversight in the use of the cash subsidies."

Establishing a new comprehensive self-directed model to meet the challenges facing continuing care in Canada would require the following:

  • an assessment system;
  • means testing;
  • a funding mechanism that is based on need but controls government costs;
  • an oversight system to ensure quality and enforce restrictions on use; and
  • establish who will oversee, coordinate and be accountable for care.

Going forward, Canada must encourage a greater role for patients in choosing their care paths, and doing so means expanding access to a more self-directed, voucher based system. "The time to adopt new systems of supportive services for the elderly is now – before many more retiring babyboomers start drawing heavily on them," conclude Blomqvist and Busby.

For the full report go to: 

The C.D. Howe Institute is an independent not-for-profit research institute whose mission is to raise living standards by fostering economically sound public policies. Widely considered to be Canada's most influential think tank, the Institute is a trusted source of essential policy intelligence, distinguished by research that is nonpartisan, evidence-based and subject to definitive expert review.

SOURCE C.D. Howe Institute

For further information: Åke Blomqvist, Adjunct Research Professor at Carleton University and Health Policy Scholar at the C.D. Howe Institute; and Colin Busby, Senior Policy Analyst, C.D. Howe Institute: 416-865-1904 or email:


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