Care system in New Brunswick: the effects of economic constraints on the structuring of a sector
Notice bibliographique
Résumé
Among Canadian provinces, New Brunswick has the highest rate of ageing in the country. Its care system is unique in that it is structured around two separate departments: the Department of Health and the Department of Social Development. The first, which has a long history, operates on the basis of delegated management of a public service, with infrastructure owned by the province. It manages hospitals and health programmes. The second, which is more recent, is based on a mixed, fully privatised model, with some establishments under delegated management and others fully privatised. Although managed autonomously, these two ministries are subject to the same demographic pressures linked to the ageing of the population, but the economic constraint of reducing public spending accentuates the tensions between their administrations and reveals logics of institutional domination. Based on qualitative fieldwork with players involved in the design and implementation of long-term care policies, we will show how the issue of ageing impacts on the organization of a public action sector at the crossroads of health and medico-social care, marked by the gradual but massive liberalisation of players dedicated to the care of populations losing their autonomy. Our observations show that the healthcare sector is clogged with bed-blockers. The healthcare sector is then trying to intervene to reduce the stock of elderly patients, by speeding up their discharge and reducing their entry into hospital care. The result, on the one hand, is increased pressure on Social Development, which is unable to meet the demand for follow-up care and rehabilitation facilities. On the other hand, it intervenes upstream of hospital admissions through a highly effective outpatient medical service, responding to the needs of frail people at home.These different interventions are therefore in competition with the prerogatives of the Ministry of Social Development, which is struggling to adapt in a context constrained as much by the lack of economic and political room for manoeuvre as by the absence of tools for real policy steering. In terms of homecare facilities, the heavy dependence on private players (community associations or for-profit organizations) makes control and the desire for planning increasingly complex. As a result, we are seeing a strategy of segmentation in the provision of care for the population, with a strengthening of the provision around facilities for the most dependent people, where the buildings are public and the management is often community-based and not for profit, and the development of a private for-profit market where the Ministry is struggling to enforce care standards.In terms of home care, the lack of visibility regarding the identification of populations means that there is no guarantee that services actually meet people's needs.In this context, however, we will show how and by what means Social Development attempts to combine increased demand, economic constraints and social innovation.
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Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,011 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,002 | 0,006 |
| Études des sciences et des technologies | 0,014 | 0,007 |
| Communication savante | 0,010 | 0,002 |
| Science ouverte | 0,004 | 0,007 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
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