UBC Theses and Dissertations
A framework for development of a provincial health plan, British Columbia Hsu, David Hsing-Sheng
The purpose of this thesis was to develop a framework for a Provincial Health Plan in British Columbia. A number of factors argue for the necessity of a clear, comprehensive statement of the goals and objectives for the health care system: complexity of the health care system; rising health care costs; rising consumer expectations; and pressures from special interest groups. The development of the framework for a Provincial Health Plan is based, firstly, on an understanding of the planning process; and secondly, on an appreciation of the components (and their relationships) of the health care system. Accordingly, the literature on these two areas is reviewed in some detail. The planning process can best be understood by reference to a matrix, where planning can take place at levels ranging from the long-term and philosophical to the day-to-day delivery of health services. Planning can also be done in a variety of modes or approaches, ranging from the strictly rational to incremental, ad hoc measures. Components of the health care system are, in general terms, "health resources", "health status", "requirements for health services", and some "process of resource allocation". A provincial Health Plan, as proposed by this thesis, addresses a specified planning level ("policy planning"), and employs a variety of planning modes in developing objectives for the components of the health care system. Certain assumptions are made in this thesis regarding the definition of "health", the role of the Ministry of Health, and the regionalization of the health care delivery system for planning purposes. Within these constraints and assumptions, the framework for a Provincial Health Plan comprises the following hierarchy of elements: Values about the health care system; Long Term Objectives; Baseline Objectives; Short Term Objectives. Values about the health care system are statements concerning general principles in four areas: (1) definition of health and the responsibility of the health care system; (2) social justice as applied to the health care system; (3) roles of government, professions, and individuals within the health care system; (4) effectiveness and efficiency of the health care system. Objectives ( whether Long Term, Baseline, or Short Term ) are specified levels describing the components of the health care system, and result from a judgemental process which considers factors of "legitimacy", "feasibility", and "support" for the issue under consideration. Long Term Objectives, with a three to five year timeframe, are determined by considering data about the present and projected states of the health care system in light of stated Values about the health care system. Baseline Objectives are those minimally acceptable levels for components of the health care system, below which there is general agreement in British Columbia that remedies should be instituted as an urgent priority. Short Term Objectives, with a one year timeframe coinciding with the government's fiscal year, are determined considering Values about the health care system, specified levels of both Long Term Objectives and Baseline Objectives, data on the health care system, and community expression about health problems and priorities. Whereas Long Term Objectives and Baseline Objectives are arrived at by the central planning authority, Short Term Objectives are determined in large part by the regional planning authority. The Delphi method is explained and proposed as a relatively simple, but effective, approach to facilitate community input concerning health problems. The development of each of the parts of the framework for a Provincial Health Plan is discussed, and a timeframe for development of a Provincial Health Plan is suggested (approximately 22 months). Further steps towards the development of a Provincial Health Plan for British Columbia are also outlined.
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