Question about Canadian regulations

  1. Can anyone tell me what is the regulatory agency in Canada that surveys hospitals (similar to JCAHO in US)? I saw it on another posting, but cannot find it now. Also, I understand that bills are not sent to individuals, but do the hospitals get reimbursed for services/care given to patients? If so, are there certains standards of documentation required of the hospitals (MD's or nurses) to validate? Thanks in advance for the information.
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  2. 5 Comments

  3. by   LadyLurker
    Originally posted by denicke
    Can anyone tell me what is the regulatory agency in Canada that surveys hospitals (similar to JCAHO in US)? I saw it on another posting, but cannot find it now. Also, I understand that bills are not sent to individuals, but do the hospitals get reimbursed for services/care given to patients? If so, are there certains standards of documentation required of the hospitals (MD's or nurses) to validate? Thanks in advance for the information.
    I work in LTC, not hospital, but as far as I know, the Ministry of Health, Compliance Division, is the regulatory agency that does the inspections.
    Our LTC facility is funded by the government, based on our Case Mix Index. Our care plans, progress notes, quarterly summaries, and daily records are all checked by the classifiers, to validate the care level documented in the care plan. Accordingly, our charting is extensive, as is our work on our care plans, especially in the fall, when they come around to gather information to get our CMI.
    If our CMIs drop, that means that the gov't thinks we don't need as much staffing, and they cut funding, and the facility cuts staffing hours. And on the rare occasion that the CMIs go UP, we get more funding, therefore more staffing.
  4. by   disher
    The Canadian council on health services accreditation is the organization that is used to accredit hospitals in Canada.Hospitals voluntarily participate in the accreditation process, the hospitals performance is compared to national standards and suggestions are made for improvements.
    The accreditation process does not affect funding in Canadian hospitals as they are publically funded.
  5. by   canoehead
    In Nova Scotia JCAHO came to visit us just like you Yanks, and it was just as enjoyable a visit if I remember correctly.

    Each nursing unit was allotted a certain amount of money from the pot the hospital was given each year, and we had to make it last. The hospital would take money from one unit to give to another based on need, and the NM could make their case, but I do not recall anyone telling us that it depended on any care planning. We rated our "patient care units" each shift based on the previous shift's charting and used that number to justify staffing, and in turn justify a need for more money.

    In the late 80's/ early 90's though the government was slashing health care budgets so we never got more money, only felt lucky if our slash was less than the hospital in general.

    Most frustrating thing was that once the year started we had our allotted $ and no matter the acuity or length of stay we were stuck providing services with the staff and equipment we had. One year we had a big problem with meningitis, the next a bad RSV season, and we had to suck it up. It was routine to reuse a pulse oximeter probe on 3-4 patients until it broke, or to disconnect monitering on one pt while their nurse sat with them to go around and spot check 4 others that also had an order to moniter, but we did not have the equipment to do it with.

    When I came to the USA felt like it was a miracle that we had the equipment necessary to carry out the orders as written. I truly think hospitals in the USA are very lucky in that respect.

    I'll get off my soapbox.
  6. by   disher
    Canoehead,You say JCAHO visited your hospital in Nova Scotia, accrediting a Canadian hospital based on American standards would be like comparing apples to oranges, perhaps it was CCHSA (Canadian council on health services accreditation)?
    Denicke,The funding for Canadian health care system is different from the US. Americans have a market model and Canadians have national health insurance. The American system depends on ability to pay private health insurance. Canadians depends on adequate tax base and fair distribution. Patients do not pay for hospitalization, diagnostic services or visits to doctor this is funded through provincial and federal government. The provincial government provides each resident with a health insurance card, patients show this card when visiting the doctor. The doctor submits a bill to the provincial government with the patients health insurance number, the doctor receives fee for the service. Hope this is what you were asking, otherwise it is probably way too much info.
  7. by   denicke
    Thanks so much for all the information and taking the time to educate me. Take care, Debbie

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