This demonstration project tested the feasibility and cost-effectiveness of a new way of organizing, financing, and delivering services for the frail elderly. It was referred to as SIPA (Système de services intégrés pour personnes âgées en perte d’autonomie), a system of integrated services for the frail elderly, in which the financing was a simulation of capitation. The report describes how two CLSC districts in Montreal put the system into practice with the help of interdisciplinary teams that coordinated all medical and social services, both primary and secondary, and dealt with both acute and chronic care for all their patients. The aim was to respond to the needs of the frail elderly and to maintain their autonomy and ability to choose appropriate solutions. For the health and social service system, the goal was to optimize the use of resources, whether community, hospital, or institutional. The report details difficulties and delays in implementation and obstacles to the effective management of the project, including difficulty involving doctors in private practice. Nonetheless, patients (and their caregivers) in the SIPA group reported perceiving a higher quality of services and a greater sense of security than did those in the control group. The SIPA group also significantly reduced its use of hospital resources, and there was a tendency to less institutionalization among these patients. The cost analysis indicated that the costs of care were slightly higher for patients in the SIPA group and that the increased use of community services was not financially compensated for by a reduction in the use of hospital services, at least during the time of the experimentation. However, the authors suggest that it may become more cost-effective when the cost of long-term care is factored in over a longer period.
This project was supported by the Health Transition Fund, which was created in 1997 to provide support for evidence-based decision-making in health care reform by supporting pilot and evaluation projects which test innovative approaches to health care delivery. The views expressed herein do no necessarily represent the official policy of federal, provincial, or territorial governments.