Case Industry – Home care services industry in Canada (Closing the Gap)
One of top 15 home care providers in Ontario
Over 500 workers.
Government looking to intervene in the current structure of the Home Care Industry.
Home care is currently largely publicly or government funded.
Comprised of THREE segments
1. Individuals and their families who paid for the services.
2. Private insurance companies that were contracted for service to their policy holders.
3. (Largest Segment 80%) Government funded home care.
Home care is part of the larger Canadian health care system.
Publically funded, but no publically insured.
Health care expenditures per capita have grown rapidly from $500 in 1975 to $4633 in 2006 and expected to be $5170 in 2008.
Growth in expenditure is driven by increase in aging population.
Health expenditures by government is 7% of the GDP in 1975 increasing to 10.5 by 2006 and were expected to reach 10.7 in 2008.
Health expenditure growth was outpacing the overall economy growth.
Government accounts for 70% of expenditures – Private 30%.
Ontario expended largest amount on health care at 67.7 billion. 50% of budget allocated to Local Health Integration Networks. 35% to Ontario health insurance (primary physician compensation) and 15% to other providers paid for CCAC.
CCAC hours breakdown 64% personal support and homemaking, 29% nursing, 7% for therapy providers.
Service providers for home care: Profit and not-for-profit.
Total of 90 Service providers in Ontario. 21 with annual revenues of more than $10 million, 8 with revenues between 5-10 mil and remaining under 5 million.
CCAC selected providers based on an RFP bidding process. (Previously bidding was done based on lowest price). No measure of quality and no follow up of quality.

Change in 2005 to the bidding process was proposed and Elinor Captan and her team conducted a review of the current process.
Prequalification process changed to each company having to be subjected to a quality inspection on each one of the services they provided once a year. This process assessed quality as well as operational and financial capacity. This assessment decided the size of contracts that each company could bid on. But the