Simultaneous temporal trends in dementia incidence and prevalence, 2005-2013: a population-based retrospective cohort study in Saskatchewan, Canada.

BACKGROUND: Original studies published over the last decade regarding time trends in dementia report mixed results. The aims of the present study were to use linked administrative health data for the province of Saskatchewan for the period 2005/2006 to 2012/2013 to: (1) examine simultaneous temporal trends in annual age- and sex-specific dementia incidence and prevalence among individuals aged 45 and older, and (2) stratify the changes in incidence over time by database of identification. METHODS: Using a population-based retrospective cohort study design, data were extracted from seven provincial administrative health databases linked by a unique anonymized identification number. Individuals 45 years and older at first identification of dementia between April 1, 2005 and March 31, 2013 were included, based on case definition criteria met within any one of four administrative health databases (hospital, physician, prescription drug, and long-term care). RESULTS: Between 2005/2006 and 2012/2013, the 12-month age-standardized incidence rate of dementia declined significantly by 11.07% and the 12-month age-standardized prevalence increased significantly by 30.54%. The number of incident cases decreased from 3,389 to 3,270 and the number of prevalent cases increased from 8,795 to 13,012. Incidence rate reductions were observed in every database of identification. CONCLUSIONS: We observed a simultaneous trend of decreasing incidence and increasing prevalence of dementia over a relatively short 8-year time period from 2005/2006 to 2012/2013. These trends indicate that the average survival time of dementia is lengthening. Continued observation of these time trends is warranted given the short study period.

Location decisions of family physicians in Saskatchewan: What really matters?

INTRODUCTION: Residents of Saskatchewan, particularly those in rural communities, have less access to family physician services than people in other parts of the country. This is partly due to the difficulty of attracting and retaining physicians. The objective of this study was to understand the major factors that influence the location decisions of family physicians in Saskatchewan. METHODS: We employed a mixed-methods approach, including a questionnaire survey of family physicians and interviews with individuals from stakeholder health agencies. We used interpretive description to analyze interview responses. RESULTS: Neither family physicians nor interviewees from health agencies named compensation as the most influential factor in location decisions. More important factors were family influences, work-life balance and community influences. CONCLUSION: We recommend that recruitment of family physicians be regarded as a matching process, in which family physicians and communities are strategically matched. Compensating incentives should be targeted at communities that cannot meet the requirements of family physicians.

INTRODUCTION: Les résidents de la Saskatchewan, en particulier ceux qui vivent dans des communautés rurales, ont un accès plus limité aux services d'un médecin de famille que les Canadiens des autres parties du pays. Cela s'explique en partie par la difficulté d'attirer et de retenir les médecins. Le but de cette étude était de comprendre les principaux facteurs qui influencent les médecins de famille de la Saskatchewan quand ils choisissent l'endroit où ils vont exercer. MÉTHODES: Nous avons utilisé diverses méthodes, notamment un sondage par questionnaire auprès des médecins de famille et des entretiens avec du personnel des organismes de santé visés. Nous avons analysé les réponses aux entretiens en faisant une description d'interprétation. RÉSULTATS: Ni les médecins de famille ni les représentants des organismes de santé n'ont dit que la rémunération était le principal facteur influençant leur décision. Les facteurs les plus importants sont l'influence de la famille et de la communauté, et l'équilibre vie­travail. CONCLUSION: Nous avons recommandé que le recrutement des médecins de famille soit considéré comme un processus de jumelage, selon lequel les médecins et les communautés sont jumelés de façon stratégique. Des mesures incitatives devraient être offertes aux communautés qui ne peuvent pas répondre à la demande de médecins de famille.

Inter-Provincial Migration Intentions of Family Physicians in Canada: The Roles of Income and Community Characteristics.

The inter-provincial migration patterns of family physicians in canada show that some provinces like newfoundland and saskatchewan experience persistent net out-migration, while others, including ontario and british columbia, are destinations more often than origins of migrants. Governments in provinces exhibiting net out-migration have responded with a number of incentive and recruitment programs. In this study, we investigate the determinants of the stated interprovincial migration intentions of 3,995 rural and urban family physicians in the 2010 wave of the national physician survey. We consider a range of physician characteristics, community attributes and working conditions. We find that in the intention to move, higher compensation has a modest effect, while the community characteristics have a consistently important influence. Our results suggest that policy and program designers should acknowledge the critical role of community-level living and working conditions in their family physician recruitment and retention efforts.

The political economy of the public-private mix in heath expenditure: an empirical review of thirteen OECD countries.

This study investigates the factors that may have influenced the public-private mix of health expenditure in 13 OECD countries from 1981 to 2007. The degree to which health services are socialized is regarded as the product of a trade-off between the desire to redistribute income through the fiscal system and the losses some citizens will incur when the public health care system expands. The estimation results show that, greater income inequality and population aging are associated with a smaller share of public health expenditure in total health expenditure. The more ideologically left-leaning the electorate is, the larger the share of public health expenditure. Private health insurance tends to erode the political support for the public health care systems in countries with private duplicate health insurance, but not in countries with private primary health insurance. The findings suggest that the role of private sources of funding for health care is likely to grow in developed countries. The expansion of public coverage to include pharmaceuticals and long-term care in some countries may (theoretically) encounter less opposition if the current insurance holders have no duplicate coverage, if the voters as a whole share more left-leaning political ideology, and if low-income voters are more politically mobilized.