Change And Continuity In Canada S Health Care System

In April 2001, the Prime Minister established the Commission on the Future of Health Care in Canada. Its mandate was to review medicare, engage Canadians in a national dialogue on its future, and make recommendations to enhance the system's quality and sustainability. The 47 recommendations in this report outline actions that must be taken in 10 critical areas, starting by renewing the foundations of medicare and considering Canada's role in improving health around the world.

While Canadians are proud of their healthcare system, the reality is that it is fragmented and disorganized. Instead of a pan-Canadian system, it is a "system of systems" - thirteen provincial and territorial systems and a federal system. As a result, Canadian healthcare has not only become one of the costliest in the world, but is falling well behind many developed countries in terms of quality. Canadians increasingly realize that their healthcare system is no longer fiscally sustainable, yet change remains elusive. The standard claim is that Canada's multijurisdictional approach makes system-wide reform nearly impossible. Toward a Healthcare Strategy for Canadians disputes this reasoning, making the case for a comprehensive, system-wide, made-in-Canada healthcare strategy. It looks at the mechanics of change and suggests ways in which the various participants in the system - governments, healthcare professionals, the private sector, and patients - can work collaboratively to transform a second-rate system. Addressing critical issues of health human resources, electronic health records, integrated care, and pharmacare, Toward a Healthcare Strategy for Canadians shows how a system-wide strategic approach to this crucial policy area can make a difference in Canada’s healthcare system in the future.

Canada’s fragmented healthcare system is one of the most expensive among the OECD countries, yet the quality of its performance is mediocre at best. Canada lacks a system-wide healthcare strategy that brings together many individual federal, provincial, and territorial strategies into a comprehensive and coherent whole. Managing a Canadian Healthcare Strategy is a collection of ten policy research essays by leading Canadian and international scholars who address three important questions. First, if Canada had a unifying strategy, how would the country measure its success and monitor its performance? Second, who are the agents of change to bring about a Canadian system-wide strategy? Third, how can the jurisdictional realities of Canada’s political system be managed to bring about strategic reform? The final section in the volume explores ways to overcome the barriers and impediments that preoccupy Canadians’ concerns about healthcare. A companion volume to Toward a Healthcare Strategy for Canadians, the contributors to Managing a Canadian Healthcare Strategy turn to the critical importance of how necessary healthcare changes can be best implemented.

This book provides insight into how the Canadian health care system is financed and organized, how it has evolved over time, and how well it performs relative to peer countries.

Canada has a complex health delivery system which is a conglomeration of 13 public plans--10 provincial and three territorial as well as a number of federally administered plans serving special populations such as Aboriginals and Veterans--all providing full coverage for most hospital and physician services as well as partial coverage for many services that vary among plans. The importance of this study is that it examines how the public/private sector relationship in health care delivery--particularly that of the for-profit sector--has developed both historically and in recent years, in three subnational provincial jurisdictions within a federal system. The case study provinces are Ontario, Quebec, and Alberta. The study examines both similarities and differences in this development. These provinces are highly distinct in their political culture and political history affecting health care delivery. Ontario and Quebec are Canada's most populous provinces and Alberta is an increasingly populous prairie state. Alberta is unique in its long-time governance of the Progressive Conservative party and its predecessor the Social Credit Party. Ontario has had a more variable political history with periods of Progressive Conservative, New Democratic Party and Liberal leadership and in recent years Quebec governance has shifted between the Parti Qu becois and the Liberal Party. In this study, one dimension that the authors examine are political dispositions to act regarding public/private initiatives in health care delivery and how this affects health care delivery in these provinces. Provincial medical and hospital plans are constrained by the Canada Health Act of 1984. For necessary medical and hospital services, the provinces and territories must adhere to the five principles of the Act in order to receive federal funding. However for other extended health care and health care-related services, there are federal contributions that are not constrained by these principles--although subject to reporting obligations. Another factor providing some flexibility in provincial Medicare plans is that necessary hospital and medical services are not enumerated in the Canada Health Act. This has allowed some "delisting" of services which is discussed in the case studies. In the provincial case studies, the authors examine how the federal/provincial dynamic in the delivery of health care services has worked out in the three provinces, with respect to similarities and differences regarding the involvement of the for-profit sector both within and outside the respective Medicare systems. They also examine how the fiscal setting has affected both political and economic sustainability pressures with respect to inclusion of private commercial initiatives in these three provincial settings. The authors note that these initiatives occur both within and external to Canadian provincial Medicare systems and that there is a need to see that such initiatives are held publicly accountability to meet equity and access goals. The study utilizes government documents, press reports and personal interviews to draw a picture of health delivery developments within the Canadian federal context. This study adds to the comparative health policy literature by applying a comparative approach to subnational provincial cases. It is also noteworthy to note that globally, many nations' health insurance plans incorporate a mixed public and private health delivery system, albeit that the mixes of for-profit and not-for-profit organizations will vary with respect to the ideological, political, cultural and historical characteristics of various nations. This is an important book for collections in Canadian studies, political science, and public health.