The Changing Political And Economic Environment Of Health Care In Canada

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.

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.

"Health and health care are at the pop of the public agenda, not only in Canada but throughout the world. Canada's most cherished social program -- health care -- is being transformed in many ways, some highly visible and others hidden from public view."--Cover.

Health Care in Canada examines the challenges faced by the Canadian health care system, a subject of much public debate. In this book Katherine Fierlbeck provides an in-depth discussion of how health care decisions are shaped by politics and why there is so much disagreement over how to fix the system. Many Canadians point to health care as a source of national pride; others are highly critical of the system's shortcomings and call for major reform. Yet meaningful debate cannot occur without an understanding of how the system actually operates. In this overview, Fierlbeck outlines the basic framework of the health care system with reference to specific areas such as administration and governance, public health, human resources, drugs and drug policy, and mental health. She also discusses alternative models in other countries such as Britain, the United States, and France. As health care becomes increasingly complex, it is crucial that Canadians have a solid grasp of the main issues within both the policy and political environments. With its balanced and accessible assessment of the main political and theoretical debates, Health Care in Canada is an essential guide for anyone with a stake in Canada's health system.

During the 1970s and 1980s policymaking in the complex area of regulatory legislation of the health disciplines became both increasingly important and increasingly difficult for the Canadian provinces. In this comparative study Joan Boase traces the evolution of relationships among governments and health care interest groups in four provinces - Ontario, Quebec, Nova Scotia, and Alberta - and finds that, although they have faced similar problems, they have responded in different ways. She employs several theoretical approaches to explain these different responses, including community/policy networks, institutionalism, and state traditions, and uses case studies to illustrate the intense interest group activity that has occurred in this sector. Boase reaches three conclusions: (1) with the development of a national health insurance plan there has been a shift in the actions of government from reliance on interest group liberalism towards concerted efforts to plan the structure of the welfare system; (2) the different systems of interest intermediation that evolved in the provinces reflected the underlying political and administrative culture and institutional structures within the provinces; and (3) the unique proactive approach taken by Ontario in the 1980s was a deliberate effort to modify the institutional arrangements through which groups had traditionally influenced policy. Boase suggests that the complexities of modern government and the move towards redistributive politics will lead the state to make extraordinary efforts to control its environment in the future. Shifting Sands will be of particular interest to health care specialists, policy-makers, and legislators as well as activists.

The first book to discuss the Canadian welfare state through a health-focused lens, The Politics of Health in the Canadian Welfare State argues that the nature of Canada’s liberal welfare state shapes the health care system, the social determinants of health, and the health of all Canadians. Documenting decades of work on the social determinants of health, authors Toba Bryant and Dennis Raphael explore topics such as power and influence in Canadian society, socially and economically marginalized populations, and approaches to promoting health. Each chapter examines different aspects of the links between public policy, health, and the welfare state, investigating how broader societal structures and processes of the country’s economic and political systems shape living and working conditions and, inevitably, the overall health of Canadians. Contextualizing the history and status of Canadian health and health care systems with Canada’s welfare state, this concise and timely text is well suited as a supplementary resource for health studies, sociology of health, and nursing courses in universities across Canada.