The Political And Economic Sustainability 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.

The Fiscal Sustainability of Health Care - the first of a three-volume set of selected papers from the Romanow Commission - comprises the most influential discussion papers on the fiscal sustainability of public health care in the future. The subjects covered include the current and potential cost drivers of the system, the financing and delivery of health care, fiscal federalism, and international trade regimes. While some of the contributors are among Canada's best known and respected figures in the field, others are relatively new scholars from Canada and abroad who bring fresh perspectives and new insights to the issue of fiscal sustainability. Presenting divergent diagnoses and policy prescriptions, the papers collectively highlight the many factors that governments and health care sector managers must confront to keep the Canadian health care system viable in the 21st century.

The importance of universal healthcare in Canada and possible areas for improvement.

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.

"This volume examines the public/private sector mix in a number of national healthcare systems and their interface with the goals of health equity and quality of healthcare. Moreover, there is a consideration of public accountability. The unique significance of this collection of national studies involving the public/private sector mix of healthcare services and/or finances is that it provides insights into the factors that enhance the public/private sector mix in fulfilling the goals of health equity and the quality of healthcare services as well as an understanding of the circumstances in which elements of the public/private sector mix may be harmful for the achievement of such goals in a variety of national settings. The contributions to this volume provide a variety of perspectives in dealing with these objectives"--