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HomePolicy Articles Article Summary

Health Care Reforms: Just How Far Can We Go?

Economic Note by Philippe Trudel, Bruce Johnston, Michel Bédard

Philippe H. Trudel, Bruce W. Johnston, and Michel Bédard explore what kinds of health care reforms can occur under existing laws. They also examine how much room the provinces have to manoeuvre under current federal legislation, namely, the Canada Health Act, as well as which laws reform-minded provincial governments could modify. In this Economic Note, the authors explore two types of reforms: 1) those that seek to reorganize the public sector or utilize the private sector without disrupting existing legislation or the state monopoly on health care, and 2) those that challenge the public financing of health care and would require amendments to the Canada Health Act and provincial legislation.

The authors discuss the legal context for health care in Canada, with a particular focus on Quebec. To qualify for federal funds, the provinces must satisfy five conditions: public administration, comprehensiveness, universality, portability, and accessibility. As Trudel, Johnston, and Bédard explain, the public health care system in Canada is established almost entirely by provincial legislation. The authors also outline reforms that are possible within the existing legal framework such as administrative reorganization, decentralization toward the regions, and replacing regional health boards with other structures. Further, the private sector can deliver services “insofar as the public system remains universal, no medically necessary service is withdrawn form the list of insured services and the state continues to finance all insured care completely.”

Trudel, Johnston, and Bédard explore the state monopoly on financing. They conclude that the Quebec government can already integrate concepts such as flexibility and competition into public management without changing legislation. Moreover, it could also increase the recourse to the private sector for the delivery of health care services, as long as the provincial government continues to completely finance all insured health care and does not contravene the Canada Health Act. As the authors point out, any problem would stem from the combination of public and private financing. A patient cannot, for example, pay for faster access to obtain a service dispensed by the public sector. The authors conclude with possible options the Quebec government can take to amend provincial legislation.

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Policy Publication Details

Author(s): Philippe Trudel; Bruce Johnston; Michel Bédard;
Publisher: Montreal Economic Institute [ Visit Website ]
Year Published: 2003; Publisher Type: Research Institute
Publicly Available: Yes Research Focus: National; Provincial;
Registration Required: No Language: English French
Payment Required: No Publication Format: Adobe PDF, Hard Copy

Subjects / Categories:

Policy Articles / Health Care / Funding
Policy Articles / Health Care / Reform
Policy Articles / Health Care / Canada Health Act
Policy Articles / Health Care / Accountability
Policy Articles / Health Care / Privatization
Policy Articles / Regional & Sectoral / Quebec
Policy Articles / Welfare & Social Issues / Health Care
Policy Articles / Health Care / Accountability / 2003
Policy Articles / Health Care / Canada Health Act / 2003
Policy Articles / Health Care / Funding / 2003
Policy Articles / Health Care / Reform / 2003
Policy Articles / Health Care / Privatization / 2003
Policy Articles / Regional & Sectoral / Quebec / 2003
Policy Articles / Welfare & Social Issues / Health Care / 2003
Policy Articles / Health Care
Policy Articles / Regional & Sectoral
Policy Articles / Welfare & Social Issues


Keywords / Tags:

health care reform; federal health legislation; provincial health legislation; Canada Health Act; Quebec; federal funding of health care; state monopoly on health care; universality; public health care funding; administrative reorganization; regional health boards; private sector health care;