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Home Policy Articles: Health Care: Measuring Results


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A Cure Worse than the Illness: Canada’s Proposed Regulatory Framework for Natural Health Products in Light of International Evidence

This article by Cynthia Ramsey examines Canada’s new regulatory framework for natural health products (NHPs), which is proposed by the newly created Natural Health Products Directorate (NHPD) of the Canadian government. Ramsey analyzes the reasoning behind the need for such a framework, compares the framework to the current regulatory policy, and distinguishes between Canada’s current and proposed policies vis-à-vis those of other countries, including the US.

A Finger on the Pulse: Comparative Models for Reporting the Quality of Hospital Care

Julia Witt argues that reporting on the quality of care that patients receive in Canadian hospitals is the responsibility of governments, hospital boards, and professional accreditation agencies. Although accreditation and ‘quality measurement’ of hospitals are controversial issues, Julia Witt contends that the demand for such measurements is growing.

Canadian Pharmacare: Performance, Incentives, and Insurance

In this paper, Graham and Tabler examine provincial drug policy. They argue that since the 1970s, provincial governments have taken away the freedom of Canadians to choose the prescription drugs they use. The result has been that provincial drug-benefit plans account for almost one-half of Canada’s prescription drug spending, placing an undue burden on taxpayers. At the same time, they argue is has been difficult to see the benefit to patients who require the drugs.

Challenging Health Care System Sustainability: Understanding Health System Performance of Leading Countries

This report, by Prada, is a follow-up to the Conference Board of Canada’s March 2004 Report, Understanding Health Care Cost Drivers and Escalators. In that report, a comparison of Canada’s health care system to those of 23 other countries found that Canada is the third largest spender on health care, but ranked near the middle with respect to performance. Prada’s report closely examines the top six countries – Australia, France, Spain, Sweden, Switzerland, and New Zealand – and attempts to explain why their systems perform and produce better results than does the Canadian system.

Fragile Recovery: The State of Public Services in Manitoba

A number of contributors helped prepare this Canadian Centre for Policy Alternatives (CCPA) report which assesses the state of Manitoba’s public services – including health care, education, emergency services, parks, libraries, and cultural institutions.

Giving Citizens a Voice in Health Care Policy in Canada

This brief report, by Maxwell, Rosell and Forest, begins with the belief that the values of a country’s citizens should define the boundaries of action in a democracy. The authors examine the Romanow Report’s use of a “ChoiceWork dialogue,” in which representative groups of ordinary citizens work through complex issues and make value- based choices. The input of these citizens had an important impact on the Commission’s report and the debate that ensued. As Maxwell, Rosell and Forest point out, this method of public engagement is more costly than polling, but essential when opinions are diverse and difficult decisions must be made.

Health Care Treatment Prices in Swedish Hospitals

Writing for the Frontier Centre, Swedish health policy commentator Johan Hjertqvist asserts that the most important reform to Swedish Medicare has been the standardization of prices for health care procedures. This compensation system, he explains, replaced the previous allocation of health care resources by budgets, paying hospitals for what they deliver rather than what they are supposed to produce. In addition, setting price tags for health care procedures has allowed a greater number of health care providers to service the public.

Health Human Resource Planning in Canada: Physician and Nursing Workforce

This report by Katya Duvalko, Patricia Baranek, Lise Lamothe and Kent Rondeau, commissioned by The Commission on the Future of Health Care in Canada, tries to explain why attempts at providing more health care workers to hospitals and clinics in need of personnel “have not met with much success.” The authors find several barriers to reform. These include but are not limited to the lack of coordinated health human resources planning (which has been seen as a separate policy area), the complexity of the issue and thus the difficulty of adequate planning, differences in legislative and regulatory schemes across Canada, and diffuse accountabilities.

How Good is Canadian Health Care? 2004 Report: An International Comparison of Health Systems

This report compares Canada to other countries that also have universal access to health care through publicly funded health care systems.

How Good is Canadian Health Care?: An International Comparison of Health Care Systems

This article by Nadeem Esmail and Michael Walker analyses Canada’s health care system relative to those of other member states of the Organization for Economic Cooperation and Development (OECD) who have systems that are characterized by universal access and public funding. They find that Canada ranks first in only one category – total age-adjusted spending, while ranking far behind in most others. Esmail and Walker also find that only about one-third of countries surveyed shun user fees (as Canada does), and that none follow a system of monopoly public provision of health insurance comparable to the Canadian example. They conclude that, regrettably, Canada’s system is inferior to that of other OECD states, contending that Canada should further emulate those countries that have achieved better results.

Making Health Spending Work

This article by Fred McMahon and Martin Zelder attempts to incorporate Medical Savings Accounts (MSAs) into the current health care system so that “a publicly funded system that incorporates market dynamics” can be designed. In McMahon and Zelder’s plan, Medical Savings Accounts would be attributed to each Canadian citizen, who would then have the option of choosing between private and public providers of health care. The authors believe this option makes most sense considering that Canada ranks near the top of OECD (Organization for Economic Co-operation and Development) member countries with respect to health spending, but places near the bottom in most categories pertaining to the quality of health care service delivery.

Managing Medicare: The Prerequisite to Spending or Reform

This article, written by Cam Donaldson, Craig Mitton and Gillian Currie, agues for the use of program budgeting and marginal analysis (PBMA), a management technique that balances marginal benefits versus marginal costs – one that has been used in the UK, New Zealand, and Australia. The authors argue that, contrary to popular belief, the Canadian health care system is not “unsustainable.” The answer, they argue, is not increased public financing (as marginal benefits decrease as financing rises). They suggest, instead, that a system which would make better priority decisions based on resources available and solid economic principles could greatly improve the situation. In sum, the authors argue that “improved management is a prerequisite to reform.”

Mapping Legislative Accountabilities

In this paper, Susan Zimmerman examines the question of “who is responsible for what” in Canadian health care legislation. While she addresses provincial, territorial, and federal legislation as it relates to health, she focuses on the provincial and territorial jurisdictions. The reason for this focus: to map how we frame accountability relationships within the health care system.

Miracle Cure: How to Solve America's Health Care Crisis and Why Canada Isn't the Answer

This is a book-length report written by Dr. Sally C. Pipes, President and CEO of the Pacific Research Institute.

Public Health, State Secret

Public Health, State Secret, by David Zitner and Brian Lee Crowley of the Atlantic Institute for Market Studies, argues Canada’s federal government faces a conflict of interest when it comes to understanding the poor performance of Canadian health care. According to Zitner and Crowley, there is overwhelming evidence that health care is declining in quality. The problem, they continue, is that politicians and policymakers lack the basic information necessary to evaluate the system in order to make the necessary improvements. If decision-makers do not know where the health care system is failing, he suggests, then they do not know where funding must be applied.

Public Reporting of Performance Measures in Health Care

In this paper, Morris and Zelmer address the issue of increasing the accountability of governments and public institutions to the people they serve vis-à-vis health care. One suggested approach, as recommended by various commissions and task forces: to increase public reporting on the performance of the health are system. This may be done either by reporting to the public directly, or using an intermediary. The authors examine both systems and their effectiveness.

Report on the Citizens’ Dialogue on the Future of Health Care in Canada

This report by by Pierre-Gerlier Forest, Karen Jackson, Barbara Legowski, Larissa Lozowchuk, Judith Maxwell and Steven Rosell, in partnership with The Commission on the Future of Health Care in Canada, attempts to evaluate what Canadians value in their health care system in a period where “difficult trade-offs” are necessary. The primary research involved dialogue with Canadians in the format of 12 sessions, each involving 40 participants who were presented with alternative means of dealing with health care issues.

Romanow and Beyond: A Primer on Health Reform Issues in Canada

This report by Cathy Fooks and Steven Lewis has two stated objectives: to highlight the key themes found in provincial and national health reform reports over the last 5 years and to identify “areas of agreement and disagreement within the key themes.” The provincial reports of Alberta, New Brunswick, Ontario, Quebec and Saskatchewan are evaluated, as are the National Forum report, Senate Committee report and the Interim Report from the Romanow Commission.

Taming of the Queue: Wait Time Measuring, Monitoring, and Management - Colloquium Report

This report was written by Cathy Fooks following the spring 2004 Colloquium addressing wait times in the Canadian health care system.

The Alberta Health Care Advantage: An Accessible, High Quality, and Sustainable System

In this paper, Esmail and Ramsay address the subject of health care reform in Alberta. They examine the Mazankowski Report, the product of a study conducted by the Premier’s Advisory Council on Health for Alberta; the Report delivered a radical set of ideas to raise health care revenues and temper demand for health services, in order to make Alberta’s health care system more sustainable.

The Health Council of Canada Proposal in light of the Council of the Federation

This brief report by Marchildon is part of a series of commentaries published by the IRPP to encourage wider knowledge and discussion of the Council of the Federation. The Council of the Federation was created in July 2003 by the provincial premiers and territorial leaders to better manage their relations, and ultimately, build a more constructive relationship with the federal government.

Transforming Health Research in Canada: The Making of the Canadian Institutes of Health Research

In 1999, then Minister of Finance Paul Martin announced the creation of the Canadian Institutes of Health Research (CIHR). With $65 million in funding in its first year, and an investment of an additional $175 million earmarked for the following year, the CIHR represented a significant investment of public funds in a new government agency. Transforming Health Research in Canada, by Robert Plamondon of the Public Policy Forum, looks at the beginning of the CIHR from the perspective of various stakeholders involved in its development. Plamondon considers the question ‘what led to the creation of this new agency?’ by interviewing individuals involved in the process.

Understanding Health Care Cost Drivers and Escalators

Prada argue that some provinces could be spending as much as 50 percent of their total budgets on health care by 2020 – just as the demographic bulge of Canadian seniors starts to pass through the system. Therefore, they argue, it is crucial for federal and provincial governments to start making critical decisions before then, in order to balance their priorities in health care vis-à-vis those in other areas. They point out that these will be difficult decisions, as the challenges they face will cut to the very heart of the Canadian health care system.

Waiting Your Turn: Hospital Waiting Lists in Canada (12th Edition)

This article by Nadeem Esmail and Michael Walker contains several graphs and data tables analyzing the current state of hospital waiting lists in Canada. The authors underscore that although data is more easily available than in the past, the data that is provided by the federal and provincial governments is still largely incomplete. By comparing government data with that of other sources they have gathered, the authors believe they generate the only available comprehensive evaluation of the state of waiting lists in Canada.

Waiting Your Turn: Hospital Waiting Lists in Canada (14th Edition)

This article documents the extent to which queues to visits to specialists, and for diagnostic and surgical procedures, are being used to control health care expenses.