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Home Policy Articles: Health Care: Reform

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Bad Medicine: Trade Treaties, Privatization and Health Care Reform in Canada popular

Jim Grieshaber-Otto and Scott Sinclair examine a central and recurring theme in Canada’s health care debate: whether private financing and for-profit delivery of health care should play a greater role. They contend that exploring Canada’s international trade-treaty obligations as well as the scope of exemptions for health care under those treaties, add a critical dimension to this important debate.
http://www.policyalternatives.ca/documents/National_Office_P...

Health Care Reforms: Just How Far Can We Go? popular

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.
http://www.iedm.org/uploaded/pdf/santejuridique_en.pdf

Will We Rise to the Challenge? Eight Mega Issues Facing Canada popular

This briefing tracks eight key trends that are having a major impact on Canada’s business and public policy environment. Charles Barrett and Anne Golden point to the global economy and the consequences of competition from developing countries. They examine Canada’s relationship with the United States and the competing priorities of defence and trade. They also look at the need for investment in human capital and innovation for Canada to compete on the global stage, as well as the importance of addressing climate change and environmental issues.
http://sso.conferenceboard.ca/e-Library/Document.asp?DID=637...

A Canada Strong and Free

In this policy paper, former Ontario Premier Mike Harris and former Reform Party leader Preston Manning argue that Canada is a country of great promise and opportunity. However, they contend Canada is being held back by an absence of national vision and ill-advised public policies.
http://www.iedm.org/uploaded/pdf/130405_en.pdf

A Lethal Guardian: The Canadian Government’s Ban on Prescription Drugs

In this paper, John Graham addresses a controversial policy of the Canadian government: when any new drug is invented and ready for distribution in Canada, the federal government responds by enforcing an automatic ban on its use. The ban is removed for patients who urgently need the drug, and the general ban is lifted only after the manufacturer has paid a user fee and waited for Health Canada to approve the drug. Graham argues this policy is harmful to the health of Canadians because it prevents patients from receiving treatments that might save their lives.
http://www.fraserinstitute.ca/admin/books/files/LethalGuardi...

A Patients’ Bill of Rights: A Cure for Canadians’ Concerns About Medicare?

This article by Colleen Flood and Tracey Epps explores the prospect of a patient’s “bill of rights” as a means of addressing some of the issues and concerns associated with health care in Canada, and also as a potential means of surpassing the limitations of current appeal procedures.
http://www.irpp.org/pm/archive/pmvol3no12.pdf

Can We Finally Move Forward to Improve Health Care?

In this brief report, Kouri recommends ways to realize this vision for health care in the Province. She argues that residents of Saskatchewan must continue demanding high quality services; she also recommends a reorganization of primary care, and an increased emphasis on community-based care.
http://www.policyalternatives.ca/documents/Saskatchewan_Pubs...

Canada’s Drug Price Paradox: The Unexpected Losses Caused by Government Interference in Pharmaceutic

In this paper, Brett Skinner examines the Canadian government’s claim that its interference in pharmaceutical markets reduces prescription drug costs for Canadians. Skinner argues that Canadians pay much more than they should for generic drugs, that price controls on patented drugs are unnecessary, and that, in general, government pharmaceutical policy is failing to provide better outcomes than competitive markets could.
http://www.fraserinstitute.ca/admin/books/files/CanDrugPrice...

Canadian Health Care in a Global Context: Diagnoses and Prescriptions

This article by Åke G. Blomqvist summarizes the strengths and weaknesses of the Canadian health care system and highlights the problems associated with the division of powers between the federal and provincial governments, particularly in relation to financing and governance. Blomqvist then describes the US system and how it “may promote diversity and efficient institutional innovation,” in addition to examining its shortcomings. The author then analyzes the health policy reforms of the Netherlands, the United Kingdom, and Sweden, suggesting they are partially akin to the American model – a model characterized by competing insurance plans.
http://www.cdhowe.org/pdf/benefactors_lecture_2002.pdf

Canadian Health Insurance: An Unregulated Monopoly

In Canadian Health Insurance: An Unregulated Monopoly David Zitner, of the Atlantic Institute for Market Studies, calls for a strengthening of government’s role as health care regulator with a corresponding reduction in influence on service delivery and evaluation. Zitner argues Canadian health care is an unregulated monopoly. Provinces set prices for delivery while at the same time influencing the supply of health care through funding levels. This, Zitner stresses, is a conflict of interest that makes it impossible for government to fulfill its role as regulator of the system. Moreover, the conflict between government roles of insurer and regulator leads, Zitner asserts, to practices that would be deemed unacceptable in a private insurance market.
http://www.aims.ca/library/monopoly.pdf

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.
http://www.fraserinstitute.ca/shared/readmore.asp?sNav=pb&id...

Caring for Canadians in a Canada Strong and Free

Former Ontario Premier Mike Harris and former Reform Party leader Preston Manning discuss the “vision deficit” and “policy deficit” they consider to be evident in Canadian politics, particularly at the federal level.
http://www.iedm.org/uploaded/pdf/241005_en.pdf

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

This report, by Prada et.al., 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 et.al.’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.
http://sso.conferenceboard.ca/e-Library/Document.asp?DID=755...

Community-Based Mental Services in BC: Changes to Income, Employment, and Housing Supports

While British Columbia has been a leading province in mental health care reform and recovery treatments for people with mental illness, this has been greatly undermined in recent years.
http://www.policyalternatives.ca/documents/BC_Office_Pubs/bc...

Community-Based Mental Services in BC: Changes to Income, Employment, and Housing Supports

While British Columbia has been a leading province in mental health care reform and recovery treatments for people with mental illness, this has been greatly undermined in recent years.
http://www.policyalternatives.ca/documents/BC_Office_Pubs/bc...

Comprehensiveness in Public Health Care: An Impediment To Effective Restructuring

This article by Claude Forget argues that the debate over public health care in Canada has been “mired in semantics and wishful thinking.” In this context, Forget contends that certain words (found in the Canada Health Act) have acquired the status of principles when, in his view, they should not be considered as such.
http://www.irpp.org/pm/archive/pmvol3no11.pdf

Definitely NOT the Romanow Report: Achieving Equity, Sustainability, Accountability and Consumer Empowerment in Health Care

Based on statements made by Roy Romanow prior to his Commission’s study of Canadian health care, the Atlantic Institute for Market Studies published Definitely NOT the Romanow Report: Achieving Equity, Sustainability, Accountability and Consumer Empowerment in Health Care. The report argues that spending for Canadian health care is not sustainable in its present form. The authors assert that health care spending has only remained stable through a reduction in services, increased closures, limited hiring, controls on compensation, and increased wait times.
http://www.aims.ca/library/notromanow.pdf

Democratizing Public Services

Marcy Cohen argues that for the past 15 years there have been repeated calls to reform and modernize how services are delivered within the Canadian public health care system. However, despite broad and continuing support among academics, unions, government, and the public, there remain systemic barriers that limit the effectiveness and scope of new approaches for delivering public health care services.
http://www.policyalternatives.ca/documents/BC_Office_Pubs/bc...

Every Number Tells a Story: A Review of Public and Private Health Expenditures and Revenues in Canada, 1980-2000

This article by Glenn Brimacombe analyzes public versus private health care spending in Canada from 1980 to 2000. In this regard, the author finds there has been no drastic move towards increased private spending, even though the author does note some increases. Brimacombe underscores that there are important differences within the health care field, with sectors functioning in fundamentally different manners from one another (physicians versus other professionals, for example). Accordingly, Brimacombe argues that Canada must bring together these sectors in a more “financially seamless structure” prior to embarking on health care reform. Finally, the author considers the particulars of Canada’s situation vis-à-vis other international cases (such as Australia).
http://sso.conferenceboard.ca/e-Library/Document.asp?DID=316...

Expenditure on Medical Care in Canada: Looking at the Numbers

Brian Ferguson’s paper Expenditure on Medical Care in Canada: Looking at the Numbers, argues the only option to afford the level of health services Canadians have become accustomed to is to allow greater private spending. Ferguson asserts the way Canadians pay for health care has changed. In the past, governments had “the luxury” of running deficits and Medicare was financed based on borrowing. Today, however, Ferguson points out health care must be paid out of current revenues. These higher costs leave governments with the option of raising taxes, reducing services, or turning to private funds.
http://www.aims.ca/library/numbers.pdf

For the Good of the Patients: Financial Incentives to Improve Stability in the Canadian Health Care System

This article by Grant L. Reuber and Finn Poschmann analyzes the costs of public health care in Canada and the means of reform. The authors believe incorporating direct financial incentives into the system would “temper growth in demand for health services and place market pressure on providers to improve their efficiency and reduce costs” while still respecting the Canada Health Act. Reuber and Poschmann believe the best way of operationalizing the aforementioned financial incentives is through a provincial tax credit which would be tied to usage of the health care system.
http://www.cdhowe.org/pdf/commentary_173.pdf

Funding Public Provision of Private Health: The Case for a Copayment Contribution through the Tax System

This article, by Shay Aba, Wolfe D. Goodman and Jack M. Mintz, builds the case for a new outlook regarding the funding for public health care in Canada – an outlook based on a “user-pay” system. The authors propose that payments be made based on the level of service use, using the existing income tax system as a model. In this vein, the more a citizen uses the health care system, the higher his or her contributions would be.
http://www.cdhowe.org/pdf/commentary_163.pdf

Getting Better Health Care: Lessons from (and for) Canada

This paper attempts to examine the nature of Canada’s health care system to determine what lessons have been learned and assess forward movement in the debate over health care reform.
http://www.policyalternatives.ca/documents/National_Office_P...

Health Care Financing: Squandering Billions Is Not The Answer

Billions of dollars have been injected into Canada’s health care system, yet the problems of increased wait times, overcrowded emergency rooms, and a shortage of medical staff persist.
http://www.iedm.org/uploaded/pdf/sept04_en.pdf

Health Care Restructuring in BC

Fuller, Fuller and Cohen argue the BC health care system has entered a period of profound upheaval. All around the province, changes are being made to the health care services offered and how they are delivered. The authors contend, however, that the changes implemented are not the right medicine for the BC health care system.
http://www.policyalternatives.ca/documents/BC_Office_Pubs/he...

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