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Home Policy Articles: Health Care: Page 2

The administration, funding and management of Canada’s health care system are hugely controversial areas of public policy. Much of the controversy is centred on the responsibilities of the federal and provincial governments to provide funding for the system; other debates focus on privatization, accountability, prescription drug policy, and how to measure the effectiveness of the system. The future of our country’s health care system will rely on sustainable investments and sound policy.

This section of policy.ca will keep you informed on the latest debates in health care policy in Canada.


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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...

Canada’s Public Health Care System Through 2020: Challenging Provincial and Territorial Financial Capacity

This study, by Frank, McIntyre and O’Sullivan, projects real provincial and territorial health expenditures through to 2020, illustrating how trends vary across seven components. The results of this study call into question the financial sustainability of the Canadian health care system. Frank, McIntyre and O’Sullivan found that overall provincial and territorial spending on health will increase from 32 percent (of government revenues) in 2001 to 44 percent in 2020.
http://www.conferenceboard.ca/boardwiseii/temp/BoardWise2EEE...

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...

Choosing a regulatory framework for private health insurance

In this economic note Norma Kozhaya discusses how to set up private health insurance and regulatory pitfalls to avoid.
http://www.iedm.org/uploaded/pdf/mars06_en.pdf

Church’s end-of-life teaching is a gift to be shared

In this brief article, Bridget Campion describes her first case as a clinical ethicist.
http://culturalrenewal.ca/downloads/sb_culturalrenewal/campi...

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

Continuing Care Renewal or Retreat? BC Residential and Home Health Care Restructuring 2001-2004

Cohen, Murphy, Nutland and Ostry examine the intense debate underway in BC about changes in residential care and home health services for seniors. The provincial government claims it is successfully implementing the plan for continuing care renewal; however, seniors groups are adamant that cuts to long-term residential care and home health services are leaving frail elders without access to affordable care.
http://www.policyalternatives.ca/documents/BC_Office_Pubs/bc...

Data, Data, Everywhere… : Improving Access to Population Health and Health Services Research Data in Canada

This report is the culmination of a project undertaken by the CPRN and the Centre for Health Services and Policy Research at the University of British Columbia. The purpose of this project: to understand how to enhance access to, and use of, current data infrastructure regarding health care (for the purposes of conducting important health research and making wise investments to increase data and analytic capacity). As the authors point out, the collectors and custodians of this data – Statistics Canada, Health Canada, provincial/territorial government ministries, and others – have no explicit mandate to support the research community.
http://www.cprn.ca/documents/36948_en.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...

Development of a Taxonomy for Health Care Decision-Making in Canada

Coyte’s paper is part of the working paper series entitled Defining the Medicare Basket: Health Care Decision Making in Canada. This series was undertaken to examine how decisions are made about what is covered by publicly funded health care, and if decisions about what is covered should be revisited.
http://www.irpp.org/miscpubs/archive/medicare_basket/wp2004-...

Doctors Have to Make a Living Too: The Microeconomics of Physician Practice

In Doctors Have to Make a Living Too: The Microeconomics of Physician Practice, Brian Ferguson, of the Atlantic Institute for Market Studies, argues the market for medical services behaves like any other economic market. Claims that economic analysis cannot be applied to medical care, Ferguson asserts, are incorrect in the face of empirical evidence of physician practice. Ultimately, Ferguson argues, physicians are entrepreneurs who must make profit to stay afloat. For this reason, a national medical insurance policy cannot regulate the ability of physicians to charge for their services nor can it dictate where they work. If it does, Ferguson concludes, it will damage the health care system.
http://www.aims.ca/library/doctors.pdf

Drug Price Controls and Pharmaceutical Innovation

Drug costs in Canada have risen more quickly than other health care costs. As Valentin Petkantchin explains, this increase is not due to increases by multinational pharmaceutical companies, but rather to other factors including more frequent use of drugs and higher markups at the wholesale and retail levels.
http://www.iedm.org/uploaded/pdf/pharma_en.pdf

Elder Care: The Nexus for Family, Work and Health Policy

Satya Brink presented this paper at an annual conference of the Canadian Association of Gerontology in Montreal in October 2002. In her paper, she discusses the wide-reaching impact of elder care on individuals, families, work, and public policy.
http://www.caledoninst.org/Publications/PDF/505ENG%2Epdf

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

Fair Pharmacare?

Sylvia Fuller provides a backgrounder on the BC government’s changes to the provincial pharmacare program. The Government has presented the recent restructuring of the pharmacare program as a reasonable solution to the problem of increasing drug costs; pharmaceuticals have been consuming an ever larger proportion of the health care budget, so the Government is seeking to limit its role in paying for prescriptions.
http://www.policyalternatives.ca/documents/BC_Office_Pubs/ph...

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

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.
http://www.policyalternatives.ca/documents/Manitoba_Pubs/mbs...

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