- Gregory P. Marchildon is Professor Emeritus at the University of Toronto. He is a Member of the Order of Canada, a Fe... moreGregory P. Marchildon is Professor Emeritus at the University of Toronto. He is a Member of the Order of Canada, a Fellow of the Canadian Academy of Health Sciences, a member of the editorial board of the European Observatory on Health Systems and Policies and an originating member of the Pan-Canadian Health Reform Analysis Network (PHRAN).
After obtaining his PhD at the London School of Economics and Political Science, he taught for five years at Johns Hopkins University’s School of Advanced International Studies in Washington, DC. He served as Deputy Minister of Intergovernmental Affairs (1994-96) and Deputy Minister to the Premier and Cabinet Secretary (1996-2000) in the provincial government of Saskatchewan. In 2001-02, he was the Executive Director of a federal Royal Commission on the Future of Health Care in Canada (the Romanow Commission).
When he returned to academic life in 2003, he was appointed a Canada Research Chair in Public Policy and Economic History (Tier 1) and helped create the Johnson-Shoyama Graduate School of Public Policy with campuses at the Universities of Regina and Saskatchewan. Dr. Marchildon is the author of numerous journal articles on comparative health policy and the history of medicare in Canada. His books include two editions of Health Systems in Transition: Canada co-published by the WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies and the University of Toronto Press. IN 2015, he became Ontario Research Chair In Health Policy and System Design at the Institute of Health Policy, Management and Evaluation at the University of Toronto with a cross appointment to the Munk School of Global Affairs and Public Policy. He retired as Professor Emeritus in July 2022.edit
This analysis of the Canadian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Life expectancy is high, but it plateaued... more
This analysis of the Canadian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Life expectancy is high, but it plateaued between 2016 and 2017 due to the opioid crisis. Socioeconomic inequalities in health are significant, and the large and persistent gaps in health outcomes between Indigenous peoples and the rest of Canadians represent a major challenge facing the health system, and society more generally. Canada is a federation: the provinces and territories administer health coverage systems for their residents (referred to as “medicare”), while the federal government sets national standards, such as through the Canada Health Act, and is responsible for health coverage for specific subpopulations. Health care is predominantly publicly financed, with approximately 70% of health expenditures financed through the general tax revenues. Yet there are major gaps in medicare, such as prescription drugs outside hospital, long-term care, mental health care, dental and vision care, which explains the significant role of employer-based private health insurance and out-of-pocket payments. The supply of physicians and nurses is uneven across the country with chronic shortages in rural and remote areas. Recent reforms include a move towards consolidating health regions into more centralized governance structures at the provincial/territorial level, and gradually moving towards Indigenous self-governance in health care. There has also been some momentum towards introducing a national programme of prescription drug coverage (Pharmacare), though the COVID-19 pandemic of 2020 may shift priorities towards addressing other major health system challenges such as the poor quality and regulatory oversight of the long-term care sector. Health system performance has improved in recent years as measured by in-hospital mortality rates, cancer survival and avoidable hospitalizations. Yet major challenges such as access to non-medicare services, wait times for specialist and elective surgical care, and fragmented and poorly coordinated care will continue to preoccupy governments in pursuit of improved health system performance.
Research Interests:
Research Interests:
The Great Depression of the 1930s often evokes images of the drought stricken Canadian prairies, a region then in the grips of environmental and economic disaster. Between 1929 and 1932, per capita incomes fell by half in Manitoba, by 61... more
The Great Depression of the 1930s often evokes images of the drought stricken Canadian prairies, a region then in the grips of environmental and economic disaster. Between 1929 and 1932, per capita incomes fell by half in Manitoba, by 61 percent in Alberta, and by an astonishing 72 percent in Saskatchewan. The resulting political and social upheaval spread throughout the rest of the country.
This sixth volume in the History of the Prairie West Series contains a broad range of articles from the journal "Prairie Forum" about the pivotal decade in the history of Alberta, Saskatchewan and Manitoba. It features a broad range of topics including unemployment, ecology, labour strife, and the disintegration of the fabric of prairie life.
This sixth volume in the History of the Prairie West Series contains a broad range of articles from the journal "Prairie Forum" about the pivotal decade in the history of Alberta, Saskatchewan and Manitoba. It features a broad range of topics including unemployment, ecology, labour strife, and the disintegration of the fabric of prairie life.
Research Interests:
This book is an analysis of the connection between federalism, which involves a degree of political decentralization, and the organization of health care using a decision space analysis to determine the actual degree of health system... more
This book is an analysis of the connection between federalism, which involves a degree of political decentralization, and the organization of health care using a decision space analysis to determine the actual degree of health system decentralization. This requires an assessment of whether national or subnational governments have narrow, moderate, or broad discretion in their decisions on health system governance, access, human resources, organization and financing. This decision space analysis is applied to eight federations (Brazil, Canada, Germany, Mexico, Nigeria, Pakistan, South Africa, and Switzerland) which vary considerably in terms of geography, history, politics and constitutional development.
Research Interests:
Fiscal Federalism and Equalization Policy in Canada aims to increase public understanding of equalization and fiscal federalism by providing a comparative and multidisciplinary perspective on the history, politics, and economics of... more
Fiscal Federalism and Equalization Policy in Canada aims to increase public understanding of equalization and fiscal federalism by providing a comparative and multidisciplinary perspective on the history, politics, and economics of equalization policy in Canada. The authors provide a brief history, an analysis of the politics of equalization as witnessed over the last fifteen years, and a discussion of key economic debates concerning the role of the program and its effects. They also explore the relationship between equalization and other components of fiscal federalism, particularly the Canada Health Transfer and the Canada Social Transfer. The result is an analysis that draws from the best scholarship available in the fields of economics, economic history, political science, political sociology, and public policy.
Research Interests:
This fifth volume of the History of the Prairie West Series contains a broad range of articles spanning the1870s to the present and examines the mostly unexplored place of women in the history of Canada’s Prairie Provinces. From... more
This fifth volume of the History of the Prairie West Series contains a broad range of articles spanning the1870s to the present and examines the mostly unexplored place of women in the history of Canada’s Prairie Provinces. From “Spinsters Need Not Apply” to “Negotiating Sex: Gender in the Ukrainian Bloc Settlement, “women’s roles in politics, law, agriculture, labour, and journalism are explored to reveal a complex portrait of women struggling to find safety, have careers, raise children, and be themselves in an often harsh environment. Launched in 2008, the History of the Prairie West Series is comprised of the very best historical articles previously published in the scholarly journal Prairie Forum.
Research Interests:
Bending the Cost Curve in Health Care offers domestic and international perspectives on the management of ever growing health costs. The objective of the book is to get beyond the sterile debates of the past decade and to try to determine... more
Bending the Cost Curve in Health Care offers domestic and international perspectives on the management of ever growing health costs. The objective of the book is to get beyond the sterile debates of the past decade and to try to determine where Canada sits, and should sit, in terms of its health care cost curve, in comparison to other OECD countries.
Leading experts from around the world and from a range of disciplines and professional backgrounds lay out the problems faced by policy-makers and provide international case studies from the UK, Norway, the United States, Australia, and Asia. Provincial experiences within Canada are explored in depth, and analyses of pan-Canadian issues such as pharmaceuticals and public-sector health spending address the question of the sustainability of health care in Canada.
Leading experts from around the world and from a range of disciplines and professional backgrounds lay out the problems faced by policy-makers and provide international case studies from the UK, Norway, the United States, Australia, and Asia. Provincial experiences within Canada are explored in depth, and analyses of pan-Canadian issues such as pharmaceuticals and public-sector health spending address the question of the sustainability of health care in Canada.
Research Interests:
Research Interests:
A guide to 23 documented canoe routes north and south of the central trunk of the Churchill River in Northern Saskatchewan including an extensive set of planning maps.
Research Interests:
Governance and Public Policy in Canada lays the foundation for a systematic analysis of policy developments, shaped as they are by multiple players, institutional tensions and governance legacies. Arguing that provinces are not the most... more
Governance and Public Policy in Canada lays the foundation for a systematic analysis of policy developments, shaped as they are by multiple players, institutional tensions and governance legacies. Arguing that provinces are not the most central site of governance and policy innovation, the book assesses the role of the provinces and places the provincial state in its broader economic, institutional, social, and territorial context. The aim throughout is to highlight the crucial role of provinces in policy changes that directly affect the lives of citizens.
Three key themes unify this book. First, it addresses the role of policy convergence and divergence among the provinces. Although the analysis acknowledges the enduring differences in political culture and institutions, it also points to patterns of policy convergence in specific areas. Second the book explores the push and pull between centralization and decentralization in Canada as it affects intergovernmental relations. Third, it underscores that although the provinces play a greater role in policy development than ever before, they now face a growing tension between their expanding policy ambitions and their capacity to develop, fund, implement, manage, and evaluate policy programs.
Three key themes unify this book. First, it addresses the role of policy convergence and divergence among the provinces. Although the analysis acknowledges the enduring differences in political culture and institutions, it also points to patterns of policy convergence in specific areas. Second the book explores the push and pull between centralization and decentralization in Canada as it affects intergovernmental relations. Third, it underscores that although the provinces play a greater role in policy development than ever before, they now face a growing tension between their expanding policy ambitions and their capacity to develop, fund, implement, manage, and evaluate policy programs.
Research Interests:
Canada is a high-income country with a population of 33 million people. Its economic performance has been solid despite the recession that began in 2008. Life expectancy in Canada continues to rise and is high compared with most OECD... more
Canada is a high-income country with a population of 33 million people. Its economic performance has been solid despite the recession that began in 2008. Life expectancy in Canada continues to rise and is high compared with most OECD countries; however, infant and maternal mortality rates tend to be worse than in countries such as Australia, France and Sweden. About 70% of total health expenditure comes from the general tax revenues of the federal, provincial and territorial governments. Most public revenues for health are used to provide universal medicare (medically necessary hospital and physician services that are free at the point of service for residents) and to subsidise the costs of outpatient prescription drugs and long-term care. Health care costs continue to grow at a faster rate than the economy and government revenue, largely driven by spending on prescription drugs. In the last five years, however, growth rates in pharmaceutical spending have been matched by hospital spending and overtaken by physician spending, mainly due to increased provider remuneration. The governance, organization and delivery of health services is highly decentralized, with the provinces and territories responsible for administering medicare and planning health services. In the last ten years there have been no major pan-Canadian health reform initiatives but individual provinces and territories have focused on reorganizing or fine tuning their regional health systems and improving the quality, timeliness and patient experience of primary, acute and chronic care. The medicare system has been effective in providing Canadians with financial protection against hospital and physician costs. However, the narrow scope of services covered under medicare has produced important gaps in coverage and equitable access may be a challenge in these areas.
Research Interests:
Research Interests:
This is the revised addition of a history of the community clinics in Saskatchewan written by Stan Rands, a noted social activist, public servant and community clinic administrator who died in 1985. This edition includes a new... more
This is the revised addition of a history of the community clinics in Saskatchewan written by Stan Rands, a noted social activist, public servant and community clinic administrator who died in 1985. This edition includes a new introductory chapter by Gregory P. Marchildon on primary health community clinics and Stan Rands' struggle for the transformation of health care in Saskatchewan and in Canada. This books also includes an examination of co-operatives and consumer control of health care services 50 years after the tumultuous doctors' strike of 1962 in Saskatchewan that marked the birth of universal medical care insurance in Canada.
Research Interests: Primary Health Care, Socialism, Canadian Public Policy, Cooperatives, Theory and History of Cooperatives, Forms of Cooperatives (Credit, Consumer, Agricultural, Housing, Energy, and other service cooperatives, Social Cooperatives, and 4 moreSaskatchewan History, Saskatchewan, Universal Health Coverage, and Medical doctors
The fifteen essays selected from the journal Prairie Forum for this volume examine the rich history of business and early industries in the Canadian Plains before the calamity of the Great Depression. Without denying the central... more
The fifteen essays selected from the journal Prairie Forum for this volume examine the rich history of business and early industries in the Canadian Plains before the calamity of the Great Depression. Without denying the central importance of agriculture in the development and growth of the Prairie West, these essays explore the lesser-known history of some of the first businesses in the region.
Research Interests:
The eighteen essays selected from the journal Prairie History for this volume all focus on the agricultural history of the Canadian Plains. The cover a detailed survey of First Nations agricultural practices, agriculture during the fur... more
The eighteen essays selected from the journal Prairie History for this volume all focus on the agricultural history of the Canadian Plains. The cover a detailed survey of First Nations agricultural practices, agriculture during the fur trade era, and ranching in its evolution from the open range to fenced-in farm settlements. The emergence of wheat as the region's premier crop after 1900 is also examined, a development which resulted in the Prairie Provinces becoming known as the "breadbasket of the world." Further studied are mechanization and adaptations to dryland farming, as well as changes to how the Prairie's cattle and crops were transported and marketed abroad. A final group of essays cover the rise of farmers' organizations and their attempts to receive fair treatment and fair prices from the grain companies and the railways.
Research Interests:
Research Interests:
Even if global warming were to be reduced substantially, the warming that has already occurred in the Canadian Plains is going to change the climate in the decades to come. Working from the best scientific evidence on the changes that are... more
Even if global warming were to be reduced substantially, the warming that has already occurred in the Canadian Plains is going to change the climate in the decades to come. Working from the best scientific evidence on the changes that are likely to occur, this book examines the ability of local communities as well as local, provincial and national institutions and governments to deal with future climate change. The thirteen chapters in this volume reflect a unique collaboration among scholars from disciplines as diverse as climatology, geography, history, hydrology, sociology, engineering, economics, law and public policy.
Research Interests:
Research Interests:
Research Interests:
This is a review of the Canadian province of Saskatchewan's health system including its political and administrative organization, financing and funding, expenditure patterns, principal organizations and stakeholders, modes of service... more
This is a review of the Canadian province of Saskatchewan's health system including its political and administrative organization, financing and funding, expenditure patterns, principal organizations and stakeholders, modes of service delivery, and recent reform activity.
Research Interests:
The centennial of Saskatchewan’s birth as a province is a natural opportunity to reflect deeply on the province’s history. Long-time observers of the province, the authors in this short book all address the question of what 100 years of... more
The centennial of Saskatchewan’s birth as a province is a natural opportunity to reflect deeply on the province’s history. Long-time observers of the province, the authors in this short book all address the question of what 100 years of history means in terms of Saskatchewan’s present and future. The heavy hand of history is a metaphor for the weight exerted by past events, decisions, institutions and attitudes on the present. To prepare for 2005, the authors in this volume were asked to write essays on their interpretation of the long-run historical factors that significantly influence Saskatchewan today and will continue to shape its future.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
This is a history, ethnography and paddling guide to the historic voyageur route through Saskatchewan.
Research Interests:
A study of high finance and capital formation during the Great Laurier Boom in Canada which lasted from 1896 until the First World War through the lens of investment banker W. Maxwell Aitken (later Lord Beaverbrook).
Research Interests:
This edited volume explores the political background of trade liberalization culminating in the signing of the North American Free Trade Agreement (NAFTA) little more than a decade after the idea of a similar accord had been rejected in... more
This edited volume explores the political background of trade liberalization culminating in the signing of the North American Free Trade Agreement (NAFTA) little more than a decade after the idea of a similar accord had been rejected in the United States, Canada and Mexico. Experts examine how political parties in all three countries grappled with the notion of continental free trade as constituent bases, interest group pressures and ideologies has shifted over time. The book treats each of Canada's established national parties, the Republican and Democratic parties in the United States, and the PRI in Mexico, concluding that North America's principal parties have flip-flopped on the issue of trade liberalization.
Research Interests:
This edited volume examines the role of Canadian finance and Canadian direct investment in foreign countries through multinational enterprises. The volume is made up of seven historical case studies.
Research Interests:
Persons living with dementia and their caregivers often face challenges in accessing support for their complex needs. This study aims to understand how program administrators, people living with dementia, unpaid caregivers, and... more
Persons living with dementia and their caregivers often face challenges in accessing support for their complex needs. This study aims to understand how program administrators, people living with dementia, unpaid caregivers, and decision-makers perceive specific dementia care programs and whether they are adequately meeting the needs of individuals living with dementia. Forty semi-structured interviews were conducted between 2018 and 2020 in five North American jurisdictions. Three main gaps were identified (1) disconnected system infrastructure, (2) lack of comprehensive services to meet diverse needs, and (3) inconsistent understandings of dementia. Despite having programs in place, there remain significant limitations in systems that could be addressed to adequately meet the needs of individuals living with dementia and their caregivers.
Research Interests:
The Saskatchewan Dental Plan in Canada was the first universal dental care plan for children in North America. Based on a similar New Zealand program, it would take over two decades from the time that the provincial government first... more
The Saskatchewan Dental Plan in Canada was the first universal dental care plan for children in North America. Based on a similar New Zealand program, it would take over two decades from the time that the provincial government first considered the New Zealand policy until a final decision was made to implement the program. This article reviews the reasons for the long gestation of the policy, including the hostility of organized dentistry in Saskatchewan and Canada and the caution of the government’s bureaucracy. It would take until a social democratic government was elected in 1971 before the political stream joined with the pre-existing problem and policy streams to open the policy window. Established in 1974, the program was terminated in 1987 due to the opposition of organized dentistry combined with the pro-market ideology of a newly elected government.
Research Interests:
Research Interests:
Research Interests:
As health service delivery shifts from institutions to the home, greater care responsibilities are being imposed on unpaid caregivers. However, gaps remain concerning how these responsibilities are contributing to caregivers’ financial... more
As health service delivery shifts from institutions to the home, greater care responsibilities are being imposed on unpaid caregivers. However, gaps remain concerning how these responsibilities are contributing to caregivers’ financial risk. This study describes results from an online survey conducted in late-2020 in Ontario, Canada, about the financial risks of unpaid, homebased caregiving throughout the first year of the COVID-19 pandemic. Among 190 caregivers, salient findings include difficulties paying for care expenses after the pandemic was declared than before (P = .002); more caregivers retiring or becoming unemployed during the pandemic than before (P = .013); and a significant relationship between paying out-of-pocket for a home care worker and experiencing a decrease in the availability of such support during the pandemic (P = .029). Overall, the financial stressors of caregiving during the pandemic contributed negatively to caregivers’ mental health, with 64.2% noting could be partly offset by greater government and employment-based assistance in managing care expenses and productivity losses. Findings from this study will better inform policies that aim to protect unpaid caregivers from financial risk in pandemic recovery efforts and beyond. Results may also be useful in other welfare states where unpaid caregivers provide the majority of home care services
Research Interests:
Despite an increase in prevalence of complex chronic conditions and dementia, longterm care services are being continuously pushed out of institutional settings and into the home and community. The majority of people living with dementia... more
Despite an increase in prevalence of complex chronic conditions and dementia, longterm care services are being continuously pushed out of institutional settings and into the home and community. The majority of people living with dementia in Canada and the United States (U.S.) live at home with support provided by family, friendsor other unpaid caregivers. Ten dementia care policy programs and service delivery
models across five different North American jurisdictions in Canada and the U.S. are compared deductively using a comparative policy framework originally developed by Richard Rose. One aim of this research was to understand how different jurisdictions have worked to reduce the fragmentation of dementia care. Another aim is to assess, relying on the theory of smart policy layering, the extent to which these policy efforts ‘patch’ health system structures or add to system redundancies. We find that these programs were introduced in a manner that did not fully consider how to patch current programs and services and thus risk creating further system redundancies. The implementation of these policy programs may have led to policy layers, and potentially to tension among different policies and unintended consequences. One approach to reducing these negative impacts is to implement evaluative efforts that assess ‘goodness of fit’. The degree to which these programs have embedded these efforts into an existing policy infrastructure successfully is low, with the possible exception of one program in New York.
models across five different North American jurisdictions in Canada and the U.S. are compared deductively using a comparative policy framework originally developed by Richard Rose. One aim of this research was to understand how different jurisdictions have worked to reduce the fragmentation of dementia care. Another aim is to assess, relying on the theory of smart policy layering, the extent to which these policy efforts ‘patch’ health system structures or add to system redundancies. We find that these programs were introduced in a manner that did not fully consider how to patch current programs and services and thus risk creating further system redundancies. The implementation of these policy programs may have led to policy layers, and potentially to tension among different policies and unintended consequences. One approach to reducing these negative impacts is to implement evaluative efforts that assess ‘goodness of fit’. The degree to which these programs have embedded these efforts into an existing policy infrastructure successfully is low, with the possible exception of one program in New York.
Research Interests:
A range of public health and social measures have been employed in response to the disproportionate impact of COVID-19 in Latin America and the Caribbean (LAC). Yet, pandemic responses have varied across the region, particularly during... more
A range of public health and social measures have been employed in response to the disproportionate impact of COVID-19 in Latin America and the Caribbean (LAC). Yet, pandemic responses have varied across the region, particularly during the first 6 months of the pandemic, with Uruguay effectively limiting transmission during this crucial phase. This review describes features of pandemic responses which may have contributed to Uruguay's early success relative to 10 other LAC countries-Argentina,
Research Interests:
This research note directs the attention of policy scholars to a unique and important research study on Canadian Medicare that is not generally known. Conducted by Murray G. Brown and Vernon A. Hicks, the study examined the impact of... more
This research note directs the attention of policy scholars to a unique and important research study on Canadian Medicare that is not generally known. Conducted by Murray G. Brown and Vernon A. Hicks, the study examined the impact of Medicare on the demand for services in Nova Scotia before and after the introduction of universal medical care insurance. Titled "The Impact of Universal Medicare on the Previously Insured Poor and Nonpoor," this research was written up into a report delivered to the US government but was, unfortunately, never disseminated—nor did it become known in Canada. By summarizing the his tory and context of the study, the approach and methods used by Brown and Hicks, and the study’s policy significance, this research note also acts as an introduction to the study.
Cette note de recherche vise à attirer l'attention des chercheurs en politiques sur une étude originale et importante qui n'est pas assez connue et qui porte sur l'assurance-santé canadienne. Menée par Murray G. Brown et Vernon A. Hicks, cette étude a examiné l'impact de l'assurance-santé sur la demande de services en Nouvelle-Écosse avant et après l'introduction de l'assurance-santé universelle. Intitulée The Impact of Universal Medicare on the Previously Insured Poor and Nonpoor, cette recherche a fait l'objet d'un rapport qui a été soumis au gouvernement américain, mais malheureusement, ce rapport n'a jamais été diffusé, ni rendu connu au Canada. En résumant l'historique et le contexte de l'étude, l'approche et les méthodes utilisées par Brown et Hicks, ainsi que la portée politique de l'étude, cette note de recherche sert également à faire connaitre cette étude.
Cette note de recherche vise à attirer l'attention des chercheurs en politiques sur une étude originale et importante qui n'est pas assez connue et qui porte sur l'assurance-santé canadienne. Menée par Murray G. Brown et Vernon A. Hicks, cette étude a examiné l'impact de l'assurance-santé sur la demande de services en Nouvelle-Écosse avant et après l'introduction de l'assurance-santé universelle. Intitulée The Impact of Universal Medicare on the Previously Insured Poor and Nonpoor, cette recherche a fait l'objet d'un rapport qui a été soumis au gouvernement américain, mais malheureusement, ce rapport n'a jamais été diffusé, ni rendu connu au Canada. En résumant l'historique et le contexte de l'étude, l'approche et les méthodes utilisées par Brown et Hicks, ainsi que la portée politique de l'étude, cette note de recherche sert également à faire connaitre cette étude.
Research Interests:
This paper compares health policy responses to COVID-19 in Canada, Ireland, the United Kingdom and United States of America (US) from January to November 2020, with the aim of facilitating crosscountry learning. Evidence is taken from the... more
This paper compares health policy responses to COVID-19 in Canada, Ireland, the United Kingdom and United States of America (US) from January to November 2020, with the aim of facilitating crosscountry learning. Evidence is taken from the COVID-19 Health System Response Monitor, a joint initiative of the European Observatory on Health Systems and Policies, the WHO Regional Office for Europe, and the European Commission, which has documented country responses to COVID-19 using a structured template completed by country experts. We show all countries faced common challenges during the pandemic, including difficulties in scaling-up testing capacity, implementing timely and appropriate containment measures amid much uncertainty and overcoming shortages of health and social care workers, personal protective equipment and other medical technologies. Country responses to address these issues were similar in many ways, but dissimilar in others, reflecting differences in health system organization and financing, political leadership and governance structures. In the US, lack of universal health coverage have created barriers to accessing care, while political pushback against scientific leadership has likely undermined the crisis response. Our findings highlight the importance of consistent messaging and alignment between health experts and political leadership to increase the level of compliance with public health measures, alongside the need to invest in health infrastructure and training and retaining an adequate domestic health workforce. Building on innovations in care delivery seen during the pandemic, including increased use of digital technology, can also help inform development of more resilient health systems longer-term.
Research Interests:
This paper compares health policy responses to COVID-19 in Canada, Ireland, the United Kingdom and United States of America (US) from January to November 2020, with the aim of facilitating crosscountry learning. Evidence is taken from the... more
This paper compares health policy responses to COVID-19 in Canada, Ireland, the United Kingdom and United States of America (US) from January to November 2020, with the aim of facilitating crosscountry learning. Evidence is taken from the COVID-19 Health System Response Monitor, a joint initiative of the European Observatory on Health Systems and Policies, the WHO Regional Office for Europe, and the European Commission, which has documented country responses to COVID-19 using a structured template completed by country experts. We show all countries faced common challenges during the pandemic, including difficulties in scaling-up testing capacity, implementing timely and appropriate containment measures amid much uncertainty and overcoming shortages of health and social care workers, personal protective equipment and other medical technologies. Country responses to address these issues were similar in many ways, but dissimilar in others, reflecting differences in health system organization and financing, political leadership and governance structures. In the US, lack of universal health coverage have created barriers to accessing care, while political pushback against scientific leadership has likely undermined the crisis response. Our findings highlight the importance of consistent messaging and alignment between health experts and political leadership to increase the level of compliance with public health measures, alongside the need to invest in health infrastructure and training and retaining an adequate domestic health workforce. Building on innovations in care delivery seen during the pandemic, including increased use of digital technology, can also help inform development of more resilient health systems longer-term.
Research Interests:
Despite an increase in prevalence of complex chronic conditions and dementia, longterm care services are being continuously pushed out of institutional settings and into the home and community. The majority of people living with dementia... more
Despite an increase in prevalence of complex chronic conditions and dementia, longterm care services are being continuously pushed out of institutional settings and into the home and community. The majority of people living with dementia in Canada and the United States (U.S.) live at home with support provided by family, friends or other unpaid caregivers. Ten dementia care policy programs and service delivery models across five different North American jurisdictions in Canada and the U.S. are compared deductively using a comparative policy framework originally developed by Richard Rose. One aim of this research was to understand how different jurisdictions have worked to reduce the fragmentation of dementia care. Another aim is to assess, relying on the theory of smart policy layering, the extent to which these policy efforts ‘patch’ health system structures or add to system redundancies. We find that these programs were introduced in a manner that did not fully consider how to patch current programs and services and thus risk creating further system redundancies. The implementation of these policy programs may have led to policy layers, and potentially to tension among different policies and unintended consequences. One approach to reducing these negative impacts is to implement evaluative efforts that assess ‘goodness of fit’. The degree to which these programs have embedded these efforts into an existing policy infrastructure successfully is low, with the possible exception of one program in NY.
Research Interests:
Introduction: Accountable Care Organizations (ACOs), implemented in the United States (US), aim to reduce costs and integrate care by aligning incentives among providers and payers. Canadian governments are interested adopting such models... more
Introduction: Accountable Care Organizations (ACOs), implemented in the United States (US), aim to reduce costs and integrate care by aligning incentives among providers and payers. Canadian governments are interested adopting such models to integrate care, though comparative studies assessing the applicability and transferability of ACOs in Canada are lacking. In this comparative study, we performed a narrative literature review to examine how Canadian health systems could support ACO models. Methods: We reviewed empirical studies (published 2011-2020) that evaluated ACO impacts in the US. Thematic analysis and critical appraisal were performed to identify factors associated with positive ACO impacts. These factors were compared with the Canadian context to assess the applicability and transferability of ACO models within Canada. Findings: Physician-led models, global budgets and financial incentives, and focus on collaborative care may optimize ACO impacts. While reforms towards alternative payments and team-based care are not unprecedented in Canada, significant further reforms to physician remuneration, intersectoral collaboration, and accountability for performance are required to support ACO-like models. Conclusion: This comparative study uncovered several insights on the applicability and transferability of ACOs to the Canadian context. Further comparative research outside the US is needed to infer the essential components of successful ACO models.
Research Interests:
In the history of social policy in advanced industrial societies, the 1942 Beveridge Report stands as one of the most influential government-sponsored reports ever published. In this article, we explore how the principles and the policy... more
In the history of social policy in advanced industrial societies, the 1942 Beveridge Report stands as one of the most influential government-sponsored reports ever published. In this article, we explore how the principles and the policy proposals formulated in the report diffused to other countries and how domestic actors adapted them to their local context through policy translation processes. The social policy ideas that Beveridge put forward in his 1942 report influenced post-war policy debates in ways that varied greatly from country to country. To illustrate this claim, we analyse the reception and policy impact of this report over time in three different welfare states: Canada, Denmark, and France. This comparison shows how Beveridge's ideas influenced policy debates in different countries through translation processes that adapted these ideas to each country's institutional and political context.
Research Interests:
Canada's experience with the coronavirus disease-2019 (COVID-19) pandemic has been characterized by considerable regional variation, as would be expected in a highly decentralized federation. Yet, the country has been beset by challenges,... more
Canada's experience with the coronavirus disease-2019 (COVID-19) pandemic has been characterized by considerable regional variation, as would be expected in a highly decentralized federation. Yet, the country has been beset by challenges, similar to many of those documented in the severe acute respiratory syndrome outbreak of 2003. Despite a high degree of pandemic preparedness, the relative success with flattening the curve during the first wave of the pandemic was not matched in much of Canada during the second wave. This paper critically reviews Canada's response to the COVID-19 pandemic with a focus on the role of the federal government in this public health emergency, considering areas within its jurisdiction (international borders), areas where an increased federal role may be warranted (long-term care), as well as its technical role in terms of generating evidence and supporting public health surveillance, and its convening role to support collaboration across the country. This accounting of the first 12 months of the pandemic highlights opportunities for a strengthened federal role in the short term, and some important lessons to be applied in preparing for future pandemics.
Research Interests:
Research Interests:
Outpatient technologies are important for maintaining health and overall quality of life, yet the degree of access and coverage of these technologies remains variable within and across jurisdictions. In Canada, assistive technologies are... more
Outpatient technologies are important for maintaining health and overall quality of life, yet the degree of access and coverage of these technologies remains variable within and across jurisdictions. In Canada, assistive technologies are not included in universal health coverage, and are not subject to the Canada Health Act's criteria and conditions that provinces and territories must fulfill to receive the full federal cash contribution under the Canada Health Transfer. As such, the thirteen Canadian provincial and territorial governments make separate decisions on programs and coverage. Drawing on the WHO Universal Coverage Cube we compare who gets access, the types of technologies that can be accessed, and the level of coverage (total costs covered) in Canada. Overall, each Canadian jurisdiction had at least one publicly supported program. All relied on a ‘health assessment’ of an individual's need to determine eligibility. Income and eligibility for social assistance was used as eligibility criteria in 6 of the 13 jurisdictions. Mobility aids as well as audio, visual, and communication aids were included in all jurisdictions. While some programs offered full financial support for some technologies, forms of cost sharing were common. The results are discussed in the context of international experiences, demographic changes, and health system trends to highlight areas for policy learning.
Research Interests:
Originally established as an expression of self-determination, Indigenous-governed health systems now play an important role in shaping the delivery of health programs and services in Canada. Operating in very diverse geographic,... more
Originally established as an expression of self-determination, Indigenous-governed health systems now play an important role in shaping the delivery of health programs and services in Canada. Operating in very diverse geographic, political and social contexts, these Indigenous health systems are highly heterogeneous. To better understand these differences, a typology is constructed based on three areas of decision-making space: governance rules, financing and accountability mechanisms. The nature of the relationship and in particular, the degree of control exercised by Indigenous communities over their respective health systems in relation to federal, provincial and territorial governments, is also assessed. The resulting five-level typology organizes Indigenous health systems into broad and strong control to moderate and narrow control. Although this typology is based on current governance arrangements, it nevertheless presents a baseline for the study of future innovations in Indigenous health systems as well as new types of provincial and territorial government engagement by Indigenous governments and organizations.
Sommaire: Au Canada, les systèmes de santé dirigés par les Autochtones qui ont été initialement établis pour exprimer leur autodétermination, jouent maintenant un rôle important dans l'orientation de la prestation des programmes et services de santé. Ces systèmes de soins de santé autochtones fonctionnant dans des contextes géographiques, politiques et sociaux très variés sont extrêmement hétérogènes. Pour mieux comprendre ces différences, nous avons établi une typologie à partir de trois domaines d’entités décisionnelles : les règles de gouvernance, et les mécanismes de financement et d’imputabilité. Nous évaluons également la nature de la relation et particulièrement, le degré de contrôle exercé par les collectivités autochtones sur leurs systèmes de santé respectifs par rapport aux gouvernements fédéral, provinciaux et territoriaux. La typologie résultante à cinq niveaux organise les systèmes de santé autochtones allant d’un contrôle large et fort à un contrôle modéré et étroit. Quoique cette typologie soit fondée sur les modalités de gouvernance actuelles, elle présente néanmoins un point de comparaison pour l'étude d’innovations futures dans les systèmes de santé autochtones, ainsi que de nouveaux types d'engagement provinciaux et territoriaux par les gouvernements et organismes autochtones.
Sommaire: Au Canada, les systèmes de santé dirigés par les Autochtones qui ont été initialement établis pour exprimer leur autodétermination, jouent maintenant un rôle important dans l'orientation de la prestation des programmes et services de santé. Ces systèmes de soins de santé autochtones fonctionnant dans des contextes géographiques, politiques et sociaux très variés sont extrêmement hétérogènes. Pour mieux comprendre ces différences, nous avons établi une typologie à partir de trois domaines d’entités décisionnelles : les règles de gouvernance, et les mécanismes de financement et d’imputabilité. Nous évaluons également la nature de la relation et particulièrement, le degré de contrôle exercé par les collectivités autochtones sur leurs systèmes de santé respectifs par rapport aux gouvernements fédéral, provinciaux et territoriaux. La typologie résultante à cinq niveaux organise les systèmes de santé autochtones allant d’un contrôle large et fort à un contrôle modéré et étroit. Quoique cette typologie soit fondée sur les modalités de gouvernance actuelles, elle présente néanmoins un point de comparaison pour l'étude d’innovations futures dans les systèmes de santé autochtones, ainsi que de nouveaux types d'engagement provinciaux et territoriaux par les gouvernements et organismes autochtones.
Research Interests:
Background: Patient registration with a primary care providers supports continuity in the patientprovider relationship. This paper develops a framework for analysing the characteristics of patient registration across countries; applies... more
Background: Patient registration with a primary care providers supports continuity in the patientprovider relationship. This paper develops a framework for analysing the characteristics of patient registration across countries; applies this framework to a selection of countries; and identifies challenges and ongoing reform efforts. Methods: 12 jurisdictions (Denmark, France, Germany, Ireland, Israel, Italy, Netherlands, Norway, Ontario [Canada], Sweden, Switzerland, United Kingdom) were selected for analysis. Information was collected by national researchers who reviewed relevant literature and policy documents to report on the estab- lishment and evolution of patient registration, the requirements and benefits for patients, providers and payers, and its connection to primary care reforms.
Results: Patient registration emerged as part of major macro-level health reforms linked to the intro- duction of universal health coverage. Recent reforms introduced registration with the aim of improving quality through better coordination and efficiency through reductions in unnecessary referrals. Patient registration is mandatory only in three countries. Several countries achieve high levels of registration by using strong incentives for patients and physicians (capitation payments).
Conclusion: Patient registration means different things in different countries and policy-makers and re- searchers need to take into consideration: the history and characteristics of the registration system; the use of incentives for patients and providers; and the potential for more explicit use of patient-provider agreements as a policy to achieve more timely, appropriate, continuous and integrated care.
Results: Patient registration emerged as part of major macro-level health reforms linked to the intro- duction of universal health coverage. Recent reforms introduced registration with the aim of improving quality through better coordination and efficiency through reductions in unnecessary referrals. Patient registration is mandatory only in three countries. Several countries achieve high levels of registration by using strong incentives for patients and physicians (capitation payments).
Conclusion: Patient registration means different things in different countries and policy-makers and re- searchers need to take into consideration: the history and characteristics of the registration system; the use of incentives for patients and providers; and the potential for more explicit use of patient-provider agreements as a policy to achieve more timely, appropriate, continuous and integrated care.
Research Interests:
The COVID-19 pandemic has exposed fault-lines in the organization of personal support work, including low wages, part-time employment, and risky working condition, despite its essential nature in long-term care (LTC). This is, in part,... more
The COVID-19 pandemic has exposed fault-lines in the organization of personal support work, including low wages, part-time employment, and risky working condition, despite its essential nature in long-term care (LTC). This is, in part, because personal support work has long-existed on the fringes of what is considered health work, thereby precluding its status as a health profession. In this perspective paper, we explore how the pandemic may contribute to the semi-professionalization of personal support work based on the provision of LTC by personal support workers (PSWs) working in LTC facilities in Ontario, Canada. We first characterize personal support work to illustrate its current organization based on the logics of work control. We then speculate how the pandemic may shift control and map speculated changes onto existing checklists of professionalism and semi-professionalism in health work. We propose the pandemic will shift control away from existing market and hierarchical controls. At most, personal support work may undergo changes that are more characteristic of semi-professional control (semi-professionalism), characterized by the formation of a PSW registry that may improve role clarity, provide market shelter, and standardize wages. We do not believe this shift in control will solve all organizational problems that the pandemic has exposed, and continued market and hierarchical controls may be necessary. This perspective may provide insights for other high-income settings, where the pandemic has exposed similar fault-lines in the organization of personal support work in LTC.
Research Interests:
Background: Patient registration with a primary care providers supports continuity in the patientprovider relationship. This paper develops a framework for analysing the characteristics of patient registration across countries; applies... more
Background: Patient registration with a primary care providers supports continuity in the patientprovider relationship. This paper develops a framework for analysing the characteristics of patient registration across countries; applies this framework to a selection of countries; and identifies challenges and ongoing reform efforts. Methods: 12 jurisdictions (Denmark,
Research Interests:
This analysis of the Canadian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Life expectancy is high, but it plateaued... more
This analysis of the Canadian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Life expectancy is high, but it plateaued between 2016 and 2017 due to the opioid crisis. Socioeconomic inequalities in health are significant, and the large and persistent gaps in health outcomes between Indigenous peoples and the rest of Canadians represent a major challenge facing the health system, and society more generally. Canada is a federation: the provinces and territories administer health coverage systems for their residents (referred to as “medicare”), while the federal government sets national standards, such as through the Canada Health Act, and is responsible for health coverage for specific subpopulations. Health care is predominantly publicly financed, with approximately 70% of health expenditures financed through the general tax revenues. Yet there are major gaps in medicare, such as prescription drugs outside hospital, long-term care, mental health care, dental and vision care, which explains the significant role of employer-based private health insurance and out-of-pocket payments. The supply of physicians and nurses is uneven across the country with chronic shortages in rural and remote areas. Recent reforms include a move towards consolidating health regions into more centralized governance structures at the provincial/territorial level, and gradually moving towards Indigenous self-governance in health care. There has also been some momentum towards introducing a national programme of prescription drug coverage (Pharmacare), though the COVID-19 pandemic of 2020 may shift priorities towards addressing other major health system challenges such as the poor quality an regulatory oversight of the long-term care sector. Health system performance has improved in recent years as measured by in-hospital mortality rates, cancer survival and avoidable hospitalizations. Yet major challenges such as access to non-medicare services, wait times for specialist and elective surgical care, and fragmented and poorly coordinated care will continue to preoccupy governments in pursuit of improved health system performance.
Research Interests:
Patient-centred care is a key priority for governments, providers and stakeholders, yet little is known about the care preferences of patient groups. We completed a scoping review that yielded 193 articles for analysis. Five health states... more
Patient-centred care is a key priority for governments, providers and stakeholders, yet little is known about the care preferences of patient groups. We completed a scoping review that yielded 193 articles for analysis. Five health states were used to account for the diversity of possible preferences based on health needs. Five broad themes were identified and expressed differently across the health states, including personalized care, navigation, choice, holistic care and care continuity. Patients' perspectives must be considered to meet the diverse needs of targeted patient groups, which can inform health system planning, quality improvement initiatives and targeting of investments.
Résumé Les soins axés sur le patient sont une priorité clé pour les gouvernements, les fournisseurs et les intervenants, mais on en sait peu sur les préférences de soins des groupes de patients. Nous avons effectué un examen de la portée dans lequel 193 articles ont été analysés. Cinq états de santé ont été utilisés pour rendre compte de la diversité des préférences possibles en fonction des besoins en santé. Cinq grands thèmes ont été identifiés et exprimés différemment selon l'état de santé : les soins personnalisés, la navigation, le choix, les soins holistiques et la continuité des soins. Le point de vue du patient doit être pris en compte afin de répondre aux divers besoins des groupes ciblés, ce qui peut éclairer la planification du système de santé de même que les initiatives visant l' amélioration des soins ainsi que le ciblage des investissements.
Résumé Les soins axés sur le patient sont une priorité clé pour les gouvernements, les fournisseurs et les intervenants, mais on en sait peu sur les préférences de soins des groupes de patients. Nous avons effectué un examen de la portée dans lequel 193 articles ont été analysés. Cinq états de santé ont été utilisés pour rendre compte de la diversité des préférences possibles en fonction des besoins en santé. Cinq grands thèmes ont été identifiés et exprimés différemment selon l'état de santé : les soins personnalisés, la navigation, le choix, les soins holistiques et la continuité des soins. Le point de vue du patient doit être pris en compte afin de répondre aux divers besoins des groupes ciblés, ce qui peut éclairer la planification du système de santé de même que les initiatives visant l' amélioration des soins ainsi que le ciblage des investissements.
Research Interests:
Research Interests:
This article compares the policy achievements of the Liberal St-Laurent government (1948-57) in the health field to the current Liberal government under Justin Trudeau (2015-present).
Research Interests:
National responses to COVID-19 depend in part on national health care financing arrangements. Yet the pandemic itself has not only strained system capacity, it has – through subsequent economic shocks – strained revenue sources that prop... more
National responses to COVID-19 depend in part on national health care financing
arrangements. Yet the pandemic itself has not only strained system capacity, it has – through subsequent economic shocks – strained revenue sources that prop up these arrangements. In federal countries, fiscal pressures are particularly pronounced. As this paper argues, however, federal health financing regimes differ in ways that are shaping the agenda for post-pandemic reforms. The analysis, which focuses on health care financing in three federal countries (Canada, the United States, and Mexico), explores the current and potential future impact of COVID-19 on existing policy legacies.
arrangements. Yet the pandemic itself has not only strained system capacity, it has – through subsequent economic shocks – strained revenue sources that prop up these arrangements. In federal countries, fiscal pressures are particularly pronounced. As this paper argues, however, federal health financing regimes differ in ways that are shaping the agenda for post-pandemic reforms. The analysis, which focuses on health care financing in three federal countries (Canada, the United States, and Mexico), explores the current and potential future impact of COVID-19 on existing policy legacies.
Research Interests:
Although it is not generally done, it is useful to compare the history of the evolution of universal health coverage (UHC) in Canada and Sweden. The majority of citizens in both countries have shared, and continue to share, a commitment... more
Although it is not generally done, it is useful to compare the history of the evolution of universal health coverage (UHC) in Canada and Sweden. The majority of citizens in both countries have shared, and continue to share, a commitment to a strong form of single-tier universality in the design of their respective UHC systems. In the postwar era, they also share a remarkably similar timeline in the emergence and entrenchment of single-tier UHC, despite the political and social differences between the two countries. At the same time, UHC was initially designed, implemented, and managed by social democratic governments that held power for long periods of time, creating a path dependency for single-tier Medicare that was difficult for future governments of different ideological persuasions to alter. Résumé. Même si peu de recherches le font, il est utile de comparer l'évolution des systèmes universels de santé (SUS) au Canada et en Suède. La majorité des citoyens de ces deux pays ont manifesté-et manifestent toujours-un attachement fort à l'égard système sanitaire de ce type. Durant l'après-guerre, leurs SUS respectifs émergent et s'enracinent d'ailleurs au fil d'une chronologie remarquablement similaire dans les deux pays, malgré les différences politiques et sociales qui les distinguent. Il est vrai que leurs systèmes de santé ont été initialement conçus, mis en oeuvre et gérés par des gouvernements sociaux-démocrates qui sont longtemps resté au pouvoir. Cette situation a créé une sorte d'accoutumance à l'universalité en matière de santé que les gouvernements ultérieurs, aux orientations idéologiques différentes, ont eu de la difficulté à remettre en cause. Methods and Issues / Problématiques et méthodes
Research Interests:
Canada lost its edge in the ’70s when Connaught Laboratories was sold. The time has come to invest in a university-based research and production capacity to ensure that vaccines will once again be produced in Canada to prepare for future... more
Canada lost its edge in the ’70s when Connaught Laboratories was sold. The time has come to invest in a university-based research and production capacity to ensure that vaccines will once again be produced in Canada to prepare for future pandemics. The full text is available at: https://policyoptions.irpp.org/magazines/march-2021/canada-needs-a-university-based-domestic-vaccine-making-capability/
Research Interests:
Patient safety is a complex systems issue. In this study, we used a scoping review of peer-reviewed literature and a case study of provincial and territorial legislation in Canada to explore the influence of mandatory reporting... more
Patient safety is a complex systems issue. In this study, we used a scoping review of peer-reviewed literature and a case study of provincial and territorial legislation in Canada to explore the influence of mandatory reporting legislation on patient safety outcomes in hospital settings. We drew from a conceptual model that examines the components of mandatory reporting legislation that must be in place as a part of a systems governance approach to patient safety and used this model to frame our results. Our results suggest that mandatory reporting legislation across Canada is generally designed to gather information about-rather than respond to and prevent-patient safety incidents. Overall, we found limited evidence of impact of mandatory reporting legislation on patient safety outcomes. Although legislation is one lever among many to improve patient safety outcomes, there are nonetheless several considerations for patient safety legislation to assist in broader system improvement efforts in Canada and elsewhere. Legislative frameworks may be enhanced by strengthening learning systems, accountability mechanisms and patient safety culture.
Research Interests:
This commentary compares Israel's COVID-10 vaccination response to the much slower and less successful vaccination campaign in Canada. Although Canada did start with some structural disadvantages relative to Israel including less... more
This commentary compares Israel's COVID-10 vaccination response to the much slower and less successful vaccination campaign in Canada. Although Canada did start with some structural disadvantages relative to Israel including less centralized and coherent emergency planning and a more complex demographic geography, there are, nonetheless, some important policy lessons Canada can draw from Israel. These include a more strategic use of national leadership in the vaccination campaign and the greater use of primary care resources and providers.
Research Interests:
The coronavirus disease 2019 (COVID-19) pandemic has shifted the health policy debate in Canada. While the pre-pandemic focus of policy experts and government reports was on the question of whether to add outpatient pharmaceuticals to... more
The coronavirus disease 2019 (COVID-19) pandemic has shifted the health policy debate in Canada. While the pre-pandemic focus of policy experts and government reports was on the question of whether to add outpatient pharmaceuticals to universal health coverage, the clustering of pandemic deaths in longterm care facilities has spurred calls for federal standards in long-term care (LTC) and its possible inclusion
in universal health coverage. This has led to the probability that the federal government will attempt to expand medicare as Canadians have known it for the first time in over a half century. However, these efforts are likely to fail if the federal government relies on the shared-cost federalism that marked the earlier introduction of medicare. Two alternative pathways are suggested, one for LTC and one for pharmaceuticals, that are more likely to succeed given the state of the Canadian federation in the early 21st century.
in universal health coverage. This has led to the probability that the federal government will attempt to expand medicare as Canadians have known it for the first time in over a half century. However, these efforts are likely to fail if the federal government relies on the shared-cost federalism that marked the earlier introduction of medicare. Two alternative pathways are suggested, one for LTC and one for pharmaceuticals, that are more likely to succeed given the state of the Canadian federation in the early 21st century.
Research Interests:
Bringing together top scholars in the field, Universality and Social Policy in Canada (published by the University of Toronto Press in May 2019) provides an overview of the universality principle in social welfare. The contributors survey... more
Bringing together top scholars in the field, Universality and Social Policy in Canada (published by the University of Toronto Press in May 2019) provides an overview of the universality principle in social welfare. The contributors survey the many contested meanings of universality in relation to specific social programs, to the field of social policy, and, more generally, to the modern welfare state. In addition to universality, the related ideas of universalism and universalization are also discussed. The book argues that, while universality is a core value undergirding certain areas of state intervention—most notably health care and education—the contributory principle of social insurance and the selectivity principle of income assistance are also highly significant precepts in practice. This book was edited by Daniel Béland, Gregory P. Marchildon, and Michael J. Prince
Research Interests:
Introduction Long-term care (LTC) is organized in a fragmented manner. Payer agencies (PA) receive LTC funds from the agency collecting funds, and commission services. Yet, distributional equity (DE) across PAs, a precondition to... more
Introduction
Long-term care (LTC) is organized in a fragmented manner. Payer agencies (PA) receive LTC funds from the agency collecting funds, and commission services. Yet, distributional equity (DE) across PAs, a precondition to geographical equity of access to LTC, has received limited attention. We conceptualize that LTC systems promote DE when they are designed to set eligibility criteria nationally (vs. locally); and to distribute funds among PAs based on needs-formula (vs. past-budgets or government decisions).
Objectives
This cross-country study highlights to what extent different LTC systems are designed to promote DE across PAs, and the parameters used in allocation formulae.
Methods
Qualitative data were collected through a questionnaire filled by experts from 17 OECD countries.
Results
11 out of 25 LTC systems analyzed, fully meet DE as we defined. 5 systems which give high autonomy to PAs have designs with low levels of DE; while nine systems partially promote DE. Allocation formulae vary in their complexity as some systems use simple demographic parameters while others apply socio-economic status, disability, and LTC cost variations.
Discussion and conclusions
A minority of LTC systems fully meet DE, which is only one of the criteria in allocation of LTC resources. Some systems prefer local priority-setting and governance over DE. Countries that value DE should harmonize the eligibility criteria at the national level and allocate funds according to needs across regions.
Long-term care (LTC) is organized in a fragmented manner. Payer agencies (PA) receive LTC funds from the agency collecting funds, and commission services. Yet, distributional equity (DE) across PAs, a precondition to geographical equity of access to LTC, has received limited attention. We conceptualize that LTC systems promote DE when they are designed to set eligibility criteria nationally (vs. locally); and to distribute funds among PAs based on needs-formula (vs. past-budgets or government decisions).
Objectives
This cross-country study highlights to what extent different LTC systems are designed to promote DE across PAs, and the parameters used in allocation formulae.
Methods
Qualitative data were collected through a questionnaire filled by experts from 17 OECD countries.
Results
11 out of 25 LTC systems analyzed, fully meet DE as we defined. 5 systems which give high autonomy to PAs have designs with low levels of DE; while nine systems partially promote DE. Allocation formulae vary in their complexity as some systems use simple demographic parameters while others apply socio-economic status, disability, and LTC cost variations.
Discussion and conclusions
A minority of LTC systems fully meet DE, which is only one of the criteria in allocation of LTC resources. Some systems prefer local priority-setting and governance over DE. Countries that value DE should harmonize the eligibility criteria at the national level and allocate funds according to needs across regions.
Research Interests:
This article examines Prime Minister Pierre Trudeau's legacy in terms of fiscal federalism in Canada. Contrary to the conventional wisdom, Trudeau leaned in the direction of greater fiscal decentralization as demonstrated by his decisions... more
This article examines Prime Minister Pierre Trudeau's legacy in terms of fiscal federalism in Canada. Contrary to the conventional wisdom, Trudeau leaned in the direction of greater fiscal decentralization as demonstrated by his decisions on social (health and post-secondary education) transfers and equalization.
Research Interests:
Background: Among Canadian residents living in long-term care (LTC) facilities, and especially among those with limited ability to communicate due to dementia, pain remains underassessed and undermanaged. Although evidence-based clinical... more
Background: Among Canadian residents living in long-term care (LTC) facilities, and especially among those with limited ability to communicate due to dementia, pain remains underassessed and undermanaged. Although evidence-based clinical guidelines for the assessment and management of pain exist, these clinical guidelines are not widely implemented in LTC facilities. A relatively unexplored avenue for change is the influence that statutes and regulations could exert on pain practices within LTC. This review is therefore aimed at identifying the current landscape of policy levers used across Canada to assess and manage pain among LTC residents and to evaluate the extent to which they are concordant with evidence-based clinical guidelines proposed by an international consensus group consisting of both geriatric pain and public policy experts.
Research Interests:
his analysis of the Canadian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Life expectancy is high, but it plateaued... more
his analysis of the Canadian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Life expectancy is high, but it plateaued between 2016 and 2017 due to the opioid crisis. Socioeconomic inequalities in health are significant, and the large and persistent gaps in health outcomes between Indigenous peoples and the rest of Canadians represent a major challenge facing the health system, and society more generally. Canada is a federation: the provinces and territories administer health coverage systems for their residents (referred to as “medicare”), while the federal government sets national standards, such as through the Canada Health Act, and is responsible for health coverage for specific subpopulations. Health care is predominantly publicly financed, with approximately 70% of health expenditures financed through the general tax revenues. Yet there are major gaps in medicare, such as prescription drugs outside hospital, long-term care, mental health care, dental and vision care, which explains the significant role of employer-based private health insurance and out-of-pocket payments. The supply of physicians and nurses is uneven across the country with chronic shortages in rural and remote areas. Recent reforms include a move towards consolidating health regions into more centralized governance structures at the provincial/territorial level, and gradually moving towards Indigenous self-governance in health care. There has also been some momentum towards introducing a national programme of prescription drug coverage (Pharmacare), though the COVID-19 pandemic of 2020 may shift priorities towards addressing other major health system challenges such as the poor quality and regulatory oversight of the long-term care sector. Health system performance has improved in recent years as measured by in-hospital mortality rates, cancer survival and avoidable hospitalizations. Yet major challenges such as access to non medicare services, wait times for specialist and elective surgical care, and fragmented and poorly coordinated care will continue to preoccupy governments in pursuit of improved health system performance.
Research Interests:
Oral health is an important component of general health, yet there is limited financial protection for the costs of oral health care in many countries. This study compares public dental care coverage in a selection of jurisdictions:... more
Oral health is an important component of general health, yet there is limited financial protection for the costs of oral health care in many countries. This study compares public dental care coverage in a selection of jurisdictions: Australia (New South Wales), Canada (Alberta), England, France, Germany, Italy, Sweden,and the United States. Drawing on the WHO Universal Coverage Cube, we compare breadth (who iscovered), depth (share of total costs covered), and scope (services covered), with a focus on adults aged65 and older. We worked with local experts to populate templates to provide detailed and comparabledescriptions of dental care coverage in their jurisdictions. Overall most jurisdictions offer public dentalcoverage for basic services (exams, x-rays, simple fillings) within four general types of coverage models:1) deep public coverage for a subset of the older adult population based on strict eligibility criteria:Canada (Alberta), Australia (New South Wales) and Italy; 2) universal but shallow coverage of the olderadult population: England, France, Sweden; 3) universal, and predominantly deep coverage for olderadults: Germany; and 4) shallow coverage available only to some subgroups of older adults in the UnitedStates. Due to the limited availability of comparable data within and across jurisdictions, further researchwould benefit from standardized data collection initiatives for oral health measures.
Research Interests:
How to mobilize the Canadian federation and its federalist institutions to achieve better policy outcomes for all Canadians in the wake of the CPVOD-19 pandemic.
Research Interests:
his article uses comparative historical analysis to explore physicians’ involvement in health care reform in Canada and Brazil. Drawing on historical institutionalism, the analysis stresses how, beyond partisanship, physicians build... more
his article uses comparative historical analysis to explore physicians’ involvement in health care reform in Canada and Brazil. Drawing on historical institutionalism, the analysis stresses how, beyond partisanship, physicians build consensus around and promote specific policy ideas, and how federal institutions shape physicians’ mobilization. In both countries, physicians’ mobilization shaped the emergence of universal health care coverage, but in quite different ways, because of the differing federal institutions. Although the Brazilian medical lobby was far more heterogeneous than the Canadian profession, one faction was able to mobilize at the local level to pursue policy ideas favorable to universal health coverage.
Research Interests:
This Literary Review of Canada article explores Andrew Rader's book "Beyond the Known: How Exploration Created the Modern World and Will Take Us to the Stars. This review article is available online at:... more
This Literary Review of Canada article explores Andrew Rader's book "Beyond the Known: How Exploration Created the Modern World and Will Take Us to the Stars. This review article is available online at: https://reviewcanada.ca/magazine/2020/07/risky-business/
Research Interests:
Canada is the only Universal Health Insurance country in the OECD without universal insurance for outpatient prescription drugs, a situation generally perceived as unfair and inefficient. In June 2018, the federal government launched an... more
Canada is the only Universal Health Insurance country in the OECD without universal insurance for outpatient prescription drugs, a situation generally perceived as unfair and inefficient. In June 2018, the federal government launched an Advisory Council on the Implementation of National Pharmacare, to report in 2019 on the best strategy to implement a national Pharmacare program that would provide all Canadians access to affordable outpatient prescription drugs. The Council was asked to consider three options: a universal public plan for all Canadians; a public catastrophic insurance plan that would kick off once spending on prescription drugs reaches a given threshold; and a more modest patching of existing gaps, providing coverage to those who are not eligible to any form of insurance. Beyond the relative consensus around the ideas that gaps in coverage should be filled to make drugs affordable to all, and that the costs of drugs are too high in Canada, the Council faces the challenge of addressing three underlying issues: 1) what amount of income redistribution will result from each of the three options; 2) how much savings would the implementation of a single payer generate? 3) what role restricting a national formulary would play in achieving those savings, and what would be the political consequences of narrowing the formulary?
Research Interests:
The goal of achieving integrated care increasingly characterizes the efforts of health systems around the world to improve effectiveness, efficiency and outcomes, yet the implementation of integrated care remains an extremely complex... more
The goal of achieving integrated care increasingly characterizes the efforts of health systems around the world to improve effectiveness, efficiency and outcomes, yet the implementation of integrated care remains an extremely complex challenge. Although large multinational projects have provided early understandings into the optimal ways to implement more integrated models of care [1, 2], insights into strategies to navigate the political and managerial demands of implementing change are difficult to generate. In this paper, we report on a policy stakeholder dialogue that took place in 2017 and was focused on operationalizing a particular policy in Ontario, Canada intended to promote better local integration of health services. We report the overall recommendations arising from the dialogue, highlight tensions that arose during the discussion, and describe new policy developments that have occurred in Ontario since the introduction of the policy in question. We draw on the theory of collaborative governance to generate insights for managers and leaders intending to implement more integrated models of care under circumstances of unstable policy environments [3]. We conclude with comments on the importance of establishing a vision for the maintenance of collaborative initiatives even in circumstances where institutional realities might be changing. Background The term "integrated care" has been defined and used in different ways but is often understood as representing the effort to improve the quality of care for individual patients, service users and caregivers by ensuring that services are well coordinated around their needs across different care Introduction: Integrated care is a goal of many health care systems. However, operationalizing and implementing integrated care remains challenging especially in continuously evolving policy environments. We report on a policy symposium held in 2017 focused on operationalizing a particular integrated care policy in the context of policy evolution in Ontario, Canada. Methodology: Forty-five participants attended the symposium including government employees, health care leaders, researchers, clinicians, and patient representatives. The symposium included presentations from representatives of each group and breakout sessions. Two trained observers recorded observational field notes. Results: We report four recommendations and fourteen sub-recommendations which arose regarding the implementation of the policy. We highlight four important tensions which characterize challenges regarding its implementation, and discuss the recommendations in the context of Collaborative Governance. Discussion: We outline how the recommendations could be strengthened by collaborative governance and identify where this framework could support governance and leadership challenges associated with implementing integrated care. We describe the unique challenges posed by working towards these goals in an evolving policy environment. Conclusion: We draw on collaborative governance to generate insights for leaders implementing integrated care and conclude by addressing the importance of maintaining collaborative governance initiatives under circumstances of unstable policy environments.
Research Interests:
Although Canada is known as a liberal welfare regime, universality is a key issue in that country, as several major social programs are universal in both their core principles and coverage rules. The objective of this article is to... more
Although Canada is known as a liberal welfare regime, universality is a key issue in that country, as several major social programs are universal in both their core principles and coverage rules. The objective of this article is to discuss the meaning of universality and related concepts before exploring the development of individual universal social programs in Canada, with a particular focus on health care and old-age pensions. More generally, the article shows how universality can exist and become resilient within a predominantly liberal welfare regime due to the complex and fragmented nature of modern social policy systems, in which policy types vary from policy area to policy area, and even from program to program within the same policy area. The broader analysis of health care and old-age pensions as policy areas illustrates this general claim. This analysis looks at the historical development and the politics of provincial universal health coverage since the late 1950s and at the evolution of the federal Old Age Security program since its creation in the early 1950s. The main argument of this article is that universality as a set of principles remains stronger in health care than in pensions yet key challenges remain in each of these policy areas. Another contention is that there are multiple and contested universalisms in social policy.
Research Interests:
We investigated the availability of health system performance indicator data in Canada’s18 northern regions and the feasibility of using the performance framework developed by theCanadian Institute for Health Information [CIHI]. We... more
We investigated the availability of health system
performance indicator data in Canada’s18 northern
regions and the feasibility of using the performance framework developed by theCanadian Institute for Health Information [CIHI]. We examined the variation in 24 indicatorsacross regions and factors that might explain such variation. The 18 regions vary in populationsize and various measures of socioeconomic status, health-care delivery, and health status. Theworst performing health systems generally include Nunavut and the northern regions of Québec,Manitoba and Saskatchewan where indigenous people constitute the overwhelming majority ofthe population, ranging from 70% to 90%, and where they also fare worst in terms of adversesocial determinants. All northern regions perform worse than Canada nationally in hospitalisa-tions for ambulatory care sensitive conditions and potentially avoidable mortality. Populationsize, socioeconomic status, degree of urbanisation and proportion of Aboriginal people in thepopulation are all associated with performance. The North is far from homogenous. Inter-regionalvariation demands further investigation. The more intermediate pathways, especially betweenhealth system inputs, outputs and outcomes, are largely unexplored. Improvement of healthsystem performance for northern and remote regions will require the engagement of Indigenous leadership, communities and patient representatives
(PDF) The north is not all the same: comparing health system performance in 18 northern regions of Canada. Available from: https://www.researchgate.net/publication/337636905_The_north_is_not_all_the_same_comparing_health_system_performance_in_18_northern_regions_of_Canada [accessed Feb 05 2020].
performance indicator data in Canada’s18 northern
regions and the feasibility of using the performance framework developed by theCanadian Institute for Health Information [CIHI]. We examined the variation in 24 indicatorsacross regions and factors that might explain such variation. The 18 regions vary in populationsize and various measures of socioeconomic status, health-care delivery, and health status. Theworst performing health systems generally include Nunavut and the northern regions of Québec,Manitoba and Saskatchewan where indigenous people constitute the overwhelming majority ofthe population, ranging from 70% to 90%, and where they also fare worst in terms of adversesocial determinants. All northern regions perform worse than Canada nationally in hospitalisa-tions for ambulatory care sensitive conditions and potentially avoidable mortality. Populationsize, socioeconomic status, degree of urbanisation and proportion of Aboriginal people in thepopulation are all associated with performance. The North is far from homogenous. Inter-regionalvariation demands further investigation. The more intermediate pathways, especially betweenhealth system inputs, outputs and outcomes, are largely unexplored. Improvement of healthsystem performance for northern and remote regions will require the engagement of Indigenous leadership, communities and patient representatives
(PDF) The north is not all the same: comparing health system performance in 18 northern regions of Canada. Available from: https://www.researchgate.net/publication/337636905_The_north_is_not_all_the_same_comparing_health_system_performance_in_18_northern_regions_of_Canada [accessed Feb 05 2020].
Research Interests:
tCanada is the only Universal Health Insurance country in the OECD without universal insurance for outpa-tient prescription drugs, a situation generally perceived as unfair and inefficient. In June 2018, the federalgovernment launched an... more
tCanada is the only Universal Health Insurance country in the OECD without universal insurance for outpa-tient prescription drugs, a situation generally perceived as unfair and inefficient. In June 2018, the federalgovernment launched an Advisory Council on the Implementation of National Pharmacare, to report in2019 on the best strategy to implement a national Pharmacare program that would provide all Canadiansaccess to affordable outpatient prescription drugs. The Council was asked to consider three options: auniversal public plan for all Canadians; a public catastrophic insurance plan that would kick off oncespending on prescription drugs reaches a given threshold; and a more modest patching of existing gaps,providing coverage to those who are not eligible to any form of insurance. Beyond the relative consensusaround the ideas that gaps in coverage should be filled to make drugs affordable to all, and that the costsof drugs are too high in Canada, the Council faces the challenge of addressing three underlying issues:1) what amount of income redistribution will result from each of the three options; 2) how much sav-ings would the implementation of a single payer generate? 3) what role restricting a national formularywould play in achieving those savings, and what would be the political consequences of narrowing theformulary?
Research Interests:
In June 2018, the Federal Government of Canada created an Advisory Council on the Implementation of National Pharmacare, scheduled to report one year later on the best strategy to implement such a program and give Canadians access to... more
In June 2018, the Federal Government of Canada created an Advisory Council on the Implementation of National Pharmacare, scheduled to report one year later on the best strategy to implement such a program and give Canadians access to affordable prescription drugs outside of the hospital. The current state of coverage through employer-sponsored plans and public plans conditional on income and age is increasingly perceived as unfair and inefficient. The Council used a mixture of expert consultations, an online survey, and discussion forums for the general public to explore three options: a universal public plan, a catastrophic spending plan, or a patching of current coverage to include non-insured individuals. Creating such a Council was seen by the government as a solution for navigating a complex policy problem with difficult federal-provincial dimensions.
Research Interests:
A review article and meditation on the Canadian health system and its real vs. alleged failings.
Research Interests:
In this paper, we discuss the processes of policy layering as they relate to health care reform. We focus on efforts to achieve systems of coordinated primary care, and demonstrate that material change can be achieved through processes of... more
In this paper, we discuss the processes of policy layering as they relate to health care reform. We focus on efforts to achieve systems of coordinated primary care, and demonstrate that material change can be achieved through processes of incremental policy layering. Such processes also have a high potential for unintended consequences. Thus, we propose new principles of 'smart' policy layering to guide decision-makers to do incrementalism better. We then apply these principles to recent primary care reforms in Ontario, Canada. This paper conceptualizes 'smart' policy layering as a mechanism to achieve productive policy change in contexts with strong institutional barriers to reform.
Research Interests:
Snoring may be an important predictor of sleep-disordered breathing. Factors related to snoring among First Nations people are not well understood in a population with high rates of smoking and excess body weight. An... more
Snoring may be an important predictor of sleep-disordered breathing. Factors related to snoring among First Nations people are not well understood in a population with high rates of smoking and excess body weight. An interviewer-administered survey was conducted among 874 individual participants from 406 households in 2012 and 2013 in two Canadian First Nations communities. The survey collected information on demographic variables, individual and contextual determinants of respiratory health and snoring (classified as present versus absent) and self-reported height and weight. Multiple logistic regression analyses were conducted to examine relationships between snoring and potential risk factors adjusting for age and sex. Snoring was present in 46.2% men and 47.0% women. Considering body mass index, 259 people (30.3%) were overweight and 311 (36.4%) were considered obese. The combined current/former smoking rate was 90.2%. Being overweight, obesity, sinus trouble, current smoking status and former smoking were significantly associated with snoring. Exposure to home dampness and mold were suggestive of an association with snoring. To the degree that snoring may be a predictor of possible sleep-disordered breathing, these results indicate that environmental conditions such as smoking and home exposures may be important factors in the pathogenesis of these conditions.
Research Interests:
In Canada, Medicare refers to universal health coverage (UHC) programs admin- istered by provincial and territorial governments under broad national standards legislated and enforced by the federal government. Established in successive... more
In Canada, Medicare refers to universal health coverage (UHC) programs admin- istered by provincial and territorial governments under broad national standards legislated and enforced by the federal government. Established in successive steps over a quarter of a century, Medicare is the financed by the Government of Canada and the 13 provincial and territorial (PT) programs to provide full coverage for hospital, diagnostic, and medical care services. Since its inception, Medicare as an ideal has become an important dimension of the Canadian identity as well. Medicare has been a programmatic policy success based on the policy’s origi- nal objectives as conceived by successive federal governments and the originating provincial governments. Medicare has also been successful in establishing and maintaining a single-tier of hospital and medical care services, even though there have been numerous attempts to introduce a second private tier of services re- served for a minority of wealthier Canadians. Politically, it has been able to attract broad and steadfast support among the public. Over its life course, Medicare should be seen as a success in terms of endurance, too: it has preserved univer- sal access to necessary physician, hospital, and diagnostic services for no cost at the point of service for all Canadians. Moreover, it has done so through a decen- tralized system in which provincial and territorial governments pay the bills while preserving the portability of coverage for Canadians within the country. This chapter begins with a summary of the evolution of Medicare with a focus on the contingency of historical events during the discrete stages of Medicare’s evolu- tion, initially an against-the-odds accomplishment but one that eventually became a path-dependent policy norm in Canada. This historical section is followed by an analysis of the various components of Medicare’s enduring accomplishments as a program, as a policy process with public support, and as a contested political suc- cess. The chapter ends with a reflection on the policy lessons that can be drawn from Medicare’s success.
Research Interests:
A short policy article on the policy purpose of the Canada Health Transfer and how it can be transformed to better meet this purpose.
Research Interests:
In this chapter, Prime Minister St-Laurent's attitude towards, and handling of, the policy of universal hospital coverage is examined. St-Laurent was both uncertain as to the merits of this extension of the Canadian welfare state, and... more
In this chapter, Prime Minister St-Laurent's attitude towards, and handling of, the policy of universal hospital coverage is examined. St-Laurent was both uncertain as to the merits of this extension of the Canadian welfare state, and tried to undermine its achievement through requiring a double majority (majority of provinces with a majority of the population) before the federal government was prepared to implement the Hospital Insurance and Diagnostic Services Act of 1957.
Research Interests:
This chapter examines the history of the regulation of private finance in Canada, in particular the key decision points that would establish medicare's regulatory regime in two key areas. The first was the active contestation among... more
This chapter examines the history of the regulation of private finance in Canada, in particular the key decision points that would establish medicare's regulatory regime in two key areas. The first was the active contestation among provincial governments over a single-payer design versus a multi-payer design, and the ultimate selection of the latter as the dominant design. The second key area concerns hospital user charges and physician extra-billing as part of the medicare policies of selected provincial governments and their eventual elimination.
Research Interests:
The evolution of single-tier and single-payer medicare in Canada and its relationship with the conceptualizations of universality.
Research Interests:
The evolution of primary and secondary education in Canada in relation to the concept of universality.
Research Interests:
This chapter examines five decades of historical writing on, and myth-making about, the origins of Medicare, Canada’s public health-care system. It examines interpretations of the 1962 doctors’ strike in Saskatchewan, and its reception... more
This chapter examines five decades of historical writing on, and myth-making about, the origins of Medicare, Canada’s public health-care system. It examines interpretations of the 1962 doctors’ strike in Saskatchewan, and its reception and uptake among physician and citizen audiences. Within the medical profession, academic and professional elites have vied to capture attention from Canadian citizen-audiences. A pro-Medicare consensus, emergent in the 1960s and 1970s, was replaced in the early 2000s by a newly polarized view, critical of public health care, which reinterprets the history of the strike action as a form of justified public protest.
Research Interests:
In this chapter, I reflect on how social democratic goals and policies are actually achieved on the ground. In particular, I examine the means used by Allan Blakeney and his cabinet government to translate his party’s intentions and goals... more
In this chapter, I reflect on how social democratic goals and policies are actually achieved on the ground. In particular, I examine the means used by Allan Blakeney and his cabinet government to translate his party’s intentions and goals into workable policy programs that would change the economic and social directions of the province and influence progressive political change in the rest of Canada. I isolate Blakeney’s unique contributions to the art of government and indicate why I think they succeeded in turning social democratic policy objectives into effective and sustainable programs.
Research Interests:
This chapter explores the contribution of social democracy to the introduction and precise design of the policy of universal health coverage in Canada. The chapter was written by Erika Dyck and Greg Marchildon
Research Interests:
My personal reflections on the impact of the Caledon Institute of Social Policy on policy agenda setting and policy formulation in Canada
Research Interests:
Research Interests:
A biography of Canadian businessman W.D. Matthews (b. 1872, d. 1919) who was considered "one of the shrewdest business men in Canada" in the late 19th and early 20th centuries. He was one of Toronto's most notable financiers.
Research Interests:
Biography of Benjamin Franklin Pearson (b. 1855, d. 1912), a Canadian lawyer, financier and politician. Pearson was heavily involved in coal interests in Nova Scotia, in particular the Dominion Coal Company, as well as street railways in... more
Biography of Benjamin Franklin Pearson (b. 1855, d. 1912), a Canadian lawyer, financier and politician. Pearson was heavily involved in coal interests in Nova Scotia, in particular the Dominion Coal Company, as well as street railways in the Caribbean and Halifax.
Research Interests:
Graham Fraser (b. 1846, d. 1915) was a Canadian industrialist who established and directed the Nova Scotia Steel and Coal Company based in New Glasgow, Nova Scotia. After his resignation from Nova Scotia Steel and Coal, Fraser went to to... more
Graham Fraser (b. 1846, d. 1915) was a Canadian industrialist who established and directed the Nova Scotia Steel and Coal Company based in New Glasgow, Nova Scotia. After his resignation from Nova Scotia Steel and Coal, Fraser went to to manage the Dominion Iron and Still Company in Cape Breton, Nova Scotia.
Research Interests:
Biography of Robert Edward Harris (b. 1860, d. 1931), a Canadian lawyer, businessman and jurist. Harris was one of the first corporate lawyers in Nova Scotia where he specialized in corporate finance. He was the head of a law firm in... more
Biography of Robert Edward Harris (b. 1860, d. 1931), a Canadian lawyer, businessman and jurist. Harris was one of the first corporate lawyers in Nova Scotia where he specialized in corporate finance. He was the head of a law firm in Halifax that would eventually become the largest law firm (Stewart McKelvey) in the Atlantic region in the latter part of the 20th century. Harris would eventually become chief judge of the Supreme Court of Nova Scotia.
Research Interests:
Biography of James Drummond McGregor (b. 1838, d. 1918), a businessman and Liberal politician who an investor in, and for a short time, president of, the Nova Scotia Steel and Coal Co. based in New Glasgow, Nova Scotia.
Research Interests:
One of Canada's most prominent financiers of the late 19th and early 20th centuries, W.D. Matthews began his career in the flour, grain and malt business. He then moved into insurance, banking and the securities business. Based in... more
One of Canada's most prominent financiers of the late 19th and early 20th centuries, W.D. Matthews began his career in the flour, grain and malt business. He then moved into insurance, banking and the securities business. Based in Toronto, he became known as one of Canada's shrewdest businessmen.
Research Interests:
This is a biography of James Henry Plummer, banker and businessman; born 19 Feb. 1848 in Mary Tavy, England, died 10 Sept. 1932 in Toronto. Plummer was heavily involved in the Dominion Steel and Coal Company before and during the First... more
This is a biography of James Henry Plummer, banker and businessman; born 19 Feb. 1848 in Mary Tavy, England, died 10 Sept. 1932 in Toronto. Plummer was heavily involved in the Dominion Steel and Coal Company before and during the First World World. After the war, Plummer opposed Dominion Steel's merger into the British Empire Steel Corporation.
Research Interests:
A review of the Canadian health system with some emphasis on public health stewardship at the national level of government.
Research Interests:
This chapter reviews the history of drought in a region of Western Canada knowns as the Palliser Triangle From the time that agriculture was introduced in the last decades of the 19th century, drought has been a recurring feature.... more
This chapter reviews the history of drought in a region of Western Canada knowns as the Palliser Triangle From the time that agriculture was introduced in the last decades of the 19th century, drought has been a recurring feature. Focusing on the Dust Bowl of the 1930s, this chapter reviews the policy interventions of the day to extract some lesson for the future of the region in preparing for prolonged droughts that may be exacerbated by climate change.
Research Interests:
While governments are responsible for monitoring and evaluating health reforms and overall performance, this chapter explains why some of this function has shifted in recent years to specialized intergovernmental bodies, and increasingly,... more
While governments are responsible for monitoring and evaluating health reforms and overall performance, this chapter explains why some of this function has shifted in recent years to specialized intergovernmental bodies, and increasingly, to organizations and networks external to European countries and the federal and provincial governments in Canada. In particular, it examines academic networks that have emerged in response to the need for better comparative data analysis. Some attention is devoted to the potential impact of these academic networks.
Research Interests:
This chapter in the book - Bending the Cost Curve in Health Care - focuses on the experience of Saskatchewan and Manitoba in attempting to control costs and get better long-term value for money for provincial health expenditures.
Research Interests:
This chapter is a contribution to a textbook for 3rd and 4th year undergraduates taking health psychology courses in Canada and the United States. After describing health systems in the world with their differing financing, administrative... more
This chapter is a contribution to a textbook for 3rd and 4th year undergraduates taking health psychology courses in Canada and the United States. After describing health systems in the world with their differing financing, administrative and delivery arrangements, the chapter focuses on the role of health psychologists in North America. The second half of the chapter focuses on medical service misuse, adherence to medical care, cost offsets and patient satisfaction in the context of the Canadian and American health systems.
Research Interests:
With a population of 35 million people spread over a vast area, Canada is a highly decentralized federation. Provincial governments have most of the responsibility for the governance, organization and delivery of health services although... more
With a population of 35 million people spread over a vast area, Canada is a highly decentralized federation. Provincial governments have most of the responsibility for the governance, organization and delivery of health services although the Government of Canada has an important role in maintaining high level standards for universal health coverage through the Canada Health Act as well as pharmaceutical regulation, health research and data collection. With 70% of total health spending financed by federal, provincial and territorial governments, most are used to provide universal access to hospital and physicians services as well as more targeted coverage for prescription drugs and long-term care. In the last decade, provincial and territorial governments have focused on reorganizing their regional delivery systems and improving the quality, timeliness and patient experience with acute, chronic care and primary care medical services. While Canada's system of universal coverage for Medicare has been effective in providing deep financial protection, the narrow scope of coverage has resulted in gaps in coverage and equitable access.
Research Interests:
This chapter discusses the implications of climate change for food production from agriculture, fisheries and other non-commercial sources (including hunting and gathering), focusing on observed and potential impacts. Adaptation is... more
This chapter discusses the implications of climate change for food production from agriculture, fisheries and other non-commercial sources (including hunting and gathering), focusing on observed and potential impacts. Adaptation is discussed, with additional details provided through case studies that highlight the challenges and vulnerabilities of food production in Canada’s changing climate.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
This is one of a series of eight country essays on the place of responsibility, monitoring, and accountability in t health care systems prepared by scholars involved in the work of the European Observatory on Health Systems and Policies... more
This is one of a series of eight country essays on the place of responsibility, monitoring, and accountability in t health care systems prepared by scholars involved in the work of the European Observatory on Health Systems and Policies and its National Lead institutions network.
Research Interests:
Research Interests:
This chapter examines three successive phases of agricultural and settlement systems in the Special Areas of Alberta in the context of drought and other climate-induced stresses. Shifts between social-ecological systems are viewed through... more
This chapter examines three successive phases of agricultural and settlement systems in the Special Areas of Alberta in the context of drought and other climate-induced stresses. Shifts between social-ecological systems are viewed through the conceptual lens of institutional fit and interplay in seeking to explain the transition from range-based agriculture to intensive crop farming, and finally to a predominantly sedentary, grazing-based agricultural system. We contend that the Special Areas have enjoyed a high capacity for adaptation to external perturbation since the last major shift in land use, avoiding a wholesale social-ecological reorganization since the 1940s.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
This biography of Howard Pawley chronicles the achievements of, and the challenges facing, the second NDP Premier of Manitoba. This chapter also briefly reviews Pawley's earlier career in politics and his ascent to provincial New... more
This biography of Howard Pawley chronicles the achievements of, and the challenges facing, the second NDP Premier of Manitoba. This chapter also briefly reviews Pawley's earlier career in politics and his ascent to provincial New Democratic Party leader and summarizes his career after leaving office.
Research Interests:
This chapter covers health reform in Saskatchewan during successive NDP administrations from the election of the Roy Romanow government in 1991 until the defeat of the NDP and the election of the Saskatchewan Party in 2007.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
A survey of the role of two Royal Commission - the Royal Commission on Health Services (the Hall Commission) of 1961-64 and the Commission on the Future of Health Care in Canada (the Romanow Commission) of 2001-02 in setting the direction... more
A survey of the role of two Royal Commission - the Royal Commission on Health Services (the Hall Commission) of 1961-64 and the Commission on the Future of Health Care in Canada (the Romanow Commission) of 2001-02 in setting the direction of health policy.
Research Interests:
Research Interests:
Research Interests:
This chapter provides a historical review of the development of health system regionalization in Saskatchewan, Canada, including the original policy objectives as well as the outcomes from thisl health system reorganization.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
This chapter presents a history of the formation and use of central agencies in the machinery of government in postwar Saskatchewan.
Research Interests:
In the policy environment, the news media play a powerful and influential role, determining not only what issues are on the broad policy agenda, but also how the public and politicians perceive these issues. Ensuring that reporters and... more
In the policy environment, the news media play a powerful and influential role, determining not only what issues are on the broad policy agenda, but also how the public and politicians perceive these issues. Ensuring that reporters and editors have access to information, that is, credible and evidence-based is critical for stimulating healthy public discourse and constructive political debates. EvidenceNetwork.ca is a non-partisan web-based project that makes the latest evidence on controversial health-policy issues available to the Canadian news media. This article introduces EvidenceNetwork.ca, the benefits it offers to journalists and researchers, and the important niche it occupies in working with the news media to build a more productive dialogue around healthcare.
Research Interests: Public Opinion, Evidence Based Medicine, Political Science, Public Relations, Politics, and 12 moreKnowledge Transfer, Health Policy, Medicine, Scientific Journalism, Mass media, Canada, Humans, Journalism And Mass communication, News Media, Information Dissemination, Political Communication and Public Opinion, and Constructive
Research Interests:
Introduction: Accountable Care Organizations (ACOs), implemented in the United States (US), aim to reduce costs and integrate care by aligning incentives among providers and payers. Canadian governments are interested adopting such models... more
Introduction: Accountable Care Organizations (ACOs), implemented in the United States (US), aim to reduce costs and integrate care by aligning incentives among providers and payers. Canadian governments are interested adopting such models to integrate care, though comparative studies assessing the applicability and transferability of ACOs in Canada are lacking. In this comparative study, we performed a narrative literature review to examine how Canadian health systems could support ACO models. Methods: We reviewed empirical studies (published 2011–2020) that evaluated ACO impacts in the US. Thematic analysis and critical appraisal were performed to identify factors associated with positive ACO impacts. These factors were compared with the Canadian context to assess the applicability and transferability of ACO models within Canada. Findings: Physician-led models, global budgets and financial incentives, and focus on collaborative care may optimize ACO impacts. While reforms towards alternative payments and team-based care are not unprecedented in Canada, significant further reforms to physician remuneration, intersectoral collaboration, and accountability for performance are required to support ACO-like models. Conclusion: This comparative study uncovered several insights on the applicability and transferability of ACOs to the Canadian context. Further comparative research outside the US is needed to infer the essential components of successful ACO models.
Research Interests:
Abstract National responses to COVID-19 depend in part on national health care financing arrangements. Yet the pandemic itself has not only strained system capacity, it has – through subsequent economic shocks – strained revenue sources... more
Abstract National responses to COVID-19 depend in part on national health care financing arrangements. Yet the pandemic itself has not only strained system capacity, it has – through subsequent economic shocks – strained revenue sources that prop up these arrangements. In federal countries, fiscal pressures are particularly pronounced. As this paper argues, however, federal health financing regimes differ in ways that are shaping the agenda for post-pandemic reforms. The analysis, which focuses on health care financing in three federal countries (Canada, the United States, and Mexico), explores the current and potential future impact of COVID-19 on existing policy legacies.
Research Interests:
Patient-centred care is a key priority for governments, providers and stakeholders, yet little is known about the care preferences of patient groups. We completed a scoping review that yielded 193 articles for analysis. Five health states... more
Patient-centred care is a key priority for governments, providers and stakeholders, yet little is known about the care preferences of patient groups. We completed a scoping review that yielded 193 articles for analysis. Five health states were used to account for the diversity of possible preferences based on health needs. Five broad themes were identified and expressed differently across the health states, including personalized care, navigation, choice, holistic care and care continuity. Patients' perspectives must be considered to meet the diverse needs of targeted patient groups, which can inform health system planning, quality improvement initiatives and targeting of investments.
Research Interests:
Originally established as an expression of self-determination, Indigenous-governed health systems now play an important role in shaping the delivery of health programs and services in Canada. Operating in very diverse geographic,... more
Originally established as an expression of self-determination, Indigenous-governed health systems now play an important role in shaping the delivery of health programs and services in Canada. Operating in very diverse geographic, political and social contexts, these Indigenous health systems are highly heterogeneous. To better understand these differences, a typology is constructed based on three areas of decision-making space: governance rules, financing and accountability mechanisms. The nature of the relationship and in particular, the degree of control exercised by Indigenous communities over their respective health systems in relation to federal, provincial and territorial governments, is also assessed. The resulting five-level typology organizes Indigenous health systems into broad and strong control to moderate and narrow control. Although this typology is based on current governance arrangements, it nevertheless presents a baseline for the study of future innovations in Indigenous health systems as well as new types of provincial and territorial government engagement by Indigenous governments and organizations. Sommaire: Au Canada, les systèmes de santé dirigés par les Autochtones qui ont été initialement établis pour exprimer leur autodétermination, jouent maintenant un rôle important dans l'orientation de la prestation des programmes et services de santé. Ces systèmes de soins de santé autochtones fonctionnant dans des contextes géographiques, politiques et sociaux très variés sont extrêmement hétérogènes. Pour mieux comprendre ces différences, nous avons établi une typologie à partir de trois domaines d’entités décisionnelles : les règles de gouvernance, et les mécanismes de financement et d’imputabilité. Nous évaluons également la nature de la relation et particulièrement, le degré de contrôle exercé par les collectivités autochtones sur leurs systèmes de santé respectifs par rapport aux gouvernements fédéral, provinciaux et territoriaux. La typologie résultante à cinq niveaux organise les systèmes de santé autochtones allant d’un contrôle large et fort à un contrôle modéré et étroit. Quoique cette typologie soit fondée sur les modalités de gouvernance actuelles, elle présente néanmoins un point de comparaison pour l'étude d’innovations futures dans les systèmes de santé autochtones, ainsi que de nouveaux types d'engagement provinciaux et territoriaux par les gouvernements et organismes autochtones.
Research Interests:
Canada's experience with the coronavirus disease-2019 (COVID-19) pandemic has been characterized by considerable regional variation, as would be expected in a highly decentralized federation. Yet, the country has been beset by... more
Canada's experience with the coronavirus disease-2019 (COVID-19) pandemic has been characterized by considerable regional variation, as would be expected in a highly decentralized federation. Yet, the country has been beset by challenges, similar to many of those documented in the severe acute respiratory syndrome outbreak of 2003. Despite a high degree of pandemic preparedness, the relative success with flattening the curve during the first wave of the pandemic was not matched in much of Canada during the second wave. This paper critically reviews Canada's response to the COVID-19 pandemic with a focus on the role of the federal government in this public health emergency, considering areas within its jurisdiction (international borders), areas where an increased federal role may be warranted (long-term care), as well as its technical role in terms of generating evidence and supporting public health surveillance, and its convening role to support collaboration across the cou...
Research Interests:
In the history of social policy in advanced industrial societies, the 1942 Beveridge Report stands as one of the most influential government-sponsored reports ever published. In this article, we explore how the principles and the policy... more
In the history of social policy in advanced industrial societies, the 1942 Beveridge Report stands as one of the most influential government-sponsored reports ever published. In this article, we explore how the principles and the policy proposals formulated in the report diffused to other countries and how domestic actors adapted them to their local context through policy translation processes. The social policy ideas that Beveridge put forward in his 1942 report influenced post-war policy debates in ways that varied greatly from country to country. To illustrate this claim, we analyse the reception and policy impact of this report over time in three different welfare states: Canada, Denmark, and France. This comparison shows how Beveridge's ideas influenced policy debates in different countries through translation processes that adapted these ideas to each country's institutional and political context.
Research Interests: Sociology, Social Policy, Transnational and World History, Welfare State, Political Science, and 9 moreFrance, Public Policy - Social Welfare Policy, Denmark, Canada, Beveridge, Public Administration and Policy, Policy Diffusion, Social Policy and Administration, and Comparative/Transnational History
Patient safety is a complex systems issue. In this study, we used a scoping review of peer-reviewed literature and a case study of provincial and territorial legislation in Canada to explore the influence of mandatory reporting... more
Patient safety is a complex systems issue. In this study, we used a scoping review of peer-reviewed literature and a case study of provincial and territorial legislation in Canada to explore the influence of mandatory reporting legislation on patient safety outcomes in hospital settings. We drew from a conceptual model that examines the components of mandatory reporting legislation that must be in place as a part of a systems governance approach to patient safety and used this model to frame our results. Our results suggest that mandatory reporting legislation across Canada is generally designed to gather information about – rather than respond to and prevent – patient safety incidents. Overall, we found limited evidence of impact of mandatory reporting legislation on patient safety outcomes. Although legislation is one lever among many to improve patient safety outcomes, there are nonetheless several considerations for patient safety legislation to assist in broader system improvem...
Research Interests:
The coronavirus disease 2019 (COVID-19) pandemic has shifted the health policy debate in Canada. While the pre-pandemic focus of policy experts and government reports was on the question of whether to add outpatient pharmaceuticals to... more
The coronavirus disease 2019 (COVID-19) pandemic has shifted the health policy debate in Canada. While the pre-pandemic focus of policy experts and government reports was on the question of whether to add outpatient pharmaceuticals to universal health coverage, the clustering of pandemic deaths in long-term care facilities has spurred calls for federal standards in long-term care (LTC) and its possible inclusion in universal health coverage. This has led to the probability that the federal government will attempt to expand medicare as Canadians have known it for the first time in over a half century. However, these efforts are likely to fail if the federal government relies on the shared-cost federalism that marked the earlier introduction of medicare. Two alternative pathways are suggested, one for LTC and one for pharmaceuticals, that are more likely to succeed given the state of the Canadian federation in the early 21st century.
Research Interests:
Research Interests:
Research Interests:
Canada is the only Universal Health Insurance country in the OECD without universal insurance for outpatient prescription drugs, a situation generally perceived as unfair and inefficient. In June 2018, the federal government launched an... more
Canada is the only Universal Health Insurance country in the OECD without universal insurance for outpatient prescription drugs, a situation generally perceived as unfair and inefficient. In June 2018, the federal government launched an Advisory Council on the Implementation of National Pharmacare, to report in 2019 on the best strategy to implement a national Pharmacare program that would provide all Canadians access to affordable outpatient prescription drugs. The Council was asked to consider three options: a universal public plan for all Canadians; a public catastrophic insurance plan that would kick off once spending on prescription drugs reaches a given threshold; and a more modest patching of existing gaps, providing coverage to those who are not eligible to any form of insurance. Beyond the relative consensus around the ideas that gaps in coverage should be filled to make drugs affordable to all, and that the costs of drugs are too high in Canada, the Council faces the challenge of addressing three underlying issues: 1) what amount of income redistribution will result from each of the three options; 2) how much savings would the implementation of a single payer generate? 3) what role restricting a national formulary would play in achieving those savings, and what would be the political consequences of narrowing the formulary?
Research Interests:
Research Interests:
Research Interests: Business, Actuarial Science, Public Economics, Health Policy, Health Financing, and 12 moreHealth Reform, Medicine, Health Systems, Social health insurance, Pooling, Public Administration and Policy, Public health systems and services research, Conceptualization, National Health System, Universal Health Coverage, National Health Insurance, and Comparative Health Systems
Research Interests: Indigenous Studies, Canadian History, Health Care, Health Care Policy, Politics, and 12 moreHealth insurance, Health Policy, Medicine, Humans, Legislation, Healthcare policy, Public health systems and services research, Canadian Public Policy, North American Indians, Saskatchewan, Insurance Coverage, and Health Services Accessibility
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.... more
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.
Research Interests:
Research Interests:
This study compares climatological data for two climate extremes, severe drought and excessive moisture, to the experience and memories of agriculturalists based on extensive interviews with farmers and ranchers in the southern Great... more
This study compares climatological data for two climate extremes, severe drought and excessive moisture, to the experience and memories of agriculturalists based on extensive interviews with farmers and ranchers in the southern Great Plains of Canada. The climate data used were the Standardized Precipitation and Evapotranspiration Index. While differences are expected between these quantitative and qualitative sources due to the fact that there is often a gap between any extreme weather event and its impact, there was less difference than expected. However, these gaps are significant because politicians, policy makers and emergency preparedness planners do, or at least should, take into account the perceptions of those most directly affected by climate extremes and understand the instances. The findings confirm the importance of localized and experiential knowledge in climate change adaptation.
Research Interests: Psychology, Geography, Environmental Science, Flood Risk Management, Climate Change Adaptation, and 10 moreClimate change policy, Natural Hazards, Drought, Disaster Management, Climate Change Adaptation And Mitigation Strategies, Atmospheric sciences, Soil moisture, Drought and Water Stress, Drought Indicators/indices, and Public Policy
This chapter covers health reform in Saskatchewan during successive NDP administrations from the election of the Roy Romanow government in 1991 until the defeat of the NDP and the election of the Saskatchewan Party in 2007.
Research Interests:
This is a special guest issue of Canadian Public Administration devoted to the rise and presumed decline of universality in social policy with special emphasis on the Canadian experience. Considerable attention is paid to the... more
This is a special guest issue of Canadian Public Administration devoted to the rise and presumed decline of universality in social policy with special emphasis on the Canadian experience. Considerable attention is paid to the conceptualization and definition of universality as well as the historical trajectory of universality and the use of history in explaining such trends in public policy.
Research Interests: Public Administration, Social Policy, Fiscal federalism and decentralization, Public Policy - Social Welfare Policy, Conditional Cash Transfers, and 6 moreUniversal Coverage, Public Administration and Policy, Canadian Public Policy, Universal Health Coverage, Unconditional Cash Transfer, and Canadian Public Administration
Pain in older adults with dementia who reside in long-term care (LTC) facilities tends to be undertreated, despite important guidelines designed to ameliorate this problem. A group of public policy and geriatric pain experts recently... more
Pain in older adults with dementia who reside in long-term care (LTC) facilities tends to be undertreated, despite important guidelines designed to ameliorate this problem. A group of public policy and geriatric pain experts recently concluded that existing guidelines are not being implemented because they fail to take into account policy and resource realities. The group published a set of more feasible guidelines that confront these realities (e.g., a recommendation for very brief pain assessments that can be conducted by nursing staff at least weekly). We asked stakeholders to provide opinions on the possibility of implementation of these guidelines within their LTC facilities. Our results support the feasibility of, interest in, and desirability of implementation. They also support an increased role for nurse leadership in LTC pain management. These results could be used to strengthen advocacy efforts for improvement in pain management.
Research Interests:
Research Interests: Sociology, Primary Care, Health Promotion, Decision Making, Primary Health Care, and 15 moreHealth Care, Politics, Applied Research, Canadian Federalism, Public Health, Home Care, Health Systems, Human Development and Psychological Services, Newspaper, Mental Health Care, Full Text Vol 5, Canadian Health Policy, Public Policy, Psychology and Cognitive Sciences, and Canadian Psychology
Although Canada is known as a liberal welfare regime, universality is a key issue in that country, as several major social programs are universal in both their core principles and coverage rules. The objective of this article is to... more
Although Canada is known as a liberal welfare regime, universality is a key issue in that country, as several major social programs are universal in both their core principles and coverage rules. The objective of this article is to discuss the meaning of universality and related concepts before exploring the development of individual universal social programs in Canada, with a particular focus on health care and old-age pensions. More generally, the article shows how universality can exist and become resilient within a predominantly liberal welfare regime due to the complex and fragmented nature of modern social policy systems, in which policy types vary from policy area to policy area, and even from program to program within the same policy area. The broader analysis of health care and old-age pensions as policy areas illustrates this general claim. This analysis looks at the historical development and the politics of provincial universal health coverage since the late 1950s and at...
Research Interests: Social Policy, Welfare State, Health Care, Political Science, Politics, and 15 moreHealth Policy, Social Inclusion, Social Security, History of Social Policy and the Welfare State, Canada, Pension, Sozialpolitik, Canadian Public Policy, Wohlfahrtsstaat, Rente, Kanada, Public Policy, Social Expenditures, Gesundheitspolitik, and Gesundheitsversorgung
Research Interests:
Research Interests: Nursing, Social Work, Participatory Action Research, Leadership, Qualitative methodology, and 9 moreDelphi Methodology, Qualitative Methods, Qualitative Health Research, Qualitative Research, Health Services Research, Health Policy, Qualitative Research Methods, Healthcare Leadership, and Public health systems and services research
The ability to think in terms of a system is critical to achieving common direction, alignment, and commitment in highly distributed health systems. In Canada, provincial and territorial ministries of health provide leadership on the... more
The ability to think in terms of a system is critical to achieving common direction, alignment, and commitment in highly distributed health systems. In Canada, provincial and territorial ministries of health provide leadership on the direction of health reform while leadership to align system levels is determined by a far more distributed group of actors. There is a natural tension between organisational (or ‘tribal’) identity and loyalty and a system-wide loyalty and identity. A major research project in Canada reveals that the challenge for health system leaders is to find the most constructive balance within this tension.
Research Interests:
This article is the first major empirical test of LEADS in a Caring Environment, the principal leadership capability framework in Canada. The results rank the perceived salience of leadership attributes, given time and budget constraints,... more
This article is the first major empirical test of LEADS in a Caring Environment, the principal leadership capability framework in Canada. The results rank the perceived salience of leadership attributes, given time and budget constraints, while implementing a major organization reform in the Saskatchewan health system. The results also indicate important differences between self-assessed leadership behaviours versus observed behaviours in other leaders that may reflect participants' expectations of managers with designated authority.
Research Interests:
Le régime d'assurance-maladie, introduit dans les années 1960 comme un programme fédéral-provincial à coûts partagés, était conforme à l'idéologie du programme «Chances égales pour tous» du premier ministre Louis J. Robichaud. Le... more
Le régime d'assurance-maladie, introduit dans les années 1960 comme un programme fédéral-provincial à coûts partagés, était conforme à l'idéologie du programme «Chances égales pour tous» du premier ministre Louis J. Robichaud. Le Nouveau-Brunswick fut l'une des premières provinces canadiennes à appuyer l'adoption de l'assurance-maladie universelle, mais il fut la dernière province à la mettre en oeuvre. Cet article examine les négociations fédérales-provinciales entourant le programme d'assurance-maladie en vue de jeter un nouvel éclairage sur la portée du programme « Chances égales » de Robichaud, de réévaluer les dernières années de l'administration Robichaud et d'explorer pourquoi c'est le gouvernement progressiste-conservateur de Richard Hatfield qui fut responsable de la mise en oeuvre de l'assurance-maladie au Nouveau-Brunswick. Introduced as a federal-provincial cost-sharing program in the 1960s, medicare aligned ideologically with Prem...
Research Interests:
An amendment to this paper has been published and can be accessed via the original article.
Research Interests:
Dementia has significant social and economic impacts for those living with dementia and their caregivers. Despite an increase in prevalence of complex chronic conditions and dementia, long-term care services are continuously pushed out of... more
Dementia has significant social and economic impacts for those living with dementia and their caregivers. Despite an increase in prevalence of complex chronic conditions and dementia, long-term care services are continuously pushed out of institutional settings and into the home and community. The majority of people living with dementia in Canada and the United States (U.S.) live at home with support provided by family, friends, or other unpaid caregivers. Ten dementia care programs and service delivery models across five different North American jurisdictions in Canada and the U.S. are compared using a deductive analytical approach using a comparative policy framework developed by Richard Rose. The policy efforts included in this research attempt to improve health system flow and access for vulnerable populations. One common theme among all jurisdictions are long-standing institutional barriers that can make change difficult. These barriers can prevent the ability for systems to be...
An amendment to this paper has been published and can be accessed via the original article.
Research Interests:
Governments deploy comprehensive strategies to address complex social problems with various New Public Governance and horizontal initiatives. Minimal attention, however, has focused on developing evidence-informed strategy de- sign for... more
Governments deploy comprehensive strategies to address complex social problems with various New Public Governance and horizontal initiatives. Minimal attention, however, has focused on developing evidence-informed strategy de- sign for such initiatives. Using a systematic literature review, five strategy design principles were identified: 1) proper selection of interventions; 2) system enablers; 3) a guiding purpose; 4) substantive political commitment; and 5) joined-up gov- ernance. Three case studies including document review and interviews tested strat- egy design principles. Empirical work supported, expanded, and further refined these principles. Application of these principles would likely contribute to improv- ing the success of horizontal strategy initiatives. Real-world political pressures and public administration constraints can be somewhat alleviated through learnings from well-designed strategies and experiences. Sommaire : Les gouvernements utilisent des stratégies globales pour répondre à des problèmes sociaux complexes avec diverses initiatives horizontales et de la Nouvelles gouvernance publique. Néanmoins, ces initiatives n’ont recu que peu d’attention en ce qui concerne l’élaboration d’une conception stratégique fondée sur des données probantes. À l’aide d’un examen systématique de la littérature, nous avons identifié cinq principes de conception stratégique : 1) une sélection ap- propriée des interventions; 2) des facilitateurs du système; 3) un objectif directeur; 4) un engagement politique réel; et 5) une gouvernance conjointe. Trois études de cas comprenant un examen de documents et des entretiens ont testé les principes de conception stratégique. Ces principes ont été soutenus, élargis et affinés par des tra- vaux empiriques. L’application de ces principes contribuerait probablement à amé- liorer le succès des initiatives stratégiques horizontales. Les enseignements tirés de stratégies et d’expériences bien conçues peuvent pallier les pressions politiques du monde réel et les contraintes de l’administration publique.
Research Interests:
In the 1990s, regionalization was introduced in Canada through administrative delegation in order to achieve a number of reform objectives, but among the most important was to improve the integration of services across diverse health... more
In the 1990s, regionalization was introduced in Canada through administrative delegation in order to achieve a number of reform objectives, but among the most important was to improve the integration of services across diverse health sectors. Despite the failure of regionalization in fulfilling its promise of integration, regionalization still provides a foundation for achieving system-wide integration. For this to occur, however, regional and provincial health authorities need to be given the effective accountability for primary care. Given that primary healthcare physicians provide the majority of primary care in Canada, the funding for primary care physicians should be returned from provincial ministries of health to regional (or provincial) authorities in order to allow them the opportunity to become responsible for coordinating health services for their patient populations across the continuum of care, and to contract providers with the necessary incentives and penalties.
Research Interests:
Research Interests:
Despite its importance in Canada, the history of Medicare has rarely been examined by historians of medicine. Of the many possible reasons, three stand out. First is the political nature of the policy and the historical profession’shift... more
Despite its importance in Canada, the history of Medicare has rarely been examined by historians of medicine. Of the many possible reasons, three stand out. First is the political nature of the policy and the historical profession’shift from political history in recent decades. Second is the challenge posed in researching a complex public policy involving numerous administrative and financial instruments. Finally, there is the decentralized nature of the Canadian federation in which the history of Medicare belongs as much, if not more, to the provinces than a single, national-level government.
Research Interests:
Research Interests:
Annual time series (1905-2005) of agricultural statistics drawn from various sources. These statistics include size of farm population, size and number of farms, wheat production, prices and value, and farm incomes.
Research Interests:
Research Interests:
List of Illustrations Introduction and Overview Part I: General Considerations on Bending the Cost Curve 1. Why We Should Bend the Cost Curve and How We Could Do It Uwe Reinhardt 2. Financial Incentives and Pay-for-Performance Jeremiah... more
List of Illustrations Introduction and Overview Part I: General Considerations on Bending the Cost Curve 1. Why We Should Bend the Cost Curve and How We Could Do It Uwe Reinhardt 2. Financial Incentives and Pay-for-Performance Jeremiah Hurley and Jinhu Li 3. Tax Burdens and Aging John Richards and Colin Busby Part II: Pan-Canadian Cost Drivers and Political Considerations 4. Common Provincial Determinants and Cost Drivers Livio Di Matteo and J. C. Herb Emery 5. Pharmaceuticals Steven G. Morgan, Jamie R. Daw, and Paige A. Thomson 6. Paying the Health Workforce Phil Leonard and Arthur Sweetman 7. Three Federal Approaches to Cost Containment in Health Care Katherine Fierlbeck 8. The Federal Role in Health Care Pierre-Gerlier Forest Part III: Provincial Experiences in Canada 9. Ontario: Changing Policies, Changing Categories Raisa Deber and Sara Allin 10. Quebec: Sustainability-Perception and Reality Francois Beland and Claude Galand 11. British Columbia: Cost Control in the Country of the Red Queen Kimberlyn M. McGrail and Robert G. Evans 12. Alberta: Health Spending in the Land of Plenty Stephen Duckett 13. Saskatchewan and Manitoba: Managing Down Gregory P. Marchildon 14. Atlantic Canada: The Impact of Aging on the Cost Curve Joe Ruggeri Part IV: What Can Canada Learn from the International Evidence? 15. The United States Gerard Anderson 16. Australia Stephen Duckett 17. England Alan Maynard 18. Nordic Countries Jon Magnussen 19. Taiwan and Other Advanced Asian Economies Tsung-Mei Cheng Index
Research Interests:
Research Interests:
Research Interests:
Research Interests:
This presentation examines six lessons that policy makers in the United States can draw from the Canadian model of universal health coverage known as Medicare (not to be confused with Medicare in the US).
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
This is a book review of "Medicare's Histories: Origins, Omissions, and Opportunities in Canada" published by the University of Manitoba Press in 2002.
Research Interests:
This is a book review of Charles Williams' biography of Lord Beaverbrook covering his life in Canada and Britain and his work as a financier, press baron, politician and backroom advisor. The review can be found online at:... more
This is a book review of Charles Williams' biography of Lord Beaverbrook covering his life in Canada and Britain and his work as a financier, press baron, politician and backroom advisor. The review can be found online at: https://cbha-acha.ca/wp-content/uploads/2021/02/MarchildonRevWilliams21.R3.pdf
Research Interests:
Summary provincial statistics including population, gross domestic product (GDP), GDP per capita, provincial revenue, personal income per capita, provincial expenditures, and provincial debt.
Research Interests:
Summary provincial statistics including population, gross domestic product (GDP), GDP per capita, provincial revenue, personal income per capita, provincial expenditures, and provincial debt.
Research Interests:
Summary provincial statistics including population, gross domestic product (GDP), GDP per capita, provincial revenue, personal income per capita, provincial expenditures, and provincial debt.
Research Interests:
Annual time series (1905-2005) of agricultural statistics drawn from various sources. These statistics include size of farm population, size and number of farms, wheat production, prices and value, and farm incomes.
Research Interests:
Annual time series (1905-2005) of agricultural statistics drawn from various sources. These statistics include size of farm population, size and number of farms, wheat production, prices and value, and farm incomes.
Research Interests:
Annual time series (1905-2005) of agricultural statistics drawn from various sources. These statistics include size of farm population, size and number of farms, wheat production, prices and value, and farm incomes.
Research Interests:
In Nepal, there has been some resistance to the new system of federalism by stakeholders and the bureaucracies within some ministries, especially in health and education, to the point that they have tried to reverse the devolution of... more
In Nepal, there has been some resistance to the new system of federalism by stakeholders and the bureaucracies within some ministries, especially in health and education, to the point that they have tried to reverse the devolution of authority and resources. The reasons for this likely go well beyond a questions of position and power but may involve perceptions, whether accurate or not, of the ability of provincial and local levels of government to carry out their new responsibilities. Whatever the motives behind this resistance, the consequence of this has been to stall the implementation of a federalized system of healthcare. The purpose of this think piece is to propose a potential way to address the current deadlock by examining the decision space, capacity and accountability of subnational governments in Nepal.
Research Interests:
This is the final report of the Independent Expert Panel reviewing the health and social programs and services in Yukon, Canada. The five member panel included Bruce McLennan (Chair), George Green, Greg Marchildon, Diane Strand and... more
This is the final report of the Independent Expert Panel reviewing the health and social programs and services in Yukon, Canada. The five member panel included Bruce McLennan (Chair), George Green, Greg Marchildon, Diane Strand and Jennifer Zelmer. The report contains a large number of recommended changes including a major health system inspired in party by the Nuka model of care developed in Alaska by the Southcentral Foundation.
Research Interests:
This report was prepared by the European Observatory on Health Systems and Policies in response to a request of the United Kingdom Department of Health. It provides a comparative overview of several domains of patient information in the... more
This report was prepared by the European Observatory on Health Systems and Policies in response to a request of the United Kingdom Department of Health. It provides a comparative overview of several domains of patient information in the following 10 countries: Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and the United States.
The report explores:
• whether there is an overall rating for quality and safety for every major hospital, every GP practice, every residential care provider and every domiciliary care provider
• whether outcomes of individual doctors are published with regard to mortality and GP outcomes
• whether data on referral to treatment times is published for every major hospital
• whether data on patient experience of hospital and GP services are published for every provider (hospital, GP practice)
• whether patients can access their medical records online and (ii) there is a single patient record across whole system (including both primary and secondary/hospital care data)
Some caution is necessary when interpreting the findings presented here. The information was collected at very short notice and may not be fully complete or accurate.
The report explores:
• whether there is an overall rating for quality and safety for every major hospital, every GP practice, every residential care provider and every domiciliary care provider
• whether outcomes of individual doctors are published with regard to mortality and GP outcomes
• whether data on referral to treatment times is published for every major hospital
• whether data on patient experience of hospital and GP services are published for every provider (hospital, GP practice)
• whether patients can access their medical records online and (ii) there is a single patient record across whole system (including both primary and secondary/hospital care data)
Some caution is necessary when interpreting the findings presented here. The information was collected at very short notice and may not be fully complete or accurate.
Research Interests:
The is a study of the underlying drivers of health care costs in Canada, mainly focusing on the periods from 1998 until 2008. This report should be used as a companion to the Canadian Institute for Health Informations's annual report on... more
The is a study of the underlying drivers of health care costs in Canada, mainly focusing on the periods from 1998 until 2008. This report should be used as a companion to the Canadian Institute for Health Informations's annual report on national health expenditure trends.
Research Interests:
Research Interests:
This is the final report of the Royal Commission on the Future of Health Care in Canada - commonly known as the Romanow Commission.Taken together, the 47 recommendations contained in this report serve as a roadmap for a collective journey... more
This is the final report of the Royal Commission on the Future of Health Care in Canada - commonly known as the Romanow Commission.Taken together, the 47 recommendations contained in this report serve as a roadmap for a collective journey by Canadians to reform and renew their health care system. They outline actions that must be taken in 10 critical areas, starting by renewing the foundations of Canadian medicare.
Research Interests:
Canada is a laggard when it comes to providing public funding for dental care, ranking close to the bottom of OECD countries. However, the federal government's proposed $13-billion Canadian Dental Care Plan could change that. This paper... more
Canada is a laggard when it comes to providing public funding for dental care, ranking close to the bottom of OECD countries. However, the federal government's proposed $13-billion Canadian Dental Care Plan could change that. This paper calls the plan a major step forward in reforming dental care but argues that the "payer of last resort model" the government has chosen to implement falls short. It identifies four broad policy goals that should guide future reform of dental care and six possible options for achieving them. It calls for the government to move toward implementing universal dental care coverage for a limited core of essential dental services and argues that the best way to achieve it is through the creation of a federally funded arm's-length agency.
Research Interests:
The response to an emergency, such as the COVID-19 pandemic, can be particularly complex in federated systems as the federal and subnational governments often share responsibility for public health, and the level of coordination and... more
The response to an emergency, such as the COVID-19 pandemic, can be particularly complex in federated systems as the federal and subnational governments often share responsibility for public health, and the level of coordination and collaboration required to protect and preserve public health is even more acute during such emergencies. For decades, information sharing across governments in Canada has been identified as a critical constraint in ensuring optimal decision-making and citizen outcomes. Other federations face similar challenges and have achieved various levels of success with implementing national public health surveillance drawing on subnational data. This rapid review aims to draw lessons for Canada from other federations and quasi-federations (in the case of UK) on the governance of COVID-19 vaccine data, with a view of compiling and standardizing subnational data at the national level. We conducted rapid comparative case studies of four jurisdictions (Germany, Australia, Switzerland, and the UK), which included an environmental scan of the literature with validation by local experts
Research Interests:
Latin America and the Caribbean (LAC) accounts for over a quarter of the world’s total cases, and a third of the total deaths, from the COVID-19 pandemic (1-3) (4). In the absence of a vaccine to prevent the transmission of the virus,... more
Latin America and the Caribbean (LAC) accounts for over a quarter of the world’s total cases, and a third of the total deaths, from the COVID-19 pandemic (1-3) (4). In the absence of a vaccine to prevent the transmission of the virus, LAC countries have introduced several public health, health system, and economic policies to reduce the spread and impacts of COVID-19 (4,5). However, contextual factors such as fragmented health systems, limited social safety nets, and high levels of informal employment and inequality have further challenged the response to the pandemic in many of these countries (4,6,7). Furthermore, these underlying conditions intensify the impact of COVID-19, particularly for the most disadvantaged, including the unemployed, informal, and low-income workers, many of whom live in overcrowded households (4,7). In this study, we aim to describe policy interventions in 10 LAC countries in response to the COVID-19 pandemic, to compare these responses based on the experiences in two relatively high-performing jurisdictions, South Korea and Uruguay, and to support cross-jurisdictional policy learning for pandemic preparedness in the LAC region through knowledge exchange activities.
Research Interests:
A review of COVID-19 case and contact management strategies in Canada that examines: workforce capacity; skills and training; case identification and management; contact identification and management; and various technologies for case and... more
A review of COVID-19 case and contact management strategies in Canada that examines: workforce capacity; skills and training; case identification and management; contact identification and management; and various technologies for case and contact management.
Research Interests:
A report from the Broadbent Institute in Canada that makes the case for incorporating community mental health, long-term care and pharmacare into universal health coverage in Canada
Research Interests:
The North American COVID-19 policy monitor has been designed to collect and organize up-to-date information on how jurisdictions are responding to the crisis, in this case the province of New Brunswick, Canada. It summarizes responses of... more
The North American COVID-19 policy monitor has been designed to collect and organize up-to-date information on how jurisdictions are responding to the crisis, in this case the province of New Brunswick, Canada. It summarizes responses of health systems as well as wider public health initiatives. The North American policy monitor is an offshoot of the international COVID-19 Health System Response Monitor (HSRM), a joint undertaking of the WHO Regional Office for Europe, the European Commission and the European Observatory on Health Systems and Policies. Canadian content to HSRM is contributed by the North American Observatory on Health Systems and Policies (NAO).
Research Interests:
The North American COVID-19 policy monitor has been designed to collect and organize up-to-date information on how jurisdictions in Canada are responding to the crisis. It summarizes responses of health systems as well as wider public... more
The North American COVID-19 policy monitor has been designed to collect and organize up-to-date information on how jurisdictions in Canada are responding to the crisis. It summarizes responses of health systems as well as wider public health initiatives. This study focuses on the province of Manitoba. The North American policy monitor is an offshoot of the international COVID-19 Health System Response Monitor (HSRM), a joint undertaking of the WHO Regional Office for Europe, the European Commission and the European Observatory on Health Systems and Policies. Canadian content to HSRM is contributed by the North American Observatory on Health Systems and Policies (NAO).
Research Interests:
The aim of this report was to summarize the review literature (e.g., systematic reviews, scoping reviews, and literature reviews) to identify best practices for using technologies to support health care in rural communities.
Research Interests:
Patient safety in the hospital setting is a major public health challenge. Mandatory reporting legislation is key to gathering information about – and learning from – patient safety incidents. This Rapid Review highlights a gap between... more
Patient safety in the hospital setting is a major public health challenge. Mandatory reporting legislation is key to gathering information about – and learning from – patient safety incidents. This Rapid Review highlights a gap between the gathering of patient safety data and the ability of regulators, professionals, and other stakeholders to learn from such data to prevent future harm. We provide an assessment of patient safety monitoring across Canadian jurisdictions and conclude by offering five workable proposals to improve the governance and utilization of patient safety data to best protect patients.
Research Interests:
Given that Electronic Medical Records (EMRs) and related information technologies are a large component of high-performing healthcare systems and there remains very little progress towards territorial, provincial, or national EMR systems,... more
Given that Electronic Medical Records (EMRs) and related information technologies are a large component of high-performing healthcare systems and there remains very little progress towards territorial, provincial, or national EMR systems, this rapid review seeks to understand the outcomes associated with EMR use, the barriers towards implementation, and strategies for encouraging adoption.
Research Interests:
The creation of Ontario Health Teams represents a major shift towards integrated care across the health system in the province. Integrated models of care intend to improve the care experiences of people and providers as well as the... more
The creation of Ontario Health Teams represents a major shift towards integrated care across the health system in the province. Integrated models of care intend to improve the care experiences of people and providers as well as the outcomes of care for populations across the care continuum. Approaches to integrate care involve a number of organizations and providers, often with an organization or a group of providers acting as the lead of the integration effort. This rapid review aims to understand the role that hospitals can play as lead integrators of care delivery models that span multiple sectors.
Research Interests:
This review compares Yukon’s health system performance with other northern regions, including: Labrador, Saguenay (QC), Côte-Nord (QC), Nord (QC), Nunavik (QC), Baie-James (QC), Northwestern (ON), Porcupine (ON), Thunder Bay (ON),... more
This review compares Yukon’s health system performance with other northern regions, including: Labrador, Saguenay (QC), Côte-Nord (QC), Nord (QC), Nunavik (QC), Baie-James (QC), Northwestern (ON), Porcupine (ON), Thunder Bay (ON), Northern (MB), Mamawetan (SK), Keewatin (SK), Athasbasca (SK), North Zone (AB), Northwest (BC), North-Interior (BC), Northeast (BC), the Northwest Territories, Nunavut, and Yukon.
Research Interests:
Research Interests:
This rapid review summarises and assesses the review literature to identify key attributes that are associated with high-performing care provided closer to home
Research Interests:
his rapid review updates the previous rapid review (no. 9) and sets out to address three broad objectives: to identify the key factors and mechanisms involved in ACOs that have demonstrated success; to consider lessons learned from the... more
his rapid review updates the previous rapid review (no. 9) and sets out to address three broad objectives: to identify the key factors and mechanisms involved in ACOs that have demonstrated success; to consider lessons learned from the perspectives of providers working in ACOs; and to conduct an appraisal of the evaluative literature.
Research Interests:
This report examines the experiences of the U.S., U.K., and France with respect to the use of regulatory waivers or administrative agreements. This report summarizes the experience of regulatory permissiveness as a way to offer... more
This report examines the experiences of the U.S., U.K., and France with respect to the use of regulatory waivers or administrative agreements. This report summarizes the experience of regulatory permissiveness as a way to offer time-limited leniency from statutory or regulatory requirements to implement innovative programs and delivery models. It concludes with lessons learned for the Ontario context.
Research Interests:
This rapid review describes the current landscape of province-wide services in Canada, including the following two, often distinct, categories of services: 1) health and clinical services; and (2) shared back-office administrative... more
This rapid review describes the current landscape of province-wide services in Canada, including the following two, often distinct, categories of services: 1) health and clinical services; and (2) shared back-office administrative services, including information technology, payroll and some human resources (HR) functions. We aim to shed light on the approaches provincial governments have taken to centralize health services and administrative functions in provincial arm’s-length organizations.
Research Interests:
This rapid review intended to address three broad objectives: to characterize public ACOs, in particular their approach to shared savings and financial risk, accountability and monitoring, as well as funding and incentive mechanisms; to... more
This rapid review intended to address three broad objectives: to characterize public ACOs, in particular their approach to shared savings and financial risk, accountability and monitoring, as well as funding and incentive mechanisms; to synthesize the results of evaluations of ACOs conducted between 2015-2018 in the US; and to explore initiatives across Canada with respect to implementing ACO-like models based on criteria identified in objective one.
Research Interests:
Assistive technologies or devices have been defined as any piece of equipment or products that are used to maintain or improve an individual’s functional capabilities. Coverage of assistive technologies (ATs) has been shaped by two... more
Assistive technologies or devices have been defined as any piece of equipment or products that are used to maintain or improve an individual’s functional capabilities. Coverage of assistive technologies (ATs) has been shaped by two different policy regimes—disability policy and health policy. However, high-income jurisdictions have varying approaches to coverage for assistive technologies with differences in the eligibility, types of devices covered, and cost-sharing approaches. These rapid reviews compare coverage policies in eight countries (Australia, Canada, Germany, Italy, the Netherlands, New Zealand, Norway, the United Kingdom) for four categories of ATs. The following rapid reviews involve an in-depth assessment of programs within each jurisdiction using a common definition of ATs and a core set of questions. In more broadly drawn universal health coverage (UHC) systems, such as the five western European countries, ATs tend to be part of UHC although patient contributions are also common albeit based on different rationales. In the more narrowly drawn UHC systems in Canada, Australia, and New Zealand, ATs tend to be part of separate extended health benefit programs and are accompanied by user fees and access restrictions. All systems have reasonably strict rules on eligibility for coverage in terms of proving disability although they vary in the requirement on the permanence of the disability.
Research Interests:
ssistive devices aim to provide individuals with tools that can support the management of their health and social needs. These devices are often used to support hospital discharge, maintain independence in the home, and to support active... more
ssistive devices aim to provide individuals with tools that can support the management of their health and social needs. These devices are often used to support hospital discharge, maintain independence in the home, and to support active participation at home, work, and in the community. Given that the proportion of older adults in Canada is growing (Statistics Canada, 2014) and assistive devices usage increases with age (Statistics Canada, 2015), we can expect increased pressure for public funding and/or provision of assistive devices. Despite the acknowledged value of having access to assistive devices, the degree to which provinces and territories (P/T) publicly support such access varies. How decisions are made are then a result of two imperatives: the first a consequence of the democratic process where decisions are made on the basis of unique interest group pressures, politics and historical policies within individual jurisdictions; the second on the basis more technocrat recommendations through deliberate processes (e.g. health technology assessments) based on clinical and cost effectiveness analyses. This review looks to identify all Canadian jurisdictions that offer publicly supported assistive devices programs and to identify program characteristics, including: program mandates, eligibility criteria, types of devices included/excluded, how decisions to include/exclude are made, the funding mechanisms used (private insurance, user fees, public insurance, a mix), and how the funding approaches are decided.
Research Interests:
Research Interests:
Research Interests:
The public sector in Canada arrived late to the quality improvement (QI) movement compared to the United States and United Kingdom. In 2002, both the Kirby and Romanow Reports called for greater accountability for quality of care.... more
The public sector in Canada arrived late to the quality improvement (QI) movement compared to the United States and United Kingdom. In 2002, both the Kirby and Romanow Reports called for greater accountability for quality of care. following the Romanow Report’s recommendation for a pan-Canadian council to regularly assess health system performance, including QI, the 2003 First Ministers’ Accord on Health Care Renewal established the Health Council of Canada. Fifteen years later, the Health Council of Canada is no longer operating[1] but five provincial quality councils have been established. There is no shared definition of healthcare QI in Canada. Quality improvement has been described as a strategic philosophy or culture focused on systematically embedding quality into daily practice. Forging a common language and shared direction is necessary if Canada is to achieve equitable, quality healthcare for all its citizens. This is particularly relevant in today’s era, marked by the United Nations Declaration on the Rights of Indigenous Peoples, the Truth and Reconciliation Commission’s Calls to Action, and the health disparities that exist between Indigenous and non-Indigenous peoples living in Canada. With this rapid review, we provide a broad understanding of quality councils and QI activities throughout Canada—their structural features, mandates, and roles. We also identify complementarities as well as suggest some potential opportunities for collaboration across jurisdictional lines.
Research Interests:
A previous rapid review of all 13 provincial/territorial jurisdictions in Canada identified Ontario, Manitoba, Alberta, and the Northwest Territories as being the most innovative in pursuing primary care reform over the last decade... more
A previous rapid review of all 13 provincial/territorial jurisdictions in Canada identified Ontario, Manitoba, Alberta, and the Northwest Territories as being the most innovative in pursuing primary care reform over the last decade (Peckham, Ho, & Marchildon, 2018). The purpose of the present rapid review was to explore these jurisdictions in greater depth. We rely on available public indicators and expert advice to determine how jurisdictions have improved access to after-hours care; worked to offer a broader scope of services through access to interdisciplinary teams; and improved communication and coordination through information technology and electronic medical records (EMRs) accessible to health and social service providers as well as patients and caregivers.
Research Interests:
Virtual care is increasingly recognized as a vital component of high-quality healthcare and may hold promise in strengthening access to primary care in northern, rural, and remote areas of Canada. In Canada, as seen around the world, the... more
Virtual care is increasingly recognized as a vital component of high-quality healthcare and may hold promise in strengthening access to primary care in northern, rural, and remote areas of Canada. In Canada, as seen around the world, the adoption of virtual care has accelerated as part of health system responses to COVID-19. Though the northern, rural, and remote regions of Canada may benefit from the improved access, satisfaction, and convenience that may come with virtual care, little is known about the key features of virtual care or the specific considerations for its effective implementation that will support enhanced access to primary care in these contexts. This rapid review sheds light on these features and considerations with the aim of supporting the effective and appropriate scale up of promising virtual care practices in the North, and other rural and remote communities across Canada. This review of the literature, combined with expert interviews with researchers and practitioners, uncovered several potential and realized benefits of virtual care. These include increased accessibility, continuity of care, cost effectiveness, better health outcomes for patients, greater provider satisfaction, and equity. However, with regard to equity, there were concerns that virtual care could exacerbate inequities in access and outcomes unless sufficient attention is paid to the needs, experiences, and availability of the necessary technologies across all communities.
Research Interests:
The North American COVID-19 policy monitor has been designed to collect and organize up-to-date information on how jurisdictions are responding to the crisis. It summarizes responses of health systems as well as wider public health... more
The North American COVID-19 policy monitor has been designed to collect and organize up-to-date information on how jurisdictions are responding to the crisis. It summarizes responses of health systems as well as wider public health initiatives. The North American policy monitor is an offshoot of the international COVID-19 Health System Response Monitor (HSRM), a joint undertaking of the WHO Regional Office for Europe, the European Commission and the European Observatory on Health Systems and Policies. Canadian content to HSRM is contributed by the North American Observatory on Health Systems and Policies (NAO). This report is on the province of Newfoundland and Labrador.
Research Interests:
The North American COVID-19 policy monitor has been designed to collect and organize up-to-date information on how jurisdictions are responding to the crisis. It summarizes responses of health systems as well as wider public health... more
The North American COVID-19 policy monitor has been designed to collect and organize up-to-date information on how jurisdictions are responding to the crisis. It summarizes responses of health systems as well as wider public health initiatives. The North American policy monitor is an offshoot of the international COVID-19 Health System Response Monitor (HSRM), a joint undertaking of the WHO Regional Office for Europe, the European Commission and the European Observatory on Health Systems and Policies. Canadian content to HSRM is contributed by the North American Observatory on Health Systems and Policies (NAO).
Research Interests:
In this rapid review, we sought to understand how select jurisdictions have been able to contain the COVID-19 pandemic and begin transitioning to more relaxed public health measures through the use of testing, case management, and contact... more
In this rapid review, we sought to understand how select jurisdictions have been able to contain the COVID-19 pandemic and begin transitioning to more relaxed public health measures through the use of testing, case management, and contact tracing. We are particularly interested in the role of digital contact tracing tools. The results of this rapid review will provide detailed information and evidence (as of May 2020) that may help inform COVID-19 recovery strategies.
Research Interests:
While there is widespread support for a national single payer plan, there has been little consensus about a specific detailed policy architecture and role for the federal government. There are two possible ways to achieve single payer... more
While there is widespread support for a national single payer plan, there has been little consensus about a specific detailed policy architecture and role for the federal government. There are two possible ways to achieve single payer Pharmacare in Canada. One is through 13 provincialterritorial program in which the federal government provides funding to the provinces and sets national standards, perhaps through the Canada Health Act, or through separate legislation. In return for the cash transfer, which would likely only cover incremental costs, PT governments would agree to provide universal coverage to their residents for an agreed upon schedule of medically necessary pharmaceuticals. The second major option is a federally financed, regulated and administered Pharmacare program. This is constitutionally feasible because of the federal government’s current jurisdiction over drug safety, price regulation and patent protection. While it is generally assumed that federalism and provincial jurisdiction over health stand in the way of a federal government public single payer program, the provinces have supported this option in the past, with the caveat that special arrangements may have to be made for Quebec. On balance, we see considerable advantages for the second option. Strong federal leadership is needed to make Pharmacare a reality, because it is far from clear that expanding public health insurance is a current priority for all provinces. Fiscal capacity varies a great deal between the provinces but the federal government has the fiscal means to act if it finds the political will to do so. The federal tax system could be used to recoup some of the cost savings of employers, workers and individuals which would result from a more cost efficient single-payer plan. A federal program would make it easier to establish a national drug formulary and to achieve the savings of co-ordinated drug purchasing. Finally, a federal Pharmacare plan could be implemented more quickly.
Research Interests:
Health care is one of the most financially onerous and contested social policy responsibilities of governments in the early 21st century. We conducted a multi-country study on federalism and decentralization in the governance, financing,... more
Health care is one of the most financially onerous and contested social policy responsibilities of governments in the early 21st century. We conducted a multi-country study on federalism and decentralization in the governance, financing, administration or delivery of health care based on a decision space approach. Our contributors examined Switzerland, Canada, Germany, Pakistan, SouthAfrica, Brazil, Mexico and Nigeria. This particular selection offered a broad range of different approaches to federalism and health system decentralization upon which to draw policy lessons.
Research Interests:
Health care is one of the most financially onerous and contested social policy responsibilities of governments in the early 21st century. We conducted a multi-country study on federalism and decentralization in the governance, financing,... more
Health care is one of the most financially onerous and contested social policy responsibilities of governments in the early 21st century. We conducted a multi-country study on federalism and decentralization in the governance, financing, administration or delivery of health care based on a decision space approach. Our contributors examined Switzerland, Canada, Germany, Pakistan, SouthAfrica, Brazil, Mexico and Nigeria. This particular selection offered a broad range of different approaches to federalism and health system decentralization upon which to draw policy lessons.
Research Interests:
Le présent document porte sur l’état de la réforme des soins primaires dans l’ensemble du Canada. Dans le cadre de ce survol, nous définissions les soins de santé primaires comme les soins quotidiens prodigués par un médecin ou un autre... more
Le présent document porte sur l’état de la réforme des soins primaires dans l’ensemble du Canada. Dans le cadre de ce survol, nous définissions les soins de santé primaires comme les soins quotidiens prodigués par un médecin ou un autre fournisseur de soins de santé qualifié. Les fournisseurs de soins primaires sont le premier point de contact du patient avec le système de santé et ils fournissent des soins continus, y compris l’aiguillage vers d’autres prestataires plus spécialisés, les tests diagnostiques et l’accès aux médicaments délivrés sur ordonnance. Nous visons à déterminer quels territoires de compétence ont été les plus novateurs en matière de soins primaires au cours de la dernière décennie. Pour évaluer le degré de progrès réalisés dans chaque territoire de compétence, nous avons utilisé six critères fondés sur des données probantes tirées de la littérature scientifique internationale et de l’environnement institutionnel canadien. Ces critères ont été retenus, car ils sont des composantes nécessaires pour rendre les soins primaires plus efficaces et plus efficients et ils contribuent à l’amélioration du rendement des systèmes de santé.
Research Interests:
This review explores the state of primary care reform across Canada. For this review we define primary care as being the day-to-day care that is provided by a physician or other qualified health care provider. Primary care providers are... more
This review explores the state of primary care reform across Canada. For this review we define primary care as being the day-to-day care that is provided by a physician or other qualified health care provider. Primary care providers are expected to be a patient’s first point of contact with the health system and should provide on-going, continuous care including referrals to other, more specialized providers, diagnostic testing and access to prescription drug therapies. We aim to elicit which jurisdictions have progressed primary care most innovatively through the last decade. To evaluate the degree of progress achieved in each jurisdiction, we have used six evidence-based criteria derived from the international scholarly literature and the institutional environment in Canada. These criteria are identified as necessary components for more effective and efficient primary care and its contribution to higher performing health systems.
Research Interests:
The purpose of the Leadership and Health System Redesign research study was to explore the leadership dynamics at play in Canadian health reform and to develop leadership capacity in the Canadian health system through applied research and... more
The purpose of the Leadership and Health System Redesign research study was to explore the leadership dynamics at play in Canadian health reform and to develop leadership capacity in the Canadian health system through applied research and knowledge mobilization. The study makes an important contribution to our understanding of how different forms of leadership are shaping health reform in Canada and the complex array of factors that make leadership of large scale reform very challenging. It illuminates the need for much greater clarity about what concepts such as distributed and complexity leadership look like in practice, and how important it is to do further research on how those models can be used to influence transformation in a decentralized health care system. Results highlight the need for a more coordinated Canadian strategy for leadership talent management and succession planning and a more robust, systematic and comprehensive approach to research and knowledge mobilization on best practices of leadership.
The four-year project was overseen by a network of senior decision-makers and health researchers, and was funded through Canadian Institutes for Health Research (CIHR) and Michael Smith Foundation for Health Research (MSFHR) grants, with acknowledgement to the MSFHR Health Services & Policy Research Support Network. The case studies explored leadership dynamics at play across Canada in redesigning the health system. One national and five regional projects were carried out to explore and understand the leadership dynamics atplay across Canada in redesigning the health system:
1) National Node Project on Access, Quality and Appropriateness
2) British Columbia Project on Integrated Primary and Community Care
3) Prairies Project on Shared Services in Saskatchewan
4) Ontario Project on New Models of Primary Care Delivery
5) Quebec Project on New Models of Primary Care Delivery
6) Atlantic Project on Engagement (one study in Nova Scotia on physician engagement, and one study in the Eastern Region of Newfoundland on employee engagement
The four-year project was overseen by a network of senior decision-makers and health researchers, and was funded through Canadian Institutes for Health Research (CIHR) and Michael Smith Foundation for Health Research (MSFHR) grants, with acknowledgement to the MSFHR Health Services & Policy Research Support Network. The case studies explored leadership dynamics at play across Canada in redesigning the health system. One national and five regional projects were carried out to explore and understand the leadership dynamics atplay across Canada in redesigning the health system:
1) National Node Project on Access, Quality and Appropriateness
2) British Columbia Project on Integrated Primary and Community Care
3) Prairies Project on Shared Services in Saskatchewan
4) Ontario Project on New Models of Primary Care Delivery
5) Quebec Project on New Models of Primary Care Delivery
6) Atlantic Project on Engagement (one study in Nova Scotia on physician engagement, and one study in the Eastern Region of Newfoundland on employee engagement
Research Interests: Participatory Action Research, Leadership, Qualitative methodology, Change Management, Qualitative Health Research, and 9 moreQualitative Research, Health Policy, Leadership Development, Health Reform, Health Systems, Qualitative data analysis, Canadian Provincial Politics, Canadian Public Policy, and Innovation & Change Management
The Prairie Node study is one of five regional case studies, or “nodes”, in the pan-Canadian “Leadership and Health System Redesign” project funded by the Canadian Institutes of Health Research’s (CIHR) Partnerships for Health System... more
The Prairie Node study is one of five regional case studies, or “nodes”, in the pan-Canadian “Leadership and Health System Redesign” project funded by the Canadian Institutes of Health Research’s (CIHR) Partnerships for Health System Improvement (PHSI) program. The purpose of the pan-Canadian project is to help develop leadership capacity in the Canadian health system through applied research and knowledge translation. The project began in 2009 in response to growing concern throughout the health system about the impending expiry of the 2004 federal provincial 10-year plan and the future role of the federal government. The project also responds to broader public concerns about health system efficiency, quality, and accessibility – crises for which restructuring is seen as a potential solution. Despite growing recognition of the importance of leadership in restructuring and transforming health systems, there is a need to clearly understand the most effective leadership practices to facilitate health system reform. Beyond this, the pan-Canadian project strives to bridge knowledge with practice by developing and mobilizing a set of approaches, tools, and techniques to create a culture of effective healthleadership in Canada.
The Prairie Node case study focused on leadership in the implementation of shared services in Saskatchewan. Originating from the 2009 Patient First Review, the goal of the Shared Services Initiative (SSI) was to achieve cost savings by consolidating supply management and business functions through a central office. Recognizing the limitations of the recent centralization initiative that produced a single health organization in Alberta, the goal of Saskatchewan’s SSI was to achieve economies of scale and scope while maintaining its decentralized system. To date, SSI implementation has targeted supply chain, linen, and human resource lines, with future projects planned for environmental services, medical imaging, and laboratory functions. Like the other regional nodes, the Prairie Node project used a Participatory Action Research (PAR) framework, which emphasizes the involvement of participants in designing and implementing the research.
The Prairie Node case study focused on leadership in the implementation of shared services in Saskatchewan. Originating from the 2009 Patient First Review, the goal of the Shared Services Initiative (SSI) was to achieve cost savings by consolidating supply management and business functions through a central office. Recognizing the limitations of the recent centralization initiative that produced a single health organization in Alberta, the goal of Saskatchewan’s SSI was to achieve economies of scale and scope while maintaining its decentralized system. To date, SSI implementation has targeted supply chain, linen, and human resource lines, with future projects planned for environmental services, medical imaging, and laboratory functions. Like the other regional nodes, the Prairie Node project used a Participatory Action Research (PAR) framework, which emphasizes the involvement of participants in designing and implementing the research.
Research Interests:
This is the final report of a five-year research initiative funded under the Major Collaborative Research Initiatives (MCRI) program of the Social Sciences and Humanities Research Council of Canada (SSHRC). The goal of the project was to... more
This is the final report of a five-year research initiative funded under the Major Collaborative Research Initiatives (MCRI) program of the Social Sciences and Humanities Research Council of Canada (SSHRC). The goal of the project was to develop a systematic, integrated and comprehensive understanding of the capacities of governmental institutions to formulate and implement strategies of adaptation to climate change on the supply and management of water resources in dryland environments. This was accomplished through a comparative study of two regions: the South Saskatchewan River Basin in western Canada and the Elqui River Basin in north-central Chile, both of which have a dry climate adjacent to major mountain ranges and landscapes at risk of desertification.
Research Interests: Climate change policy, Chile, Climate Change Adaptation And Mitigation Strategies, Canada, Comparative Analysis, and 4 moreClimate Change and Its Impact on Food Security and Agriculture, Pastoral Livelihoods, Natural Resource Management N Drylands, Climate Change Adaptation, Climate Change and Adptation, and Semi-arid Environments
This is the final report summarizing the findings from a study on adaptation to climate change in the South Saskatchewan River Basin that was conducted between 2003 and 2009.
Research Interests:
This research paper on GM food policy had its beginnings in late 2001, when the Saskatchewan Institute of Public Policy began a research project on the GM industry in Saskatchewan supported equally by the Government of Saskatchewan and... more
This research paper on GM food policy had its beginnings in late 2001, when the Saskatchewan Institute of Public Policy began a research project on the GM industry in Saskatchewan supported equally by the Government of Saskatchewan and the Department of Western Economic Diversification. Dr. Greg Marchildon and Dr. Louise Greenberg oversaw much of the research for this project while they were, successively, Government of Saskatchewan Public Policy Fellows at the Institute. The Institute would like to acknowledge their contribution to this project. This report is divided into a number of sections. The first section, prepared by Saskatchewan Institute of Public Policy (SIPP), provides an overview on issues surrounding genetic modification in food and policy recommendations to Saskatchewan Agriculture and Food and Western Economic Diversification. The remaining sections, prepared by Dr. Alan McHughen, Dr. Cristine de Clercy, and Dr. Donald Gilchrist, provides information and analysis in the following areas: an environmental scan of the current state of the genetically modified (GM) food industry in Canada, particularly as it relates to commodities produced, or potentially produced, in the western Canadian prairie region; an environmental scan of organized food consumer groups in Canada and their respective
perceptions of the GM industry; an environmental scan of the opposition within Canada to GM food production and consumption, including the nature and sources of external influence such as nongovernmental organizations with international influence; scenario-building concerning the environment that will be faced by the western Canadian GM industry in the immediate and near future, and an analysis of the threats to the industry as well as the potential opportunities in the most likely scenario-environment.
A preliminary analysis of the economic impact of biotechnology in Saskatchewan
perceptions of the GM industry; an environmental scan of the opposition within Canada to GM food production and consumption, including the nature and sources of external influence such as nongovernmental organizations with international influence; scenario-building concerning the environment that will be faced by the western Canadian GM industry in the immediate and near future, and an analysis of the threats to the industry as well as the potential opportunities in the most likely scenario-environment.
A preliminary analysis of the economic impact of biotechnology in Saskatchewan
Research Interests:
The existing research on the first merger waves in the United States, Britain, and to a lesser extent in Germany, has produced valuable information on the rise of the modern industrial enterprise. These studies reveal important... more
The existing research on the first merger waves in the United States, Britain, and to a lesser extent in Germany, has produced valuable information on the rise of the modern industrial enterprise. These studies reveal important similarities as well as a few significant differences in the nature of the economic development of these nations. A new merger series for Canadian manufacturing industry was generated to provide a further comparison. In addition, a large pool of information was gathered concerning the workings of promotional syndicates, corporate flotations, and secondary financial markets. This aggregate data, in conjunction with a case study of the most prominent Canadian promoter of the era and the companies he consolidated, is used to determine the relationship between security financing and the evolution of manufacturing industry in Canada. An explanation of the cause of the first Canadian merger wave, 1909-1912, is based on individual case evidence and the results of causality tests using aggregate data. The necessary pre-condition to a merger wave was the emergence of a broad market for Canadian industrial securities. Although high stock prices stimulated merger waves in Britain and the United States at the turn of the century, the first Canadian merger wave had to wait another decade until the expansion of the Canadian market and the tapping of the British market for Canadian "industrials" permitted large-scale flotations. The potential profits which were available through corporate reorganisation, rationalisation of manufacturing and distribution networks, and monopolisation, were reflected in the higher rates of return which British investors sought en masse in the new Canadian securities. This flood of British capital in turn accelerated the industrial transformation taking place in Canada and encouraged further mergers. High stock prices triggered the first merger movement as they had in Britain and the United States. Corporate financiers became merger promoters as they catapulted propositions into consolidations large enough to be listed on public stock exchanges and to be of interest to prospective investors. High-risk financial methods provided the incentive to financial intermediaries to broaden this market as quickly as possible and, therefore, to deliver the maximum amount of cash to the new industrial consolidations.
Research Interests:
Presentation for an executive course at the Instituto Nacional de Salud Públic (National Institute of Public Health) in Mexico. The course was led by Miguel Gonzalez-Block, Associate Director, North American Observatory on Health Systems... more
Presentation for an executive course at the Instituto Nacional de Salud Públic (National Institute of Public Health) in Mexico. The course was led by Miguel Gonzalez-Block, Associate Director, North American Observatory on Health Systems and Policies.
Research Interests:
This chapter evaluates Canadian Medicare's based on a PPPG (policy, politics and program) assessment framework.
Research Interests:
This is a biography of Tommy Douglas (1904-86), among the most influential politicians and leaders in Canada during the 20th century. This biography will eventually be published online by the Dictionary of Canadian Biography.