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SHARP provides an analytical framework that for the first time brings together all major elements of the health care system and helps to organize our thoughts about the system as a system . (The acronym stands for System for Health Area Resource Planning; SHARP has been developed for Ontario, the largest of the Canadian provinces.) A framework for discussion is especially important during the current period of “health reform”, spurred largely by concerns to bring cost increases under control. The central message of this paper is that the planning process should be well informed and should take an integrated view of the health care system so that major future repercussions of actions taken today can be foreseen (albeit imperfectly). In reforming the system, it is important to anticipate both the requirements for health care services and the resources that are likely to be available to satisfy those requirements. That is where SHARP can be helpful. With its comprehensive and forward-looking view of the health care system, SHARP can usefully inform the current debate about the future of the health care sector. The main features of SHARP are described and the system is illustrated with special reference to nurses and the services that they provide.

An analytical framework for studying the population dynamics and lifetime patterns of cigarette smoking is developed. The key idea is that changes in the distribution of the population among smoking and nonsmoking categories can be viewed as an age-sex-dependent Markov process and that transition probability matrices for successive ages can be linked to generate the complete smoking history of a cohort as it moves along its age path. The framework is used to analyse data from 1981 and 1986 Canadian surveys of smoking habits: transition probabilities are estimated from the data and some interesting results are obtained that could not be obtained by more conventional forms of analysis. The movements of the population among smoking/nonsmoking categories are examined and the lifetime smoking patterns implicit in the 1981–1986 data are derived and discussed. It is emphasized that a lifetime perspective on smoking behaviour is important for assessing health risks because smoking effects tend to be cumulative, especially with regard to the respiratory system.

The paper reports on a series of models designed for computer simulation of Canadian manpower flows at different levels of unemployment, either alone or in conjunction with related population flows. The models are disaggregated macromodels of the state-transition variety. One relates to annual flows, the others to monthly flows. The models have been used for various purposes, including simulation analyses of the effects of changes in economic conditions and government policy variables on two government programs, namely unemployment insurance and manpower training. Other applications are possible and, in general, the basic approach underlying the models is considered to have much potential for manpower policy analysis.

An investigation is reported of the potential for reducing aggregate medical costs by the introduction of nurse practitioners into the Canadian health care system to an extent consistent with demonstrated safety and effectiveness. A cost model is developed for this purpose and estimates of its parameters are provided. The cost model is coupled with a demographic projection model and potential cost reductions are simulated over the period 1980–2050, under alternative assumptions. Results suggest that savings could have been in the range 10–15% in 1980 for medical services as a whole, and 16–24% for ambulatory services. The estimated savings percentages are quite insensitive to projected changes in the age structure of the Canadian population.