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In the fall of 2014, the Government of Canada formally split the role of the Chief Public Health Officer (CPHO) into two positions: the CPHO and the President of the Public Health Agency of Canada. Despite concerns raised by the public health community, these changes are consistent with the CPHO's authority. However, the nature of responsible government means that the CPHO cannot simultaneously serve as an independent advocate for policies and programs that might prevent disease and as a senior advisor to the government of the day. A 1'automne 2014, le gouvernement du Canada a annonce le dedoublement officiel du role de l'Administrateur en chef de la sante publique (ACSP) en deux postes : l'ACSP et le president de l'Agence de la sante publique du Canada. Malgre les inquietudes exprimees dans les milieux de la sante publique, ces changements sont compatibles avec le mandat original de l'ACSP. La nature d'un gouvernement responsable suppose que l'ACSP ne peut a la fois s'instituer en champion independant de politiques ou de programmes favorables a la sante et conserver son role de conseiller principal du gouvernement du jour., Introduction On October 24, 2014, the Government of Canada announced a proposed amendment to the Public Health Agency of Canada Act through a budget implementation bill, Bill C-43. This amendment [...]

This article focuses on Quebec's most recent reform in the regionalization of health care to understand why the government chose to transform the regional boards into agencies. This case study used interviews and documentary analysis. Rooted in a political science perspective, the conceptual framework is inspired by the work of John Kingdon (1995) and draws on the four variables that influence the choice of policy: ideas, interests, institutions and events. Results of the case study suggest that Quebec's Commission of Study for Health and Social Services (the Clair Commission) in 2000 and the 2002 pre-electoral environment put the issue on the agenda. In 2003, the newly elected Liberal government passed Bill 25--An Act Respecting Local Health and Social Services Network Development Agencies, which represented a political compromise: originally slated for eradication, the regional tier survived but in a new form. The element that sparked reform was the change in government following the elections. Different inquiry reports spread the reform's ideas, while interest groups articulated contrasting visions on the transformation. Above all, regional institutions showed great resilience in the face of change. From a historical perspective, this regionalization policy is a step backward: the regional tier is now stronger from a managerial and technocratic point of view, but it is politically and democratically weakened. This suggests a government intention, at that time, to maintain the regional level as a means of retaining centralized control over Quebec's health-care system. Cet article se concentre sur la plus recente reforme du Quebec en matiere de regionalisation des soins de sante pour comprendre pourquoi le gouvernement a choisi de transformer les regies regionales en agences. Des entrevues et une analyse documentaire ont ete utilisees pour cette etude de cas. Enracine dans une perspective de sciences politiques, le cadre conceptuel s'inspire des travaux de John Kingdon (1995) et tire parti des quatre variables qui influencent le choix de politique : les idees, les interets, les institutions et les evenements. Les resultats de l'etude de cas laissent entendre que la Commission d'etude sur les services de sante et les services sociaux du Quebec (la Commission Clair) en 2000 et le climat pre-electoral de 2002 ont mis la question a l'ordre du jour. En 2003, le gouvernement Liberal nouvellement elu a adopte le projet de loi 25, Loi sur les agences de developpement de reseaux locaux de services de sante et de services sociaux, qui representait un compromis politique : devant etre initialement abroge, le palier regional a survecu, mais sous une nouvelle forme. L'element qui a suscite la reforme a ete le changement de gouvernement a la suite des elections. Differents rapports d'enquetes ont propage les idees de la reforme, tandis que des groupes d'interet ont formule des visions opposees sur la transformation. Avant tout, les institutions regionales ont montre une remarquable resilience face au changement. D'un point de vue historique, cette politique de regionalisation constitue un pas en arriere : le palier regional est maintenant plus fort d'un point de vue technocratique et managerial, mais il est affaibli sur le plan politique et democratique. Cela donne a penser que l'intention du gouvernement a cette epoque etait de maintenir le niveau regional comme moyen de conserver un contrele centralise sur le systeme de soins de sante du Quebec., Public policy-makers from around the world have moved to decentralize health-care systems in recent years in the hopes of achieving better governance and a more judicious distribution of management and [...]

A common thread weaving through the current public participation debate is the need for new approaches that emphasize two-way interaction between decision makers and the public as well as deliberation among participants. Increasingly complex decision making processes require a more informed citizenry that has weighed the evidence on the issue, discussed and debated potential decision options and arrived at a mutually agreed upon decision or at least one by which all parties can abide. We explore the recent fascination with deliberative methods for public involvement first by examining their origins within democratic theory, and then by focusing on the experiences with deliberative methods within the health sector. In doing so, we answer the following questions 'What are deliberative methods and why have they become so popular? What are their potential contributions to the health sector?' We use this critical review of the literature as the basis for developing general principles that can be used to guide the design and evaluation of public involvement processes for the health-care sector in particular. Keywords: Public participation; Health-care decision making

This paper is centred on the use of legislation as a tool of public action in health policy. We suggest that, as with the Canada Health Act (CHA) of 1984, this option should be considered to direct future reform efforts and pursue our collective aims of health and wellness. The CHA is the legislative expression of the federal government's exercise of its spending power, serving to consolidate key national agreements governing the circumstances under which the federal government contributes to the costs of medically necessary health services delivered by the provinces and territories. Two features of the CHA merit highlighting. The first is that its core provisions -- in particular, the five criteria often referred to as Canada's "national standards" for health care -- were not new or original to the CHA. The CHA was nonetheless an important step in the development of Canada's health system because it enshrined together, in one statute, longstanding commitments. A second feature of the CHA worth highlighting is that it does not stand alone. The CHA is one of 13 statutes across the country, including one in each province and territory, that serve together to establish the basic legal infrastructure of Canada's health insurance system. The CHA's powers to make regulations and issue policy interpretation letters offer important potential to achieve needed health system reforms without needing to "open" the act. Even where these powers are unrestricted by an express requirement for consultation with the provinces and territories, however, this would undoubtedly be required, given the fundamentally consensual nature of the CHA. Finally, the federal government's legislative options are not limited to the CHA. Jurisdiction over health and health care in Canada is shared between the federal and provincial and territorial governments. The various federal powers with health aspects allocated by the Constitution Act, 1867 are significant, including the residual "federal health power" to make laws "for the peace, order and good government of Canada" It therefore makes good sense to consider federal policy objectives in the health domain with regard for the full spectrum of federal legislative competence. [ABSTRACT FROM AUTHOR]

Interest in finding more effective methods for public involvement in decision-making about health systems is more widespread than ever in Canada since significant aspects of health-care decision-making were devolved from provincial governments to regional health authorities. Involving the public can be risky business, however, as the accountability and legitimacy of decisions made by governing authorities are often assessed against the nature and degree of interaction that occurs with the public. Consequently, decision-makers in a variety of policy domains routinely struggle with questions about when it is appropriate to involve the public, what the most effective means are for doing this, and how to measure their success. The authors analysed these issues by documenting the experiences of health-systems decision-makers in two Canadian provinces (Ontario and Quebec) with public consultation and participation over the past decade. Their findings illustrate that despite the different roles and responsibilities held by Ontario and Quebec decision-makers, decisions to consult with their communities are driven by the same basic set of objectives: to obtain information from and to provide information to the community; to ensure fair, transparent and legitimate decision-making processes; and to garner support for their outcomes. Decision-makers also acknowledged the need to rethink approaches for involving the public in decision-making processes in response to the perceived failure of past public participation and consultation processes. While these experiences have clearly left some participation practitioners feeling beleaguered, many are approaching future community consultation processes optimistically with plans for more focused, purposeful consultations that have clear objectives and more formal evaluation tinged with a healthy dose of pragmatism.

"Health in All Policies" (HiAP) is an approach that systematically considers the health and social implications of policies contemplated by all sectors of government - aiming for synergistic benefits and to minimize social and health-related harms. Although no data on definitive health outcomes are yet available, HiAP implementation has become widespread, comprehensive and systematic in China, driven by strong political commitment, stable funding, and considerable support from the national health commission and local government. Clinicians, in their roles as community leaders, can advocate for the importance of HiAP in addressing the social determinants of health while delivering wide-ranging benefits beyond the health sector, and teach the potential value of HiAP to undergraduate and graduate physicians in training. [Extracted from the article]

Introduction Integrated care is viewed widely as a potential solution to some of the major challenges faced by health and social care systems, such as those posed by service duplication, fragmentation and poor care coordination, and associated impacts on the quality and cost of services. Fragmented models of allocating funds to and across sectors, programmes and providers are frequently cited as a major barrier to integration and countries have experimented with different models of allocating funds to enhance care coordination among service providers and to reduce ineffective care and avoid costly adverse events. This scoping review aims to assess published international experiences of different models of allocating funds to facilitate integration and the evidence on their impacts. Methods and analysis We will adopt a scoping review methodology due to the potentially vast and multidisciplinary nature of the literature on different models of allocating funds in health and social care systems, as well as the scarcity of existing knowledge syntheses. The framework developed by Arksey and O'Malley will be followed that entails six steps: (1) identifying the research question(s), (2) searching for relevant studies, (3) selecting studies, (4) charting the data, (5) collating, summarising and reporting the results and (6) and conducting consultation exercises. These steps will be conducted iteratively and reflexively, making adjustments and repetitions when appropriate to make sure the literature has been covered as comprehensively as possible. To ensure comprehensiveness of our literature review, we also search a wide range of sources. Ethics and dissemination An integrated knowledge translation strategy will be pursued by engaging our knowledge users through all stages of the review. We will organise two workshops or policy roundtables/policy dialogues in Alberta and British Columbia with participation of diverse knowledge users to discuss and interpret the findings of our review and to draw out policy opportunities and lessons that can be applied to the context of these two provinces. [ABSTRACT FROM AUTHOR]

Background: Long waits for core specialized services have consistently been identified as a key barrier to access. Governments and organizations at all levels have responded with strategies for better wait list management. While these initiatives are promising, insufficient attention has been paid to factors influencing the implementation and sustainability of wait time management strategies (WTMS) implemented at the organizational level. Methods: A systematic review was conducted using the main electronic databases, such as CINAHL, MEDLINE, and Cochrane Database of Systematic Reviews, to identify articles published between 1990 and 2011 on WTMS for scheduled care implemented at the organizational level or higher and on frameworks for analyzing factors influencing their success. Data was extracted on governance, culture, resources, and tools. We organized a workshop with Canadian healthcare policy-makers and managers to compare our initial findings with their experience. Results: Our systematic review included 47 articles: 36 related to implementation and 11 to sustainability. From these, we identified a variety of WTMS initiated at the organizational level or higher, and within these, certain factors that were specific to either implementation or sustainability and others common to both. The main common factors influencing success at the contextual level were stakeholder engagement and strong funding, and at the organizational level, physician involvement, human resources capacity, and information management systems. Specific factors for successful implementation at the contextual level were consultation with front-line actors and common standards and guidelines, and at the organizational level, financial incentives and dedicated staffing. For sustainability, we found no new factors. The workshop participants identified the same major factors as found in the articles and added others, such as information sharing between physicians and managers. Conclusions: Factors related to implementation were studied more than those related to sustainability. However, this finding was useful in developing a tool to help managers at the local level monitor the implementation of WTMS and highlighted the need for more research on specific factors for sustainability and to assess the unintended consequences of introducing WTMS in healthcare organizations. [ABSTRACT FROM AUTHOR]

Health care systems are under pressure to control their increasing costs, to better adapt to evolving demands, to improve the quality and safety of care, and ultimately to ameliorate the health of their populations. This article looks at a battery of organizational options aimed at transforming health care systems and argues that more attention must be paid to reforming the delivery mechanisms that are so crucial for health care systems' overall performance. To support improvement, policies can rely on organizational assets in two ways. First, reforms can promote the creation of new organizational forms; second, they can employ organizational levers (e.g., capacity development, team- based organizations, evidence-informed practices) to achieve specific policy goals. In both cases organizational assets are mobilized with a view to creating complete health care organizations - that is to say, organizations that have the capacity to function as high- performing systems. The challenges confronting the development of more complete health care organizations are significant. Real health care system reforms may likewise require implementing ecologies of complex innovation at the clinical, organizational, and policy levels. Policies play a determining role in shaping these new spaces for action so that day-to-day practices may change. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the guest editors discuss essays and papers in the journal's special issue pertaining to real reform in health care systems.

At their origin, public healthcare systems were designed mainly for the treatment of acute illnesses. For many years, therefore, public health care focused on services offered in healthcare establishments and primary care was allowed to evolve on the periphery of hospitals, with doctors free to follow their own conception of how best to provide and follow up on care. As hospital costs grew, however, and new challenges regarding the provision of care began to emerge, governments felt increasingly responsible for organizing the front line (Nolte and McKee 2008). How doctors would be called upon to participate in the new configuration of services — particularly in Canada, where physicians function as independent entrepreneurs — is the subject of this article, which investigates the decision to introduce family medicine groups (FMGs) to the province of Quebec. [ABSTRACT FROM AUTHOR]

The article examines the operation of Canadian federalism with respect to provincial health systems. Canadian provinces have the ability to shape the development of health delivery systems within the constraints of the mandates of the federal Canada Health Act of 1984. Under federalism, its health care delivery system remains dynamic in terms of the levels of government involved in the delivery of medical services. There is also a pattern of regionalization within its health system.

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The availability of federal funding, or the limits of such funding, shape the parameters of “reform” at the provincial level within the Canadian health care delivery system and within the constraints of the Canada Health Act. We will examine how “fiscal federalism” sets parameters with respect to the “regionalization” reforms of provincial health care delivery systems and also influences such trends as “privatization” which are occurring in the Canadian provinces (and territories). Finally, after this contextual presentation, we will utilize the province of Quebec as a case study of the interface of developments in a provincial health care system and the context of the federal Canada Health Act and fiscal federalism. [ABSTRACT FROM PUBLISHER]

The author reflects on the need of transformation in organization and administrative services of the U.S. healthcare industry. He discusses several changes that occurred in health stream including the biosocial stress perspective, behavioral economics and policies implemented by the U.S. government while focusing on the contributions in the area. The author suggests a health research in areas including the advantages and disadvantages of health insurance and its impact on population.

Among the many reasons that may limit the adoption of promising reform ideas, policy capacity is the least recognized. The concept itself is not widely understood. Although policy capacity is concerned with the gathering of information and the formulation of options for public action in the initial phases of policy consultation and development, it also touches on all stages of the policy process, from the strategic identification of a problem to the actual development of the policy, its formal adoption, its implementation, and even further, its evaluation and continuation or modification. Expertise in the form of policy advice is already widely available in and to public administrations, to well-established professional organizations like medical societies and, of course, to large private-sector organizations with commercial or financial interests in the health sector. We need more health actors to join the fray and move from their traditional position of advocacy to a fuller commitment to the development of policy capacity, with all that it entails in terms of leadership and social responsibility. [ABSTRACT FROM AUTHOR]

Objectives: To examine the sociodemographic characteristics, activities, motivations, experiences, skills and challenges of patient partners working across multiple health system settings in Canada., Design: Online cross-sectional survey of self-identified patient partners., Setting: Patient partners in multiple jurisdictions and health system organisations., Participants: 603 patient partners who had drawn on their experiences with the health system as a patient, family member or informal caregiver to try to improve it in some way, through their involvement in the activities of a group, organisation or government., Results: Survey respondents predominantly identified as female (76.6%), white (84%) and university educated (70.2%) but were a heterogeneous group in the scope (activities and organisations), intensity (number of hours) and longevity (number of years) of their role. Primary motivations for becoming a patient partner were the desire to improve the health system based on either a negative (36.2%) or positive (23.3%) experience. Respondents reported feeling enthusiastic (83.6%), valued (76.9%) and needed (63.3%) always or most of the time; just under half felt they had always or often been adequately compensated in their role. Knowledge of the health system and the organisation they partner with are key skills needed. Two-thirds faced barriers in their role with over half identifying power imbalances. Less than half were able to see how their input was reflected in decisions or changes always or most of the time, and 40.3% had thought about quitting., Conclusions: This survey is the first of its kind to examine at a population level, the characteristics, experiences and dynamics of a large sample of self-identified patient partners. Patient partners in this sample are a sociodemographically homogenous group, yet heterogeneous in the scope, intensity and longevity of roles. Our findings provide key insights at a critical time, to inform the future of patient partnership in health systems., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Canada's COVID-19 response has been described as slow, with reactive decision making that has left the most vulnerable populations at risk of infection and death from the virus. Yet, within and across the provincial health systems, the supply chain processes and data infrastructure needed to generate the relevant data for, and evidence of, the spread of COVID-19 and the health system's capacity to respond to the pandemic are non-existent in Canada. Emerging evidence from a national research study highlights the significance of supply chain data infrastructure and processes that offer transparent, real-time data to inform decisions that support a coordinated, evidence-informed pandemic strategy that is proactive and capable of protecting the health of every Canadian., (Copyright © 2021 Longwoods Publishing.)

Health systems are changing continuously, due to powerful forces such as scientific and technical advances, social and economic conditions and demography. Change affects health systems by disrupting their internal balance, that is, the adjustment of supply and demand for healthcare. At a high level, the answer is to adopt a policy approach that covers and connects the three areas of patient experience, health outcomes and cost-effectiveness, similar to the "Triple Aim" or its numerous avatars. Closer to the action, at the level at which decisions about treatment or care are made, the current trend is to focus on the "value agenda.", (Copyright © 2020 Longwoods Publishing.)

Competing Interests: Competing interests: Marcello Tonelli received grants from the Canadian Institutes of Health Research (paid to institution). Pierre-Gerlier Forest provides advice to Norton Rose Fulbright LLP on health policy issues as part of a retainer agreement and has received consulting fees from Innovative Medicines Canada in that context. No other competing interests were declared.

Background: Escalating health care spending is a concern in Western countries, given the lack of evidence of a direct connection between spending and improvements in health. We aimed to determine the association between spending on health care and social programs and health outcomes in Canada., Methods: We used retrospective data from Canadian provincial expenditure reports, for the period 1981 to 2011, to model the effects of social and health spending (as a ratio, social/health) on potentially avoidable mortality, infant mortality and life expectancy. We used linear regressions, accounting for provincial fixed effects and time, and controlling for confounding variables at the provincial level., Results: A 1-cent increase in social spending per dollar spent on health was associated with a 0.1% (95% confidence interval [CI] 0.04% to 0.16%) decrease in potentially avoidable mortality and a 0.01% (95% CI 0.01% to 0.02%) increase in life expectancy. The ratio had a statistically nonsignificant relationship with infant mortality ( p = 0.2)., Interpretation: Population-level health outcomes could benefit from a reallocation of government dollars from health to social spending, even if total government spending were left unchanged. This result is consistent with other findings from Canada and the United States., Competing Interests: Competing interests: None declared., (© 2018 Joule Inc. or its licensors.)

One essential role of the central government in a federation is to universalize the good--if necessary, against the will of some federated states. This function does not imply superior knowledge or exceptional experience. In fact, it does not presuppose anything but sensitivity to public opinion and a semblance of constitutional authority. The current government of Canada is less inclined than its predecessors to intervene in the health sector; one might even say that federal leadership is lacking. Yet in fact, if innovation is now at a halt in our health system, it could be less because of what the federal government is (not) doing to support national solutions, and more because of intrinsic issues of management and orientation at the level of healthcare organizations and delivery systems., (Copyright © 2014 Longwoods Publishing.)

Applications of behavioural economics to public policy are immediate and enlightening. In health policy, where we are exposed to a new fad every other month, it is not indifferent that we deal with a research program that is solidly grounded in decades of scholarship and that is supported by economic theory. Moreover, the experimental and realist bias of behavioural economics is attuned to our need for tested solutions and pragmatic improvements. Adam Oliver's paper is centred on methods that could incite people to make better, healthier lifestyle choices. But his approach can also help us formulate better regulations and smarter legislation. It can help us review the design of health organizations and care pathways. It encourages our efforts to properly use evidence and information. And finally, it forces us to examine the system of incentives and may even give someone the idea of looking at the underlying structure of power.

Although the costs of doctors' visits and hospital stays in Canada are covered by national public health insurance, the cost of outpatient prescription drugs is not. To solve problems of access, Canadian provinces have introduced provincial prescription drug benefit programs. This study analyzes the prescription drug policymaking process in five Canadian provinces between 1992 and 2004 with a view to (1) determining the federal government's role in the area of prescription drugs; (2) describing the policymaking process; (3) identifying factors in each province's choice of a policy; (4) identifying patterns in those factors across the five provinces; and (5) assessing the federal government's influence on the policies chosen. Analysis shows that despite significant differences in policy choices, the ideological motivations of the provinces were unexpectedly similar. The findings also highlight the importance of institutional factors, for example, in provinces' decision to compete rather than to collaborate. We conclude that, to date, Canada's federalism laboratory has only partly benefited the Canadian public. Cost pressures may, however, eventually overcome barriers to cooperation between the provincial and the federal governments, enabling them to capitalize on Canada's federal structure to improve the accessibility and affordability of drugs.

Objectives: To assess experts' perceptions of the contextual and local factors that promote or inhibit the implementation of waiting time management strategies (WTMS) in Canadian healthcare organizations., Methods: We conducted 16 semi-structured interviews and one focus group with individuals involved in WTMS at the federal, provincial or organizational level., Results: The most frequently cited local factor was physicians' participation. Physicians' leadership made the greatest difference in bringing resistant physicians on board. To be effective, however, local leadership had to be supported by senior management. Alignment of financial incentives between the contextual and local levels was also frequently cited, and interviewees stressed the importance of tools used to design, monitor, evaluate and prioritize WTMS., Conclusions: Finding the right balance between supportive resources and tools and an effective management system is a tough challenge. But achieving this balance will help reconcile contradictions between top-down and bottom-up WTMS.

This study focuses on the ability of Canadian provinces to shape in different ways the development of various provincial health delivery systems within the constraints of the mandates of the federal Canada Health Act of 1984 and the fiscal revenues that the provinces receive if they comply with these mandates. In so doing, it will examine the operation of Canadian federalism with respect to various provincial health systems. This study applies a comparative analysis framework developed by Heisler and Peters to facilitate an understanding of the dimensionality of provincial health delivery systems as applied to the case of provincial regionalization and community-based initiatives. The three sets of relationships touched upon are: first, the levels of government and the nature of their involvement in public policy concerning the provincial health care delivery systems; and secondly, understanding of the factors influencing provincial governments' political dispositions to act in various directions. A third dimension that is taken are the factors influencing the "timing" of particular decisions. A fourth area noted by Heisler and Peters and other comparative analysts is the nature and characteristics of public and private sector activities in health care and other social policy areas. While the evolving nature of public and private sector health care delivery activities within Canada's provincial and territorial systems is a significant policy matter in the Canadian context, due to the space limitations of this article, they are not discussed herein.