Search

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]

"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]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Public Policy is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of International Political Science Review is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Public Administration is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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.

Abstract: To resolve tensions among competing sources of evidence and public expectations, health-care managers and policy makers are turning more than ever to involve the public in a wide range of decisions. Yet efforts to use research evidence to inform public involvement decisions are hampered by an absence of rigorous public participation evaluation research. In particular, greater rigour in exploring the roles played by different contextual variables—such as characteristics of the issue of interest, the culture of the sponsoring organization and attributes of the decision being made—is needed. Using a comparative quasi-experimental design, we assessed the performance of a generic public participation method implemented in 5 Canadian regionalized health settings between 2001 and 2004. Participant and decision-maker perspectives were assessed and, through direct observation, the roles exerted by contextual variables over the public involvement processes were documented and analysed. Our findings demonstrate that a generic public participation method can be implemented in a variety of contexts and with considerable success. Context exerts fostering and inhibiting influences that contribute to more (or less) successful implementation. Public participation practitioners are encouraged to pay careful attention to the types of issues and decisions for which they are seeking public input. Sufficient organizational resources and commitment to the goals of the public participation process are also required. Attention to these contextual attributes and their influence on the design and outcomes of public participation processes is as important as choosing the “right” public participation mechanism. [Copyright &y& Elsevier]

Copyright of Zeitschrift für Ärztliche Fortbildung und Qualität im Gesundheitswesen is the property of Elsevier GmbH, Urban & Fischer Verlag and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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 AUTHOR]

Gives a brief description of the process, the outcome, and the effects of the Romanow Commission on the Future of Health Care in Canada, which entailed a dialogue with representative cross-sections of the Canadian population. View that the legitimacy and sustainability of any major policy decisions depends on how well it reflects the underlying values of the public; Mention of ChoiceWork dialogues, which were created by Viewpoint Learning and based on the research of its chairman, Daniel Yankelovich; Way that the dialogues engage members of the public on important issues before the decisions are made; Impact of combining the roles of citizens as taxpayers and patients on the debate; Opinion that engaging the public in this way is more costly than polling, but is essential when making difficult decisions. INSETS: Summary points;Box 1: Basic steps in a ChoiceWork dialogue project;Box 2: Four scenarios for the future of health care in Canada;Box 3: Participants' own words (extracted from session...

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.)

In Canada, government mandates for patient-centred care (PCC) vary across the 10 provinces and three territories. Although basic medical and hospital services are provided for all, health care options for patients also depend on having private insurance. Thus, the current design of the Canadian healthcare system has several implications for PCC and shared decision-making (SDM). Since 2007, this is our fourth update on SDM in Canada. The aim of this paper is to provide an update on the current state of SDM and patient and public involvement in Canada. Overall, we still observed the difficulty of implementing any sort of national strategy partly because of the decentralized nature of the healthcare system. Second, national professional education programs are complicated by licensure and scope of practice variations across jurisdictions. Third, there are variations in the availability of different options covered by universal healthcare. Canada has experienced some favorable development as PCC is now explicitly articulated in the policies of most provinces and territories and there are increased efforts to give patients more access to their electronic health records. However, patient and public engagement (PPE) reform in health programs and governance remains an exception, and continuing centralization of governance structures may reduce their responsiveness to patient priorities. In a 2018 survey, 47.2% of respondents reported that they were not told by their health professional that they had a choice about treatment. Nonetheless, decision aids and decision coaching are increasingly available for health-related decisions and the Ottawa Hospital Research Institute's decision aid inventory has ensured continued leadership in this area. Diverse jurisdictions are starting to embed decision aids into care pathways, with some decision aids being included in clinical practice guidelines. The COVID-19 pandemic may have had a negative impact on SDM by removing decision choices due to emergency public health mandates, but stimulated new research and decision aids. Canada continues to assign health research funding to SDM and PCC, and a program dedicated to patient-oriented research is central to this effort. Guides and frameworks are increasingly available for planning and evaluating PPE. Finally, various initiatives are attempting to involve and empower Indigenous peoples through PPE and SDM., (Copyright © 2022. Published by Elsevier GmbH.)

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.)

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.

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.

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.

In 2002 Canadians were less anxious about the state of their health care system than they were a few years earlier, when perceptions peaked that the system needed major reform. They expressed strong support in 2002 for maintaining the status quo on health care financing (that is, no user fees and no two-tier care) within the traditional domains of physician and hospital care. But they appeared more receptive to two-tier care and for-profit delivery for the newer and rapidly expanding domains of home care and high-tech care.

The Canadian debate surrounding pharmacare follows some strange rules. On the one hand, there is a strong and widely shared belief that drugs ought to be among the benefits of the public health system, along with the other core services--hospitals and physicians. On the other hand, it is hard not to see the many obstacles to such a project, including the costs associated with drug consumption and the indifference of a large part of the population, which seems to be coming to terms with the fragmentary coverage it already has. Champions prepared to defend the cause of a universal and public system are but a few, and the sour experience of the National Forum on Health (1994-97), which proposed nothing short of comprehensive public coverage, is there as a reminder that a frontal attack is pointless--it looks too expensive, too complicated, too difficult. As did the Greek kings outside Troy, when Ulysses suggested to them that they build a wooden horse, the experts endlessly debate the stratagem that will make it possible to create a public system, without arousing the suspicions of the policy-makers or even the population. The lead paper by Morgan and Willison is no exception: once again, the idea is to achieve pharmacare without alerting potential opponents.