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Changing Health Care in Canada

Changing Health Care in Canada: The Romanow Papers, Volume 2

Pierre-Gerlier Forest
Gregory P. Marchildon
Tom Mclntosh
Copyright Date: 2004
Pages: 388
  • Book Info
    Changing Health Care in Canada
    Book Description:

    The second in a series of three volumes presenting a selection of the best studies prepared for the Romanow Commission, this volume focuses on the problem of change in health care and health systems. Combining the talents of experienced health policy experts with innovative researchers, the resulting studies provide unique perspectives on the difficult issues under scrutiny, including complexity in health systems, management of human resources, organizational control and regulation, and public engagement.

    Commissioned and prepared with applicability as the foremost criteria, all of the studies presented in this volume offer solutions in managing obstacles to change. Each study also includes an appraisal of the most recent literature in the field.

    eISBN: 978-1-4426-7283-3
    Subjects: Political Science

Table of Contents

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  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Acknowledgments
    (pp. vii-viii)
  4. Contributors
    (pp. ix-2)
  5. Introduction: Changing Health Care in Canada
    (pp. 3-18)

    Of all the major public services, the health care system is without doubt the one that has been subject to the most powerful, if not to say the most brutal, forces for change. Every day, there are new ways of doing things, new ideas, new medications, new machines and instruments, new problems, and new organizations. It could even be said that there are new users, since the patients themselves have changed over the years and are more educated, better informed, more autonomous, and more demanding. The stability and continuity of the institutions responsible for the funding and governance of our...

  6. Part One: System Change, Organization Change

    • 1 Complicated and Complex Systems: What Would Successful Reform of Medicare Look Like?
      (pp. 21-53)

      While virtually everyone agrees that there is trouble in the Canadian health care system there is little agreement on the nature of the trouble. Pollsters and health-related surveys indicate that something is wrong, but, depending on the survey orientation and the kinds of questions asked, many different sources are identified. Solutions seem to be polarized along ideological lines when left- and right-wing think tanks offer their preferred solutions. They become polarized along professional lines when doctors, nurses, and other health care providers offer their advice. Even academics have some trouble maintaining independent scholarly views in the face of what many...

    • 2 Financial Rules As a Catalyst for Change in the Canadian Health Care System
      (pp. 54-81)

      In 2001 it is estimated that almost $40 billion was distributed by provincial/territorial governments to health organizations with mandates that include the provision of institution-based health services (Canadian Institute for Health Information [CIHI] 2001a). Individually and collectively, these organizations have responsibility for the delivery of quality services designed to enhance and promote the health of Canadians.

      Designing organizational structures and policies that support the delivery of health services in a comprehensive and equitable fashion is a non-trivial endeavour that has long occupied the minds of researchers, funders, and practitioners alike (see, e.g., Palmer 2000; Coast et al. 2000; Anderson...

    • 3 Governance and Management of Change in Canadaʹs Health System
      (pp. 82-114)

      Pressure for significant transformations in health care delivery is present in the health care systems of all OECD countries and is giving rise to numerous reform projects (Saltman, Figueras, and Sakellarides 1998; Contandriopoulos and Souteyrand 1996; Contandriopoulos 1994). Although there is considerable consensus on the inevitability of change in health care delivery, it is important to acknowledge our considerable unfamiliarity with the processes by which to achieve such transformations. In addition, we know little about the nature of the changes actually achieved. Furthermore, we note that a number of these changes, including changes to the payment system for physicians, greater...

  7. Part Two: Change and Providers

    • 4 Planning for Care: Approaches to Health Human Resource Policy and Planning in Health Care
      (pp. 117-149)

      Shortly after the Commission on the Future of Health Care in Canada asked us to address the question ′How do health human resource practices and policies promote or inhibit change?′ the Canadian Institute for Health Information (CIHI) released its reportCanada′s Health Care Providers(CIHI 2002). The Canadian Policy Research Networks have also just completed a substantial report summarizing the literature and issues related to human resource planning for physicians and registered nurses (RNs) (Koehoorn et al. 2002). Instead of repeating what is in these reports, we take as given the wealth of information they provide and set out to...

    • 5 How Do Human Resources Policies and Practices Inhibit Change in Health Care? A Plan for the Future
      (pp. 150-182)

      Canada′s health care system has undergone enormous change over the past few years through reform and economic rationalization. These initiatives have created new challenges for what is known as ′health human resource planning′ (HHRP). Every health profession has been affected in terms of levels of demand for their services, roles played, and skills required. Positions have been downsized, restructured, and in some cases eliminated. The nature and scope of practice within and among health professions have been altered, often dramatically. Effective HHRP has become critically important in this environment of change. However, current work in this area is intermittent and...

    • 6 Changes and a Few Paradoxes: Some Thoughts on Health System Personnel
      (pp. 183-206)

      In recent years, a succession of changes in the health system have had a significant impact on personnel.¹ Yet it seems that neither new investments nor new technologies nor administrative controls have resulted in real progress in making the system more effective and efficient, especially with regard to the public′s health. Health system reforms should have provided an opportunity to identify the place and role of personnel and introduce changes to it. Infact, however, the changes implemented seem to have considered the financial dimension (i.e., the escalation of health system budgets and the ways to counter it) more than the...

    • 7 The Influence of Physician-Payment Methods on the Efficiency of the Health Care System
      (pp. 207-240)

      The efficiency of the health care system affects the public economy and economic policy because health costs are always met from the pooled contributions of individuals and corporations, if not from various forms of taxation. The question of efficiency has long been confined to controlling the rising costs of health care, but it is now being raised in a more complex fashion: how to reconcile reasonable spending with the requirement for quality and fairness.

      This question has generated a great deal of economic literature, which analyses the characteristics of the medical care market and the behaviours of producers and consumers...

  8. Part Three: Change and the Public

    • 8 Public Involvement in the Development of a Health Care Vision
      (pp. 243-278)

      We live in turbulent times. New scientific knowledge, technological innovations, and organizational reforms render traditional truths, occupational hierarchies, and established social roles obsolete at increasingly rapid rates. The perpetual transformation of the health care system, for example, is accompanied by calls for greater public involvement in a variety of decision-making and service-delivery activities. In responding to these calls, the public – in the roles of patient, consumer, volunteer, and citizen – is imbued with new rights and responsibilities relative to governments, service providers, and others. Changes of this sort are contentious because they affect established needs and interests (Lalonde 1974;...

    • 9 Public Participation and Citizen Governance in the Canadian Health System
      (pp. 279-311)

      Public participation in the health sector in Canada has taken many forms since the establishment of a universal, publicly administered health system. Citizen users routinely act as ′consultants′ in service and program planning, offering their advice about service needs and problems. Interested citizens act as resource allocators through membership on priority-setting committees and, ultimately, as health system governors in their role as hospital, health centre, or health authority board members. The public also participates as ′protector of the public interest′ through membership on regulatory bodies. Increasingly, the public is being asked to offer its views about the future directions of...

    • 10 Practical Strategies for Facilitating Meaningful Citizen Involvement in Health Planning
      (pp. 312-348)

      The concept of including citizens in the process of defining their health needs and developing solutions to meet those needs has been supported by the World Health Organization (WHO 1978), the federal government (Epp 1986; Ministry of Health 1993), provincial governments (Government of Quebec 1988; Ontario Ministry of Health 1989; Premier′s Commission on Future Health Care for Albertans 1989; Nova Scotia Royal Commission on Health Care 1989; Saskatchewan Commission on Directions in Health Care 1990), regional health organizations (e.g., Association of District Health Councils of Ontario 1991; Regional Municipality of Ottawa-Carleton 1995; Regional Municipality of the Halton Health Department 1993),...

    • 11 The Responsiveness of the Canadian Health Care System towards Newcomers
      (pp. 349-388)

      There remains a great deal of variation in the health status of those living in Canada in spite of the existence of the Canada Health act. The Act was developed with a focus on ′equalizing′ health status by ′equalizing′ access to services, once thought to be the prime determinant of health. Today, people with particular health care needs include newcomers to Canada, specifically those with a precarious immigration status such as asylum seekers and those with a high-risk profile such as refugees arriving in Canada from conflict-laden areas. Specific newcomer needs are often not examined on a systematic basis. This...