Health System Design

Are the legislative structures that provide the basis for Canada’s Medicare system up to the task of meeting Canadians healthcare needs in the 21st century? That question provides the focal point for articles and reports in this section, which present different perspectives on why changes are needed and how they can be introduced, along with lessons from experience in other countries.

Concerto cover Evidence-based multidisciplinary care for people with multiple chronic conditions

This case study, prepared by Health Innovation Forum with contributions from Dr. Alain Larouche and Ms. Guylaine Chabot from the Concerto Health Group, as well as Mr. Louis Larouche from Bell Business Solutions looks at how the Concerto Health Group brought technology and pharmaceutical partners together to support multidisciplinary primary care teams in Lanaudière, Québec. — Produced as part of the series “Partnerships to Enhance Health System Performance.”

October 2013

PHR cover Personal health records in primary care: One province takes steps to make sure they’re available

This case study, prepared by Health Innovation Forum with contributions from family physician Dr. Ajantha Jayabarathan; PHR project director in the Nova Scotia Department of Health and Wellness, Ms. Mary Russell; and product manager at McKesson, Mr. David Mosher, looks at the Nova Scotia Department of Health and Wellness efforts to make the patient a partner in care and implement McKesson’s RelayHealth PHR. — Produced as part of the series “Partnerships to Enhance Health System Performance”

October 2013

2011 Simpson Fig 1_FR Economic challenges to Medicare in Canada

Jeffrey Simpson looks at where our health system stands in international comparisons, what it is costing us and what needs to happen to protect it from the economic challenges ahead.

November 2011

Michael cover England’s National Health Service in evolution

Sir Jonathan Michael, Chief Executive at Oxford Radcliffe Hospitals NHS Trust, looks at the gradual evolution of the U.K.’s National Health Service (NHS) and at current efforts to bring in the most radical set of reforms yet.

November 2011

2011 Westert Cover Monitoring the impact of reforms in The Netherlands

Health reforms in The Netherlands were introduced in 2006 and have had some time to settle. Gert Westert, co-editor of the Dutch health care performance report, looks at what impact these reforms have had on care and how this is monitored.

November 2011

homecare Disengaging Montreal hospitals from the provision of long-term care

This case study, prepared by Health Innovation Forum with contributions from Dr. Anita Brown-Johnson, Dr. Nadine Larente and Mr. Michel Clair, examines the transition care expertise developed at the MUHC and at efforts to effect a smooth transition to faster placements in community resources as new laws take effect.

October 2011

Round Table group Medicines, long-term care and home care: The impact of keeping them out of the Medicare model

At present, Canadian provinces and territories each approach the provision and coverage of medicines, long-term care and home care in their own way, according to their resources and priorities. At a roundtable discussion chaired by Philippe Couillard as part of the 2011 program of the MUHC-ISAI, participants from different sectors of health care were invited to explore the impact of keeping these services outside the Canada Health Act. They discussed how this affects health system effectiveness and equity, and examined the potential advantages and disadvantages of bringing medicines, long-term care and home care under the Medicare umbrella.

October 2011

PACM cover Escape from the treadmill of outdated health policies

Report from a meeting of the MUHC-ISAI’s Partners’ Advisory Council held in June, 2011. Among the participants were: Heather Chalmers, General Manager of Healthcare Systems, GE Healthcare Canada; Kathy Megyery, Vice-President, Strategy and Public Affairs, Sanofi; Cristina Rabasquinho, Director, Patient Access, Eastern Region, Merck; Joe Sardi, GE Healthcare; Marie-France Verdon, Strategic Account Manager, Roche; and Dale Weil, Senior Vice President, Integrated Healthcare Solutions and Pharmaceutical Solutions, McKesson Canada.

July 2011

2010 Anderson Fig 3_ENG 2 IT and health system integration

Matthew Anderson, head of the William Osler Health System, is working to forge stronger links between tertiary, secondary and community care organizations.

October 2010

2010 Home monitoring Image Effective home management of chronic disease

This case study, produced by Health Innovation Forum with contributions from Sylvie Nolet from the CSSS Alphonse-Desjardins, Louis-Marie Boivin from TELUS Health Solutions and Guy Paré from HEC, looks at a health and social services centre in Eastern Québec’s use of telemonitoring for chronic obstructive pulmonary disease.— Produced as part of the MUHC-ISAI’s 2010 program.

June 2010

Couillard cover What can government do to improve access to excellent health services?

During his tenure as Minister of Health and Social Services from 2003 to 2008, Dr. Couillard increased Quebec’s health care budget by more than $7 billion; divided the province into four integrated networks — the RUIS (réseaux universitaires intégrés de santé); banned smoking in public places; introduced Bill 33, a framework to regulate private sector activities; introduced a landmark pharmaceutical drug policy; and established mental health and age-related dependency action plans, among other accomplishments. He was also a strong advocate for the modernization of academic hospitals. Here, he outlines a prescription for further government action.

August 2009

Liepert cover Changes to provincial health structures in Alberta

Each Canadian province has created somewhat different structures to manage health service delivery. Through the 1990s, most adopted some form of regionalization and devolved a certain amount of responsibility for identifying and meeting health care needs to these regional structures. But in 2008-2009, two provinces took sharp turns away from regional models. Minister of Health Ron Liepert explains why Alberta did away with its regional structures altogether.

August 2009

Ferguson cover Changes to provincial health structures in New Brunswick

Each Canadian province has created somewhat different structures to manage health service delivery. Through the 1990s, most adopted some form of regionalization and devolved a certain amount of responsibility for identifying and meeting health care needs to these regional structures. But in 2008-2009, two provinces took sharp turns away from regional models. Deputy Minister of Health Don Ferguson, describes why New Brunswick cut the number of health regions from eight to two.

August 2009

Heriaud cover Public private coexistence in France

In France, government is highly centralized, public and private health services coexist, and performance incentives are gaining ground. Alain Hériaud, Director General of the CHU de Bordeaux, explains the challenges this situation presents to directors of public health centres.

August 2009

private cover Private healthcare delivery in Canada

Private health care delivery exists in Canada but the relationship between public and private contrasts in important ways with that in other countries. Four Canadian physicians who have ventured into private delivery describe their activities and their interactions with the public sector.

August 2009

Baier cover Provincial flexibility under the Canada Health Act

Provinces are responsible for health care, but when do the changes they make become a violation of the CHA? In this discussion paper, Gerald Baier from the University of British Columbia looks at the federal-provincial dynamic.

May 2008

maioni cover The media and public opinion about health care

Antonia Maioni presents preliminary results from an analysis of public opinion and the media in health care reform, work she has undertaken with Stuart Soroka from the Department of Political Science at McGill University.

May 2008

Clair Kenny cover Debate: Would more private delivery improve health care?

Mr. Michel Clair, who advocated a greater role for private care in his 2001 commission report for the Quebec government was invited to take the “yes” side in the debate. Dr. Nuala Kenny, a founding member of Canadian Doctors for Medicare as well as a Sister of Charity and paediatrician took the “no” side.

May 2008

Hjert cover Consumer satisfaction in Canada and Europe

Johan Hjertqvist, founder and President of the Health Consumer Powerhouse, presents 2008 data from European consumer surveys that, for the first time, included Canada.

May 2008

kaiser cover Kaiser Permanente: The best of the US

The US may have its problems, but certain health plans stand out as models of excellence. Patricia Lynch, Vice President, State Government Relations, presents some of the reasons for Kaiser Permanente’s success.

May 2008

Labrie cover France: Improvement through private participation

Yanick Labrie from the Montreal Economic Institute (MEI) points to evidence that despite an injection of new money, Quebec’s health system is even less responsive than it was a few years ago. He describes MEI research into the results achieved through greater private sector participation in health services in France.

May 2008

McGregLynch cover Do Canadians have access to better care than Americans?

Dr. Maurice McGregor, MUHC Cardiologist and founding member of Canadian Doctors for Medicare, presents the strong points of Canadian health care. Ms. Patricia Lynch, Vice-President of State Government Relations Services at Kaiser Permanente discusses what works well within the American system.

May 2008

2008 RT Cover Agents of change: Physician productivity in the Canadian healthcare system

This first ISAI round table, held in November 2007, takes a frank look at what’s happening on the front lines of medicine and how the situation might be improved. The session was chaired by Mr. Bernard Lord, Special Advisor to the MUHC-ISAI. Participants were: Dr. James Brophy, Director of the joint MUHC/CHUM Technology Assessment Unit; Dr. Jacques Chaoulli, Family Physician, President and CEO, The Chaoulli Group; Dr. David Eidelman, Chief, Department of Medicine, MUHC; Dr. Dennis Furlong, former Minister of Health for New Brunswick; Dr. Gilles Hudon, Director of Health Policy and Professional Development, FRSQ; Dr. Hugh Scully, Senior Cardiac Surgeon, Toronto General Hospital; Dr. Fernand Taras, President and CEO, Rockland MD; Dr. John Wade, Chair of the Board, Winnipeg Regional Health Authority. All had strong opinions about what needs to be done. Presented here are some of the highlights of their discussion.

November 2007