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.
Health System Design
Federal transfers for Quebec health and social services
Report from the Expert Committee on federal intervention in Québec’s health and social services sector between 2002 and 2013.
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.”
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”
Bringing home the benefits: Quality improvement at the bedside
Patricia O’Connor, Director of Nursing and Chief Nursing Officer, MUHC, describes how international work benefits patient care at home.
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.
Is our healthcare system’s future tied to the Canada Health Act? Part 2
How important is the CHA in shaping our healthcare system, and what are the risks and benefits of updating the Act to respond to changing priorities? Pierre-Gerlier Forest expresses his views on the question.
Is our healthcare system’s future tied to the Canada Health Act? Part 1
How important is the CHA in shaping our healthcare system, and what are the risks and benefits of updating the Act to respond to changing priorities? Claude Castonguay expresses his views.
What does New Brunswick expect from the renewal of the Health Accord?
New Brunswick’s Minister of Health, The Honourable Madeleine Dubé, reviews the challenges faced by her province and describes how a renewed Accord can support needed changes
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.
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.
Comprehensiveness, portability and accessibility in the 21st century
Terrence Sullivan looks at where the Canadian health system stands in upholding principles of comprehensiveness, portability and accessibility
Issues, ideas, actions: Overcoming barriers to change
Bernard Lord leads Antonia Maioni, Philippe Couillard and André Picard in a discussion on how Canadians and their politicians might act to improve health care.
Comprehensiveness and accessibility in breast cancer
Joseph Ragaz from the BC Cancer Agency presents evidence that cross-Canada variations in comprehensiveness and accessibility combine to affect patient health outcomes.
Improving access, portability and comprehensiveness through telemedicine
Telemedicine is stretching the boundaries of accessibility, portability and comprehensiveness in health care. The head of the Ontario Telemedicine Network, Edward Brown, feels that policy needs to catch up to new practice possibilities.
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.
Why are Canadian patients so patient with gaps in the Medicare model?
Canadians tolerate a health system that is difficult to access and only covers part of their needs. André Picard asks what will it take to shake the complacency?
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.
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.
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.
Can health information technology liberate the UK’s NHS?
Charles Gutteridge, National Clinical Director for Informatics, presents the current status and likely evolution of the UK’s national health IT program.
Health IT in Denmark: a culture of public responsibility
Otto Larsen, CEO of Digital Health, presents the current status and likely evolution of Denmark’s national health IT program
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.
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.
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.
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.
The pillars of health policy: Recent trends in Europe
Kieke Okma, Associate Professor at New York University, reviews the core elements of health systems to highlight key differences between countries.
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.
Government withdrawal from long-term care in The Netherlands
Wilma Zwijnenburg from Omring, The Netherlands largest long-term care provider, discusses how the sector is adapting to recent policy changes.
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.
Health system transformation: What becomes possible with health IT
Rob Kolodner, who led the development of the Veterans Health Administration’s award-winning suite of health IT solutions, describes how these drove the shift to person-centred care.
The aging of the baby boomer generation: Catastrophe or catalyst for improvement?
In this discussion paper, Andrew Wister, Chair of the Department of Gerontology at Simon Fraser University assesses the impact of aging boomers on Canadian health care.
What do we expect to gain from health system reorganization?
In this discussion paper, Don Philippon, Professor of Strategic Management and Health Policy at the University of Alberta, looks at the motivations for changing regional health structures.
A decade of health care commissions
Antonia Maioni assesses the net effect of federal and provincial healthcare reports over the last decade.
Recommendations from key health care commissions
Antonia Maioni highlights significant changes in Canadian health care that resulted from Commissions and reports between 1997 and 2008.
Québec’s health sector: Open to change
Yanick Labrie from the Montreal Economic Institute looks at the role of private health care in Quebec.
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.
Government’s role in the Bermuda triangle of health care
Claude E. Forget, a pioneer in the design, implementation and study of health and social services in Québec, traces the evolution of government’s role in health care to see where our system is heading today.
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.
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.
How does Canada measure up against other OECD countries?
Comparative data helps situate Canada in international context. In this article, the OECD’s Peter Scherer tracks certain trends apparent in all developed nations over the past few decades.
Considerations in comparing health care systems in Canada and Europe
Bernard Merkel from the European Commission highlights six things Canadians should remember when they look to European models.
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.
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.
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.
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.
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.