Why it is so hard to reform health care policy in Canada?:

Lessons from a Cross-Provincial Comparison of Health Care Policy Reform in Canada

Introduction

The project assesses the nature and extent of healthcare reform in Canada since the beginning of the 1990s, sets out factors that account for the limited reform that has occurred, and analyzes the prospects for reform going forward. The volume is based on a representative series of case studies from four policy categories: governance, finance, delivery, and program content. From these categories six issues were selected: Regionalization, Needs-Based Funding, Alternative Payment Plans for Primary Care Physicians, Privatization (For-profit Delivery), Waiting Lists, and Prescription Drug Coverage.  Each of these six issues was studied in five provinces: Alberta, Saskatchewan, Ontario, Quebec, and Newfoundland and Labrador. Data were collected using key-informant interviews, supplemented by a review of publicly available documents about these policies.

The 30 case studies involve an analysis of the policy-making processes at the various stages of the decision process. They focus on whether and why an issue became an agenda item that required government decision; and for those cases in which a reform decision was taken, the factors that shaped the policy choice.  The case studies are within the 1990-2003 period.

The cases are being “rolled up” into five intra-provincial and six cross-provincial issue papers. The issue papers are to be published in peer-reviewed journals. The intra-provincial papers will be included as chapters in a volume which will provide the results for the project as a whole.

In addition to the five provincial chapters the volume will also include chapters with cross-provincial and cross-issue analysis. The last chapter will extend the research to the 2004-2010 period in two ways- tracing the evolution of the factors that were found to be the most powerful influences in shaping outcomes in the 1990-2003 and assessing reform momentum for the 30 cases. The volume ends with a discussion of alternative futures and some reflections on reform prospects going forward.

Target audiences include elected and appointed provincial, territorial, and federal officials, leaders of stakeholder groups and community associations, the research  community, and others with an interest in public policy.

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Team Coordinator
Harvey Lazar, University of Victoria and Queen's Institute of Intergovernmental Relations, (Principal Investigator) 

Coordinators
Pierre-Gerlier Forest , Trudeau Foundation
John Lavis , McMaster University

Case Study Coordinators
Regionalization – Stephen Tomblin , Memorial University
Needs-Based Funding- Tom McIntosh, University of Regina
Payment Plans - John Church , University of Alberta
Privatization - Alina Gildiner , formerly McMaster University, now Ministry of Health and Long-Term Care, Ontario
Waiting Lists - Claudia Sanmartin , Statistics Canada
Drug Plans -   Marie-Pascale Pomey, Université de Montréal

Provincial Coordinators
Alberta – John Church , University of Alberta
Ontario – John Lavis, McMaster University
Newfoundland and Labrador - Stephen Tomblin, Memorial University
Quebec - Marie-Pascale Pomey, Université de Montréal; Elisabeth Martin, Laval
Saskatchewan - Tom McIntosh, University of Regina

Literature Review
Vandna Bhatia , Carleton University
Kevin O’Fee, Saskatchewan Institute of Public Policy, University of Regina

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Project Funding

The research team acknowledges with thanks the funding provided by the Canadian Institutes for Health Research, Health Canada and the Canadian Health Services Research Foundation.

Project Status

Two of the six papers have been accepted in peer-reviewed journals. The other four will be submitted when ready. The volume will be in print June 2013. The papers below are among team outputs as of December 2010.

Papers and Presentations

The following are some of the published outputs and presentations of team members arising from the project research:

Church, John and Neale Smith. 2006. "Health Reform and Privatization in Alberta." Canadian Public Administration,  Vol. 49, No. 4 (Winter): 486-505. Abstract available at http://www3.interscience.wiley.com/journal/119819740/abstract.

Church, John and Neal Smith. 2006. "Health Reform and Regionalization in Alberta." 2006 Canadian Association for Health Services and Policy Research (CAHSPR) Conference. 17-19 September 2006: Vancouver, Canada. Abstract available for download.

Church, John and Neale Smith. 2008. "Health Reform in Alberta: The Introduction of Health Regions." Canadian Public Administration, Vol. 51, No. 2 (June): 217-238. Abstract available at http://www3.interscience.wiley.com/journal/120695818/abstract.

Church, John and Neale Smith. 2008. "Shifting the Lens:  The Introduction of Population-Based Funding in Alberta." Healthcare Management FORUM, 21(2) (September): 36-42. Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18795557.

Church, John and Neale Smith. 2009. "Health Reform and Wait Times Policy in Alberta under the Klein Government." Canadian Political Science Review, Vol.3, No.4 (December): 63-84. Available for download.

Lazar, Harvey. 2009. "Health Care Reform Opportunities and Barriers: New Evidence from a Recent Period." Northern and Rural Health Conference, Ontario Hospital Association. 21 May 2009: Toronto, Canada. Available for download.

Lazar, Harvey. 2009. "A Cross-Provincial Comparison of Health Care Reform in Canada: Building Blocks and Some Preliminary Results." Canadian Political Science Review, Vol.3, No.4 (December): 1-14. Available for download.

Martin, Elisabeth, M-P Pompey and P-G Forest. 2010. "One step forward, One step back: Quebec's 2003-04 health and social services regionalization." Canadian Public Administration. December 2010. Volume 53, No.4.

Martin, Elisabeth, et al. 2006. "Elaboration and Implementation of Family Medicine Groups (FMGs): A Relevant Model for Primary Care Renewal in Quebec (Canada)?" 5th Nordic Health Promotion Research Conference. 15-17 June 2006: Esbjerg, Denmark. Available for download.

Martin, Elisabeth, et al. "Elaboration and Implementation of Family Medicine Groups(FMGs): An Opportunity for Primary Care Renewal in Quebec?" Available for download.

Martin, Elisabeth, et al. 2006. "The Reform to Regionalization in Quebec: Towards a New Model of Local Governance in Health Care." National Healthcare Leadership Conference. 12-13 June 2006: Victoria, Canada. Available for download.

McIntosh, Tom and Michael Ducie. 2009. "Private Health Facilities in Saskatchewan: Marginalization through Legalization." Canadian Political Science Review, Vol.3, No.4 (December): 47-62. Available for download.

McIntosh, Tom, et al. 2009. "Population Health and Health System Reform: The Challenge of Needs-Based Funding Models in Five Provinces." Johnson-Shoyama Graduate School of Public Policy. 13 November 2009: University of Regina. Abstract available at http://www.schoolofpublicpolicy.sk.ca/news_events/calendar_details.php?id=122.

McIntosh, Tom and G. Marchildon. 2009. "The Fyke in the Road: Health Reform in Saskatchewan from Romanow to Calvert and Beyond. Forthcoming " In Saskatchewan Politics: Crowding the Centre, ed. H. Leeson. Regina: Canadian Plains Research Centre. 337-353.

McIntosh, Tom, Michael Ducie, Marcy Burka-Charles, John Church, John Lavis, Marie-Pascal Pomey, Neale Smith, and Stephen Tomblin. 2010. "Population Health and Health System Reform: Needs-Based Funding for Health Services in Five Provinces." Canadian Political Science Review, Vol.4, No.1 (March): 42-61. Available for download.

Neville, Doreen, Gwynedd Barrowman, Brenda Fitzgerald and Stephen Tomblin. 2005. "Regionalization of Health Services in Newfoundland and Labrador: Perceptions of the Planning, Implementation and Consequences of Regional Governance." Journal of Health Services Research & Policy, Vol. 10, Supp. 2: 12-21. Abstract available at http://jhsrp.rsmjournals.com/cgi/content/abstract/10/suppl_2/12.

Pomey, Marie-Pascale, et al. 2007. "Le Régime Général d'Assurance Médicaments au Québec: Un Partenariat Public/Privé Confronté à des défis." Journal d'Economie Médicale, Vol. 25, No. 5-6 (Septembre - Novembre): 1-17. Available for download.

Pomey, Marie Pascale, et al. 2007. "Public/Private Partnerships for Prescription Drug Coverage: Policy Formulation and Outcomes in Quebec's Universal Drug Insurance Program, with Comparisons to the Medicare Prescription Drug Program in the United States." The Milbank Quarterly, Vol. 85, No. 3: 469-498. Available for download.

Pomey, Marie Pascale, et al. 2009. "Quebec's Family Medicine Groups: Innovation and Compromise in the Reform of Front-Line Care." Canadian Political Science Review, Vol.3, No.4 (December): 31-46. Available for download.

Smith, Neale and John Church. 2006. "Health Reform and Wait Times in Alberta." 2006 Canadian Association for Health Services and Policy Research (CAHSPR) Conference. 17-19 September 2006: Vancouver, Canada. Abstract available for download.

Tomblin, Stephen. 2007. "Effecting Change and Transformation through Regionalization: Theory versus Practice." Canadian Public Administration, Vol. 50, No. 1 (Spring): 1-20. Abstract available at http://www3.interscience.wiley.com/journal/119818761/abstract.

Tomblin, Stephen and Jeff Braun Jackson. 2009. "Renewing Health Governance: A Case-Study of Newfoundland and Labrador." Canadian Political Science Review, Vol.3, No.4 (December): 15-30. Available for download.

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