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Queen's University
 

Institute of Intergovernmental Relations

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

Latest update: January 23, 2014

Contents:

  1. Research Status and Publications
  2. Project Team
  3. Project Funding

This research project was launched in the early 2000s. It is based on the findings from 30 case studies that were selected as representative of health-care policy writ-large. A common methodology was used in assessing the 30 cases.

The cases describe and assess the nature and extent of health-care policy reform in Canada between 1990 and 2003 and set out the factors that account for the limited reform. The findings are updated to cover the 2004-2011 period.

This note (1) provides the status of the research (2) lists the members of the research team and (3) and acknowledges the sources of funding.

(1)Research Status and Publications

Project outputs are listed under four headings below: main findings, 30 case studies, background studies and other papers and presentations.

Main Findings

The project entailed an assessment of the nature and extent of health-care policy reform in Canada since the beginning of the 1990s, sets out factors that account for the meagre reform that has occurred since then, and analyzes the prospects for reform going forward. The volume is based on studies of a representative series of policy-reform issues drawn from four policy categories: governance arrangements, financial arrangements, delivery arrangements, and policy content. From these categories six issues were selected: regionalization, needs-based funding, alternative payment plans for primary care physicians, 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.

Each of the 30 case studies involves: description of the context within which the case was studied; the nature and extent of reform; and analysis of the factors that influenced policy-making processes at the various stages of the decision process (to the extent that there was reform). It thus focuses 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 focus initially on the 1990-2003 period (primarily a period centre and left-of-centre provincial and federal governments) and the analysis is extended to the 2004-2011 period (primarily a period of centre and right-of-centre governments).

Each of the cases is analyzed in relation to a specified definition of reform. These definitions are based on the consensus about the desired nature and extent of reform as set out in the reports of the many provincially and federally appointed commissions, task forces and advisory groups beginning in the second half of the 1980s. The data are then analyzed from cross-issue, cross-provincial, and cross-ideology perspectives.

The main findings are set out in Paradigm Freeze: Why It Is So Hard to Reform Health Care Policy in Canada.It is published by McGill-Queen’s University Press for the Institute of Intergovernmental Relations in the Queen’s Policy Study Series, School of Public Studies.

Copies can be ordered from McGill-Queen’s University Press 

30 Case Studies

All case study authors used the same methodology for consistency. The “inputs” from their case studies were used for intra-provincial analysis as reflected in chapters 3-7 and also for cross-province and cross-issue in chapters 8-11 of  Paradigm Freeze: Why It Is So Hard to Reform Health Care Policy in Canada.  

The case studies are available for download below this paragraph. Each author had the freedom to organize his or her findings in whatever style he or she preferred. Thus, these papers vary in presentation and style but share common objectives and analytic frameworks. Some of the 30 cases have been published in peer-reviews journals, while others remain unpublished. Links to published works are provided; for those papers labelled "unpublished," they may not be cited, reproduced, or distributed without permission of the lead author

 

Alberta Case Studies

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 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.

Church, John and Neale Smith. 2013. "Health Reform and Drug Policy in Alberta." Unpublished, available for download.

Church, John and Neale Smith. 2013. "The Introduction of APPs in Alberta." Unpublished, available for download.

Saskatchewan Case Studies

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, 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 .

McIntosh,Tom  Michael Ducie and Courtney England. "Comparative Provincial Health Reform Regionalization in Saskatchewan." 2007.  Unpublished, available for  download .

McIntosh, Tom  Michael Ducie and Courtney England. "Alternative Payment Plans in Saskatchewan." 2007.  Unpublished, available for  download .

McIntosh, Tom  Michael Ducie and Courtney England. "Coping with Fiscal Crisis: Drug Plan Retrenchment in Saskatchewan." 2007. Unpublished, available for  download .

McIntosh, Tom  Michael Ducie and Courtney England. "Managing Wait Times in Saskatchewan." 2007.  Unpublished, available for  download .  

Ontario Case Studies

Tables available for download.

The tables in this document are cited in the following chapter:

Lavis JN, Pasic D, Wilson MG. Health-care reform in Ontario: More tortoise than hare? Chapter 5 in Lazar H, Lavis JN, Forest P-G, Church J (2013). Paradigm Freeze: Why It Is So Hard to Reform Health-Care Policy in Canada? Montreal and Kingston, Canada: McGill-Queen’s University Press; 2013, p. 89-111.

The tables are made available here for those who want additional details about each of the cases described in the aforementioned chapter. They are the tabular equivalent of the case-specific reports prepared for provinces other than Ontario. The tables can be cited as follows:

Lavis JN, Pasic D, Wilson MG. Health-care reform in Ontario: More tortoise than hare? – Online tables for chapter 5 in Lazar H, Lavis JN, Forest P-G, Church J (2013). Paradigm Freeze: Why It Is So Hard to Reform Health-Care Policy in Canada? Hamilton, Canada: McMaster University Program in Policy Decision-making; 2013.

Quebec Case Studies

Pomey, Marie-Pascale,  Martin, Elisabeth  and P-G Forest. "Budget allocation reform in Quebec: Using a population-based approach to allocate resources for medical and social services (except physical health)." 2006. Unpublished, available for  download .

Martin, Elisabeth, M-P Pompey and P-G Forest. "The Reform of Front-line Services in Quebec: The Implementation of Family Medicine Groups (FMGs) and New Terms of Remuneration for General Practitioners." Unpublished, available for  download.

Martin, Elisabeth, M-P Pompey and P-G Forest. "The Reform of Regionalization in Quebec: The Introduction of Bill 25 Proposing the Transformation of Regional Boards Into Health and Social Services Agencies and the Implementation of Local Service Networks." Unpublished, available for  download.

Pomey,  Marie-Pascale,  Martin,  Elisabeth and P-G Forest. "Indecision Making: The Privatization of Health Care in Quebec." Unpublished, available for download.

Pomey,  Marie-Pascale,  Martin,    Elisabeth  and P-G Forest. "Making Decisions about Prescriptions in Quebec: Implementing the Public Prescription Drug Insurance Regime in 1996-1997." 2005. Unpublished, available for  download .

Pomey,    Marie-Pascale,  Martin,    Elisabeth  and P-G Forest. "Waiting List Management in Quebec:Implementing a System to Manage Access to Care." 2005. Unpublished, available for  download .

Newfoundland and Labrador Case Studies

Tomblin, Stephen and Jeff Braun-Jackson. " For-Profit Provision of Medical Services:  The Case of Newfoundland and Labrador." 2005. Unpublished, available for download.

Tomblin, Stephen and Jeff Braun-Jackson. "The Doctor Is Not Available to See You Now: Alternate Physician Payment Models and Primary Health Care Reform in Newfoundland and Labrador." 2005. Unpublished, available for download.

Tomblin, Stephen and Jeff Braun-Jackson. "Wait List Management and Reform in Newfoundland and Labrador: What is the Prognosis?." 2005. Unpublished, available for download.

Tomblin,  Stephen and Jeff Braun-Jackson.  "Regionalization – Newfoundland and Labrador." 2005. Unpublished, available for download.

Tomblin,  Stephen and Jeff Braun-Jackson.  " Prescription Drug Reform in Newfoundland and Labrador: Reform or Lack of Reform?" 2005. Unpublished, available for download.

Tomblin,  Stephen and Jeff Braun-Jackson.  "Health Budgeting and the Experience of Newfoundland and Labrador: Why Haven't we Moved to a Needs-based System." 2005. Unpublished, available for download.

Background Studies

Bhatia, Vandna. "A Cross-Provincial Study of Health Care Reform in Canada - Academic Literature Review: Synthesis Paper." 2002. Unpublished, available for download.

Bhatia, Vandna. "A Cross-Provincial Study of Health Care Reform in Canada - Academic Literature Review: Report Summaries." 2002. Unpublished, available for download.

O'Fee, Kevin. " A Cross-Provincial Study of Health Care Reform in Canada - Academic Literature Review: Synthesis Paper." 2002. Unpublished, available for  download .

O'Fee, Kevin."A Cross-Provincial Study of Health Care Reform in Canada - Academic Literature Review: Report Summaries." 2002. Unpublished, available for  download .

Other Studies

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

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.

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 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.

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 athttp://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.

(2) Project Team

Project Leader/Coordinator
Harvey Lazar, University of Victoria and Queen's Institute of Intergovernmental Relations, Principal Investigator (E-mail)

Associate Coordinators
John Lavis , McMaster University (E-mail)
Pierre-Gerlier Forest,   Johns Hopkins University  (E-mail)

Provincial Coordinators/ Principal Provincial Chapter Authors
Alberta – John Church, University of Alberta (E-mail)
Saskatchewan Tom McIntosh, University of Regina (E-mail)
Ontario – John Lavis, McMaster University (E-mail)
Quebec Marie-Pascale Pomey, Université de Montréal (E-mail
                   Elisabeth Martin , Université Laval (E-mail)
Newfoundland and Labrador Stephen Tomblin, Memorial University ( E-mail

Issue Coordinators
Regionalization Stephen Tomblin , Memorial University
Needs-Based Funding    Tom McIntosh , University of Regina
Payment Plans -   John Church , University of Alberta
For-Profit Delivery Alina Gildiner, Ministry of Health and Long-Term Care, Ontario (formerly McMaster University) (E-mail)
Waiting Lists    Claudia Sanmartin , Statistics Canada  ( E-mail )
Drug Plan Coverage   Marie-Pascale Pomey , Université de Montréal

Literature Review
Vandna Bhatia 2003. Theoretical Literature Review, Carleton University (E-mail)
Kevin O’Fee, Review of Grey literature, Saskatchewan Institute of Public Policy, University of Regina (E-mail)

 

Adminstrative Officer  
Mary Kennedy, Queen's Institute of Intergovernmental Relations

Website Coordinator
Ryan Zade, Queen's Institute of Intergovernmental Relations

Research Assistants

Queen’s University 
Aaron Holdway 2002-2004
Ryan Zade 2006-2008, 2012-2013

University of Victoria 
Julia Diamond 2011-2012
Bryan Gulka-Tiecheko 2011-2012
John Schmid 2010-2011
Jessica Hartog 2010-2011

McGill University 
Daniel Wolfe 2011

University of Alberta
Neale Smith 2003-2006
Deborah Lafleur 2003-2006   

University of Regina
Michael Ducie 

McMaster University
Dianna Pasic 2003-2006 

Université de Montréal

Memorial University
Jeff Braun-Jackson 

Editorial Services
Ellie Barton
Val Jarus
William Church, Q.C.

(3) Project Funding

The team gratefully acknowledges the research funding provided by the Canadian Institutes for Health Research and Health Canada.

The team also thanks  the Canadian Foundation for Healthcare Improvement for financial support in communicating and disseminating the research results.

The views expressed herein are those of the authors and do not necessarily represent the views of the funders.

(Last modified: 2014-01-23)

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