Caring for our Elderly

Caring for the Elderly: A Health Human Resource Problem


Authored by Rosalie Wyonch, Policy Analyst, C.D. Howe Institute, and Don Drummond, Stauffer-Dunning Fellow in Global Public Policy and Adjunct Professor, School of Policy Studies, Queen’s University

(Originally published as an Intelligence Memo from C.D. Howe Institute  –March 10, 2020)


From: Rosalie Wynoch and Don Drummond
To: Healthcare policy planners

Re:  Caring for the Elderly: A Health Human Resource Problem


Canada’s population is aging and there is a shortage of specialists trained to provide healthcare to elderly patients. One in six Canadians are over 65 years of age and these older individuals have higher need and utilization of healthcare services.

While most physicians gain some experience with the complex and interrelated healthcare needs of seniors, there are only 304 geriatric specialists to provide care for Canada’s more than 6.1 million seniors. Continue Reading »

Indigenous Peoples

Improving on a Mandate Letter


Authored by Don Drummond, Stauffer-Dunning Fellow in Global Public Policy and Adjunct Professor, School of Policy Studies, Queen’s University.

(Originally published as an Intelligence Memo from C.D. Howe Institute  – January 14, 2020)


From: Don Drummond
To: The Honourable Marc Miller, Minister of Indigenous Services

Re: Improving on a Mandate Letter

Your mandate letter falls short of setting out a vision for really making a difference for Indigenous Peoples because it lacks targets for specific, measurable outcomes that would reflect improvements in living standards.

There is much to be applauded in the letter. Set in the context of the need for “capacity building to bring control of and jurisdiction for service delivery back to Indigenous communities,” it correctly identifies many of the areas, such as health, education, housing, Continue Reading »

Foreign Affairs Minister Francois-Philippe Champagne responds to a question in the House of Commons on Dec. 6, 2019.

The brewing situation between Iran and the U.S. is very much Canada’s problem


Authored by Hugh Segal, Mathews Fellow in Global Public Policy at the Queen’s University School of Policy Studies

(Originally published in The Globe and Mail – January 6, 2020)

On the surface, it may not be obvious what Canada can do about the brewing crisis around Iran. Investigating the motivations and intelligence that led to the U.S. government’s decision to neutralize Iranian general Qassem Soleimani, the most powerful and malevolent supreme commander of Iran’s potent terrorist and proxy forces worldwide, is not likely to be on the agenda of our federal government and the high command of our Armed Forces right now.

But the tensions between Iran and the U.S. are most assuredly our problem. As a founding partner of the NATO treaty, which provides for mutual defence between the 28 member nations, an Iranian attack upon American forces, Continue Reading »

Assessing Ottawa’s New Health Mandate

Assessing Ottawa’s New Health Mandate


(Originally published as an Intelligence Memo from C.D. Howe Institute  –December 23, 2019)


From: Duncan G. Sinclair, David Walker, Chris Simpson and Don Drummond
To: The Hon. Patty Hajdu, Minister of Health

Re: Assessing Ottawa’s New Health Mandate

Your mandate letter from the Prime Minister last week lays out many worthwhile goals to improve healthcare by family doctors, primary health care teams, mental health services, home care and palliative care and pharmacare.

It also identifies the need to address certain public health risks such as opioids, vaping and poor nutrition. You will no doubt run into stiff resistance from provinces and territories as these matters are in their constitutional jurisdiction.  They will undoubtedly protest that while the federal government seeks a partnership in shaping healthcare, it has allowed its once equal partnership in funding to shrink to a one-quarter contribution that will decline further if the current cap on the growth rate of Canada Health Transfer payments is not lifted. Continue Reading »

The WTO headquarters in Geneva, Switzerland. The organization's appeals court was crippled last week when two members reached the end of their term and the U.S. blocked any new appointments.

The WTO still has vital work to do, despite the crippling of its appeals court


Authored by Robert Wolfe, Professor Emeritus, School of Policy Studies at Queen’s University and Bernard Hoekman, Professor, European University Institute in Florence, Italy, and leader of a Bertelsmann Stiftung project on World Trade Organization reform.

(Originally published in The Globe and Mail – December 18, 2019)

The World Trade Organization’s appellate body went into hibernation last week when two members reached the end of their term and the Trump administration continued to block a process to appoint successors.

The United States is not alone in its concerns about the appellate body, which hears appeals from reports issued by panels in disputes brought by WTO members. But the current impasse does not signal the end of the WTO, or even its ability to settle disagreements, let alone its role in conflict management. Continue Reading »

Getting to a People-Centred Health System

Getting to a People-Centred Health System


(Originally published as an Intelligence Memo from C.D. Howe Institute  –November 6, 2019)


From: Duncan G. Sinclair, David Walker, Chris Simpson and Don Drummond
To: Canada’s health ministers

Re: Getting to a People-Centred Health System

Notwithstanding its iconic standing as one of Canada’s defining characteristics, medicare, our publicly funded health insurance program, is widely recognized to be in need of fundamental change.

It was designed primarily to ensure a younger population’s access to in-hospital and physicians’ services, divorced from ability-to-pay considerations.

But now we face a greater challenge to optimize the health and well-being of people, many of them aging, with multiple chronic conditions, some preventable. Once developed, few are curable but their ill effects can be significantly ameliorated by appropriate care. That appropriateness now involves many institutions in addition to acute-care hospitals, Continue Reading »

Toward Healthcare’s Culture Change

Toward Healthcare’s Culture Change


(Originally published as an Intelligence Memo from C.D. Howe Institute  –November 5, 2019)


From: Duncan G. Sinclair, David Walker, Chris Simpson and Don Drummond
To: Canada’s health ministers

Re: Toward Healthcare’s Culture Change

Many Canadians have bought into the unsubstantiated hype that our healthcare system is the best in the world, and our political leaders know well that voters get nervous about proposals to change it.

Currently, there is some discussion about how to pay for extending medicare’s first-dollar coverage beyond in-hospital and physicians’ care to prescription drugs. And inclusion of addictions and mental health care and dentistry have also been mentioned. Ironically, no provincial or territorial system has a primary focus on optimizing people’s health. Rather, the focus is on the repair of ill-health, the restoration to health of patients rendered unwell by disease, Continue Reading »

Systems to Optimize Health


Health is determined by the interplay of a wide variety of factors. While genetic inheritance remains relatively immutable, some, like personal life-style, are almost entirely under the control of individuals. Others, the availability and quality of health-related services for example, are subject to a combination of changeable market and societal forces. It is this latter group, healthcare and those social services known to be among the determinants of health, that will be of prime concern to the new Ontario Health Teams (OHT) being established. The overall goal, held in common by every person, family, government, and society as a whole, is to optimize good health and reduce to a minimum the need for and use of healthcare services, the “repair-shop” functions that come into play when good health is compromised, as inevitably some will be, by disease, injury, disability, or other misadventure.

Ever since Medicare began in Canada, Continue Reading »

A Policy Framework for Ontario Health Teams


Over the last 25 years and more many schemes have been hatched to transform Canada’s health/healthcare “system”. All have had one basic aim – to connect the dots; to co-ordinate the work of the ‘players’, hospitals through primary and home care to mental health and other community-based providers, getting them working together to make it easier for patients and their families to navigate care transitions from one to another. Reform’s imperative has also been governments’ concern about healthcare’s growing cost, measured both in terms of its share of total spending and also the opportunity cost over the longer term of constrained funding for the social determinants of health, education, housing, financial security, et cetera. That concern also reflects people’s growing unease about sustainability, possibly combined with increased awareness that the outcomes achieved here in Canada are middling at best when compared to those achieved in other developed countries. Continue Reading »

What’s an Ontario Health Team?


Teams of different health service providers have been variously dubbed Accountable Care Organizations (ACO), Sustainability and Transformation Partnerships (STP), Integrated Health Systems (IHS), and Integrated Care Systems (ICS); some would claim their origin in Health Maintenance Organizations (HMO). Ontario Health Teams (OHT) is their most recent sobriquet. What’s an OHT?

There’s no easy answer. It is said of Accountable Care Organizations, the most numerous of the species, ‘if you have seen one ACO you have seen one’. They vary widely in terms of size, not only of their membership and structure but also the in the nature of the populations they serve, their geographic distribution, their mandates, the spectrum of services provided, source(s) of their funding, and other factors too. But they all exhibit the following core characteristics:

  • Each is (1) a collection of health service providers, (2) operating within a single,
  • Continue Reading »